Mia Thomas was just 23 years old when she died on September 7 last year.
Her family described Mia as a fit and healthy young person, with no significant illnesses or diseases from her childhood.
But on September 1, she began suffering with nausea, vomiting and abdominal pain, which spread to her back and shoulders, following a bout of Covid the previous month.
Doctors gave a range of potential diagnoses for her condition over the following days, including a peptic stomach ulcer and gall bladder issues.
But Mia’s condition worsened and, following deterioration, she tragically died on September 7.
Only a post-mortem was able to diagnose the cause of her death as a rare heart condition, myocarditis – but she was said to have suffered “abnormal” symptoms of it.
Mia’s family raised concerns about the care she received, in particular, why the myocarditis was not diagnosed earlier on, at an inquest into her death at Bolton Coroners Court.
Her stepmother, Catherine Dorsett, read out the family statement, which had been given by Mia’s father, Scott Thomas.
The inquest heard that she attended St Teresa’s Primary School in Little Lever, then St Gabriel’s High School in Bury, before going on to study travel and tourism at Bury College.
Mia initially pursued work as an air hostess, but found it was not for her, pivoting to her “dream job” as a customer experience specialist at Car Benefit Solutions in Bury.
Her family said she got “so much enjoyment” out of the role and that she was “extremely well thought of”, with her managers earmarking her for a supervisor role going forward.
Mia was described as “vibrant”, confident around people and “outgoing”, and a loving sister to her younger brother.
She lived at her parents’ house in Darcy Lever with her partner, Rhys Marsden, but the couple were looking to get their own home together.
In August she suffered with a bout of Covid.
But in September she began suffering pain in her upper abdomen, which “spread across her lower back and shoulders”, breathing issues, struggle eating and a high temperature of over 40 degrees.
Her symptoms persisted so she consulted her GP about them.
Dr Haider of Little Lever Health Centre 2 gave evidence about her consultation with Mia on September 3.
The inquest took place at Bolton Coroner’s Court (Image: Anthony Moss)
She was told of the symptoms and asked Mia to undertake a urine test to investigate potential “renal infection”, with a blood test scheduled for the following day.
The doctor advised her to go to A&E if her condition worsened in the meantime, diagnosing potential gall bladder issues.
During the blood test, the nurse was concerned about Mia “looking unwell”, but despite initially struggling to get a blood sample, they managed to successfully obtain one.
Assistant coroner, Ceri Owen, asked Dr Haider what she knows about myocarditis.
She said: “I would suspect chest pains and a high temperature. It is not a very common condition. I would not have considered myocarditis.”
Ms Dorsett asked about Mia’s elevated C-reactive protein (CRP) level of 50.2, saying that it showed “significant inflammation” from a normal range.
Dr Haider replied: “A CRP of 50.2 is raised but not drastically raised.”
She said that she has seen them as high as 200 to 300, adding that Mia’s was not “significantly high”, and that there were no other signs of inflammation.
Mia’s condition worsened and on September 5 she called 111, who told her to attend A&E at Royal Bolton Hospital.
Dr Rehan Aslam, a trainee GP, was on the ward that day. He told the inquest that, with her symptoms, he made a potential diagnosis of a peptic stomach ulcer.
Dr Aslam sent her home later in the day with medication to treat such an ulcer.
Observations were taken when Mia arrived at the hospital that day at around 10am. She had a National Early Warning Score (NEWS) of four, which is said to be relatively high.
The NEWS is a way of recording, scoring and responding to changes in routinely measured physiological parameters in acutely ill patients.
The inquest heard that NEWS scores should be done every “four to six hours”, but that another was not done before she left at around 5pm.
Dr Aslam told the inquest that he understands myocarditis to be rare, saying that he had not come across any other cases of it in his career.
He added that Mia’s presentation was “atypical” compared to expected myocarditis symptoms.
Her condition worsened again following this, and on the morning of September 7, her face was said to be “grey” and her lips “blue”.
Mia’s family called 111 and they advised her to return to hospital.
Her parents took her, but as she got out of the car she collapsed, with nurses coming out to help her into a wheelchair.
Dr Rachel Newport was the consultant in charge that day.
She said that staff took Mia into resuscitation immediately, adding: “It was quite apparent to me that she was so unwell that she might have cardiac arrest at any time.”
She initially stabilised and staff took her in for a CT scan, but when she returned to the resuscitation ward she went into cardiac arrest.
Mia Thomas was just 23 when she tragically died (Image: Family)
Attempts were made to resuscitate her but they were deemed to be “futile”. The decision was made to stop the attempts at 1.12pm.
Dr Newport said that, having spoken to a senior cardiologist following Mia’s death, who said that by September 7 she was in “cardiogenic shock” and that no treatment on that day could have saved her.
Ms Dorsett asked her about a potential gap in knowledge around myocarditis in the medical profession.
She replied that there is a “paucity of medical evidence and research” into how women present with illnesses and diseases generally, compared to men.
Dr Newport also said that European guidelines on myocarditis, which were only published a few months ago, do not mention Mia’s symptoms.
She added that Covid and other viruses can have a causative effect on myocarditis.
Pathologist, Dr Ravindra Sawant, gave Mia’s medical cause of death as acute cardiac failure, caused by acute myocarditis.
Coroner Ceri Owen concluded Mia’s death as having been due to natural causes.
Regarding the family’s concerns, she said that she could not find that there was any neglect, referring to Mia’s “atypical symptoms” of myocarditis.
But, regarding no further NEWS being taken on September 5, she said: “It was a missed opportunity to provide further care and treatment, but it would be speculation to say whether it would have changed the outcome for Mia.
A family statement was read out by Ms Dorsett at the end of the inquest.
It stated: “Mia had tried to get help from every single medical pathway available to her, but was systematically let down at every point in terms of an accurate diagnosis.
“We hope that Mia’s tragic death highlights the importance of carefully assessing young people who present with symptoms such as vomiting, abdominal and back pain and fatigue, particularly if they have had a viral infection or Covid in recent weeks.
“Even in otherwise healthy young adults, these subtle early signs can indicate serious complications like myocarditis. Careful monitoring, including vital signs, labs and consideration of cardiac involvement could give clinicians a chance to detect deterioration early.
“We hope her case helps guide clinicians to consider post viral and Covid complications in young patients, so that others might have a better chance of survival and prevent further families from enduring the unbearable heartache that we have suffered and will carry with us for the rest of our lives.”