JACKSONVILLE, Fla. – William Fowler was admitted to Memorial Hospital on July 25, complaining of shortness of breath. Less than a week later, he died at age 22.

“He was trying to talk and he couldn’t,” said Fowler’s grandmother. “He was gasping, and this will haunt me forever. It was just gasping on the phone, and he’s saying he couldn’t breathe.”

The Florida Department of Law Enforcement’s Medical Examiner Commission list of COVID-19-related deaths — a list maintained by medical examiners across the state — shows a 22-year-old male died of pulmonary complications of COVID-19 infection and chronic drug abuse in Duval County on July 31. That refers to Fowler.

The same probable cause of death was described in the medical examiner’s death investigation report the family showed to News4Jax.

Florida Department of Health data doesn’t show the death of a 22-year-old man in Duval County.

When asked why the state Department of Health did not include that death in its own data, health officials wrote back, saying a death is reported when COVID-19 is listed as the immediate or underlying causes of death or listed as one of the significant conditions contributing to death. It can also be counted when there’s a confirmed COVID-19 infection within 30 days of death and there’s no alternate cause of death, like trauma or homicide, according to FDOH.

The state later explained that “county medical examiners are the only ones who can attribute cause of death.”

The District 4 medical examiner wrote the probable cause of death was pulmonary complications of COVID-19 infection and chronic intravenous drug use. Fowler was also pronounced dead within less than a week of testing positive for the coronavirus. Those complied with both criteria to be counted by FDOH.

There are some other differences in the way medical examiners and FDOH count COVID-19-related deaths. The list based on medical examiner reports assigns a death to the county where the person died, meaning if a patient was from Clay County but died in a Duval County hospital, the death would be counted in Duval County. The Florida Department of Health assigns a death to a county based on the patient’s county of residence.

There are other cases in which COVID-19-related deaths reported in the FDLE’s Medical Examiner Commission list do not appear to be counted in FDOH data of reported COVID-19 deaths, some of which could possibly be explained by the death being counted in a county other than where the person died.

A 22-year-old woman died in mid-July from COVID-19 in Clay County, according to medical examiner data. Health department data does not show a 22-year-old woman dying from COVID-19 in Clay County or any surrounding counties. Health department data does show the death of a 21-year-old in Duval County, reflecting either a discrepancy in how the woman’s age was entered or a difference in how the death was recorded.

The District 4 interim medical examiner did not respond to email and phone requests for comment by the time of publication.