A coroner’s report has confirmed that a Canadian teen who died during an overnight school trip suffered from toxic shock syndrome (TSS). Sara Manitoski, who was on an outdoor education trip on Hornby Island, near Vancouver Island, was found lifeless in bed in March 2017.

Her friends had assumed the 16-year-old was sleeping and left for breakfast without her, but when they returned her phone alarm was going off and she was unresponsive. Paramedics and school staff unsuccessfully attempted CPR.

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Now, more than a year later, the BC Coroners Service confirmed a strain of staphylococcus aureus on a tampon, as well as other symptoms consistent with TSS, were discovered, CTV News reported. TSS is a dangerous, sometimes fatal illness caused by bacterial toxins. It’s primarily linked to menstruating women who use super-absorbent tampons, but the infection can affect people of all ages, including men, children and postmenopausal women.

“We know there is an association,” Dee Hoyano, Island Health Medical officer, told CTV Vancouver Island. “Certainly we know a person needs to have this particular bacteria to get sick, and then there may be something with tampon use, maybe prolonged tampon use, that puts that risk higher for developing a more widespread infection.”

Manitoski’s sister, Carli Manitoski, took to Facebook to warn about TSS in December.

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“After 9 agonizing months we have finally got confirmation that my litter sister passed away from Toxic Shock Syndrome or (TSS). Women need to be more educated on this subject, some of you might not even know TSS is,” she wrote. “They say getting TSS is incredibly rare but I know two people that have had it, with one barely surviving and my sister who died from it. Can it really be that rare? My sister complained of stomach cramps before going to bed and then she never woke up.”

She said her sister was healthy, and that others need to educate themselves on safe tampon use.

“There is such little education on this and it needs to be brought to light,” she posted. “Such an unnecessary and tragic thing to happen to such an amazing young lady. I wouldn’t want this to happen to anyone else and if this post makes even one person aware and go look up and educate themselves on TSS then I am grateful.”