Abstract: On November 23, 2011, Employee #1 was pulling a log from a culvert while working at the Northlake Reservoir. The employee had prior abdominal surgery, which was not work related. Employee #1 was diagnosed as having a ventral incisional hernia, which was corrected by surgery on December 2, 2010. On September 14, 2011, the employee strained his lower back and leg while pulling a manhole cover using a pick. Employee #1 went to his private physician on September 22, 23, and 28, 2011. The employee was placed on modified duty on September 29, 2011. A written accident report was submitted by the supervisor on October 7, 2011. On November 11, 2011, Employee #1 stepped down off of a sewer maintenance vehicle and walked on uneven ground and he stepped into a hole injuring his left knee, left ankle and lower back. The employee was seen later that day at an occupational health clinic, where he stated that after the incident he developed some increasing low back pain on the left side. On November 14, 2011, Employee #1 was again seen by the occupational health clinic physician, who discharged him and stated that on November 14, 2011 Employee #1 could return to work and resume the activity level related to his previous back injury. The employee did not return to work. Physical therapy, pain therapy and an epidural injection failed to relieve Employee #1's pain. A micro-discectomy was performed on March 15, 2012. The surgery was uneventful, and the employee woke up from the anesthesia. One or two days after the micro-discectomy surgery, the employee began to have abdominal pain and doctors found a "mass" in the abdomen. On March 17, 2012, Employee #1 underwent abdominal surgery to remove the mass. Shortly after that an unexplained medical event occurred and the employee took a turn for the worst. After the event, Employee #1 did not regain consciousness. The employee was intubated, treated for septic shock, renal, and liver failure. On or about March 18, 2012, Employee #1 suffered cardiac arrest and was placed on a ventilator, but his health continued to decline. The employee was twice tested for cerebral blood flow with negative results. Employee #1 was taken off of life support and died on March 25, 2012. The family requested a postmortem evaluation to be performed by Loyola Hospital. The autopsy results have not yet been released. The death certificate listed the cause of death as 1) anoxic brain injury (lack of oxygen in the brain), and 2) hypoxemia (lack of oxygen in the blood).