Lack of national anaphylaxis death register
Department of Health and Social Care received 2 coroners' reports about this hazard between 30 Sept 2019 and 6 Apr 2023.
They came from 2 different coroners in 2 coroner areas. A similar concern was raised again 1 time after the first warning.
A published response was found for 1 of the 1 earlier reports, stating 2 specific actions.
The story, report by report
Spacing grows with the time between reports.
“there is therefore no national register recording the circumstances of these deaths which could then be analysed and learnt from by allergy specialists”
Original on judiciary.uk ↗ Department of Health and Social Care responded, stating 2 specific actions.Response (PDF) ↗Response (PDF) ↗
“The BSACTI believes that there is a need for 2 distinct registries. The first is a national register for all anaphylactic reactions, that can be contributed to by any health care professional and would provide invaluable data on emerging patterns of reactions and their circumstances and effectively operate as an early warning signal for new risks and highlight specific situations where risk is higher so that they can be actively mitigated. Such a registry already exists in Europe and the Food St”
“The FSA will be hosting an Allergy Symposium in”
Stated timescale: early 2020
- 3 years 6 months laterClosely relatedConfidence 0.80 · moderatea different coroner
“Gathering data and using this to research and reduce the risk of future deaths requires funding, and this should be reviewed.”
Original on judiciary.uk ↗ Department of Health and Social Care responded.Response (PDF) ↗Response (PDF) ↗
- All reports to Department of Health and Social Care
Each row is one judged link between an earlier and a later report. Open a row to read both quotes, found word for word in the originals.
2019 → 2023Alexandra Briess3 years 6 months after Owen Carey · different coronerClosely relatedConfidence 0.80 · moderate
Closely relatedConfidence 0.80 · moderateBoth reports highlight the absence of a systematic way to collect and analyse data on fatal anaphylaxis deaths. The earlier report calls for a national register, while the later report stresses that gathering and using such data needs dedicated funding.
Owen Carey · 30 Sept 2019
“there is therefore no national register recording the circumstances of these deaths which could then be analysed and learnt from by allergy specialists”
Original on judiciary.uk ↗ Alexandra Briess · 6 Apr 2023
“Gathering data and using this to research and reduce the risk of future deaths requires funding, and this should be reviewed.”
Original on judiciary.uk ↗
Stated action
“The BSACTI believes that there is a need for 2 distinct registries. The first is a national register for all anaphylactic reactions, that can be contributed to by any health care professional and would provide invaluable data on emerging patterns of reactions and their circumstances and effectively operate as an early warning signal for new risks and highlight specific situations where risk is higher so that they can be actively mitigated. Such a registry already exists in Europe and the Food St”
Stated action · timescale: early 2020
“The FSA will be hosting an Allergy Symposium in”
No specific action could be extracted with a verified quote.
No specific action could be extracted with a verified quote.
- Each report's concerns were extracted by Nemotron 3 Nano on Nebius Token Factory, each with a quote copied from the report.
- Concerns from reports to Department of Health and Social Care at least six months apart were compared by meaning (Qwen3 embeddings) and wording (TF-IDF).
- The closest pairs were judged by Nemotron 3 Super with reasoning on. Only identical or closely related, with confidence of at least 0.70, are shown.
- Every quote was checked by code as an exact substring of the original text. Names of staff and family are redacted, and the deceased are named by report title only.
| Link | Meaning | Wording | Judge | Coroner |
|---|---|---|---|---|
| 2019 → 2023 | 0.77 | 0.29 | Closely related · 0.80 | different |
Judge model: nvidia/nemotron-3-super-120b-a12b. How Nemotron did the work · Full methodology.
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Other chains for Department of Health and Social Care
This shows that a similar concern was raised again after an earlier report. It does not say why, and it is not a finding about any organisation or person. To report an error, see the corrections route.