Comedienne and fashion critic Joan Rivers, who passed away last month at the age of 81, died of a complication during a medical procedure, the New York Chief Medical Examiner’s Office has confirmed. Rivers was having an examination of the back of her throat and vocal cords at a New York clinic when she stopped breathing and was rushed to Mount Sinai Hospital, where she was put on life support.

“The manner of death is therapeutic complication,” the medical examiner said in a statement.

“The death resulted from a predictable complication of medical therapy.” It listed the cause of death as anoxic encephalopathy, a condition caused when brain tissue is deprived of oxygen and there is brain damage. Rivers, who paved the way for women in stand-up comedy, died in hospital in September. The clinic denied media reports that it had administered a general anaesthesia or conducted a vocal cord biopsy on Rivers.