Greenville, N.C. — A state medical examiner in Greenville ruled Tuesday that the death of a Greenville Rose football player was accidental and the result of “second impact syndrome.”

In a statement, Dr. M.G.F. Gilliland said Jaquan Waller died because of a “very rare condition which can occur when two relatively minor head injuries occur in a short time interval. It usually occurs in young athletes and is very rapidly fatal.”

Waller, a junior running back, left the field after being tackled in Rose’s game Friday against Wilmington Hoggard. He then collapsed on the sideline. Waller was taken to Pitt County Memorial Hospital, where he was placed on life support. He died Saturday morning. Waller had been hit in practice two days before the game and suffered a mild concussion.

The cause of death was “closed head injury (due) to sequential impacts during contact sport,” according to the statement.

Waller is the third N.C. high school football player to die this season.

Matt Gfeller, a sophomore at Winston-Salem Reynolds, died Aug. 24, two days after a hit that he took in a game against Greensboro Page led to cranial bleeding.

On Aug. 12, Atlas Fraley, a senior at Chapel Hill, was found unresponsive in his home a few hours after he called 911 complaining of body aches and dehydration following a morning scrimmage. An official cause of death has not been released.

Heather Mayo, Pitt County Schools spokeswoman, said an investigation into Waller’s death is under way. She said the investigation will include verifying everything that took place, interviewing some students and staff and reviewing district procedures. She did not say how long that would take.

“We want to make sure we do a thorough investigation,” Mayo said. “Folks are going to want answers, and we realize folks are going to want to know things as soon as possible.”

Waller suffered a mild concussion in practice last Wednesday, according to Gilliland’s statement. He was examined by the school’s athletic trainer and held out of practice the rest of the day, and his mother picked him up and took him home.

“[Waller] was coherent, was able to say where he was. His memory and cognitive assessment checked out,” Mayo said. “Based on what Jaquan presented, [the athletic trainer] did not recommend any further medical evaluation.”

Waller was in school on Thursday and was examined and cleared to participate in the team’s light workout that afternoon. According to Gilliland’s statement, based on information available to the medical examiner, Waller had returned to his “previous level of functioning” by Thursday. He was in school on Friday, and he was checked out again before the start of the game.

“All indications were that he was coherent and the same old Jaquan,” Mayo said.

In the second quarter of Friday’s game, the hit Waller sustained, coupled with the hit he sustained two days earlier, caused his brain to swell. Neither hit on its own would have been fatal, according to Gilliland’s statement.

“The swelling was sufficient to cause him to collapse by the time he had walked off the field, the usual length of time described in the literature on this rare syndrome – two to five minutes,” Gilliland’s report said. “Although medical attention was available very rapidly, the brain swelling could not be reversed and led to brain death by Saturday morning.”