Her death certificate listed the cause of death as unknown, because Janelle was never able to afford a proper diagnosis, a diagnosis that with care might have saved her life.

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After noticing the death certificate of his great-great-great-grandmother had omitted a cause of death, he made inquiries which revealed she was killed by "injuries inflicted on the head by someone unknown".

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He said arrangements must be made to release the body and once that happens a death certificate will be filed and the cause of death made public.

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"That ... led us to issue an amended death certificate that (established) cyanide toxicity as the cause of death, and the manner of death as homicide, " Chief Medical Examiner Dr. Steve Cina said Monday.

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The official cause of death on his death certificate, released by Al-Wefaq, was listed as internal bleeding and gunshot wounds.

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Tsarnaev's cause of death will not be released until the death certificate is filed with the Boston city clerk, he said.

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