A woman who was partially paralyzed during the 1999 mass shooting at Columbine High School died last month, and her death has now been ruled a homicide.

Anne Marie Hochhalter died of sepsis on Feb. 16 at 43 years old. Complications from her paralysis contributed significantly to her death, according to an autopsy report from the Jefferson County Coroner’s Office obtained by The Associated Press on Thursday.

Hochhalter was one of 23 people who were injured in the shooting at the Littleton, Colorado, high school, but survived.

Including her death, the Columbine shooting claimed 14 victims as 12 students and one teacher were killed the day of the April 20, 1999, attack. Both of the shooters, who were students, took their own lives.

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Hochhalter’s brother, Nathan, said an infected pressure sore led to sepsis, and though he knew her condition would shorten her life, her death was not expected this early.

“We didn’t think it would be this bad this soon,” he told The AP.

Hochhalter was shot in the back and chest while she was eating in the school’s cafeteria, resulting in paralysis. She struggled with intense pain for years following the shooting, but friends and family said she fought hard to overcome the complications that came with her injuries – and remained positive while doing so.

In 2016, Hochhalter wrote a letter of forgiveness to Sue Klebold, the mother of one of the shooters.

“A good friend once told me, ‘Bitterness is like swallowing a poison pill and expecting the other person to die.’ It only harms yourself. I have forgiven you and only wish you the best,” she wrote, in part.

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Hochhalter’s own mother died by suicide six months after Columbine. She said her mother struggled with depression and did not believe the shootings were directly to blame for the tragedy.

After her mother’s death, she became very close to the Townsend family, whose daughter, Lauren, was killed in the Columbine shooting. 

“She brought a light to our lives that will shine for a long time,” said Sue Townsend, the stepmother of Lauren.

Following a vigil last year marking the 25th anniversary of the shooting, Hochhalter said she was flooded with happy memories from her childhood and she wanted the victims to be remembered for how they lived, not how they died.

“I’ve truly been able to heal my soul since that awful day in 1999,” she wrote in a social media post.