A 15-year-old Esko football player died of natural causes, authorities announced Monday.

According to the preliminary report from the Ramsey County Medical Examiner's Office, Jackson Pfister's death was due to congenital heart disease, a condition he had since birth.

Jackson, an Esko High School student, died after collapsing during his football team's varsity game in Aitkin Friday. Jackson was transported by ambulance to Riverwood Healthcare Center in Aitkin with a serious medical condition, according to the Aitkin Police Department. He died shortly after.

Jackson entered the game late as the backup quarterback when Esko had a 41-14 lead. With 3:30 left, Esko fumbled the ball on a fourth-and-2 play, and Aitkin recovered it.

A sports announcer from KKIN Radio out of Aitkin said during his broadcast that Jackson had collapsed on the field after the play about 10 yards back from the action, then “got up and began to jog back to the sideline when then he just collapsed.”

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Both teams returned to their respective sidelines, an ambulance was called, Jackson was taken to the hospital and the game ended there with three minutes left on the clock.

“Jackson was a special young man from a great family. His kindness and compassion for others, combined with his dedication and competitiveness, made him not only a great individual but a great leader among his peers,” said Chad Stoskopf, athletic director for Esko schools. “Our entire community is grieving his loss and the outpouring of support from the region and state has been tremendous. Jackson's spirit is with us and we are all better having known him.”

A somber day at school

The first day of school since Jackson’s death was difficult for students and staff.

“It was a very subdued, challenging day because everyone here is just heartbroken over the loss of Jackson,” superintendent Aaron Fisher told the News Tribune. “Our thoughts and prayers go out to the family, a tremendously wonderful family.”

Fisher said the staff united to support each other as well as the students. He said not only were all of the Esko school district counselors available to students and staff Monday, but neighboring school districts also provided their counselors to help out.

“We had a lot of support today and as kids needed that support they were available for one-on-one and small groups,” Fisher said. “Considering how difficult of a situation it was (Monday), I felt that things were managed very well and kids did get a lot of good support. We’re all just continuing to work through the process and continue to keep Jackson and his family in our hearts and prayers.”

Sports community shows support

An outpouring of support from all over the state has been shared on social media for the Eskomo football team.

“We are saddened beyond words hearing about this tragic loss,” a tweet from Moose Lake-Willow River Rebel Football read. “We stand united with the entire Northeast Minnesota football community in offering our support, thoughts and prayers to Jackson’s family, the Esko football family and the entire community of Esko.”

Goodhue Boys Basketball tweeted, “Different sport, different corner of the state, but our support is with you @Eskomo_Football. Our thoughts (are) with you on the passing of Jackson.”

Pine City football player Hunter Peacock tweeted, “R.I.P Jackson Pfister, we might (have) been rivals in football but nobody wants to hear the sad news on a 15 year old passing away playing the sport they loved, rest easy brother.” Pine City is a conference rival of Esko’s.

Fisher said the support has been amazing.

“I did speak with the family (Monday) and they are very appreciative of all the support coming from the Esko community and the other communities. It’s just a showing of how much caring and goodwill is out there,” he said. “It’s very important to all of us because he was such a wonderful kid and he’s getting an opportunity to be remembered.”

Esko plays its final regular season game Wednesday at 6:30 p.m. against Crosby-Ironton in Esko. Fisher said the school plans to honor Jackson during the game, but details are still being finalized.

“Wednesday will be another important day for us as we go forward,” Fisher said. “Jackson was a tremendous young man and a joy to be around. He was an outstanding athlete and an outstanding student. He will be greatly missed by everyone.”

A funeral will be held for Jackson on Sunday. Visitation will begin at 1 p.m. until Mass at 4 p.m. at Queen Peace Catholic Church in Cloquet, followed by a luncheon in the church social hall. Jackson would have turned 16 on Saturday.

An unusual incident

Jackson had a heart defect which required him to have three open-heart surgeries by the time he was 9 years old, according to a 2011 Facebook post by his grandmother Lynn Davidson. What happened to Jackson was unusual.

“I think this is a very unfortunate situation but also a very, very unusual situation that doesn’t necessarily carry over to the millions of other student athletes that play sports each year,” said Dr. Chris Latanich, cardiac electrophysiologist at Essentia Health-St. Mary’s Medical Center in Duluth. “I think it needs to be viewed as a very specialized situation in this case.”

Latanich said congenital heart disease is any abnormality of the heart that has been present since birth, ranging from minor issues to life-threatening issues. The likelihood of this occurring in student athletes is very rare, Latanich said.

He pointed to a study done in Minnesota and compared it with a study in the Veneto region of Italy where mandatory electrocardiography, or EKG, screenings were done on student athletes. In this study, cardiovascular-related mortality rates in the athletes were compared with those in Minnesota, where screening is limited to history and physical examination. There were 55 sudden cardiovascular deaths reported in Veneto over 26 years (1979-2004), compared with 22 deaths in 23 years (1985-2007) in Minnesota.

The study concluded that sudden cardiovascular deaths in the student athletes did not differ significantly in recent years and the data doesn’t support a lower mortality rate associated with preparticipation screening programs involving routine electrocardiography and examinations by specially trained personnel.

Latanich said parents worried about their children should look for these signs.

“I think the easiest thing to start with is if your kid has ever passed out, especially during or right around after participating in sports, or complaining of chest pain or shortness of breath that seems out of proportion with what they just did, then they should come and see a pediatrician or cardiologist,” he said. “They may need more testing, but it doesn’t mean they can’t participate in sports.”

Latanich said if someone does undergo heart surgery or their heart requires surgical repair for a congenital heart abnormality, the recommendation, generally, is that the person should be followed by a cardiologist who specializes in congenital heart disease.

“Generally, they are followed pretty closely. There may be situations where with what they had, what was done and depending on the outcome, they may have less frequent follow-ups,” Latanich said. “But again, it just depends entirely on what the actual issue was. It could be as frequent as every three months or every five years. Typically, those people are followed very closely by very dedicated specialists in congenital heart disease.”

The Minnesota State High School League requires that student athletes have a physical examination performed by a physician every three years to be eligible to play.

The MSHSL bylaws also require a health questionnaire be completed by the student and the student’s parents or legal guardian. The questionnaire asks questions such as “in the last year, has a doctor restricted your participation in sports for any reason without clearing you to return to sports?”

The questionnaire also asks about heart health, family heart health and head injuries. There is a section for parents or legal guardians to note any health concerns. If the answer to any of the questions in the questionnaire are marked “yes,” then the student is required to get a clearance note from a physician prior to participation.