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Miranda Schaup-Werner Danker Holmes and Cyndi Day

“Our condolences and sympathy go out to the families during this difficult time,” the spokesperson said in a statement.

There were no signs of physical violence or foul play, the spokesperson said after at least nine Americans died on the island in recent months.

RELATED VIDEO: Dominican Republic Health Official Claims Cynthia Day Died from the ‘Shock’ of Seeing Fiancé Dead

Schaup-Werner, of Pennsylvania, died on May 25 while celebrating her 9th anniversary with husband Daniel Werner at the the Luxury Bahia Principe Bouganville hotel in La Romana.

Family spokesman Jay McDonald, Daniel’s brother-in-law, toldFox Newsthat shecollapsed shortly after mixing a drinkfrom the minibar in her room on the same day the couple checked in.

McDonald said in June that Schaup-Werner died of respiratory failure, while a statement from the hotel said she had a heart attack, citing the National Institute of Forensic Sciences and the National Police Investigations Unit.

Grand Bahia Principe Hotel Resort.Shutterstock

Grand Bahia Principe Hotel Resort

The Dominican Republic National Police later announced an autopsy found the coupledied of respiratory failure and pulmonary edema. Day also reportedly suffered cerebral edema.

The engaged couple both had internal bleeding, including in their pancreases,CNNreported, citing authorities in the Dominican Republic, while Holmes also reportedly had an enlarged heart and cirrhosis of the liver.

After Holmes and Day’s causes of death were announced, McDonald expressed skepticism that all three had died of respiratory failure.

“They died just five days after, and the cause was determined to be the same, this just puts the whole thing through the stratosphere,” he toldFox News. “Something is going on, and we want to know what it is.”

PEOPLE was unable to reach McDonald for comment.

source: people.com