Tennessee's former top vaccination official, Dr. Michelle Fiscus, told state investigators in July that she received a dog muzzle in the mail, which she deemed to be a threat to keep her quiet.
The muzzle, however, was bought on an Amazon account and with an American Express card in her name, according to a state investigation that concluded Monday.
"There is no evidence to indicate the dog muzzle was intended to threaten Dr. Fiscus," said the report, written by Special Agent Mario Vigil of the state Department of Safety and Homeland Security.
Fiscus, a pediatrician, was the state's medical director of the Vaccine Preventable Disease and Immunization Program. She was fired July 12 in a political firestorm, less than two weeks after, she said, she was mailed the muzzle.
She has said her firing was a political decision to placate lawmakers who disapproved of the Health Department's outreach to vaccinate teenagers against Covid-19.
Fiscus could not be immediately reached for comment Tuesday. She told NBC affiliate WSMV of Nashville that she acknowledges that the muzzle was paid for using an American Express that belongs to her but that she "vehemently denies" buying the muzzle and sending it to herself.
"I've thought about who could be to blame. It's not anything that I have any evidence to show," Fiscus told WSMV. "I think there is just a lot of layers here that ... I don't understand."
Fiscus tweeted Monday night that "the state's investigation did NOT conclude I sent the muzzle."
"In fact, it only concluded my credit card was charged with the incorrect billing address – my state work office – to an Amazon account I didn't know existed," she said in the tweet.
"That account was apparently accessed from the State of Washington, where I had never been, by a cell phone using a carrier I have never used," she said in another tweet. "I have asked the state for the full unredacted report and am awaiting a response."
The report, which was reviewed by NBC News, was partly redacted. At times, it omitted names or personal identifiers, such as phone numbers.
An investigation was opened July 7 when a doctor with the state Health Department contacted the state's homeland security director, Greg Mays, and expressed concern that the muzzle was intended as a threat, according to the report.
Two special agents met with Fiscus on July 8. She told them that the muzzle was delivered to her office in an Amazon package July 2 but that she did not open it until July 6, after the holiday weekend, the report said. There was no return address or other identifying data to indicate who sent the "silicon basket dog muzzle," the report said.
Fiscus said she first thought a colleague had sent her the muzzle as a joke. But when the colleague denied having sent it, Fiscus told investigators that she viewed it as a veiled threat.
"Dr. Fiscus said she felt it was a threat and that she should stop talking about vaccinating people," the report said. "Due to her role in the vaccination program and her authoring a memo on Tennessee's 'Mature Minor' Doctrine that she had been singled out for criticism by some people in the public, as well as several Tennessee Legislators."
A special agent contacted Amazon on July 8 about the muzzle. An Amazon employee told the agent that without a subpoena, he could do only a cursory bar code search. The employee said that based on the search, "the receiver (Dr. Fiscus) was also the sender, but he could not be certain," the report said.
An investigator then spoke to Fiscus, who told the special agent that she had no knowledge of who sent the muzzle or why Amazon indicated that she had sent it. The report also said Fiscus allowed investigators to access an Amazon account in her name and to view archived purchases from the account. The account did not list the muzzle as a purchased item, the report said. Fiscus also said neither her husband nor her daughter sent the muzzle, the report said.
After a judge signed off on a subpoena ordering Amazon to provide more details about the account behind the muzzle, investigators learned that "the account which the muzzle had been purchased on was in Dr. Fiscus' name and had been opened in March 2021."
Investigators also asked a judge to subpoena the service provider of the phone number listed on the Amazon account the muzzle was purchased on, the investigation said. Records provided to the investigation showed that the carrier was T-Mobile.
Although Fiscus said her termination was political, state documents say she was fired because she was a poor leader and manager.
Tennessee's chief medical officer, Dr. Tim Jones, recommended removing Fiscus partly because of complaints about her leadership approach and because of how she handled a letter about the vaccination rights of minors, which prompted outrage among Republican legislators, state records show.