Andrew Fryberg, 15, died yesterday evening at Harborview Medical Center in Seattle, a hospital spokeswoman said.
Zoe Galasso, 14, was killed during the shooting on Oct 24 by a popular freshman at Marysville-Pilchuck High School. Gia Soriano, also 14, died on Oct 26 at Providence Regional Medical Center in Everett and 14-year-old Shaylee Chuckulnaskit died on Oct 31 at the Everett hospital.
The shooter, Jaylen Fryberg, died of a self-inflicted wound.
The family also thanked "all the amazing staff" who cared for the boy in Harborview's pediatric intensive care unit. The relatives asked for privacy.
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Andrew Fryberg was the last wounded student still hospitalized.
On Thursday, 14-year-old Nate Hatch was released from Harborview and returned home. He had been shot in the jaw.
More than 200 friends and family gathered along the road leading onto the Tulalip Indian Reservation north of Seattle to welcome Hatch home. He was driven past the crowd in a black tribal police vehicle.
In a statement yesterday, the Tulalip Tribes said they and Marysville "will be forever changed as a result of the senseless and tragic incident that took place on the morning of Oct 24 and know that healing will not happen overnight. We remain committed to taking this journey together, step by step, holding up the families most impacted and helping our communities heal."
The school 30 miles north of Seattle reopened Monday after being closed for a week. Hundreds of people lined the entrance. Well-wishers waved at returning students and many held candles. People cheered as buses and cars entered the school campus.