Narrative Review: Death

Site:

AE:

Complication:

Event date:

Adverse event code:

• Demograghic: [age] year old [gender]
• Past Medical History: [eg. CAD, diabetes, former tobacco use, dyslipidemia, ...]
• Index Procedure Date/Time: xx/xx/xxxx at xx:xx [insert date and time]
• Index Procedure Detail:
  • On [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
  • Enter access site details
  • Baseline MR severity was classified as [select none, trace, mild, mild-moderate, moderate, moderate-severe-severe] and post-implant MR was classified as [select severity].
  • The site reported that there were/were not procedural complication(s).
• Event: MI
• Site Reported Event Onset Date: xx/xx/xxxx
• Event summary:
  • Symptoms and sign: Subject presented with [sign and symptom] on xx/xx/xxxx.
  • Important characteristics of the chief complaint such as severity, site, and duration.
  • Other important symptoms related to the chief compliant.
  • Physical assessment:
  • Vital sign
  • Positive physical examinations or related negative examinations.
• Lab studies:
  • Date/ name/ value [ as a list ]

• ECG / date:

• ECHO / date:

• CXR / date:
• Other relevant imaging and diagnostic tests / date:
• Clinical course:
• Treatment: