Narrative Review: Death

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Site:

AE:

Complication:

Event date:

Adverse event code:

  • Demograghic: [age] year old [gender]
  • Past Medical History: [eg. CAD, Severe mitral stenosis, 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
  • ECHO/ date:
  • CXR / date:
  • Other imaging and diagnostic tests / date:
  • Clinical course:
  • Treatment: