Sandbox:ssw 2

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Site	Patient	AE	Complication	Event date	AE code
00007	L003/ZZK	0	TIA	mm/dd/YYYY	xxx

Demographic / Medical history

• Demographic: 77, M
• Past Medical History: HTN, CAD w CABG, MI, AVR
• Past Surgical History:
  • AVR (#25 magna ease valve) on 12/14/17
  • Stent on 10/10/2017
  • CABG in 2007
  • Appendectomy in 1957

• Medications: [relevant to the event not all]

Procedure

• Index Procedure Date/Time:
  • mm/dd/YYYY at xx:xx [insert date and time]
• Index Procedure Detail:
  • On mm/dd/YYYY at xx:xx [insert date and time] the subject underwent a [select surgical correction] for [select etiology].
  • Access site details
  • The site reported that there were/were not procedural complication(s).

Event(s)

Event (1):

• Site Reported Event Onset Date: 12/26/2017

• Event summary:
  • Symptoms and sign: Subject presented 1. Right leg collapse,

2. Right arm and right leg weakness

• • Episodes last ~ 2 -10 minutes, beginning from 1 to 3-4/day
  • No visual or speech difficulties, no headache or neck pain
  • No history of vertigo, syncope, loss of consciousness or seizures
  • Other important symptoms related to the chief complaint.
  • Physical assessment:
    • Normal neurological exam
    • BP: 124/66
    • HR: 96

Event (2):

• Site Reported Event Onset Date: mm/dd/YYYY
• Event summary:
  • Symptoms and sign: Subject presented with [sign and symptom] on mm/dd/YYYY.
  • Important characteristics of the chief complaint such as severity, site, and duration.
  • Other important symptoms related to the chief compliant.
  • Physical assessment:
    • Vital signs
    • Positive physical examinations or related negative examinations.

Laboratory data

• Lab studies list: (Date/ name/ value)

Diagnostic tests

• mm/dd/YYYY at xx:xx on brain MRI
• mm/dd/YYYY at xx:xx on MRA
• mm/dd/YYYY at xx:xx on CT
• mm/dd/YYYY at xx:xx on EEG
• mm/dd/YYYY at xx:xx on Carotid US
• mm/dd/YYYY at xx:xx on ECG:

• mm/dd/YYYY at xx:xx on ECHO:
• mm/dd/YYYY at xx:xx on Ultrasound:
• mm/dd/YYYY at xx:xx on Endoscopy:
• mm/dd/YYYY at xx:xx ... (Other relevant imaging and diagnostic tests)

Consults

• Date and time of consult
• Suggested treatments

Clinical course

• Date and time of events,
• Patient condition got worse or better.

Treatment and outcome

• List of relevant medical treatments
• Out come [Discharge / Hospice / Death]