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
xxx	xxx	x		mm/dd/YYYY	xxx

Demographic / Medical history

• Demographic: [age] year old [gender]
• Past Medical History: [eg. VHD, diabetes, and CAD,.../ including date]
• Past Surgical History: [including date]
• 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: 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 complaint.
  • Physical assessment:
    • Vital signs
    • Positive physical examinations or related negative examinations.

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]