MULTI-EVENT EXTERNAL UNEXPECTED SERIOUS ADVERSE EVENT REPORTING FORM (more than one case) Study code: Adverse Event AGE & OUTCOME DESCRIPTION RELATIONSHIP TO EXPECTED (E) TREATMENT UNEXPECTED(U) ID or Reference SEX O=Ongoing, P=Partial Code (e.g. (R=Related, Recovery, 51M) P=Possibly related, R=Recovered, N=Not related, F=Fatal, U=Unknown) U=Unknown,
MULTI-EVENT EXTERNAL UNEXPECTED SERIOUS ADVERSE EVENT REPORTING FORM (more than one case) Study code: Adverse Event ID or Reference Code AGE & SEX (e.g. 51M) OUTCOME O=Ongoing, P=Partial Recovery, R=Recovered, F=Fatal, U=Unknown, RELATIONSHIP TO TREATMENT (R=Related, P=Possibly related, N=Not related, U=Unknown) EXPECTED (E) UNEXPECTED(U) DESCRIPTION
HSREB%20-%20UnexpectedSAEMultiEventReportForm_v_2016MAR03%20(6)%20(2).docx