| Document Date: 2014-12-02 15:17:36
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City Facility / Secondary / Atlanta / Patient / / Company AMP / Pneumatoceles (in ≤1 y.o.) Signs & Symptoms Laboratory / / Event FDA Phase / / Facility Facility ID / / IndustryTerm gas exchange / / MedicalCondition Pseudomonas / Pneumonia / Pleuritic chest pain / dyspnea / Leukopenia / *Secondary Bloodstream Infection / Hypothermia / Apnea / Hemoptysis / leukocytosis / New onset/worsening cough / tachycardia / nasal flaring / Bradycardia / moxifloxacin Pneumonia / tachycardia / infection / Cough / MS / N Pneumonia / ____Klebsiella pneumonia / Wheezing / Histopathologic exam w/ abscess / / Organization FDA / Medicare / / Person MICA S NS / Candida spp / / Position Reports Clearance Officer / / Product BAL / ceftazidime / levofloxacin / piperacillin / itraconazole / cefazolin / trimethoprim / linezolid / amoxicillin / gentamicin / doxycycline / cefotaxime / ampicillin / cefoxitin / CIPRO / erythromycin / ciprofloxacin / rifampin / sulfamethoxazole / fluconazole / cefuroxime / cefotetan / ceftriaxone / tobramycin / D-74 / / ProvinceOrState Georgia / / Technology specific algorithm / / |
Pneumonia (PNEU) Page 1 of 4 *required for saving **required for completion Facility ID: Event #: *Patient ID: