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Influenza-Associated Pediatric Mortality Case Report Form Approved OMB No. 0920-0004 Exp. Date 6/30/2013 STATE USE ONLY DO NOT SEND INFORMATION IN THIS SECTION TO CDC Last Name: Address: First Name:
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Influenza-associated pediatric mortality case refers to a report filed regarding the death of a child due to influenza or its complications.
Healthcare providers, hospitals, and medical examiners are required to file influenza-associated pediatric mortality cases.
To fill out an influenza-associated pediatric mortality case, healthcare providers should gather relevant information such as the child's medical history, symptoms, laboratory test results, and cause of death. This information is then reported using the designated reporting system or form provided by the appropriate health agency.
The purpose of the influenza-associated pediatric mortality case is to track and monitor influenza-related deaths among children in order to better understand the impact of influenza on pediatric populations, identify risk factors, and inform public health interventions.
The information that must be reported on an influenza-associated pediatric mortality case includes the child's demographic information (such as age, sex, and race/ethnicity), detailed medical history, vaccination status, clinical symptoms, laboratory test results, cause of death, and any underlying medical conditions or complications.
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