Category | Information | |
---|---|---|
General | Hospital | Country |
Demographic | Gender | Date of birth |
Underlying diseases | Heart disease | Lung disease |
Tuberculosis | Asthma | |
Pneumonia | HIV infection | |
Others | ||
Medical history | Contact with tuberculosis | Previous influenza |
Prior treatment with antibiotics | Prior treatment for fever | |
Date of first symptoms | ||
Clinical examination at enrollment | Weight | Height |
Arm circumference | Temperature | |
Blood pressure | Breathing rate | |
Arterial oxygen saturation | Cough | |
Dyspnea | Lower chest indrawing | |
Cyanosis | Pulmonary crackles | |
Dullness to percussion of the thorax | Rhonchi | |
Wheezing | Rasping | |
Diminished breathing sounds | Convulsions | |
Other pulmonary signs and symptoms | Rhinopharyngitis | |
Prostration or lethargy | Conjunctivitis | |
Otitis | Inability to drink | |
Skin rash | Diarrhea | |
Vomiting | Other signs | |
Radiological | Opacification | Abscess |
findings | Interstitial syndrome | Pneumothorax |
(cases only) | Alveolar infiltrate | Parenchymatous infiltrate |
Vaccination (dates, number of doses) | Pneumococcal conjugate vaccine Influenza vaccine | Diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type B vaccine |
During hospital stay | Antibiotics (dates, doses, duration) | Oxygen therapy |
Other drugs | Death | |
Acute complications | Cause of death | |
Recovery |