OARRS 2023 Infection Data Collection

The Medical Review Subcommittee (MRS) is requesting additional data on reported infectious adverse reactions, following 2023 surgeries. They will be using this data to identify factors that associate recipient infection with donor sepsis, as part of our response to FDA. Please note – all data submitted on this form should be from 2023 surgeries only. If you have any questions about the data, please contact Jennifer DeMatteo.

Organization Name

Contact Information

Please enter your contact information below.

Name(Required)

First Last

Email(Required)

Phone

Case Information

OARRS Report Number(Required)

MedWatch Report Number(Required)

Donor Cause of Death(Required)

Did donor have any concerns for sepsis?(Required)

Yes

If yes, were they approved for transplant via any of the following methods?

Sepsis Algorithm

Medical Director Consult

Infectious Disease Consult

Attending physician consult

Other

Were there any positive lab cultures, imaging, or other diagnostic tests?(Required)

Yes

If yes, list the date, culture type or test, and results including pathogen(s) isolated.

Donor's Lab Results: If easier, you may upload a copy of the donor’s lab results here.

Drop files here or

Accepted file types: jpg, gif, png, pdf, doc, Max. file size: 256 MB, Max. files: 10.

List all antibiotics the donor was on at the time of death.

Additional Information. Include any additional information you’d like the Medical Review Subcommittee to have.

Additional Files: Upload any other necessary documentation here.

Accepted file types: pdf, png, docx, jpg, Max. file size: 256 MB.