Thank you for completing the Serious Adverse Event Report Form for the US Expanded Access Program for Convalescent Plasma for the Treatment of Patients with COVID-19.

This form is for reporting Serious Adverse Events (SAE)s that occur after 4 hour post-transfusion through day 7.

NOTE: You are required by Federal Regulation to report Serious Adverse Events (SAEs) utilizing the 4 hour Post-Transfusion Form and this Event Report Form.

Please fill in the form with as much detail as possible.

Please use the unique patient code assigned at the time of patient enrollment to complete the form.

Information, protocol, consent forms and site registration, enrollment and followup forms are available at www.USCOVIDplasma.org.

If you have any questions or difficulties please email USCOVIDplasma@mayo.edu, which will be monitored from 7am-7pm CST.

Note: Submission of this form on iOS devices using Safari may cause duplicate submissions. If possible, please submit from another browser such as Google Chrome, Internet Explorer, or Mozilla Firefox. Thank you.

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