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 |
|