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. 2017 Mar 23;16(4):348–351. doi: 10.2450/2017.0268-16

Table I.

Questionnaire sent to participants of the Mirasol® haemovigilance programme.

Name of Institution, Department:
Period of report:
Blood component Platelets Plasma
Apheresis Whole blood Apheresis Whole blood
Total produced
Total Mirasol®-treated
Total issued to hospitals
Total Mirasol® products issued to hospitals
Total expired Mirasol® products
Total transfused Mirasol® products
Total n. of patients transfused with the products
Total n. of adverse event reports, with grades of severity (I, II, III, IV)
N. of adverse events reports for Mirasol®-treated products, with grades of severity (I, II, III, IV)
Imputability levels: definite, probable, unlikely, excluded
Patient’s disease
Previous history of transfusion (yes/no)
Presence of allo-antibodies before transfusion (yes/no)