Report a Case of Reye's Syndrome

Welcome to the National Reye's Syndrome Foundation

National Reye's Syndrome Foundation

Reye's Syndrome, a deadly disease, strikes swiftly and can attack any child, teen, or adult without warning. All body organs are affected, with the liver and brain suffering most seriously. While the cause and cure remain unknown, research has established a link between Reye's Syndrome and the use of aspirin and other salicylate containing medications, over the counter products, and topical use products. In 1974, the National Reye's Syndrome Foundation, a health advocacy organization, was incorporated as a 501(c)3 charity, whose mission is to eradicate the incidence of Reye's Syndrome.

Information Alerts!

Reporting a Case of Reye's Syndrome

Please fill in the following form to report a past or recent case of Reye's Syndrome, or (Click Here) to download this form to mail or FAX.

Items in bold are required.

Date of Reye's Syndrome Occurrence

Age at Occurrence

Legal Name at Time of Occurrence, of Person Having Reye's

Male

Female

Geographic Location at Time of Reye's Syndrome Occurrence:

Address / Street

City

State

Zip Code

County

Country

Precedent Illness and/or Symptom:

Was Medication Given?	Yes		No

Was Aspirin Given?

Yes

No

Other?

Yes

No

Specify

Doctor and Hospital Where Treated (Include City & State/Province)

Course of Reye's Syndrome Illness and Treatment

Additional Comments

Outcome

Survived

Age

Deceased

Date

Survived With Residual Handicapping Condition (Please Specify)

Current Information of Survivor or Person Reporting Case:

Name

Address / Street

City

State

Zip Code

County

Country

Phone

E-mail

This Report Has Been Completed By:

Relationship To Person Having Reye's

Thank you for taking the time to complete this report.

� 1974 - 2011 National Reye's Syndrome Foundation, Inc. A 501(c)3 - All Rights Reserved