National Reye's Syndrome Foundation
426 N. Lewis St.
PO Box 829
Bryan, OH 43506
800-233-7393 nrsf@reyessyndrome.org
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.
The Foundation's Top Objectives are:
... AWARENESS - to aid in early detection and educate the public and medical communities about the risk involved with using aspirin and other salicylates.
... SERVICE - to provide emotional support and guidance to families experiencing the trauma of Reye's Syndrome.
... RESEARCH - to support investigation into the disease's cause, management, treatment and prevention, as well as study its impact on survivors.
Know that your donations and memberships allow us to continue spreading Awareness about Reye's Syndrome to new mom's, new medical professionals, caregivers, schools, daycare centers, churches, and immigrants, and to a global population who can now access this website. You make a difference, a life and death difference. -- Thank You.
Tylenol and Ibuprophen do not contain Salicylates and can be used as a fever reducer. When taking any medication we recommend you check with your doctor first.
Be A Member, Add A Member, & get your Free Heart Pin! When you renew your membership, or become a new member of the NRSF, and give a gift of membership to a friend or loved one, we will send you both our beautiful new Heart Pin, so you can proudly show you care. Join Us. Help us save young lives!
The National Reye's Syndrome Foundation neither seeks nor receives government grants or funds for
services rendered and depends totally on voluntary contributions for support of all programs.
... AWARENESS - to aid in early detection and educate the public and medical communities about the risk involved with using aspirin and other salicylates.
