Bookmark and Share
Home..About Us.. Free Literature..Contact Us.. Donate: Wipe Out Reye's Syndrome ..

What Is Reye's Syndrome The Aspirin Link Reye's & Chickenpox Reye's, Flu & H1N1 Reye's & Teens Free School Packages Report A Case of Reye's

Reye's Syndrome
Aspirin Lists Article Library Medical Library Video Library eBooks & Apps
Dick Van Dyke; NRSF Spokesperson
Donate - Your Support is Appreciated!

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.

 

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. 

      

 



Android Apps & eBooks The NRSF Blog School and Health Department Packages - Free! Talking to Tweens and Teens About Aspirin and Other Medications Join the Effort to Eradicate Reye's
We've created an App for the Android phone and tablets all about Aspirin, from lists of products containing and not containing aspirin, to drug interactions with aspirin, to diseases that aspirin negatively impacts...Learn More Our Blog is a great way to learn even more about aspirin and children, and get tips and hints about a range of things all centered around Reye's Syndrome and aspirin...Learn More The Foundation makes a special Reye's Syndrome Information package available to Schools, Health Departments, Human Resource Divisions, and to anyone who would like Reye's Syndrome information...Learn More Helping themselves, and sharing meds is a serious issue with Tweens and Teens. They do not realize the dangers involved, and often think OTC drugs are harmless. Talk to them about drugs, and Reye's... Learn More Through Awareness and Education, we can drastically lower the number of Reye's Syndrome cases. To do this, we need your help...Learn More

Share:

Bookmark and Share

Follow Me on Pinterest

View National Reye's Syndrome Foundation's LinkedIn profileView National Reye's Syndrome Foundation's LinkedIn profile

Help Spread Awareness
Spread Awareness with the
Kids & Aspirin Don't Mix
car magnet ribbon.
Get News & Updates:

SignUp to get Updates

* indicates required
Email Format
Privacy Policy | Disclaimer | Site Map | News
© 1974 - 2013 National Reye's Syndrome Foundation, Inc
All Rights Reserved
In 1974, the National Reye's Syndrome Foundation, a children's health advocacy organization, was incorporated as a 501(c)3 charity, with a mission to eradicate the incidence of Reye's Syndrome.
The Foundation does not receive, nor seek, government funding, and relies on the generosity of donors for support of all programs.
National Reye's Syndrome Foundation 426 N Lewis St. Bryan OH 43506 800.233.7393
nrsf(at)ReyesSyndrome(dot)Org