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[NCEZID] Multistate investigation of serious adverse events, including deaths, of unknown etiology following ceftriaxone administration_Sep 2024-Present 0920-1011-25-0015
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1011 Case Report Form - Ceftriaxone Injection in Healthcare Settings - Public Health Departments CDC Case Report Form - Serious Adverse Events Following Ceftriaxone Injection - PRA.pdf N/A No   Fillable Fileable
Form and Instruction 0920-1011 Case Report Form - Ceftriaxone Injection in Healthcare Settings - Healthcare Providers CDC Case Report Form - Serious Adverse Events Following Ceftriaxone Injection - PRA.pdf N/A No   Fillable Fileable

Disaster Management Emergency Response

09-20-0113 - Epidemic Investigation Case Records  51 FR 42466

60 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 90 0 90 0 0 0
Annual IC Time Burden (Hours) 45 0 45 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
0920-1011 EEI GenIC Request Memo GenIC Request Form for Emergency Epidemic Investigation_Serious adverse events 24-25(2)_02132025(2).docx 02/14/2025
Letter of Support - CSTE letter of support for CDC to coordinate multi-state adverse events investigation.pdf 02/14/2025
Burden Request Memo Burden Memo_serious adverse events24-25_02132025(2).docx 02/14/2025
Non-Research Determination Non-research determination_Serioius Adverse Events Following Cefriaxone Injection.pdf 02/14/2025
Email Request for Approval - Acting Director_NCEZID Director Eamil Emergency-Multistate_Ceftriaxone_Acting Director-NCEZID Director.msg 02/14/2025
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.