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(All fields must be completed before laboratory tests are performed) 1. CONTACT INFORMATION Patient Name: Unique identification number: DOB (dd/mmm/yyyy): Gender: Male TRALI date (dd/mmm/yyyy) : Time : Physician : Telephone : Institution : Female CBS Centre : 2. INCLUSION CRITERIA: must fit a, b AND c, otherwise TRALI investigation is NOT warranted a) Transfusion within 6 hours of TRALI b) New CXR findings Yes Yes No No N/A Bilateral infiltrate Yes No If no, describe: c) Hypoxe.

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