Q1-2: Tepadina® Stop Date

Questions 1 & 2: Tepadina® stop date

!Questions 1-2 can only be completed on the 100 day follow-up form. These questions will be skipped for all subsequent reporting periods.

Indicate if Tepadina® stop date is “Known” or “Unknown” in question 1. Start date is reported on F2400 in the conditioning regimen section. Report the final administration date of Tepadina® in question 2. If the stop date is partially known, use the process for reporting partial or unknown dates as described in the General Instructions, General Guidelines for Completing Forms.

If the date therapy stopped is “Unknown,” go to question 3.

Section Updates:

Question Number	Date of Change	Add/Remove/Modify	Description	Reasoning (If applicable)
.	.	.	.	.

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