Q1-3: Survival

!Post-infusion admission
The following questions will only be enabled if the cell therapy was reported as Outpatient on the Pre- Cellular Therapy Baseline Data (4001) form and can only be completed on the 100-day follow-up form. These questions will be skipped for all subsequent reporting periods.

*Combined follow up
In scenarios where an HCT was given after a cellular therapy and this form is now being completed based on the subsequent HCT date, these questions do not apply and should be left blank.

Question 1: Was the recipient admitted to the hospital post-infusion?

The practice of outpatient cellular therapy infusions is increasing however there might still be the need for admission for cellular therapy toxicities/complications. In order to capture if recipients require admission following cellular therapy a date of admission and discharge will be collected.

Indicate if the recipient was admitted to the hospital, in this reporting period, for any reason related to the infusion / product.

Question 2: Date of first hospital admission

Report the first date the recipient was admitted to the hospital post-infusion in the current reporting period. If there were multiple admissions during the reporting period, report the date of the first admission.

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Question 3: Date of first discharge

Report the date of first discharge after the first hospital admission. If the recipient was not discharged in this reporting period, or died prior to discharge, leave the question blank and override the error using the code “Unable to Answer.”

For more information regarding reporting partial or unknown dates, see General Instructions, General Guidelines for Completing Forms.

Section Updates:

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