Guide during AEFI Investigation

We recommend the following actions for a comprehensive clinical investigation to aid in determining the valid
diagnosis to launch the step 1 of the causality assessment by the RAEFIC:

1. Post-mortem RT-PCR swab - If this is not possible, please cite or explain the reasons in the case
investigation form and during the causality assessment (i.e. not a protocol in the clinic nor hospital)
2. Medical autopsy - If this is not possible, please cite or explain the reasons in the case investigation form
and during the causality assessment (i.e. no consent, no available pathologist in the nearest hospital,
NBI, or PNP availability)
3. Verbal autopsy from the patient's relatives particularly on:
A. Physical look of the patient - was he emaciated / nangangayayat, obese
B. Level of control of hypertension, if any - Was the patient compliant on taking medications.
Indicate how long has he started medications, usual BP and highest BP
C. Level of control of diabetes mellitus, if any - Was he insulin-requiring, what are the medications,
latest FBS or HbA1C
D. Level of control of chronic kidney disease, if any.
E. Previous hospitalizations, medical records, laboratory, imaging or pathologic findings,
particularly 12-L ECG, Chest X-ray, 2D-Echo, CBC w/ quantitative platelet count with or without
peripheral blood smear, electrolytes (Na, K, Cl BUN, Crea), metabolic panel (TG HDL, LDL,
vLDL), FBS, HbA1c
F. Family medical history - hypertension, diabetes, early cardiac death (<50 y/o) in 1st generation
members of the family -- parents, siblings, children of the patient, allergies, asthma or allergic
rhinitis, previous COVID-19 exposure or diagnosis
G. Personal social history
 Was the patient a smoker? how many pack-years or how many sticks of cigarettes does
he use in a day, and around how many years has s/he been smoking?
 Alcohol drinking and frequency and usual beverage and quantity (ex. beer drinker,
consumes ~2L every other night
 Occupation/line of work - ex. farmer, kaingin, miner
 Recent COVID Exposure in the past 14 days prior to death
H. Baseline functional status - was the patient ambulatory without assistance? what is his body
habitus? does he look generally emaciated?
I. Did the patient experience the following symptoms that may pertain to organic causes of death:
 Neuro: Focal neurologic no matter how mild (seizures, slurring of speech, facial
asymmetry, dragging of feet, numbness, of extremities, hands/feet)
 Cardio: cardiac (chest pain- -- characterize the pain, even in the vernacular --- point
tenderness, heaviness, tightness, radiation to the back or left upper shoulder; heart
failure symptoms -- hinihingal pagkatapos maglakad o magbuhat o pagkatapos nang
malalapit na tinatakbuhan, nalulunod kung matulog na walang unan)
 Pulmonary: if any (DOB, Cough, Colds, shortness of breath or respiratory symptoms)
 GU: Genitourinary (weak stream, urinary incontinence or hindi ma-kontrol ang pag-
ihi, difficulty in urination, nocturia bumabangon sa tulog para umihi))
 GI: Gastrointestinal (nausea, vomiting, abdominal pain, diarrhea, constipation, loss of
appetite / walang ganang kumain, early satiety / madaling mabusog)
 Extremities (pallor, edema, jaundice naninilaw)
 HEENT (Head, Ears, Eyes, Nose & Throat): if any significant findings: Sudden-onset
blindness, tinnitus, anosmia nawalan ng pang-amoy, ageusia nawalan ng panlasa,
hirap lumunok
J. Provide a day-by-day to hour-by-hour narrative of events prior to death
4. Retrieval of other medical records, laboratory tests. Please take note that if the retrieval of these
records is difficult from the patient or previous attending physicians, the investigation team may opt to ask
for a written summary asking the contents of these records and tests, provided as a detailed medical
abstract to the investigation team. If these are not possible, please document the efforts done for
transparency purposes
5. This is a general advice and may be supplemented by the respective RESU and/or RAEFIC