COUNTRNIGERIA

STATE: KATSINA

Epid number

Epid number
Country State LGA Year Number

S/N CCC SSS LLL NNNNN EPID

23
1 NIE KTS KAT 23 00001 NIE-KTS-KAT-23-001
2 NIE KTS KAT 23 00002 NIE-KTS-KAT-23-002
3 NIE KTS KAT 23 00003 NIE-KTS-KAT-23-003
 COUNTRY
YEAR: 2023 STATE: KATSINA

Surname Other Names Date of birth Age

DD-MMM-YYYY
Years (>= 1
Months (<1 year)
year)

AgeMonths AgeYears
LastName FirstName DOB
SALISU FAUZIYA NA 3 YRS NA
ABUBAKAR HALILU NA 35 YRS
IBRAHIM YAKUBU NA 11 YRS
 NIGERIA

TATE: KATSINA

Sex Occupation Permanent Residence of Case

Ward
M/F Settlement

Sex Settlement Ward

Occupation
F CHILD KABOBI MATSAI
M ADULT GAFIYA GAFIYA
M CHILD GANDE FULANI KAITA
 LGA:KAITA
YEAR: 2023
Date seen at Name of Reporting Date of
health facility Health Facility Symptom
dence of Case onset
LGA State DD-MMM-YYYY
DD-MMM-YYYY

DateConsultation
LGA State HealthFacility DateOnset

KAITA KATSINA 22-Feb-23 CHC KAITA 21-Feb-23

KAITA KATSINA 3-Mar-23 CHC KAITA 2-Mar-23
KAITA KATSINA 5-Mar-23 CHC KAITA 5-Mar-23
EPID WEEK Signs/symptoms
Sensitivity
Neck
Temperature (ºC) Headache to Confusion Seizure
stiffness
Yes/No Yes/No light Yes/No Yes/No
Yes/No
Yes/No
Sensitivity
Week of Onset Temp NeckStiff Headache to Confusion Seizure
light
8 yes no yes No yes No
9 yes yes yes No yes No
9 yes no yes No yes No
 Vaccination status
Vomiting=V,
Fatigue=F, If yes, which vaccine?
Vaccinated? Other CSM
Coma Rashes=R ,
Yes/No/ Pneumococc vaccine
Yes/No Buldging MenA NmACYW NmAC
fontanelle=BF, Unknown al vaccine (specify)
Loss of

Coma Others Immu VNMA VACYW VAC PCV VaccineOther

No yes unknown No No No No No
No yes unknown No No No No No
No yes unknown No No No No No
 CSF
Collected Date specimen Date Specimen
(Yes/No) collected sent to lab Name of Lab Results
Date of Last Pastorex
CSM (Pending,
vaccination DD-MMM-YYYY DD-MMM-YYYY Positive,
(DD-MMM- Negative, Not
YYYY) Done)
Specimen
DateCSMvac DSpecCollected DSpecSent LabName Pastorex
Collected

No No No unknown No Not done

No No No unknown No Not done
No No No unknown No Not done
 Final lab Outcome
Results result Serotype (Alive/Dead)
Culture
PCR (Pending,
(Pending,
Positive, (Positive /
Positive,
Negative, Not Negative)
Negative, Not
Done)
Done)

Culture PCR FinalResult Serotype Outcome

Not done Not done NA NA Alive

Not done Not done NA NA Alive
Not done Not done NA NA Alive
 Comments

Observations

Csf not collected

Csf not collected
Csf not collected