Registry for suspected cases of Kawasaki Disease

Pathologist's Information

Enter Name of Institution

Enter Last Name

Enter First Name

Enter Email address

Phone number: ###-###-####

Enter phone extension, if any

Enter Institutional Case number

Ethnicity

Coronary artery aneurysm?

Medical history (check all that apply)

Trauma

Drug/Alcohol

Suicide

Cancer

Congenital heart disease

Obesity

Diabetes

Hypertension

Hyperlipidemia

Unknown

Age at death (years). Enter "0.5"= 6 mos old

Sex

Enter Cause of death

Next-of-kin information available?

Coronary artery calcification?

Coronary artery stenosis/occlusion?

History of KD?

Autopsy performed?

Select date of autopsy

Your case has been submitted for review. We will contact you within 2 weeks. Thank you.