Adverse Event Tracking Log Template V 1.0 www.crtutor.com
ADVERSE EVENT TRACKING LOG Principal Investigator:
Site Number:
Protocol Title:
Subject ID:
S. No
Adverse Event(Record Diagnosis)
Start Date/ Stop Date
Severity 1=Mild 2=Moderate 3=Severe
SAE 1=Yes 2=No
Relationship 1=Not Related 2=Unlikely Related 3=Possibly Related 4=Related
Action Taken
Reported IRB/IEC (Yes, No)/Date reported if applicable
PI Initials/Date
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