Case ID: #CASEID#
Version: #VERSION#
Authority ID: #AUTHNUM#
Manufacturer ID: #MFRNUM#
Case Status: #CASESTATUS#
Report Type: #REPORTTYPE#
Event Date: #EVENTDATE#
Manfacturer Date: #MFR_DATE#
FDA Date: #FDADATE# (Initial FDA Date: #INITFDADATE#)
Report Date: #REPORTDATE#
Manufacturer: #MANUF#
Manuf notified: #MANUFNOTIFIED#
Electronically submitted: #ESUB#
Country of occurence: #OCCURCOUNTRY#
Reporter occupation: #REPOCCUPAION#
Reporter Country: #REPCOUNTRY#
Age: #AGE# #AGECODE#
Age group: #AGEGROUP#
Weight: #WEIGHT# #WEIGHTCODE#
Gender: #GENDER#