Central Nervous System: Headache Delerium Seizures Lethargy 
Paralysis: Flaccid Spastic 
Muscle Weakness __ Bulbar Involvement 
Meningismus Nuchal Rigidity 
Other 
Others: Jaundice __ Myalgia Pleurodynia 
Myositis Conjunctivitis 
Hemorrhagic Phenomena Hepatomegaly 
Associated Illness: 
F atal 
TREATMENT 
Antibiotics 
Other 
SPECIMENS SUBMITTED FOR EXAMINATION: 
Origin: Human Animal Other 
Date of 
Specimen Collection 
Stool 
Throat Washing 
Spinal Fluid 
Others 
STORAGE OF SPECIMENS: Duration 
Specimen Local File No. Date of Collection 
Serum: Acute 
Convalescent 
Virus Isolate: Source Passage 
Tissue Culture 
Mouse 
Egg 
Other 
Method 
LOCAL LABORATORY RESULTS: 
Clinical diagnostic: WBC Differential 
CSF: Cell Count 
Others 
Liver Function Studies 
Bacteriological Studies: 
Pathological Examinations: 
Virus Isolation: Specimen 
Resu Its 
% Lymphocytes 
Method 
Serology: Method used: CF Neut. HI 
Test Antigen 
Acute 
C on valescen t 
Other Pertinent Information: 
44 
* U S. GOVERNMENT PRINTING OFFICE : I96S 0-335-970 
