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Case presentation: We present a case of a 29-year-old Arab female who was admitted to the hospital with severe upper abdominal pain that started 1 week from the date of admission, associated with nausea, anorexia, low-grade fever, and vomiting, with no past medical history or comorbidities. A computerized tomography scan with contrast showed intraperitoneal free fluid along with multiple hypodense splenic cysts. Hence, an emergent exploratory laparotomy with splenectomy was performed. Splenic peliosis was confirmed by the histopathological examination.

Clinical findings: A 7-month-old male infant, the only child of non-consanguineous parents, presented with cough, fever, fast breathing, oral thrush, and axillary lymphadenopathy ipsilateral to the Calmette-Gurin bacillus scar. He had been hospitalized 5 weeks prior for severe pneumonia. Plain chest radiography showed bilateral patchy airspace opacification; chest computed tomography revealed multiple large lung nodules and left axillary lymphadenopathy. HIV ELISA was negative; tuberculin skin test was positive; lymph node biopsy macroscopically revealed caseous granulomas seen on histology; isoniazid- and rifampicin-susceptible Mycobacterium tuberculosis complex isolate was detected on the Hain test. First-line anti-tuberculous drugs were added to his empiric treatment comprising piperacillin-tazobactam, amikacin, cotrimoxazole, and fluconazole. He was discharged after 10 days based on clinical resolution.

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who, what, where, when, and how: Incident reports should describe what happened, answering key questions. Incident reporting needs may vary by organization, but this basic information is generally required:

Despite the availability of incident reporting systems, many healthcare organizations still rely on manual, paper-based incident reporting, often using hand-written reports. Manual incident reporting is a time-consuming, costly, error-prone process that has many limitations, including low-quality data and limited flexibility.

In this study, we aimed to identify if composite rates of various vaccine-related illnesses are associated with significant reported rates of hospitalization, life-threatening events and deaths, which are classified as severe adverse events following immunization (sAEFI), using data from the vaccine adverse events reporting system (VAERS) (18).

The cumulative rates of reported hospitalizations, life-threatening events, and deaths attributed to SARS-CoV-2 vaccines and occurring within 28 days of vaccination were 5.3, 1.7, and 1.1 per 100,000 doses, respectively (the latter two risks are lower than the risk of dying in 100,000 h of flying). While these are not absolute incidence rates and should not be so conflated, surveillance data from VAERS indicates an overall absence of significant rates of sAEFI which would alert regulators of serious safety concerns. These results are comparable to those published by the European Medicines Agency (EMA) from the EudraVigilance database as of August 29, 2022, with a risk of death from BNT-162b2 reported to be 1.23/100,000 doses, for mRNA-1,272 at 0.71/100,000 doses, and Ad26.COV2.S at 1.71/100,000 doses (26).

Crude reporting rates per 100,000 doses for the adenovector Ad26.COV2.S vaccine seem higher than those for mRNA vaccines; however, it is important to note that Ad26.COV2.S is a single dose regimen for initial immunization, whereas the mRNA vaccine regimen would expose vaccinees to this risk twice, making the overall risks similar. These are further borne out in the interactions in Table 4 wherein the reporting rates while higher for ED visits in younger age groups, do not appear to translate into higher rates of hospitalizations or life-threatening events and may reflect increased anxiety associated with reported adverse events in these groups prompting more ED visits (immunization anxiety related disorder). Meanwhile, the lower relative rate of sAEFI attributed to SARS-CoV-2 vaccination for females compared to males may be due to a higher baseline age-specific mortality rates in males for every adult age stratum (numerator) (27), or because of the lower total number of reported adverse events among males (denominator): the latter of which is supported by evidence of sociocultural barriers that prevent males from seeking medical services (28). However, this requires further investigation.

The overall risks of sAEFI (hospitalization, life-threatening illness, death) for new vaccines are reported to be up to 7% in the literature, with clear early over-reporting (18). In our findings, the reporting rates are much lower than this threshold, and the initial high reporting rates mirror the expected reporting pattern. However, initial high reporting rates of sAEFI may also be linked to the populations selected to be vaccinated earlier: older, nursing home populations who are more vulnerable. Additionally, the outcomes rates may also include unrelated background population event rates; approximately 723 deaths per 100,000 people occur annually in the US, as well as those related to COVID-19 disease in those experiencing these events in the 14 days after vaccination; therefore, some deaths may have occurred unrelated to the vaccine (27). Similarly, all AEFIs related to vaccines may not be reported completely, though sAEFI occur in hospitals and carry greater reporting accuracy (18, 19).

The reports were first assessed to verify they were valid for the study. To do this, all reports were reviewed to check if they had the minimum 4 mandatory fields that the SPS needs to accept the report: identifiable patient, suspect drug(s), event(s), and identifiable reporter. Next, the reports were assessed for completeness by reviewing all the elements in the ADRs reporting forms, and how many of these fields were completed.

Of the 14,545 (98.4%) reports that had event(s), there were 44,787 events mentioned in these reports (that is; some reports have several events in one report). As with the drugs field, the events could occur in more than one report. The mean was 3 events per report and the range was between 1-61 event(s) per report. The dates when the events started (67.2%) and disappeared (19.6%) were completed. Laboratory tests were ordered in 54% of the reports; of those requested laboratory tests, 97.5% of them were completed. In the action taken section of the report, the most reported fields, which were filled out were the drug withdrawn (8.4%) and unknown fields (12%) (Table 1).

Complete blood count (CBC) and reticulocyte (Retics) are routine hematology tests useful for the differential diagnosis of anemia and other medical conditions. However, it has been presumed that they are not used as regular as they should be in medical practice in Addis Ababa hospitals.

A hospital-based cross-sectional questionnaire survey was conducted during November-December 2010, in which 408 clinicians participated and their response on the use of CBC and Retics was assessed. The always/frequently (A/F) response was considered to reflect routine use of the CBC/Retics parameters by the clinicians. The Chi square test was used to study statistical associations among different variables.

Overall, most clinicians do not use much of the data provided on routine CBC report. Additional research is needed to understand the issue further. Responsible bodies should promote the appropriate use of CBC/Retics reports by clinicians.

The complete blood count (CBC) and reticulocyte (Retics) parameters are hematologic tests essential in the diagnostic workup of a broad variety of clinical conditions, mainly in the differential diagnosis of anemia and related disorders [4] which are commonly seen in Addis Ababa hospitals [5]. A study on women of reproductive age in Ethiopia reported that the leading causes of anemia are iron and vitamin B12 deficiency and chronic infections [5].

In Ethiopia no documented data exists regarding the use and interpretation of hematological parameters in clinical practice. In addition, feedback of physicians on appropriateness of the CBC report design and the educational background of clinicians in laboratory based course has not been studied. This study aims at ascertaining the extent of use of CBC/Retics results, and feedback of clinicians on CBC in Addis Ababa hospitals.

A cross-sectional, questionnaire-based survey was conducted in Addis Ababa hospitals in November and December 2010. Clinicians involved in the diagnosis and treatment of patients in Addis Ababa hospitals, including interns, residents, health officers (*HO), general practitioners (GP), and specialists participated in the survey. Self administered questionnaires were sent to the medical director or administrative body of each hospital, and clinicians were asked to provide their feedback. [*HO: Health Officers in Ethiopia are medical graduates who undertake promotive, preventive, curative and rehabilitative services compatible to the needs of the population; are public health oriented and have less years of training than medical doctors].

The questionnaire used in the survey asked physicians to rate the frequency of use of each component of the CBC/differential and reticulocyte reports for patient management. Items included in a CBC test report were white blood cell count (WBC), WBC differential, hemoglobin (HGB), hematocrit (HCT), red blood cell (RBC) count, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC), red cell distribution (RDW), platelet (PLT) count, mean platelet volume (MPV), platelet distribution width (PDW) and morphologic comments on RBC and WBC. [Various automated hematology analyzers of different manufacturers are used in Addis hospitals: Cell Dyn 1800 and Sysmex are used commonly for CBC; Abbot Cell Dyn 3200, Beckman Coulter LH 500 and Sysmex-2000 xi are used for CBC and Retics]. As a strategy, clinicians use the facility of other private or central laboratory services whenever they require an essential test. Reticulocyte reports included were the reticulocyte percentage, reticulocyte absolute count, reticulocyte production index (RPI) and the corrected reticulocyte count. 006ab0faaa