Hemovigilance Module

2025 HV Module Protocol – March 2025 [PDF – 31 Pages]
Guidelines and procedures for monitoring transfusion-related reactions.

A revised protocol will be available in early 2026. Please check back soon.

Additional Resources

Hemovigilance Module Data Dictionary – Coming Soon

CDC Location Labels and Location Description [PDF – 822 KB] 

NHSN Key Terms [PDF – 367 KB] 

Printable versions of the forms are available below. To report to CDC, data should be entered into NHSN.

HV Module Annual Facility Survey

• Annual Facility Survey [PDF – 100 KB]
  • Customizable form [DOCX – 80 KB]
  • Table of Instructions [PDF – 133 KB]

Adverse Reaction Form

• Adverse Reaction Form [PDF – 293 KB]
  • Customizable Form [DOC – 164 KB]
  • Table of Instructions [PDF – 226 KB]

Transfusion-Transmitted Infection (TTI) Rapid Alert

• Transfusion-Transmitted Infection (TTI) Rapid Alert [PDF – 215 KB]
  • Customizable Form [DOC – 143 KB]
  • Table of Instructions [PDF – 138 KB]

Transfusion-Transmitted Infection (TTI) Investigation Form

• Transfusion-Transmitted Infection (TTI) Investigation Form [PDF – 320 KB]
  • Customizable Form [DOC – 170 KB]
  • Table of Instructions [PDF – 221 KB]