MPA SAHPRA Data Capture Form

Name: Sarah Johnson Date of Birth: 1988-05-15 / ID: 8805156789012 Date of interview: 2024-11-01 Interviewer: Dr. Eleanor Vance Language of interview: English Patient contact details: 0721234567 Patient email: sarah.johnson@email.com Hospital where patient treated: Groote Schuur Hospital Groote Schuur Hospital folder number: GHS/1234567 Have you ever used Depo-Provera / 3-month injection: Yes Are you currently receiving Depo medroxyprogesterone: No When did you stop Depo: 2022-03 First Depo injection date: 2010-09 Most recent Depo injection before diagnosis: 2021-12-10 Typical injection frequency: Every 3 months Total time on Depo: Approximately 11 years Other hormonal contraception used: None Date of other hormone treatment: N/A Depo clinic card or prescription available: Yes Preferred way to share card or prescription: Email scanned copy Other cancer diagnoses ever made: No Date when first meningioma symptoms started: 2022-01 First or main symptoms: Persistent headaches, vision changes (blurred vision in left eye), and occasional dizziness. Date of meningioma diagnosis or first scan: 2022-02-20 (MRI scan date) Which doctor diagnosed the meningioma: Dr. Mark Reynolds (Neurologist) Tumour location if known: Right frontal lobe, near the sphenoid wing Has surgery ever been performed: Yes, 2022-04-15 at Groote Schuur Hospital by "Professor David Chen" Have you ever received radiotherapy for your meningioma: No Radiotherapy start date and centre: N/A Most recent MRI or CT: MRI brain, Groote Schuur Hospital Radiology Department, 2024-10-15 When is the next MRI or CT booked: 2025-04-15, Groote Schuur Hospital, booked by Dr. Vance Current treating doctor for meningioma: Dr. Eleanor Vance (Otorhinolaryngologist), Groote Schuur Hospital Next follow-up appointment date: 2025-01-10 Ongoing symptoms now: Mild intermittent headaches, occasional tinnitus, and slight numbness on the right side of the face. Reported to SAHPRA as possible adverse event related to Depo: No Patient wants us to report to SAHPRA: Yes Consent to send SAHPRA radiology report and histology or proof of meningioma: Yes Other: Patient expressed concern about the potential link between long-term Depo-Provera use and meningioma development. Patient also mentioned a family history of benign brain tumours on her maternal side.