Covance CLS

Anagh Vora, MD, FCAP

8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 27-Apr-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

PROINFLAM CYTOKINES
TNF-Alpha <1.3800 L 2.4000-4.3000 pg/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 22-Apr-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

PROINFLAM CYTOKINES
IFN-Gamma <14.900 <14.900 pg/mL
TNF-Alpha To follow
IL-2 <1.780 L 1.780-2.680 pg/mL
IL-6 5.606 3.160-27.200 pg/mL
IL-1-Beta <4.280 L 4.280-24.300 pg/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 14-Apr-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

C3A
*1 Comp C3a 352.6 H 16.5-82.3 ng/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 14-Apr-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - This Enzyme Immunoassay test was developed and its analytic performance determined
by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

EGFR
2
GFR MDRD 176.5 mL/min/1.73m
No Ref Rng

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

COAGULATION GROUP
APTT 19.8 L 21.9-29.4 sec
PT 9.9 9.7-12.3 sec
INR 0.9 Patient not taking
oral anticoagulant:
0.8 - 1.2
Patient taking
oral anticoagulant:
2.0 - 3.0

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 1 of 4
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CHEMISTRY PANEL
Total Bili 0.5 0.2-1.2 mg/dL
Alk Phos 75 35-104 U/L
ALT (SGPT) 30 4-43 U/L
AST (SGOT) 23 8-40 U/L
GGT 58 H 4-49 U/L
LDH 359 H 53-234 U/L
Urea Nitr 11 4-24 mg/dL
Creatinine 0.38 0.35-1.14 mg/dL
Glucose 102 H 70-100 mg/dL
Uric Acid 2.2 L 2.5-7.5 mg/dL
Calcium 8.1 L 8.3-10.6 mg/dL
Phosphorus 3.7 2.2-5.1 mg/dL
Total Prot 6.6 6.1-8.4 g/dL
Alb BCG 3.1 L 3.3-4.9 g/dL
CK 27 26-192 U/L
Sodium 138 132-147 mEq/L
Potassium 3.8 3.5-5.2 mEq/L
Bicarb 21.0 19.3-29.3 mEq/L

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 2 of 4
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CHEMISTRY PANEL continued

Chloride 102 94-112 mEq/L

LIPID PANEL
HDLC4 34 L 40-60 mg/dL
Triglycer 89 52-262 mg/dL
Cholest 116 L 171-291 mg/dL
CHOL4 64 L 88-201 mg/dL

LIPASE
Lipase 26 0-100 U/L

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 3 of 4
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

HEMATOLOGY&DIFFERENTIAL PANEL
HGB 14.0 11.6-16.4 g/dL
HCT Beyond stability
34-48 %
6
RBC 4.4 4.1-5.6 x10 /uL
MCH 32 26-34 pg
MCHC Beyond stability
31-38 g/dL
RDW Beyond stability
12.0-15.0 %
RBC Morph Normocytic
MCV Beyond stability
79-98 fL
3
WBC 20.98 H 3.80-10.70 x10 /uL
3
Neutrophil 19.93 H 1.96-7.23 x10 /uL
3
Lymphocyte 0.84 L 0.91-4.28 x10 /uL
3
Monocytes 0.21 0.12-0.92 x10 /uL
3
Eosinophil 0.00 0.00-0.57 x10 /uL
3
Basophils 0.00 0.00-0.20 x10 /uL
Neutrophil 95.0 H 40.5-75.0 %
Lymphocyte 4.0 L 15.4-48.5%
Monocytes 1.0 L 2.6-10.1 %
Eosinophil 0.0 0.0-6.8 %
Basophils 0.0 0.0-2.0 %
Platelets Platelet clumps present
3
140-400 x10 /uL
*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514065983

Page 4 of 4
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D3
Chancay, Huaral, Peru 15131 DAY 3
SPONSOR REPORT TO: COLLECTION TIME:10:06 DATE:07-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 10-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 28-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

URINE MACRO PANEL

Color Yellow Ref Rng:
Colorless or Yellow
Clarity Clear Ref Rng:Clear
Spec Grav 1.026 1.003-1.035
pH 5.5 5.0-8.0
Protein Negative Ref Rng:Negative
Glucose Normal Ref Rng:Normal
Ketones Negative Ref Rng:Negative
Bilirubin Negative Ref Rng:Negative
Urobilin Normal Ref Rng:Normal
Blood Negative Ref Rng:
Negative-Trace
Nitrite Negative Ref Rng:Negative
Leuk Est Negative Ref Rng:Negative

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 22-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

SARS-COV2 RNA RT-PCRV2 NP SWAB

*1 COV19 v2 <2228cp/mL SARSCoV2 detected
copies/mL
No Ref Rng

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 22-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - The SARS-CoV2 RNA RT- PCR quantitative test is performed by real time PCR Taqman
assay. This test was developed and its analytic performance determined by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 22-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

SARS-COV2 RNA RT-PCRV2 MT SWAB

*1 COV19 v2 19489 copies/mL
No Ref Rng

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 22-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - The SARS-CoV2 RNA RT- PCR quantitative test is performed by real time PCR Taqman
assay. This test was developed and its analytic performance determined by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 19-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

C5A
#1 Comp C5a 123.76 H <=74.33 ng/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 19-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note #1 - Diluted for quantitation

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 15-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CH50
CH50 Eq <30.00 L 79.00-187.00
CH50 U Eq/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 12-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CYTOKINE PANEL 1
GM-CSF <1.684 <1.684 pg/mL
IL-1Alpha <5.700 <5.700 pg/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 11-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

D-DIMER
*1 D-Dimer 0.76 H <0.59 mg/L FEU

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 11-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - This test must be used with additional tests (usually objective imaging studies)
in the evaluation of VTE (venous thromboembolism).

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
CANCELLATION REPORT

Covance CLS Page 1

Cancellation Report Mar 11, 2021 09:00:09 AM
FOR DATE: 10-Mar-2021

Protocol: C001-2020-01 (522933) Inv #: 101

Oncotelic Inc. Investigator: Manuel Castellanos Florian

Hospital de Chancay
Mariscal Sucre S/N
Chancay, Huaral 15131
-------------------------------------------------------------------------------
Accession No: 6514065983 Collection Date: 07-Mar-2021
Patient Number:1011019 Time: 10:06:00 AM
Patient Initials: Visit: D3
DAY 3

Test Code Description

Group HM3331 HEMATOLOGY&DIFFERENTIAL PANEL
HMT102 MCHC ADC26 Beyond stability
HMT2 HCT ADC26 Beyond stability
HMT278 RDW ADC26 Beyond stability
HMT4 MCV ADC26 Beyond stability
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 10-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CKMB
CKMB <0.6 L 0.6-6.3 ng/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CKMB
CKMB To follow

COAGULATION GROUP
APTT 23.8 21.9-29.4 sec
PT 11.4 9.7-12.3 sec
INR 1.1 Patient not taking
oral anticoagulant:
0.8 - 1.2
Patient taking
oral anticoagulant:
2.0 - 3.0

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

IS SUBJECT OF BLACK RACE?

black? No

EGFR
2
GFR MDRD 128.6 mL/min/1.73m
No Ref Rng

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 5
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CHEMISTRY PANEL
Total Bili 0.4 0.2-1.2 mg/dL
Alk Phos 47 35-104 U/L
ALT (SGPT) 35 4-43 U/L
AST (SGOT) 20 8-40 U/L
GGT 50 H 4-49 U/L
LDH 394 H 53-234 U/L
Urea Nitr 16 4-24 mg/dL
Creatinine 0.50 0.35-1.14 mg/dL
Glucose 187 H 70-100 mg/dL
Uric Acid 2.3 L 2.5-7.5 mg/dL
Calcium 8.3 8.3-10.6 mg/dL
Phosphorus 3.7 2.2-5.1 mg/dL
Total Prot 7.2 6.1-8.4 g/dL
Alb BCG 3.5 3.3-4.9 g/dL
CK 33 26-192 U/L
Sodium 138 132-147 mEq/L
Potassium 4.3 3.5-5.2 mEq/L
Bicarb 22.0 19.3-29.3 mEq/L

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 5
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CHEMISTRY PANEL continued

Chloride 98 94-112 mEq/L

LIPID PANEL
#1 HDLC4 7 L 40-60 mg/dL
Triglycer 102 52-262 mg/dL
Cholest 145 L 171-291 mg/dL
CHOL4 118 88-201 mg/dL

LIPASE
Lipase 28 0-100 U/L

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 3 of 5
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

HEMATOLOGY&DIFFERENTIAL PANEL
HGB 14.1 11.6-16.4 g/dL
HCT 44 34-48 %
6
RBC 4.5 4.1-5.6 x10 /uL
MCH 31 26-34 pg
MCHC 32 31-38 g/dL
RDW 13.7 12.0-15.0 %
RBC Morph No Review Required
MCV 98 79-98 fL
3
WBC 10.10 3.80-10.70 x10 /uL
3
Neutrophil 8.28 H 1.96-7.23 x10 /uL
3
Lymphocyte 1.50 0.91-4.28 x10 /uL
3
Monocytes 0.28 0.12-0.92 x10 /uL
3
Eosinophil 0.02 0.00-0.57 x10 /uL
3
Basophils 0.03 0.00-0.20 x10 /uL
Neutrophil 82.0 H 40.5-75.0 %
Lymphocyte 14.9 L 15.4-48.5%
Monocytes 2.8 2.6-10.1 %
Eosinophil 0.2 0.0-6.8 %
Basophils 0.3 0.0-2.0 %
3
Platelets 358 140-400 x10 /uL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 4 of 5
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

URINE MACRO PANEL

Color Yellow Ref Rng:
Colorless or Yellow
Clarity Clear Ref Rng:Clear
Spec Grav 1.029 1.003-1.035
pH 6.0 5.0-8.0
Protein Negative Ref Rng:Negative
Glucose Normal Ref Rng:Normal
Ketones Negative Ref Rng:Negative
Bilirubin Negative Ref Rng:Negative
Urobilin Normal Ref Rng:Normal
Blood Negative Ref Rng:
Negative-Trace
Nitrite Negative Ref Rng:Negative
Leuk Est Negative Ref Rng:Negative

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 5 of 5
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 09-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note #1 - Result verified by repeat analysis

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

SARS-COV2 RNA RT-PCRV2 MT SWAB

*1 COV19 v2 To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - The SARS-CoV2 RNA RT- PCR quantitative test is performed by real time PCR Taqman
assay. This test was developed and its analytic performance determined by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

D-DIMER
*1 D-Dimer To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - This test must be used with additional tests (usually objective imaging studies)
in the evaluation of VTE (venous thromboembolism).

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

PROINFLAM CYTOKINES
IFN-Gamma To follow
TNF-Alpha To follow
IL-2 To follow
IL-6 To follow
IL-1-Beta To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

C3A
*1 Comp C3a To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - This Enzyme Immunoassay test was developed and its analytic performance determined
by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CH50
CH50 Eq To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

C5A
Comp C5a To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CYTOKINE PANEL 1
GM-CSF To follow
IL-1Alpha To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

Test kit/reagent not cleared/approved by the FDA. Covance determined analytic performance OC43184
characteristics per CLIA regulations. Don't use for diagnosis without confirmation by other
medically established means. H(High) or L(Low)=Values above or below Covance CLS reference range.
(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

SARS-COV2 RNA RT-PCRV2 NP SWAB

*1 COV19 v2 To follow

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note *1 - The SARS-CoV2 RNA RT- PCR quantitative test is performed by real time PCR Taqman
assay. This test was developed and its analytic performance determined by Covance CLS.

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

CKMB
CKMB To follow

COAGULATION GROUP
APTT To follow
PT To follow
INR To follow

CRP
#1 CRPHS 8.35 H 0.00-0.50 mg/dL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 2 of 2
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Note #1 - Sample diluted for quantitation; results verified by repeat analysis

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

HCV
HCV ab Negative Normal is Negative

HBV
HBsAgII Negative Normal is Negative

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

HIV 1/2 AG/AB SCREEN

HIV1/2 Scr Non-Reactive Ref Rng:
Non-Reactive

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

This testing is performed as part of a clinical trial. OC43184

Diagnostic testing should be conducted locally.

(INV)
 Covance CLS
Anagh Vora, MD, FCAP
8211 SciCor Drive - Indianapolis, IN 46214-2985
Tel. +1 (866) 762 6209
LABORATORY REPORT

ACCESSION NO. 6514779533

Page 1 of 1
INVESTIGATOR: (OC43184) PROTOCOL C001-2020-01
Oscar Carbajal Paulet, M.D. INVESTIGATOR NO.: 101
c/o Manuel Castellanos Florian SUBJECT ID: 1011019
Hospital de Chancay SUBJECT INITIALS NOT COLLECTED:
Mariscal Sucre S/N VISIT: D1
Chancay, Huaral, Peru 15131 DAY 1
SPONSOR REPORT TO: COLLECTION TIME:09:19 DATE:05-Mar-2021
Norberto Soto DATE RECEIVED IN LABORATORY: 06-Mar-2021
c/o Sponsor Esite access DATE REPORTED BY LABORATORY: 08-Mar-2021
Covance SEX: F BIRTHDATE: 01-Jan-1967 AGE: 54y
8211 Scicor Dr.
Indianapolis, IN United States 46214
Ref. Ranges Clinical Comments
Significance
Yes* No

FERRITIN
Ferritin 357.8 H 11.0-306.8 ng/mL

*If clinically significant, comment is required.

Signature: _____________________________________________________ Date: ___________________

H(High) or L(Low) =Values above or below Covance CLS reference range OC43184
T=Telephone P="Panic" RX= Possible Exclusion

(INV)