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Responsible Adverse Event (AE) Reporting: Finding Appropriate AE Terms Adverse Events - continued Documenting Grade A patient need not exhibit all elements of a Grade description to be designated that Grade. Example: Induration/fibrosis (skin and subcutaneous tissue) Grade 3: Dysfunction interfering with ADL; very marked density, retraction or fixation ï«Read as âDysfunction â¦.. OR very markedâ¦â¦â Interpretation: A patient with very marked density, retraction or fixation, but is able to perform ADLs, is Graded 3. When a patient exhibits elements of multiple Grades, the highest Grade is to be assigned.