We describe the epidemiology of COVID-19 exposure, preceding illness, and SARS-CoV-2 testing in a large population with MIS-C during the first 18 months of the COVID-19 pandemic. The majority of cases had exposure, preceding illness, or positive SARS-CoV-2 testing 4-8 weeks before MIS-C onset. Serology can help establish epidemiological link to COVID-19 when past infection or exposure are unknown.
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