A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019 (Covid-19). In New York State, the Department of Health established surveillance to track hospitalized patients with MIS-C. Between March 1 and May 10, 2020, 191 potential cases were reported. Of these, 95 had confirmed MIS-C (with SARS-CoV-2 infection) and 4 were suspected. The majority were male, with 31% aged 0-5 years, 42% aged 6-12 years, and 26% aged 13-20 years. All patients presented with fever or chills, with 97% having tachycardia, 80% gastrointestinal symptoms, 60% rash, and 56% conjunctival injection. Elevated inflammatory markers were common, with 62% receiving vasopressor support and 80% admitted to the ICU. Two patients died. The median hospital stay was 6 days. MIS-C was associated with cardiac dysfunction and had features similar to Kawasaki's disease, toxic shock syndrome, and other inflammatory conditions. The syndrome emerged alongside widespread SARS-CoV-2 transmission. The study highlights the need for surveillance and early identification of MIS-C, particularly in areas with high SARS-CoV-2 transmission. The findings suggest that MIS-C is a postinfectious inflammatory process linked to Covid-19. The study also notes racial and ethnic disparities in SARS-CoV-2 infection rates, which may influence MIS-C incidence. Limitations include possible underreporting and underestimation of mild cases. The study underscores the importance of continued monitoring and research to better understand MIS-C and its long-term implications.A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019 (Covid-19). In New York State, the Department of Health established surveillance to track hospitalized patients with MIS-C. Between March 1 and May 10, 2020, 191 potential cases were reported. Of these, 95 had confirmed MIS-C (with SARS-CoV-2 infection) and 4 were suspected. The majority were male, with 31% aged 0-5 years, 42% aged 6-12 years, and 26% aged 13-20 years. All patients presented with fever or chills, with 97% having tachycardia, 80% gastrointestinal symptoms, 60% rash, and 56% conjunctival injection. Elevated inflammatory markers were common, with 62% receiving vasopressor support and 80% admitted to the ICU. Two patients died. The median hospital stay was 6 days. MIS-C was associated with cardiac dysfunction and had features similar to Kawasaki's disease, toxic shock syndrome, and other inflammatory conditions. The syndrome emerged alongside widespread SARS-CoV-2 transmission. The study highlights the need for surveillance and early identification of MIS-C, particularly in areas with high SARS-CoV-2 transmission. The findings suggest that MIS-C is a postinfectious inflammatory process linked to Covid-19. The study also notes racial and ethnic disparities in SARS-CoV-2 infection rates, which may influence MIS-C incidence. Limitations include possible underreporting and underestimation of mild cases. The study underscores the importance of continued monitoring and research to better understand MIS-C and its long-term implications.