Non-serious adverse events
If Yes, record details below. Note: If this is a Serious Adverse Event (SAE), do not complete this form, go to the SAE section and complete the SAE form.
boolean
Diagnosis Only (if known). Otherwise Sign/Symptom
text
Start date
date
Outcome
integer
End Date
date
Maximum Intensity
text
Action Taken
text
withdrawal
boolean
AE caused by the investigational product
boolean