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GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Diary Card NCT00291876

1 forms  
Study administration
Description

Study administration

Center
Description

Center

Data type

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Subject number
Description

Subject Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
LOCAL SYMPTOMS
Description

LOCAL SYMPTOMS

Redness, size
Description

Redness

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 0
Description

Redness size day 0

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 1
Description

Redness size day 1

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 2
Description

Redness size day 2

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 3
Description

Redness size day 3

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Ongoing after day 3?
Description

Ongoing after day 3?

Data type

boolean

Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0518690
UMLS CUI [1,3]
C0549178
Date of last day of symptoms
Description

Date of last day of symptoms

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
Size Swelling
Description

Size Swelling

Data type

integer

Measurement units
  • dd/mm/yy
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
dd/mm/yy
Size Swelling Day 0
Description

Size Swelling Day 0

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 1
Description

Size Swelling Day 1

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 2
Description

Size Swelling Day 2

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 3
Description

Size Swelling Day 3

Data type

integer

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Ongoing after day 3?
Description

Ongoing after day 3?

Data type

boolean

Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0549178
Date of last day of symptoms
Description

Date of last day of symptoms

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
Pain intensity
Description

Pain (at injection site): 0 : Absent 1 : Painful on touch 2 : Painful when limb is moved 3 : Spontaneously painful

Data type

integer

Alias
UMLS CUI [1,1]
C3840282
UMLS CUI [1,2]
C2700396
Pain intensity day 0
Description

Pain intensity day 0

Data type

integer

Alias
UMLS CUI [1]
C3840282
Pain intensity day 1
Description

Pain intensity day 1

Data type

integer

Alias
UMLS CUI [1]
C3840282
Pain intensity day 2
Description

Pain intensity day 2

Data type

integer

Alias
UMLS CUI [1]
C3840282
Pain intensity day 3
Description

Pain intensity day 3

Data type

integer

Alias
UMLS CUI [1]
C3840282
Ongoing after day 3?
Description

Ongoing after day 3?

Data type

boolean

Alias
UMLS CUI [1,1]
C0549178
UMLS CUI [1,2]
C0030193
Date of last day of symptoms
Description

Date of last day of symptoms

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0030193
Other Local Symptoms
Description

Other Local Symptoms

Description - please specify side(s) and site(s)
Description

Description - please specify side(s) and site(s)

Data type

text

Alias
UMLS CUI [1]
C0441987
UMLS CUI [2]
C1515974
Intensity
Description

Intensity

Data type

integer

Alias
UMLS CUI [1]
C0522510
Start date
Description

Start date

Data type

date

Measurement units
  • day month year
Alias
UMLS CUI [1]
C0808070
day month year
End date
Description

End date

Data type

date

Measurement units
  • day month year
Alias
UMLS CUI [1]
C0806020
day month year
check box if continuing
Description

Ongoing

Data type

boolean

Alias
UMLS CUI [1]
C0549178
MEDICATION
Description

MEDICATION

Alias
UMLS CUI-1
C0013227
Trade / Generic Name
Description

Trade / Generic Name

Data type

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C0013227
Reason
Description

Medical Indication

Data type

text

Alias
UMLS CUI [1,1]
C3146298
UMLS CUI [1,2]
C0013227
Total Daily Dose
Description

Total Daily Dose

Data type

text

Alias
UMLS CUI [1,1]
C2348070
UMLS CUI [1,2]
C0013227
Start date
Description

Start date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
End date
Description

End date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
check box if continuing
Description

pharmacotherapy

Data type

boolean

Alias
UMLS CUI [1,1]
C0013216
UMLS CUI [1,2]
C0549178
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Similar models

GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Diary Card NCT00291876

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Study administration
Center
Item
Center
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Subject Number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Item Group
LOCAL SYMPTOMS
Redness
Item
Redness, size
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness size day 0
Item
Redness size day 0
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness size day 1
Item
Redness size day 1
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness size day 2
Item
Redness size day 2
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness size day 3
Item
Redness size day 3
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing after day 3?
Item
Ongoing after day 3?
boolean
C0332575 (UMLS CUI [1,1])
C0518690 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,3])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size Swelling
Item
Size Swelling
integer
C0456389 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size Swelling Day 0
Item
Size Swelling Day 0
integer
C0456389 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size Swelling Day 1
Item
Size Swelling Day 1
integer
C0456389 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size Swelling Day 2
Item
Size Swelling Day 2
integer
C0456389 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size Swelling Day 3
Item
Size Swelling Day 3
integer
C0456389 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing after day 3?
Item
Ongoing after day 3?
boolean
C0038999 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain intensity
Item
Pain intensity
integer
C3840282 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Item
Pain intensity day 0
integer
C3840282 (UMLS CUI [1])
Pain intensity day 0
Code List
Pain intensity day 0
CL Item
0  (1)
CL Item
1  (2)
CL Item
2  (3)
CL Item
3 (4)
Item
Pain intensity day 1
integer
C3840282 (UMLS CUI [1])
Medically attended visit
Code List
Pain intensity day 1
CL Item
HO  (1)
CL Item
ER  (2)
CL Item
MD (3)
Item
Pain intensity day 2
integer
C3840282 (UMLS CUI [1])
Medically attended visit
Code List
Pain intensity day 2
CL Item
HO  (1)
CL Item
ER  (2)
CL Item
MD (3)
Item
Pain intensity day 3
integer
C3840282 (UMLS CUI [1])
Medically attended visit
Code List
Pain intensity day 3
CL Item
HO  (1)
CL Item
ER  (2)
CL Item
MD (3)
Ongoing after day 3?
Item
Ongoing after day 3?
boolean
C0549178 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
Item Group
Other Local Symptoms
Description - please specify side(s) and site(s)
Item
Description - please specify side(s) and site(s)
text
C0441987 (UMLS CUI [1])
C1515974 (UMLS CUI [2])
Item
Intensity
integer
C0522510 (UMLS CUI [1])
Intensity
Code List
Intensity
CL Item
Mild: An adverse event which is easily tolerated by the subject, causing minimal discomfort and not (1)
CL Item
Moderate: An adverse event which is sufficiently discomforting to interfere with normal everyday activities. (2)
CL Item
Severe: An adverse event which prevents normal, everyday activities. (In a young child, such an adverse spontaneously painful event would, for example, prevent attendance at school/kindergarten/a day-care center and would cause the parents/guardians to seek. medical advice). (3)
Start date
Item
Start date
date
C0808070 (UMLS CUI [1])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
Ongoing
Item
check box if continuing
boolean
C0549178 (UMLS CUI [1])
Item Group
MEDICATION
C0013227 (UMLS CUI-1)
Trade / Generic Name
Item
Trade / Generic Name
text
C0027365 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Medical Indication
Item
Reason
text
C3146298 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Total Daily Dose
Item
Total Daily Dose
text
C2348070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Start date
Item
Start date
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End date
Item
End date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
pharmacotherapy
Item
check box if continuing
boolean
C0013216 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
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