ID

25019

Descripción

Study ID: 100571 (M138) Clinical Study ID: 100571 Study Title: Double-blind randomized study to evaluate the immunogenicity and reactogenicity of two different lots of GlaxoSmithKline Biologicals' inactivated hepatitis A vaccine containing 1440 EL.U of antigen per mL and injected according to a 0, 12 month schedule in healthy adult volunteers Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00291876 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 4 Study Recruitment Status: Completed Generic Name: Hepatitis A Vaccine, Inactivated Trade Name: Havrix Study Indication: Hepatitis A https://clinicaltrials.gov/ct2/show/NCT00291876

Link

https://clinicaltrials.gov/ct2/show/NCT00291876

Palabras clave

Versiones (3)
  1. 24/8/17 24/8/17 -
  2. 24/8/17 24/8/17 -
  3. 24/8/17 24/8/17 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

24 de agosto de 2017

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
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GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Diary Card NCT00291876

Inglés

GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Diary Card NCT00291876

1 formularios  
Study administration
Descripción

Study administration

Center
Descripción

Center

Tipo de datos

text

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

Subject Number

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348585
LOCAL SYMPTOMS
Descripción

LOCAL SYMPTOMS

Redness, size
Descripción

Redness

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 0
Descripción

Redness size day 0

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 1
Descripción

Redness size day 1

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 2
Descripción

Redness size day 2

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness size day 3
Descripción

Redness size day 3

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Ongoing after day 3?
Descripción

Ongoing after day 3?

Tipo de datos

boolean

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

Date of last day of symptoms

Tipo de datos

date

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

Size Swelling

Tipo de datos

integer

Unidades de medida
  • 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
Descripción

Size Swelling Day 0

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 1
Descripción

Size Swelling Day 1

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 2
Descripción

Size Swelling Day 2

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Size Swelling Day 3
Descripción

Size Swelling Day 3

Tipo de datos

integer

Unidades de medida
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
mm
Ongoing after day 3?
Descripción

Ongoing after day 3?

Tipo de datos

boolean

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

Date of last day of symptoms

Tipo de datos

date

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

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

Tipo de datos

integer

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

Pain intensity day 0

Tipo de datos

integer

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

Pain intensity day 1

Tipo de datos

integer

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

Pain intensity day 2

Tipo de datos

integer

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

Pain intensity day 3

Tipo de datos

integer

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

Ongoing after day 3?

Tipo de datos

boolean

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

Date of last day of symptoms

Tipo de datos

date

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

Other Local Symptoms

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

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

Tipo de datos

text

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

Intensity

Tipo de datos

integer

Alias
UMLS CUI [1]
C0522510
Start date
Descripción

Start date

Tipo de datos

date

Unidades de medida
  • day month year
Alias
UMLS CUI [1]
C0808070
day month year
End date
Descripción

End date

Tipo de datos

date

Unidades de medida
  • day month year
Alias
UMLS CUI [1]
C0806020
day month year
check box if continuing
Descripción

Ongoing

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0549178
MEDICATION
Descripción

MEDICATION

Alias
UMLS CUI-1
C0013227
Trade / Generic Name
Descripción

Trade / Generic Name

Tipo de datos

text

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

Medical Indication

Tipo de datos

text

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

Total Daily Dose

Tipo de datos

text

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

Start date

Tipo de datos

date

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

End date

Tipo de datos

date

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

pharmacotherapy ongoing

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0013216
UMLS CUI [1,2]
C0549178
SOLICITED ADVERSE EVENTS – GENERAL SYMPTOMS
Descripción

SOLICITED ADVERSE EVENTS – GENERAL SYMPTOMS

Has the subject experienced any of the following signs/symptoms during the solicited period?
Descripción

Adverse Events General Symptoms

Tipo de datos

text

Alias
UMLS CUI [1]
C1556354
Fever
Descripción

Fever

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0015967
Fever measurement site
Descripción

body temperature site

Tipo de datos

integer

Alias
UMLS CUI [1]
C0489453
Fever Day 0
Descripción

Fever Day 0

Tipo de datos

float

Unidades de medida
  • °C
Alias
UMLS CUI [1]
C0015967
°C
Fever Day 1
Descripción

Fever Day 1

Tipo de datos

float

Unidades de medida
  • dd/mm/yy
Alias
UMLS CUI [1]
C0015967
dd/mm/yy
Fever Day 2
Descripción

Fever Day 2

Tipo de datos

float

Unidades de medida
  • dd/mm/yy
Alias
UMLS CUI [1]
C0015967
dd/mm/yy
Fever Day 3
Descripción

Fever Day 3

Tipo de datos

float

Unidades de medida
  • dd/mm/yy
Alias
UMLS CUI [1]
C0015967
dd/mm/yy
Ongoing after day 3?
Descripción

symptom ongoing

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C3174772
Date of last day of symptoms
Descripción

date last symptoms

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1517741
UMLS CUI [1,3]
C1457887
Fatigue
Descripción

Fatigue

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0015672
Fatigue Day 0
Descripción

Fatigue Day 0

Tipo de datos

integer

Alias
UMLS CUI [1]
C0015672
Fatigue Day 1
Descripción

Fatigue Day 1

Tipo de datos

integer

Alias
UMLS CUI [1]
C0015672
Fatigue Day 2
Descripción

Fatigue Day 2

Tipo de datos

integer

Alias
UMLS CUI [1]
C0015672
Fatigue Day 3
Descripción

Fatigue Day 3

Tipo de datos

integer

Alias
UMLS CUI [1]
C0015672
Ongoing after day 3?
Descripción

Fatigue ongoing after day 3

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0015672
UMLS CUI [1,2]
C3174772
Date of last day of symptoms
Descripción

Date of last day of symptoms

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0015672
UMLS CUI [1,3]
C2700396
Headache
Descripción

Headache

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0018681
Headache, Intensity
Descripción

If Yes, please specify

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0522510
Headache on Day 0
Descripción

Headache on Day 0

Tipo de datos

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 1
Descripción

Headache on Day 1

Tipo de datos

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 2
Descripción

Headache on Day 2

Tipo de datos

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 3
Descripción

Headache on Day 3

Tipo de datos

integer

Alias
UMLS CUI [1]
C0018681
Headache ongoing after day 3?
Descripción

Headache ongoing after day 3

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0018681
Date of last day of symptoms
Descripción

Headache ongoing after day 3? If Yes, please specify

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0011008
Gastrointestinal symptoms
Descripción

Gastrointestinal symptoms

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms, Intensity
Descripción

If Yes, please specify

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0426576
UMLS CUI [1,2]
C0522510
Gastrointestinal symptoms on Day 0
Descripción

Gastrointestinal symptoms on Day 0

Tipo de datos

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 1
Descripción

Gastrointestinal symptoms on Day 1

Tipo de datos

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 2
Descripción

Gastrointestinal symptoms on Day 2

Tipo de datos

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 3
Descripción

Gastrointestinal symptoms on Day 3

Tipo de datos

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms ongoing after day 3?
Descripción

Gastrointestinal symptoms ongoing after day 3

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0426576
Date of last day of symptoms
Descripción

Gastrointestinal symptoms ongoing after day 3? If Yes, please specify

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0426576
UMLS CUI [1,2]
C0011008
PLEASE DO NOT FORGET TO BRING BACK THE DIARY CARD ON
Descripción

visit date

Tipo de datos

date

Alias
UMLS CUI [1]
C1320303
IN CASE OF HOSPITALISATION, PLEASE INFORM
Descripción

telephone number

Tipo de datos

text

Alias
UMLS CUI [1]
C1515258
Other General Symptoms
Descripción

Other General Symptoms

Alias
UMLS CUI-1
C1457887
Description - please specify side(s) and site(s)
Descripción

symptom

Tipo de datos

text

Alias
UMLS CUI [1]
C1457887
Intensity
Descripción

Intensity

Tipo de datos

integer

Alias
UMLS CUI [1]
C0518690
Start date:
Descripción

symptom Start Date

Tipo de datos

date

Alias
UMLS CUI [1]
C0808070
End date
Descripción

End date

Tipo de datos

date

Alias
UMLS CUI [1]
C0806020
check box if continuing
Descripción

ongoing

Tipo de datos

date

Alias
UMLS CUI [1]
C0549178
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Similar models

GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Diary Card NCT00291876

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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 ongoing
Item
check box if continuing
boolean
C0013216 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Item Group
SOLICITED ADVERSE EVENTS – GENERAL SYMPTOMS
Item
Has the subject experienced any of the following signs/symptoms during the solicited period?
text
C1556354 (UMLS CUI [1])
Hib-MenCY vaccine
Code List
Has the subject experienced any of the following signs/symptoms during the solicited period?
CL Item
No [N] (1)
CL Item
Information not retrievable [U] (2)
CL Item
No vaccine administered [NA] (3)
CL Item
Yes [Y] (4)
Fever
Item
Fever
boolean
C0015967 (UMLS CUI [1])
Item
Fever measurement site
integer
C0489453 (UMLS CUI [1])
body temperature site
Code List
Fever measurement site
CL Item
Oral (recommended) (1)
CL Item
Axillary(recommended) (2)
CL Item
Rectal (3)
Fever Day 0
Item
Fever Day 0
float
C0015967 (UMLS CUI [1])
Fever Day 1
Item
Fever Day 1
float
C0015967 (UMLS CUI [1])
Fever Day 2
Item
Fever Day 2
float
C0015967 (UMLS CUI [1])
Fever Day 3
Item
Fever Day 3
float
C0015967 (UMLS CUI [1])
symptom ongoing
Item
Ongoing after day 3?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
date last symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
Fatigue
Item
Fatigue
boolean
C0015672 (UMLS CUI [1])
Item
Fatigue Day 0
integer
C0015672 (UMLS CUI [1])
Fatigue Day 0
Code List
Fatigue Day 0
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
Item
Fatigue Day 1
integer
C0015672 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Fatigue Day 1
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Fatigue Day 2
integer
C0015672 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Fatigue Day 2
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Fatigue Day 3
integer
C0015672 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Fatigue Day 3
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Fatigue ongoing after day 3
Item
Ongoing after day 3?
boolean
C0015672 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0015672 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Headache
Item
Headache
boolean
C0018681 (UMLS CUI [1])
Item
Headache, Intensity
integer
C0018681 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Have any medications/treatments been administered during study period?
Code List
Headache, Intensity
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Headache on Day 0
integer
C0018681 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Headache on Day 0
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Headache on Day 1
integer
C0018681 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Headache on Day 1
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Headache on Day 2
integer
C0018681 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Headache on Day 2
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Headache on Day 3
integer
C0018681 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Headache on Day 3
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Headache ongoing after day 3
Item
Headache ongoing after day 3?
boolean
C0018681 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0018681 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Gastrointestinal symptoms
Item
Gastrointestinal symptoms
boolean
C0426576 (UMLS CUI [1])
Item
Gastrointestinal symptoms, Intensity
integer
C0426576 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Have any medications/treatments been administered during study period?
Code List
Gastrointestinal symptoms, Intensity
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Gastrointestinal symptoms on Day 0
integer
C0426576 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Gastrointestinal symptoms on Day 0
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Gastrointestinal symptoms on Day 1
integer
C0426576 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Gastrointestinal symptoms on Day 1
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Gastrointestinal symptoms on Day 2
integer
C0426576 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Gastrointestinal symptoms on Day 2
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Item
Gastrointestinal symptoms on Day 3
integer
C0426576 (UMLS CUI [1])
Have any medications/treatments been administered during study period?
Code List
Gastrointestinal symptoms on Day 3
CL Item
No (1)
CL Item
Yes, please complete the following table. (2)
Gastrointestinal symptoms ongoing after day 3
Item
Gastrointestinal symptoms ongoing after day 3?
boolean
C0426576 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0426576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
visit date
Item
PLEASE DO NOT FORGET TO BRING BACK THE DIARY CARD ON
date
C1320303 (UMLS CUI [1])
telephone number
Item
IN CASE OF HOSPITALISATION, PLEASE INFORM
text
C1515258 (UMLS CUI [1])
Item Group
Other General Symptoms
C1457887 (UMLS CUI-1)
symptom
Item
Description - please specify side(s) and site(s)
text
C1457887 (UMLS CUI [1])
Intensity
Item
Intensity
integer
C0518690 (UMLS CUI [1])
symptom 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
date
C0549178 (UMLS CUI [1])
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