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Vaccine Administration "Safety and Immunogenicity Study of a Booster Dose of GSK Biologicals' 10-valent Pneumococcal Conjugate Vaccine" NCT00370396

1 forms  
Identification
Description

Identification

Alias
UMLS CUI-1
C1300638
Center number
Description

Center number

Data type

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0805701
Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
Treatment Number
Description

Treatment Number

Data type

text

Alias
UMLS CUI [1]
C1522541
Vaccine Administration Meta
Description

Vaccine Administration Meta

Alias
UMLS CUI-1
C1533734
UMLS CUI-2
C0042196
Vaccine Administratrion Date
Description

Fill in only if different from visit date

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1533734
UMLS CUI [1,3]
C0042196
Pre-Vaccination temperature
Description

Pre-Vaccination temperature

Data type

text

Alias
UMLS CUI [1]
C0039476
Pre-Vaccination Temperature Route of Measurement
Description

Pre-Vaccination Temperature Route of Measurement

Data type

text

Alias
UMLS CUI [1]
C0449444
Vaccine Administration Details
Description

Vaccine Administration Details

Alias
UMLS CUI-1
C1533734
UMLS CUI-2
C0042196
Vaccine Administration
Description

please complete not administered below

Data type

text

Alias
UMLS CUI [1]
C0042196
Replacement vial Number
Description

only if vial is replaced

Data type

text

Alias
UMLS CUI [1]
C0184301
Wrong vial number
Description

only fill in if vial number is wrong

Data type

text

Alias
UMLS CUI [1]
C0184301
Side / Route Site
Description

Injection according to Protocol ist right side I.M.

Data type

integer

Alias
UMLS CUI [1]
C1515974
Has the study vaccine been administered according to protocol?
Description

Administration according to Protocol

Data type

boolean

Alias
UMLS CUI [1]
C1507394
Injection side
Description

If the study vaccine has not been administered according to protocol

Data type

text

Alias
UMLS CUI [1]
C0441987
Injection site
Description

If the study vaccine has not been administered according to protocol

Data type

integer

Alias
UMLS CUI [1]
C1515974
Injection Route
Description

If the study vaccine has not been administered according to protocol

Data type

text

Alias
UMLS CUI [1]
C0013153
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Similar models

Vaccine Administration "Safety and Immunogenicity Study of a Booster Dose of GSK Biologicals' 10-valent Pneumococcal Conjugate Vaccine" NCT00370396

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Identification
C1300638 (UMLS CUI-1)
Center number
Item
Center number
text
C1301943 (UMLS CUI [1,1])
C0805701 (UMLS CUI [1,2])
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Treatment Number
Item
Treatment Number
text
C1522541 (UMLS CUI [1])
Item Group
Vaccine Administration Meta
C1533734 (UMLS CUI-1)
C0042196 (UMLS CUI-2)
Vaccine Administratrion Date
Item
Vaccine Administratrion Date
date
C0011008 (UMLS CUI [1,1])
C1533734 (UMLS CUI [1,2])
C0042196 (UMLS CUI [1,3])
Pre-Vaccination temperature
Item
Pre-Vaccination temperature
text
C0039476 (UMLS CUI [1])
Item
Pre-Vaccination Temperature Route of Measurement
text
C0449444 (UMLS CUI [1])
Pre-Vaccination Temperature Route of Measurement
Code List
Pre-Vaccination Temperature Route of Measurement
CL Item
Axillary (A)
CL Item
Oral (O)
CL Item
Rectal (R)
CL Item
Tympanic (oral conversion) (X)
CL Item
Tympanic (rectal conversion) (Y)
Item Group
Vaccine Administration Details
C1533734 (UMLS CUI-1)
C0042196 (UMLS CUI-2)
Item
Vaccine Administration
text
C0042196 (UMLS CUI [1])
vaccination
Code List
Vaccine Administration
CL Item
10Pn-PD-DiT Vaccine OR Prevenar Vaccine (S)
CL Item
Replacement vial  (R)
CL Item
Wrong vial number (W)
CL Item
Not administered (N)
Replacement vial Number
Item
Replacement vial Number
text
C0184301 (UMLS CUI [1])
Wrong vial number
Item
Wrong vial number
text
C0184301 (UMLS CUI [1])
Item
Side / Route Site
integer
C1515974 (UMLS CUI [1])
Side / Route Site
Code List
Side / Route Site
CL Item
deltoid (1)
CL Item
thigh (3)
Administration according to Protocol
Item
Has the study vaccine been administered according to protocol?
boolean
C1507394 (UMLS CUI [1])
Item
Injection side
text
C0441987 (UMLS CUI [1])
Injection site
Code List
Injection side
CL Item
Left  (L)
CL Item
Right (R)
Item
Injection site
integer
C1515974 (UMLS CUI [1])
Injection site
Code List
Injection site
CL Item
deltoid (1)
CL Item
thigh (3)
CL Item
buttock (6)
Item
Injection Route
text
C0013153 (UMLS CUI [1])
Injection Route
Code List
Injection Route
CL Item
I.M. (im)
CL Item
S.C. (sc)
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