Local Symptoms
Type of Vaccine Administered
integer
If yes, please tick No/Yes for each symptom. If Yes is ticked, please complete all items. If any of these adverse events meets the protocol definition of serious, please complete a Serious Adverse Event report and fax to GSK Biologicals Study Contact for SAE reporting within 24 hours.
text
In case of large swelling reaction at the injected limb, please fill in ALSO the Large Swelling Reaction forms.
text
Intensity: 0,1,2,3 (see Adverse Events definitions)
text
Intensity: 0,1,2,3 (see Adverse Events definitions)
text
Intensity: 0,1,2,3 (see Adverse Events definitions)
text
Intensity: 0,1,2,3 (see Adverse Events definitions)
text
If yes name date of last Symptoms below
boolean
Date of last day of symptoms
date
if yes, please specify the place below
boolean
Place of Medical Attendance
text
General Symptoms
General Symptoms specification
If Fever, please specify below.
text
Fever Measuring Route
text
Fever: Axillary >37.5°C Oral >37.5°C Rectal >38.0°C Tympanic (oral conversion) >37.5°C Tympanic (rectal conversion) >38.0°C Intensity: 0,1,2,3
text
Intensity/°C Day 1
text
Intensity/°C Day 2
text
Intensity/°C Day 3
text
Ongiong after Day 3
text
Date of last day of symptoms
date
Casualty
boolean
Medically Attended visit
boolean
Health Care Facility
text
Unsolicited Adverse Events
If Yes: Fill in the Non-Serious Adverse Event section or Serious Adverse Event report as necessary.
text
Meningitis
boolean