Engelsk

ODM-Form

1 Formulär  
  1. StudyEvent: ODM
    1. ODM-Form
Identification
Beskrivning

Identification

Alias
UMLS CUI-1
C1300638
Center number
Beskrivning

Center number

Datatyp

text

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

Subject ID

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Treatment Number
Beskrivning

Treatment Number

Datatyp

text

Alias
UMLS CUI [1]
C1522541
Visit Number
Beskrivning

Visit Number

Datatyp

integer

Alias
UMLS CUI [1]
C0545082
Non Serious Adverse Events
Beskrivning

Non Serious Adverse Events

Alias
UMLS CUI-1
C0877248
Has any non-serious adverse events occurred within one month (minimum 30 days) post-vaccination, excluding those recorded on the Solicited Adverse Events pages?
Beskrivning

If yes, please complete the following table.

Datatyp

boolean

Alias
UMLS CUI [1]
C0877248
Non Serious Adverse Events: List
Beskrivning

Non Serious Adverse Events: List

Alias
UMLS CUI-1
C0877248
Number of Adverse Event
Beskrivning

AE No.

Datatyp

boolean

Alias
UMLS CUI [1]
C0877248
Description of Adverse Event
Beskrivning

Description of Adverse Event

Datatyp

text

Alias
UMLS CUI [1]
C0877248
Site of Adverse Event
Beskrivning

Site of Adverse Event

Datatyp

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C1515974
Start date
Beskrivning

Start date

Datatyp

date

Måttenheter
  • dd/mm/yy
Alias
UMLS CUI [1]
C0808070
dd/mm/yy
Stop Date
Beskrivning

Stop Date

Datatyp

date

Alias
UMLS CUI [1]
C0806020
Start during immediate Post Vaccination Period
Beskrivning

Start during immediate Post Vaccination Period

Datatyp

boolean

Alias
UMLS CUI [1]
C0205253
Maximum Intensity:
Beskrivning

Maximum Intensity:

Datatyp

integer

Alias
UMLS CUI [1]
C0518690
Is there a reasonable possibility that the AE may have been caused by the investigational product?
Beskrivning

Relationship to investigational products

Datatyp

text

Alias
UMLS CUI [1,1]
C0085978
UMLS CUI [1,2]
C0877248
Outcome:
Beskrivning

Outcome

Datatyp

integer

Alias
UMLS CUI [1]
C1705586
Medically attended visit
Beskrivning

(Refer to protocol for full definition.) If yes please specify type: HO: Hospitalisation ER: Emergency Room MD: Medical Personnel

Datatyp

boolean

Alias
UMLS CUI [1]
C0545082
Medically Attended visit Specification
Beskrivning

Medically Attended visit Specification

Datatyp

text

Alias
UMLS CUI [1]
C0018704
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Similar models

ODM-Form

1 Formulär
  1. StudyEvent: ODM
    1. ODM-Form
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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
Visit Number
integer
C0545082 (UMLS CUI [1])
Visit Number
Code List
Visit Number
CL Item
1 (1)
CL Item
2 (2)
Item Group
Non Serious Adverse Events
C0877248 (UMLS CUI-1)
Non-Serious Adverse Events occurred
Item
Has any non-serious adverse events occurred within one month (minimum 30 days) post-vaccination, excluding those recorded on the Solicited Adverse Events pages?
boolean
C0877248 (UMLS CUI [1])
Item Group
Non Serious Adverse Events: List
C0877248 (UMLS CUI-1)
AE No.
Item
Number of Adverse Event
boolean
C0877248 (UMLS CUI [1])
Description of Adverse Event
Item
Description of Adverse Event
text
C0877248 (UMLS CUI [1])
Item
Site of Adverse Event
text
C0877248 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Site of Adverse Event
Code List
Site of Adverse Event
CL Item
Administration sites: 10Pn-PD-DiT vaccineor Prevenar vaccine (L901)
CL Item
Administration sites: DTPa-HBV-IPV/Hib vaccine (L93)
CL Item
Non-administration site (G)
Start date
Item
Start date
date
C0808070 (UMLS CUI [1])
Stop Date
Item
Stop Date
date
C0806020 (UMLS CUI [1])
Start during immediate Post Vaccination Period
Item
Start during immediate Post Vaccination Period
boolean
C0205253 (UMLS CUI [1])
Item
Maximum Intensity:
integer
C0518690 (UMLS CUI [1])
Maximum Intensity:
Code List
Maximum Intensity:
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Is there a reasonable possibility that the AE may have been caused by the investigational product?
text
C0085978 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
Relationship to investigational products
Code List
Is there a reasonable possibility that the AE may have been caused by the investigational product?
CL Item
Yes (Y)
CL Item
No (N)
Item
Outcome:
integer
C1705586 (UMLS CUI [1])
Outcome
Code List
Outcome:
CL Item
Recovered / resolved (1)
CL Item
Recovering / resolving (2)
CL Item
Not recovered / not resolved (3)
CL Item
Recovered with sequelae / resolved with sequelae (4)
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1])
Item
Medically Attended visit Specification
text
C0018704 (UMLS CUI [1])
Medically Attended visit Specification
Code List
Medically Attended visit Specification
CL Item
Hospitalisation (HO)
CL Item
Emergency Room (ER)
CL Item
Medical Personnel (MD)
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