General Symptoms
Please fill in below and assess the occurrence of any of the followinq siqns or symptoms accordinq to the criteria listed hereafter: Temperature: Please record the temperature every day. If temperature has been taken more than once a day, please report the highest value for the day. Intensity: Irritability / fussiness: 0: Behavior as usual Drowsiness: Loss of appetite: 0: Behavior as usual 0: Appetite as usual 1: Crying more than usual I no effect on normal activity 2: Crying more than usual I interferes with normal activity 3: Crying that cannot be comforted I prevents normal 1: Drowsiness easily tolerated 2: Drowsiness that interferes with normal activity 3:Drowsiness that prevents normal activity 1: Eating less than usual I no effect on normal activity activity 2: Eating less than usual I interferes with normal activity 3: Not eating at all Other general svmptoms: 1:Mild: An adverse event which is easily tolerated by the subject, causing minimal discomfort and not interfering with everyday activities. 2:Moderate: An adverse event which is sufficiently discomforting to interfere with normal everyday activities. 3:Severe: An adverse event which prevents normal, everyday activities. (In a young child, such an adverse event would, for example, prevent attendance at school/kinderqarten/a day-care center and would cause the parents/guardians to seek medical advice).
integer
Temperature / Intensity Day 0
text
Temperature Measurement site
integer
Temperature / Intensity Day 1
text
Temperature / Intensity Day 2
text
Temperature / Intensity Day 3
text
Ongoing after Day 3
boolean
Date of last Symptoms
date
Medically attended visit
boolean
Other General Symptoms
Description
text
Intensity
integer
Start Date
date
End date
date
Medically attended visit
boolean
Medication
Name
text
Reason
text
total daily dose
text
Start date
date
End date
date
Continuing
boolean
Administration