Further information Adverse Event
aestdtc
date
Dauerhaft
integer
aeendtc
date
aesev
integer
Severity of Event
An event is serious, if it's a or several of these sequences has: hospitalization, life-threatening, resulting in death, congenital malformations, handicap / disability or medically important events!
integer
Kriterien für den Schweregrad
integer
Outcome
aeout
integer
aeouttx
text
Todesdatum
date
Ursache
text
Autopsie
integer
Causality (UE & MS-Medication)
Multiple Sclerosis Medication
MS-Medikament
integer
Anderes MS-Medikament
text
Einnahme seit
partialDate
Einnahme bis
partialDate
Tagesdosis
float
Einheit
integer
Maßnahme
integer
Kausalität
integer
Causality (UE & Concomittant Medication)
Concomittant Medication
Andere Medikation
string
Einnahme seit
partialDate
bis
partialDate
Tagesdosis
float
Einheit
integer
Indikation
string
Kausalität
integer
Please fill promptly the following fields in case of a serious adverse event (SUE)! After you have entered your name and saved the form, it is "not yet" transferred automatically with all information from the system: as an internal message (in the database) to all participants of your Centre as E-Mail and fax (fax number: 0251-83-55300) to the Westfälische Wilhelms-Universität Münster, Institute of epidemiology and social medicine, Alber-Schweitzer-campus 1, building D3, 48149 Münster.
Datum der Meldung
date
2-digit number for the identification of the Suez.
integer
Typ der Meldung
integer
Patient's Data
Alter
integer
Geschlecht
integer
Gewicht
float
height
integer
Schwangerschaft
integer
Schwangerschaftswoche
integer
Treatment
relevant preexcisting diseases/ symptoms
multimor_1
text
mordata_1
partialDate
mordatb_1
partialDate
Relevant Diagnostic Test Result
Name of reporter
Berichterstatters
string
Telefonnummer
string
Faxnummer
string
string
Signature
text