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Visit 21 Immunogenicity and reactogenicity of GlaxoSmithKline Biologicals' inactivated hepatitis A vaccine 100580

1 Formulär  
Pre-Vaccination Assessment
Beskrivning

Pre-Vaccination Assessment

Alias
UMLS CUI-1
C0220825
UMLS CUI-2
C0005903
UMLS CUI-3
C0042196
Subject number
Beskrivning

Subject number

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Temperature :
Beskrivning

Temperature

Datatyp

float

Måttenheter
  • °C
Alias
UMLS CUI [1]
C0039476
°C
Route :
Beskrivning

Body temperature measurement site

Datatyp

integer

Alias
UMLS CUI [1]
C0489453
Laboratory Tests
Beskrivning

Laboratory Tests

Alias
UMLS CUI-1
C0022885
UMLS CUI-2
C0005834
Has a blood sample been taken?
Beskrivning

blood sample

Datatyp

boolean

Alias
UMLS CUI [1]
C0005834
Has a blood sample for CMI testing been taken ?
Beskrivning

blood sample for CMI testing

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0013175
UMLS CUI [1,2]
C1277698
Has a urine sample been taken?
Beskrivning

urine sample

Datatyp

boolean

Alias
UMLS CUI [1]
C0200354
Urine sample result, Pregnancy test - HCG:
Beskrivning

urine pregnancy test

Datatyp

integer

Alias
UMLS CUI [1]
C0430056
UMLS CUI [2,1]
C0200354
UMLS CUI [2,2]
C0456984
Vaccine Administration, Additional Vaccination
Beskrivning

Vaccine Administration, Additional Vaccination

Alias
UMLS CUI-1
C2368628
UMLS CUI-2
C0042196
Vaccine Administration
Beskrivning

Vaccine Administration

Datatyp

integer

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C0700881
Administration Side
Beskrivning

Administration Side

Datatyp

text

Alias
UMLS CUI [1,1]
C0441987
UMLS CUI [1,2]
C0013153
UMLS CUI [1,3]
C0042210
Administration Site
Beskrivning

Administration Site

Datatyp

text

Alias
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0013153
UMLS CUI [1,3]
C0042210
Administration Route
Beskrivning

Administration Route

Datatyp

text

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C0042210
Has the study vaccine been administered according to the Protocol ?
Beskrivning

Study vaccine Administration

Datatyp

boolean

Alias
UMLS CUI [1]
C2368628
Study vaccine Administration: Side
Beskrivning

Has the study vaccine been administered according to the Protocol? If No, please tick all items that apply

Datatyp

integer

Alias
UMLS CUI [1,1]
C0441987
UMLS CUI [1,2]
C0013153
UMLS CUI [1,3]
C0042210
Study vaccine Administration: Site
Beskrivning

Has the study vaccine been administered according to the Protocol? If No, please tick all items that apply

Datatyp

integer

Alias
UMLS CUI [1,1]
C1515974
UMLS CUI [1,2]
C0013153
UMLS CUI [1,3]
C0042210
Study vaccine Administration: Route
Beskrivning

Has the study vaccine been administered according to the Protocol? If No, please tick all items that apply

Datatyp

integer

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C0042210
Comments
Beskrivning

Comments

Datatyp

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C2368628
Solicited Adverse Events - Local Symptoms
Beskrivning

Solicited Adverse Events - Local Symptoms

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0205276
UMLS CUI-3
C0877248
UMLS CUI-4
C0700881
Has the subject experienced any of the following local (at administration site) solicited signs/symptoms during the solicited period?
Beskrivning

Additional Vaccination

Datatyp

text

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C2700396
UMLS CUI [1,3]
C0700881
Redness
Beskrivning

Redness

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C2700396
Redness, size (mm)
Beskrivning

If Yes, please specify

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness on Day 0
Beskrivning

Redness on Day 0

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness on Day 1
Beskrivning

Redness on Day 1

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness on Day 2
Beskrivning

Redness on Day 2

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness on Day 3
Beskrivning

Redness on Day 3

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness ongoing after day 3?
Beskrivning

Redness ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C2700396
Date of last day of symptoms
Beskrivning

Redness ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
Swelling
Beskrivning

Swelling

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C2700396
Swelling, size (mm)
Beskrivning

If Yes, please specify

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling on Day 0
Beskrivning

Swelling on Day 0

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling on Day 1
Beskrivning

Swelling on Day 1

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling on Day 2
Beskrivning

Swelling on Day 2

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling on Day 3
Beskrivning

Swelling on Day 3

Datatyp

float

Måttenheter
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling ongoing after day 3?
Beskrivning

Swelling ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C2700396
Date of last day of symptoms
Beskrivning

Swelling ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
Pain
Beskrivning

Pain

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C2700396
Pain, intensity
Beskrivning

If Yes, please specify

Datatyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain on Day 0
Beskrivning

Pain on Day 0

Datatyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain on Day 1
Beskrivning

Pain on Day 1

Datatyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain on Day 2
Beskrivning

Pain on Day 2

Datatyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain on Day 3
Beskrivning

Pain on Day 3

Datatyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain ongoing after day 3?
Beskrivning

Pain ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C2700396
Date of last day of symptoms
Beskrivning

Pain ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C2700396
Solicited Adverse Events - General Symptoms
Beskrivning

Solicited Adverse Events - General Symptoms

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0042196
UMLS CUI-3
C0877248
UMLS CUI-4
C0700881
Has the subject experienced any of the following general solicited signs/symptoms during the solicited period?
Beskrivning

Additional Vaccination

Datatyp

text

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0042196
Fever
Beskrivning

Axillary > 37.5°C Oral > 37.5°C

Datatyp

boolean

Alias
UMLS CUI [1]
C0015967
Fever
Beskrivning

If Yes, please specify

Datatyp

float

Måttenheter
  • °C
Alias
UMLS CUI [1]
C0015967
°C
Fever, Site of measurement
Beskrivning

Site of measurement

Datatyp

text

Alias
UMLS CUI [1,1]
C0449687
UMLS CUI [1,2]
C0015967
Fever on Day 0
Beskrivning

Fever on Day 0

Datatyp

integer

Alias
UMLS CUI [1]
C0015967
Fever on Day 0
Beskrivning

if taken, please specify

Datatyp

float

Måttenheter
  • °C
Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C0015967
°C
Fever on Day 1
Beskrivning

Fever on Day 1

Datatyp

integer

Alias
UMLS CUI [1]
C0015967
Fever on Day 1
Beskrivning

if taken, please specify

Datatyp

float

Måttenheter
  • C
Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C0015967
C
Fever on Day 2
Beskrivning

Fever on Day 2

Datatyp

integer

Alias
UMLS CUI [1]
C0015967
Fever on Day 2
Beskrivning

if taken, please specify

Datatyp

float

Måttenheter
  • °C
Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C0015967
°C
Fever on Day 3
Beskrivning

Fever on Day 3

Datatyp

integer

Alias
UMLS CUI [1]
C0015967
Fever on Day 3
Beskrivning

if taken, please specify

Datatyp

float

Måttenheter
  • °C
Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C0015967
°C
Fever ongoing after day 3?
Beskrivning

Fever ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1]
C0015967
Date of last day of symptoms
Beskrivning

Fever ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0015967
Causality?
Beskrivning

Causality

Datatyp

boolean

Alias
UMLS CUI [1]
C0015127
UMLS CUI [2]
C0015967
Fatigue
Beskrivning

Fatigue

Datatyp

boolean

Alias
UMLS CUI [1]
C0015672
Fatigue, Intensity
Beskrivning

If Yes, please specify

Datatyp

integer

Alias
UMLS CUI [1,1]
C0015672
UMLS CUI [1,2]
C0522510
Fatigue on Day 0
Beskrivning

Fatigue on Day 0

Datatyp

integer

Alias
UMLS CUI [1]
C0015672
Fatigue on Day 1
Beskrivning

Fatigue on Day 1

Datatyp

integer

Alias
UMLS CUI [1]
C0015672
Fatigue on Day 2
Beskrivning

Fatigue on Day 2

Datatyp

integer

Alias
UMLS CUI [1]
C0015672
Fatigue on Day 3
Beskrivning

Fatigue on Day 3

Datatyp

integer

Alias
UMLS CUI [1]
C0015672
Fatigue ongoing after day 3?
Beskrivning

Fatigue ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1]
C0015672
Date of last day of symptoms
Beskrivning

Fatigue ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0015672
UMLS CUI [1,2]
C0011008
Causality?
Beskrivning

Causality

Datatyp

boolean

Alias
UMLS CUI [1]
C0015127
UMLS CUI [2]
C0015672
Headache
Beskrivning

Headache

Datatyp

boolean

Alias
UMLS CUI [1]
C0018681
Headache, Intensity
Beskrivning

If Yes, please specify

Datatyp

integer

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0522510
Headache on Day 0
Beskrivning

Headache on Day 0

Datatyp

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 1
Beskrivning

Headache on Day 1

Datatyp

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 2
Beskrivning

Headache on Day 2

Datatyp

integer

Alias
UMLS CUI [1]
C0018681
Headache on Day 3
Beskrivning

Headache on Day 3

Datatyp

integer

Alias
UMLS CUI [1]
C0018681
Headache ongoing after day 3?
Beskrivning

Headache ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1]
C0018681
Date of last day of symptoms
Beskrivning

Headache ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0018681
UMLS CUI [1,2]
C0011008
Causality
Beskrivning

Causality

Datatyp

boolean

Alias
UMLS CUI [1]
C0015127
UMLS CUI [2]
C0018681
Gastrointestinal symptoms
Beskrivning

Gastrointestinal symptoms

Datatyp

boolean

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms, Intensity
Beskrivning

If Yes, please specify

Datatyp

integer

Alias
UMLS CUI [1,1]
C0426576
UMLS CUI [1,2]
C0522510
Gastrointestinal symptoms on Day 0
Beskrivning

Gastrointestinal symptoms on Day 0

Datatyp

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 1
Beskrivning

Gastrointestinal symptoms on Day 1

Datatyp

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 2
Beskrivning

Gastrointestinal symptoms on Day 2

Datatyp

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms on Day 3
Beskrivning

Gastrointestinal symptoms on Day 3

Datatyp

integer

Alias
UMLS CUI [1]
C0426576
Gastrointestinal symptoms ongoing after day 3?
Beskrivning

Gastrointestinal symptoms ongoing after day 3

Datatyp

boolean

Alias
UMLS CUI [1]
C0426576
Date of last day of symptoms
Beskrivning

Gastrointestinal symptoms ongoing after day 3? If Yes, please specify

Datatyp

date

Alias
UMLS CUI [1,1]
C0426576
UMLS CUI [1,2]
C0011008
Causality?
Beskrivning

Causality

Datatyp

boolean

Alias
UMLS CUI [1]
C0015127
UMLS CUI [2]
C0426576
Tillbaka till toppen

Similar models

Visit 21 Immunogenicity and reactogenicity of GlaxoSmithKline Biologicals' inactivated hepatitis A vaccine 100580

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Pre-Vaccination Assessment
C0220825 (UMLS CUI-1)
C0005903 (UMLS CUI-2)
C0042196 (UMLS CUI-3)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Temperature
Item
Temperature :
float
C0039476 (UMLS CUI [1])
Item
Route :
integer
C0489453 (UMLS CUI [1])
Body temperature measurement site
Code List
Route :
CL Item
Oral (1)
CL Item
Axillary (2)
CL Item
Rectal (3)
CL Item
Not assessed (4)
Item Group
Laboratory Tests
C0022885 (UMLS CUI-1)
C0005834 (UMLS CUI-2)
blood sample
Item
Has a blood sample been taken?
boolean
C0005834 (UMLS CUI [1])
blood sample for CMI testing
Item
Has a blood sample for CMI testing been taken ?
boolean
C0013175 (UMLS CUI [1,1])
C1277698 (UMLS CUI [1,2])
urine sample
Item
Has a urine sample been taken?
boolean
C0200354 (UMLS CUI [1])
Item
Urine sample result, Pregnancy test - HCG:
integer
C0430056 (UMLS CUI [1])
C0200354 (UMLS CUI [2,1])
C0456984 (UMLS CUI [2,2])
urine pregnancy test
Code List
Urine sample result, Pregnancy test - HCG:
CL Item
Negative (1)
CL Item
Positive (2)
Item Group
Vaccine Administration, Additional Vaccination
C2368628 (UMLS CUI-1)
C0042196 (UMLS CUI-2)
Item
Vaccine Administration
integer
C2368628 (UMLS CUI [1,1])
C0700881 (UMLS CUI [1,2])
Vaccine Administration
Code List
Vaccine Administration
CL Item
Havrix Vaccine (1)
(Comment:en)
CL Item
Not administered  (2)
(Comment:en)
Administration Side
Item
Administration Side
text
C0441987 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Administration Site
Item
Administration Site
text
C1515974 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Administration Route
Item
Administration Route
text
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Study vaccine Administration
Item
Has the study vaccine been administered according to the Protocol ?
boolean
C2368628 (UMLS CUI [1])
Item
Study vaccine Administration: Side
integer
C0441987 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Study vaccine Administration Side
Code List
Study vaccine Administration: Side
CL Item
Non-dominant arm  (1)
CL Item
Dominant arm  (2)
Item
Study vaccine Administration: Site
integer
C1515974 (UMLS CUI [1,1])
C0013153 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Study vaccine Administration Site
Code List
Study vaccine Administration: Site
CL Item
Deltoid (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
Item
Study vaccine Administration: Route
integer
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Study vaccine Administration Route
Code List
Study vaccine Administration: Route
CL Item
I.M. (1)
CL Item
S.C. (2)
Comments
Item
Comments
text
C0947611 (UMLS CUI [1,1])
C2368628 (UMLS CUI [1,2])
Item Group
Solicited Adverse Events - Local Symptoms
C1457887 (UMLS CUI-1)
C0205276 (UMLS CUI-2)
C0877248 (UMLS CUI-3)
C0700881 (UMLS CUI-4)
Item
Has the subject experienced any of the following local (at administration site) solicited signs/symptoms during the solicited period?
text
C1457887 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
C0700881 (UMLS CUI [1,3])
symptoms
Code List
Has the subject experienced any of the following local (at administration site) solicited signs/symptoms during the solicited period?
CL Item
Unknown (U)
CL Item
No (N)
CL Item
Yes, please tick No/Yes for each symptom. If Yes is checked, please fill in the complete line (Y)
Redness
Item
Redness
boolean
C0332575 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Redness
Item
Redness, size (mm)
float
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness on Day 0
Item
Redness on Day 0
float
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness on Day 1
Item
Redness on Day 1
float
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness on Day 2
Item
Redness on Day 2
float
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness on Day 3
Item
Redness on Day 3
float
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Redness ongoing after day 3
Item
Redness ongoing after day 3?
boolean
C0332575 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling
boolean
C0038999 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Swelling
Item
Swelling, size (mm)
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling on Day 0
Item
Swelling on Day 0
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling on Day 1
Item
Swelling on Day 1
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling on Day 2
Item
Swelling on Day 2
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling on Day 3
Item
Swelling on Day 3
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling ongoing after day 3
Item
Swelling ongoing after day 3?
boolean
C0038999 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Item
Pain
boolean
C0030193 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Item
Pain, intensity
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Pain on Day 0
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain on Day 0
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Pain on Day 1
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain on Day 1
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Pain on Day 2
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain on Day 2
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Pain on Day 3
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain on Day 3
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Pain ongoing after day 3
Item
Pain ongoing after day 3?
boolean
C0030193 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Item Group
Solicited Adverse Events - General Symptoms
C1457887 (UMLS CUI-1)
C0042196 (UMLS CUI-2)
C0877248 (UMLS CUI-3)
C0700881 (UMLS CUI-4)
Item
Has the subject experienced any of the following general solicited signs/symptoms during the solicited period?
text
C1457887 (UMLS CUI [1,1])
C0042196 (UMLS CUI [1,2])
symptoms
Code List
Has the subject experienced any of the following general solicited signs/symptoms during the solicited period?
CL Item
Unknown (U)
CL Item
No (N)
CL Item
Yes, please tick No/Yes for each symptom. If Yes is checked, please fill in the complete line (Y)
Fever
Item
Fever
boolean
C0015967 (UMLS CUI [1])
Fever
Item
Fever
float
C0015967 (UMLS CUI [1])
Item
Fever, Site of measurement
text
C0449687 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Site of measurement
Code List
Fever, Site of measurement
CL Item
Axillary (A)
CL Item
Oral (O)
CL Item
Rectal (R)
Item
Fever on Day 0
integer
C0015967 (UMLS CUI [1])
Fever on Day 0
Code List
Fever on Day 0
CL Item
taken (1)
CL Item
not taken (2)
Fever on Day 0
Item
Fever on Day 0
float
C0005903 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Item
Fever on Day 1
integer
C0015967 (UMLS CUI [1])
Fever on Day 0
Code List
Fever on Day 1
CL Item
taken (1)
CL Item
not taken (2)
Fever on Day 1
Item
Fever on Day 1
float
C0005903 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Item
Fever on Day 2
integer
C0015967 (UMLS CUI [1])
Fever on Day 0
Code List
Fever on Day 2
CL Item
taken (1)
CL Item
not taken (2)
Fever on Day 2
Item
Fever on Day 2
float
C0005903 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Item
Fever on Day 3
integer
C0015967 (UMLS CUI [1])
Fever on Day 0
Code List
Fever on Day 3
CL Item
taken (1)
CL Item
not taken (2)
Fever on Day 3
Item
Fever on Day 3
float
C0005903 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Fever ongoing after day 3
Item
Fever ongoing after day 3?
boolean
C0015967 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1])
C0015967 (UMLS CUI [2])
Fatigue
Item
Fatigue
boolean
C0015672 (UMLS CUI [1])
Item
Fatigue, Intensity
integer
C0015672 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Pain
Code List
Fatigue, Intensity
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Fatigue on Day 0
integer
C0015672 (UMLS CUI [1])
Pain
Code List
Fatigue on Day 0
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Fatigue on Day 1
integer
C0015672 (UMLS CUI [1])
Pain
Code List
Fatigue on Day 1
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Fatigue on Day 2
integer
C0015672 (UMLS CUI [1])
Pain
Code List
Fatigue on Day 2
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Fatigue on Day 3
integer
C0015672 (UMLS CUI [1])
Pain
Code List
Fatigue on Day 3
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Fatigue ongoing after day 3
Item
Fatigue ongoing after day 3?
boolean
C0015672 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0015672 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1])
C0015672 (UMLS CUI [2])
Headache
Item
Headache
boolean
C0018681 (UMLS CUI [1])
Item
Headache, Intensity
integer
C0018681 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Pain
Code List
Headache, Intensity
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Headache on Day 0
integer
C0018681 (UMLS CUI [1])
Pain
Code List
Headache on Day 0
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Headache on Day 1
integer
C0018681 (UMLS CUI [1])
Pain
Code List
Headache on Day 1
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Headache on Day 2
integer
C0018681 (UMLS CUI [1])
Pain
Code List
Headache on Day 2
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Headache on Day 3
integer
C0018681 (UMLS CUI [1])
Pain
Code List
Headache on Day 3
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Headache ongoing after day 3
Item
Headache ongoing after day 3?
boolean
C0018681 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0018681 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Causality
Item
Causality
boolean
C0015127 (UMLS CUI [1])
C0018681 (UMLS CUI [2])
Gastrointestinal symptoms
Item
Gastrointestinal symptoms
boolean
C0426576 (UMLS CUI [1])
Item
Gastrointestinal symptoms, Intensity
integer
C0426576 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Pain
Code List
Gastrointestinal symptoms, Intensity
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Gastrointestinal symptoms on Day 0
integer
C0426576 (UMLS CUI [1])
Pain
Code List
Gastrointestinal symptoms on Day 0
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Gastrointestinal symptoms on Day 1
integer
C0426576 (UMLS CUI [1])
Pain
Code List
Gastrointestinal symptoms on Day 1
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Gastrointestinal symptoms on Day 2
integer
C0426576 (UMLS CUI [1])
Pain
Code List
Gastrointestinal symptoms on Day 2
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Gastrointestinal symptoms on Day 3
integer
C0426576 (UMLS CUI [1])
Pain
Code List
Gastrointestinal symptoms on Day 3
CL Item
None (0)
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Gastrointestinal symptoms ongoing after day 3
Item
Gastrointestinal symptoms ongoing after day 3?
boolean
C0426576 (UMLS CUI [1])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0426576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1])
C0426576 (UMLS CUI [2])
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