Center
Item
Center
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date of Visit
Item
Date of Visit
date
C1320303 (UMLS CUI [1])
Subject Identifier
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item
Have any of the above mentioned medications/treatments been administered during the period starting 30 days prior to the vaccine dose and ending one month [minimum 30 days] after it?
integer
C0013227 (UMLS CUI [1])
Code List
Have any of the above mentioned medications/treatments been administered during the period starting 30 days prior to the vaccine dose and ending one month [minimum 30 days] after it?
CL Item
Yes, please complete the following table. (2)
pharmaceutical preparations
Item
Trade / Generic Name
text
C0013227 (UMLS CUI [1])
drug Indication
Item
Medical Indication
boolean
C0199176 (UMLS CUI [1,1])
C3146298 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
total daily dose
Item
Total daily dose
text
C2348070 (UMLS CUI [1])
Item
Route
text
C0013153 (UMLS CUI [1])
CL Item
Intramuscular (IM)
CL Item
Intraarticular (IR)
CL Item
Subcutaneous (SC)
Medication Start Date
Item
Start Date
date
C1521826 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Medication End Date
Item
End Date
date
C1521826 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Medication Ongoing
Item
Medication Ongoing: check box if continuing at end of Visit 24
boolean
C2826666 (UMLS CUI [1])