Inglés

GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Tracking Document Long Term Follow-up NCT00291876

1 formularios  
Study administration
Descripción

Study administration

Center
Descripción

Center

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Long Term Follow-up
Descripción

Long Term Follow-up

Subject number of previous study
Descripción

Subject number of previous study

Tipo de datos

text

Alias
UMLS CUI [1,1]
C2348585
UMLS CUI [1,2]
C2242969
Subject initials first name family name
Descripción

Subject initials

Tipo de datos

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Descripción

Date of birth

Tipo de datos

date

Unidades de medida
  • day month year
Alias
UMLS CUI [1]
C0421451
day month year
Please contact the following subjects for inclusion in the long-term follow-up study and document whether or not he/she agrees to participate.
Descripción

study subject participation subject

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348568
If answer is 3., choose
Descripción

study subject participation status adverse event

Tipo de datos

integer

Alias
UMLS CUI [1]
C2348568
please specify
Descripción

study subject participation status specify

Tipo de datos

text

Alias
UMLS CUI [1]
C2348568
Date of contact
Descripción

Date of contact

Tipo de datos

date

Alias
UMLS CUI [1]
C0805839
Investigator
Descripción

Investigator

Investigator name
Descripción

Investigator name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Signature
Descripción

Signature

Tipo de datos

text

Alias
UMLS CUI [1]
C1519316
Date
Descripción

Signature date

Tipo de datos

date

Alias
UMLS CUI [1]
C0807937
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Similar models

GSK Hepatitis A Vaccine ADDITIONAL VACCINATION Tracking Document Long Term Follow-up NCT00291876

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Study administration
Center
Item
Center
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Item Group
Long Term Follow-up
Subject number of previous study
Item
Subject number of previous study
text
C2348585 (UMLS CUI [1,1])
C2242969 (UMLS CUI [1,2])
Subject initials
Item
Subject initials first name family name
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Please contact the following subjects for inclusion in the long-term follow-up study and document whether or not he/she agrees to participate.
integer
C2348568 (UMLS CUI [1])
study subject participation subject
Code List
Please contact the following subjects for inclusion in the long-term follow-up study and document whether or not he/she agrees to participate.
CL Item
1. Subject not eligible (1)
CL Item
2. Subject lost to follow-up or not reached (2)
CL Item
3. Subject eligible but not willing to participate due to: (3)
CL Item
4. Subject eligible and agreed to participate in the (4)
CL Item
long-term follow-up study (5)
Item
If answer is 3., choose
integer
C2348568 (UMLS CUI [1])
study subject participation subject
Code List
If answer is 3., choose
CL Item
adverse events, or serious adverse event: (1)
CL Item
other: (2)
study subject participation status specify
Item
please specify
text
C2348568 (UMLS CUI [1])
Date of contact
Item
Date of contact
date
C0805839 (UMLS CUI [1])
Item Group
Investigator
Investigator name
Item
Investigator name
text
C2826892 (UMLS CUI [1])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
Signature date
Item
Date
date
C0807937 (UMLS CUI [1])
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