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Visit 5 Booster Dose Vaccine Administration Biologicals HepA/HepB vaccine 208127/125

1 formularios  
Header
Descripción

Header

Alias
UMLS CUI-1
C1320722
Protocol
Descripción

Protocol

Tipo de datos

text

Alias
UMLS CUI [1]
C1507394
Activity
Descripción

Activity

Tipo de datos

text

Alias
UMLS CUI [1]
C1512346
Subject number
Descripción

Subject number

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
VACCINE ADMINISTRATION
Descripción

VACCINE ADMINISTRATION

Alias
UMLS CUI-1
C2368628
Temperature :
Descripción

As specified in the protocol, the temperature of the subject should be taken by the oral route.

Tipo de datos

float

Unidades de medida
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Axillary route
Descripción

Axillary temperature

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1531924
Oral route
Descripción

Oral temperature

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1532216
Rectal route
Descripción

Rectal temperature

Tipo de datos

boolean

Alias
UMLS CUI [1]
C0489749
Has the study vaccine been administered ?
Descripción

If Yes, complete the table below.

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0042210
UMLS CUI [1,2]
C0008972
Please specify and go to next page :
Descripción

Study vaccine has not been administered

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0042210
UMLS CUI [1,2]
C0008972
HAB
Descripción

Vaccine

Tipo de datos

text

Alias
UMLS CUI [1]
C0593947
Site/Route of injection: Deltoid I.M.
Descripción

Please specify side :

Tipo de datos

text

Alias
UMLS CUI [1]
C2700396
Date administered (day month year)
Descripción

Date administered

Tipo de datos

date

Alias
UMLS CUI [1]
C0011008
Time (24 hr. clock)
Descripción

Time

Tipo de datos

time

Alias
UMLS CUI [1]
C0040223
Has the study vaccine been administered according to the protocol ?
Descripción

Vaccine protocol

Tipo de datos

boolean

Alias
UMLS CUI [1]
C2368628
UMLS CUI [2]
C1507394
Injection site :
Descripción

study vaccine has not been administered according to the protocol

Tipo de datos

text

Alias
UMLS CUI [1]
C2700396
Route :
Descripción

study vaccine has not been administered according to the protocol

Tipo de datos

text

Alias
UMLS CUI [1]
C1828121
POST VACCINATION OBSERVATION
Descripción

POST VACCINATION OBSERVATION

Alias
UMLS CUI-1
C1443955
UMLS CUI-2
C0700325
Has any adverse experience occurred during the immediate 30 minute post vaccination observation period ?
Descripción

If Yes, please fill in the Adverse Experience Section and detail the exact time of onset.

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0151862
Has any prophylactic medication been administered in anticipation of study vaccine reactions ?
Descripción

If Yes, please complete the Medication Section

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0420172
UMLS CUI [1,2]
C0413534
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Similar models

Visit 5 Booster Dose Vaccine Administration Biologicals HepA/HepB vaccine 208127/125

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol
Item
Protocol
text
C1507394 (UMLS CUI [1])
Activity
Item
Activity
text
C1512346 (UMLS CUI [1])
Subject number
Item
Subject number
text
C2348585 (UMLS CUI [1])
Item Group
VACCINE ADMINISTRATION
C2368628 (UMLS CUI-1)
Temperature
Item
Temperature :
float
C0005903 (UMLS CUI [1])
Axillary temperature
Item
Axillary route
boolean
C1531924 (UMLS CUI [1])
Oral temperature
Item
Oral route
boolean
C1532216 (UMLS CUI [1])
Rectal temperature
Item
Rectal route
boolean
C0489749 (UMLS CUI [1])
Study vaccine administered
Item
Has the study vaccine been administered ?
boolean
C0042210 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
Study vaccine not administered
Item
Please specify and go to next page :
text
C0042210 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
Item
HAB
text
C0593947 (UMLS CUI [1])
Vaccine
Code List
HAB
CL Item
HAB (HAB)
Item
Site/Route of injection: Deltoid I.M.
text
C2700396 (UMLS CUI [1])
Site/Route of injection
Code List
Site/Route of injection: Deltoid I.M.
CL Item
left (left)
CL Item
right (right)
Date administered
Item
Date administered (day month year)
date
C0011008 (UMLS CUI [1])
Time
Item
Time (24 hr. clock)
time
C0040223 (UMLS CUI [1])
Vaccine protocol
Item
Has the study vaccine been administered according to the protocol ?
boolean
C2368628 (UMLS CUI [1])
C1507394 (UMLS CUI [2])
Injection site
Item
Injection site :
text
C2700396 (UMLS CUI [1])
Route
Item
Route :
text
C1828121 (UMLS CUI [1])
Item Group
POST VACCINATION OBSERVATION
C1443955 (UMLS CUI-1)
C0700325 (UMLS CUI-2)
Adverse experience after vaccination
Item
Has any adverse experience occurred during the immediate 30 minute post vaccination observation period ?
boolean
C0877248 (UMLS CUI [1,1])
C0151862 (UMLS CUI [1,2])
Prophylactic medication
Item
Has any prophylactic medication been administered in anticipation of study vaccine reactions ?
boolean
C0420172 (UMLS CUI [1,1])
C0413534 (UMLS CUI [1,2])
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