Item
Anaphylactic reaction to food
integer
Code List
Anaphylactic reaction to food
CL Item
No medical history (3)
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
No medical history (3)
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
No medical history (3)
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
No medical history (3)
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
No medical history (3)
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
No medical history (3)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
No medical history (3)
Specific Condition Other allergies
Item
10.a Specific Condition
text
CL Item
Check all that apply (Check all that apply)
Blisters Stevens-Johnson syndrome
Item
Blisters
boolean
Biopsy confirmed Stevens-Johnson syndrome
Item
Biopsy confirmed
boolean
Mucous membrane involvement Stevens-Johnson syndrome
Item
Mucous membrane involvement
boolean
Stevens-Johnson syndrome Symptom start date
Item
Symptom start date
date
CL Item
Check all that apply (Check all that apply)
Blisters Toxic epidermal necrolysis
Item
Blisters
boolean
Biopsy confirmed Toxic epidermal necrolysis
Item
Biopsy confirmed
boolean
Mucous membrane involvement Toxic epidermal necrolysis
Item
Mucous membrane involvement
boolean
Symptom start date Toxic epidermal necrolysis
Item
Symptom start date
date
CL Item
Check all that apply (Check all that apply)
Generalised Urticaria (hives)
Item
Generalised
boolean
Localised Urticaria (hives)
Item
Localised
boolean
Photosensitivity Urticaria (hives)
Item
Photosensitivity
boolean
Other symptoms Urticaria (hives)
Item
Other
boolean
Other symptoms Urticaria (hives) specification
Item
Other, specify
text
Symptom start date Urticaria (hives)
Item
Symptom start date
date
CL Item
Check all that apply (Check all that apply)
Angioedema Face
Item
Face (including eyes, lips)
boolean
Angioedema Throat
Item
Throat (including tongue, larynx)
boolean
Angioedema Laryngeal
Item
Laryngeal
boolean
Angioedema Dyspnoea
Item
Dyspnoea
boolean
Angioedema Dysphagia
Item
Dysphagia
boolean
Angioedema Required intubation
Item
Required intubation
boolean
Angioedema Other symptoms
Item
Other
boolean
Angioedema Other symptoms specification
Item
Other, specify
text
Symptom start date Angioedema
Item
Symptom start date
date
CL Item
Check all that apply (Check all that apply)
Dyspnoea Anaphylactic/Anaphylactoid reaction
Item
Dyspnoea
boolean
Bronchospasm Anaphylactic/Anaphylactoid reaction
Item
Bronchospasm
boolean
Hypotension Anaphylactic/Anaphylactoid reaction
Item
Hypotension
boolean
Loss of consciousness Anaphylactic/Anaphylactoid reaction
Item
Loss of consciousness
boolean
Persistent gastrointestinal symptoms Anaphylactic/Anaphylactoid reaction
Item
Persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
boolean
Other symptoms Anaphylactic/Anaphylactoid reaction
Item
Other
boolean
Other symptoms specidication Anaphylactic/Anaphylactoid reaction
Item
Other, specify
text
Symptom start date Anaphylactic/Anaphylactoid reaction
Item
Symptom start date
date
CL Item
Check all that apply (Check all that apply)
Other symptoms of hypersensitivity reaction Rash
Item
Rash
boolean
Other symptoms of hypersensitivity reaction Photosensitivity
Item
Photosensitivity
boolean
Other symptoms of hypersensitivity reaction
Item
Other
boolean
Other symptoms of hypersensitivity reaction specification
Item
Other, specify
text
Start date Other symptoms of hypersensitivity reaction
Item
Symptom start date
date