Item
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the Protocol ?
text
C0042196 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Code List
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the Protocol ?
CL Item
Yes, please record concomitant vaccination with trade name and / or generic name, route and vaccine (Yes, please record concomitant vaccination with trade name and / or generic name, route and vaccine)
CL Item
administration date. (administration date.)
Trade name
Item
Trade / (Generic) Name
text
C0013227 (UMLS CUI [1])
Route
Item
Route
text
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Administration date
Item
Administration date
date
C1533734 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Investigator Use
Item
For GSK
text
C0008961 (UMLS CUI [1,1])
C0457083 (UMLS CUI [1,2])
Item
Have any medications/treatments been administered during study period?
text
C2347852 (UMLS CUI [1])
Code List
Have any medications/treatments been administered during study period?
CL Item
Yes, please complete the following table. (Yes, please complete the following table.)
Trade/Generic Name
Item
Trade/Generic Name
text
C0013227 (UMLS CUI [1])
Item
Medical indication
text
C3146298 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Code List
Medical indication
CL Item
Specify (Specify)
CL Item
Prophylactic (Prophylactic)
Daily dose
Item
Total daily dose
text
C2348070 (UMLS CUI [1])
Route
Item
Route
text
C0013153 (UMLS CUI [1])
Start date
Item
Start date
date
C0808070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
End date
Item
End date
date
C0806020 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Continuing
Item
tick box if continuing at end of study
boolean
C2826666 (UMLS CUI [1])
Investigator Use
Item
For GSK
text
C0008961 (UMLS CUI [1,1])
C0457083 (UMLS CUI [1,2])