Previous Urinary Tract Infection
Item
1. Did you have one or more urinary tract infection in the last three weeks?
boolean
C0205156 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
Numbers of Previous Urinary Tract Infection
Item
1a. If YES, how many urinary tract or bladder infections did you have in the last three weeks? (Please specify the number:)
text
C0449788 (UMLS CUI [1,1])
C0205156 (UMLS CUI [1,2])
C0042029 (UMLS CUI [1,3])
Urinary Tract Infection: Sick Leave
Item
1b. Have you been on sick leave due to an urinary tract infection in the last 4 weeks (since the beginning of the study)?
boolean
C0242807 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
Urinary Tract Infection: Sick Leave Specification
Item
1b. Have you been on sick leave due to an urinary tract infection in the last 4 weeks (since the beginning of the study)? If YES, specify the number of days:
float
C0242807 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Urinary Tract Infection: Start Date
Item
1c. When was your last urinary tract infection (in the last 3 weeks)? Start Date:
date
C0042029 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Urinary Tract Infection: End Date
Item
1c. When was your last urinary tract infection (in the last 3 weeks)? End Date:
date
C0042029 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Urinary Tract Infection: Office Visit
Item
1d. Did you went to your general practitioner or another doctor because of your last urinary tract infection?
boolean
C0042029 (UMLS CUI [1,1])
C0028900 (UMLS CUI [1,2])
Item
1d1. If YES, who provided medical care? (several answers are possible)
text
C0042029 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Code List
1d1. If YES, who provided medical care? (several answers are possible)
CL Item
(durch den Hausarzt)
CL Item
(durch den Facharzt)
CL Item
(in der Notfallambulanz)
Urinary Tract Infection: Febrile Infection
Item
1d2. Had fever (>38°C) occurred in the course of this urinary tract infection?
boolean
C0042029 (UMLS CUI [1,1])
C0948233 (UMLS CUI [1,2])
Pharmacotherapy
Item
2. Have you taken any medication (antibiotics, analgesics, other medication, herbal drugs) for an urinary tract infection in the last 3 weeks?
boolean
C0013216 (UMLS CUI [1])
Antibiotics
Item
Antibiotics: Drug Name (e.g. Cefuroxim)
text
C0003232 (UMLS CUI [1])
Antibiotics: Dosage
Item
Antibiotics: Dosage (e.g. 500 mg)
text
C0003232 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Antibiotics: Medication Frequency
Item
Antibiotics: Medication Frequency (e.g. 2x1 tablets)
text
C0003232 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Antibiotics: Start Date
Item
Antibiotics: Start Date
date
C0003232 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Antibiotics: End Date
Item
Antibiotics: End Date
date
C0003232 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Analgesics
Item
Analgesics: Drug Name
text
C0002771 (UMLS CUI [1])
Analgesics: Dosage
Item
Analgesics: Dosage (e.g. 500 mg)
text
C0002771 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Analgesics: Medication Frequency
Item
Analgesics: Medication Frequency (e.g. 2x1 tablets)
text
C0002771 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Analgesics: Start Date
Item
Analgesics: Start Date
date
C0002771 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Anagesics: End Date
Item
Analgesics: End Date
date
C0002771 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Other Medication
Item
Other Medication: Drug Name
text
C1115771 (UMLS CUI [1])
Other Medication: Dosage
Item
Other Medication: Dosage (e.g. 500 mg)
text
C1115771 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Other Medication: Medication Frequency
Item
Other Medication: Medication Frequency (e.g. 2x1 tablets)
text
C1115771 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Other Medication: Start Date
Item
Other Medication: Start Date
date
C1115771 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Other Medication: End Date
Item
Other Medication: End Date
date
C1115771 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Further Urinary Tract Infection
Item
3. Did you have a further urinary tract infection in the last three weeks?
boolean
C0042029 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Date of Further Urinary Tract Infection
Item
3a. Date of further Urinary Tract Infection?
date
C0011008 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,3])
Further Urinary Tract Infection: Office Visit
Item
3b. Did you went to your general practitioner or another doctor because of further urinary tract infection?
boolean
C1517331 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C0028900 (UMLS CUI [1,3])
Item
3b1. If YES, who provided medical care? (several answers are possible)
text
C1517331 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
Code List
3b1. If YES, who provided medical care? (several answers are possible)
CL Item
(durch den Hausarzt)
CL Item
(durch den Facharzt)
CL Item
(in der Notfallambulanz)
Further Urinary Tract Infection: Febrile Infection
Item
3b2. Had fever (>38°C) occurred in the course of this urinary tract infection?
boolean
C1517331 (UMLS CUI [1,1])
C0042029 (UMLS CUI [1,2])
C0948233 (UMLS CUI [1,3])
Further Pharmacotherapy
Item
4. Have you taken any medication (antibiotics, analgesics, other medication, herbal drugs) for this further urinary tract infection?
boolean
C0013216 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Further Antibiotics
Item
Antibiotics: Drug Name (e.g. Cefuroxim)
text
C0003232 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Further Antibiotics: Dosage
Item
Antibiotics: Dosage (e.g. 500 mg)
text
C0003232 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
Further Antibiotics: Medication Frequency
Item
Antibiotics: Medication Frequency (e.g. 2x1 tablets)
text
C0003232 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
Further Antibiotics: Start Date
Item
Antibiotics: Start Date
date
C0003232 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Further Antibiotics: End Date
Item
Antibiotics: End Date
date
C0003232 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Further Analgesics
Item
Analgesics: Drug Name
text
C0002771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Further Analgesics: Dosage
Item
Analgesics: Dosage (e.g. 500 mg)
text
C0002771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
Further Analgesics: Medication Frequency
Item
Analgesics: Medication Frequency (e.g. 2x1 tablets)
text
C0002771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
Further Analgesics: Start Date
Item
Analgesics: Start Date
date
C0002771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Further Anagesics: End Date
Item
Analgesics: End Date
date
C0002771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Further Other Medication
Item
Other Medication: Drug Name
text
C1115771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
Further Other Medication: Dosage
Item
Other Medication: Dosage (e.g. 500 mg)
text
C1115771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
Further Other Medication: Medication Frequency
Item
Other Medication: Medication Frequency (e.g. 2x1 tablets)
text
C1115771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
Further Other Medication: Start Date
Item
Other Medication: Start Date
date
C1115771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
Further Other Medication: End Date
Item
Other Medication: End Date
date
C1115771 (UMLS CUI [1,1])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
Further Symptoms
Item
5. Did you have a further symptoms since study inclusion?
boolean
C1457887 (UMLS CUI [1])
Further Symptoms: Specification
Item
5a. If YES, please specify your symptoms.
text
C1457887 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Further Symptoms: Start Date
Item
5b. When did your symptoms occur? Start Date
date
C1457887 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Further Symptoms: End Date
Item
5b. When did your symptoms occur? End Date
date
C1457887 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
5c. How much have you been affected by the described symptoms in your everyday life?
text
C1457887 (UMLS CUI [1,1])
C0392760 (UMLS CUI [1,2])
Code List
5c. How much have you been affected by the described symptoms in your everyday life?
CL Item
(leicht: normale Aktivitäten des täglichen Lebens werden nicht beeinträchtigt)
CL Item
(mittel: normale Aktivitäten des täglichen Lebens werden störend beeinträchtigt)
CL Item
(schwer: verhindert Aktivitäten des täglichen Lebens)
Further Symptoms: Office Visit
Item
5d. Did you went to your general practitioner or another doctor because of the described symptoms?
boolean
C1457887 (UMLS CUI [1,1])
C0028900 (UMLS CUI [1,2])
Item
5d1. If YES, who provided medical care? (several answers are possible)
text
C1457887 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Code List
5d1. If YES, who provided medical care? (several answers are possible)
CL Item
(durch den Hausarzt)
CL Item
(durch den Facharzt)
CL Item
(in der Notfallambulanz)
Item
5d2. Specify the treatment. (several answers are possible)
text
C1457887 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Code List
5d2. Specify the treatment. (several answers are possible)
CL Item
(Keine Maßnahmen)
CL Item
(neue Medikamente)
CL Item
(weitere Diagnostik)
CL Item
(Studienmedikation abgesetzt)
CL Item
(stationäre Aufnahme)
Further Symptoms: Referral
Item
5d2. Specify the treatment. If REFERRAL, please specify.
text
C1457887 (UMLS CUI [1,1])
C0034927 (UMLS CUI [1,2])
Further Symptoms: Treatment Specification
Item
5d2. Specify the treatment. If OTHER, please specify.
text
C1457887 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Antibiotics
Item
Antibiotics: Drug Name (e.g. Cefuroxim)
text
C0003232 (UMLS CUI [1])
Antibiotics: Dosage
Item
Antibiotics: Dosage (e.g. 500 mg)
text
C0003232 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Antibiotics: Medication Frequency
Item
Antibiotics: Medication Frequency (e.g. 2x1 tablets)
text
C0003232 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Antibiotics: Start Date
Item
Antibiotics: Start Date
date
C0003232 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Antibiotics: End Date
Item
Antibiotics: End Date
date
C0003232 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Analgesics
Item
Analgesics: Drug Name
text
C0002771 (UMLS CUI [1])
Analgesics: Dosage
Item
Analgesics: Dosage (e.g. 500 mg)
text
C0002771 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Analgesics: Medication Frequency
Item
Analgesics: Medication Frequency (e.g. 2x1 tablets)
text
C0002771 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Analgesics: Start Date
Item
Analgesics: Start Date
date
C0002771 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Anagesics: End Date
Item
Analgesics: End Date
date
C0002771 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Other Medication
Item
Other Medication: Drug Name
text
C1115771 (UMLS CUI [1])
Other Medication: Dosage
Item
Other Medication: Dosage (e.g. 500 mg)
text
C1115771 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
Other Medication: Medication Frequency
Item
Other Medication: Medication Frequency (e.g. 2x1 tablets)
text
C1115771 (UMLS CUI [1,1])
C3476109 (UMLS CUI [1,2])
Other Medication: Start Date
Item
Other Medication: Start Date
date
C1115771 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Other Medication: End Date
Item
Other Medication: End Date
date
C1115771 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Study Medication Completed
Item
Study Medication fully completed?
boolean
C2826299 (UMLS CUI [1])
Adverse Event Symptom
Item
Symptoms of Adverse Event
text
C0877248 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
Adverse Event Diagnosis
Item
Diagnosis of Adverse Event
text
C0877248 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Adverse Event ICD-10-Code
Item
ICD-10-Code
text
C2598420 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
Adverse Event: Start Date
Item
Start Date
date
C2697888 (UMLS CUI [1])
Adverse Event: End Date
Item
End Date
date
C2697886 (UMLS CUI [1])
Adverse Event: Ongoing
Item
Ongoing?
boolean
C2826663 (UMLS CUI [1])
Item
Is a SAE present?
text
C1519255 (UMLS CUI [1])
Code List
Is a SAE present?
CL Item
(wiederhergestellt)
CL Item
(noch nicht wiederhergestellt)
CL Item
(bleibender Schaden)
CL Item
(Patientin verstorben (Bitte SAE melden))
Item
Outcome of Adverse Event
text
C1705586 (UMLS CUI [1])
Code List
Outcome of Adverse Event
CL Item
(wiederhergestellt)
CL Item
(noch nicht wiederhergestellt)
CL Item
(bleibender Schaden)
CL Item
(Patientin verstorben (Bitte SAE melden))
Item
Severity of Adverse Event
text
C1710066 (UMLS CUI [1])
Code List
Severity of Adverse Event
CL Item
(leicht: normale Aktivitäten des täglichen Lebens werden nicht beeinträchtigt)
CL Item
(mittel: normale Aktivitäten des täglichen Lebens werden störend beeinträchtigt)
CL Item
(schwer: verhindert Aktivitäten des täglichen Lebens)
Item
Action Taken
text
C2826626 (UMLS CUI [1])
CL Item
(Prüfmedikation abgesetzt)
CL Item
(neue Begleitmedikation)
CL Item
(weitere Diagnostik)
CL Item
(stationäre Aufnahme)
CL Item
(anderwertige medizinische Versorgung)
Concomitant Medication: Pharmaceutical Preparations
Item
If Action Taken with Concomitant Medication, specify: Substance
text
C2347852 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Concomitant Medication: Daily Dosage
Item
If Action Taken with Concomitant Medication, specify: Daily Dosage
text
C0178602 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Item
Any relation to intake of fosfomycin?
text
C0439849 (UMLS CUI [1,1])
C0016610 (UMLS CUI [1,2])
Code List
Any relation to intake of fosfomycin?
CL Item
(unwahrscheinlich)
CL Item
(nicht abschätzbar)
Item
Any relation to intake of Arctuvan (Bearberry preparation)
text
C0439849 (UMLS CUI [1,1])
C0885849 (UMLS CUI [1,2])
Code List
Any relation to intake of Arctuvan (Bearberry preparation)
CL Item
(unwahrscheinlich)
CL Item
(nicht abschätzbar)
Date of Adverse Event
Item
Date of Adverse Event
date
C2985916 (UMLS CUI [1])
Investigator's Signature
Item
Signature
text
C2346576 (UMLS CUI [1])