ID
27314
Description
Original CRFs from: K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor. Further details on: http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html https://clinicaltrials.gov/ct2/show/NCT03151603 Questionnaire Day 28
Link
http://www.allgemeinmedizin.med.uni-goettingen.de/en/content/research/510_520.html
Keywords
Versions (1)
- 11/7/17 11/7/17 -
Copyright Holder
K.Afshar, J. Bleidorn, E. Hummers-Pradier, I. Gágyor
Uploaded on
November 7, 2017
DOI
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License
Creative Commons BY-NC-ND 3.0
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Questionnaire Day 28 REGATTA NCT03151603
Questionnaire Day 28 REGATTA NCT03151603
- StudyEvent: ODM
Description
Previous Urinary Tract Infection
Alias
- UMLS CUI-1
- C0205156
- UMLS CUI-2
- C0042029
Description
Previous Urinary Tract Infection
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0205156
- UMLS CUI [1,2]
- C0042029
Description
Numbers of Previous Urinary Tract Infection
Data type
text
Alias
- UMLS CUI [1,1]
- C0449788
- UMLS CUI [1,2]
- C0205156
- UMLS CUI [1,3]
- C0042029
Description
Urinary Tract Infection: Sick Leave
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0242807
- UMLS CUI [1,2]
- C0042029
Description
Urinary Tract Infection: Sick Leave Specification
Data type
float
Measurement units
- Tage
Alias
- UMLS CUI [1,1]
- C0242807
- UMLS CUI [1,2]
- C0042029
- UMLS CUI [1,3]
- C2348235
Description
Urinary Tract Infection: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C0808070
Description
Urinary Tract Infection: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C0806020
Description
Urinary Tract Infection: Office Visit
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C0028900
Description
Urinary Tract Infection: Physicians
Data type
text
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C0031831
Description
Urinary Tract Infection: Febrile Infection
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C0948233
Description
Pharmacotherapy - If you have a further urinary tract infection, continue on page 3. If you have further health problems/issues continue on page 4.
Alias
- UMLS CUI-1
- C0013216
Description
If YES, please specify everything what you have not noted in patient diary.
Data type
boolean
Alias
- UMLS CUI [1]
- C0013216
Description
Antibiotics
Data type
text
Alias
- UMLS CUI [1]
- C0003232
Description
Antibiotics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0178602
Description
Antibiotics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C3476109
Description
Antibiotics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0808070
Description
Antibiotics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0806020
Description
Analgesics
Data type
text
Alias
- UMLS CUI [1]
- C0002771
Description
Analgesics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0178602
Description
Analgesics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C3476109
Description
Analgesics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0808070
Description
Anagesics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0806020
Description
Other Medication
Data type
text
Alias
- UMLS CUI [1]
- C1115771
Description
Other Medication: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0178602
Description
Other Medication: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C3476109
Description
Other Medication: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0808070
Description
Other Medication: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0806020
Description
Further Urinary Tract Infection
Alias
- UMLS CUI-1
- C0042029
- UMLS CUI-2
- C1517331
Description
Further Urinary Tract Infection
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0042029
- UMLS CUI [1,2]
- C1517331
Description
Date of Further Urinary Tract Infection
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0042029
- UMLS CUI [1,3]
- C1517331
Description
Further Urinary Tract Infection: Office Visit
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1517331
- UMLS CUI [1,2]
- C0042029
- UMLS CUI [1,3]
- C0028900
Description
Further Urinary Tract Infection: Physicians
Data type
text
Alias
- UMLS CUI [1,1]
- C1517331
- UMLS CUI [1,2]
- C0042029
- UMLS CUI [1,3]
- C0031831
Description
Further Urinary Tract Infection: Febrile Infection
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1517331
- UMLS CUI [1,2]
- C0042029
- UMLS CUI [1,3]
- C0948233
Description
Pharmacotherapy: Further Urinary Tract Infection
Alias
- UMLS CUI-1
- C0013216
- UMLS CUI-2
- C0042029
- UMLS CUI-3
- C1517331
Description
If YES, please specify everything what you have not noted in patient diary.
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0013216
- UMLS CUI [1,2]
- C1517331
Description
Further Antibiotics
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C1517331
Description
Further Antibiotics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0178602
Description
Further Antibiotics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C3476109
Description
Further Antibiotics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0808070
Description
Further Antibiotics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0806020
Description
Further Analgesics
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C1517331
Description
Further Analgesics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0178602
Description
Further Analgesics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C3476109
Description
Further Analgesics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0808070
Description
Further Anagesics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0806020
Description
Further Other Medication
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C1517331
Description
Further Other Medication: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0178602
Description
Further Other Medication: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C3476109
Description
Further Other Medication: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0808070
Description
Further Other Medication: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C1517331
- UMLS CUI [1,3]
- C0806020
Description
Further Symptoms - On the following pages we ask you for information on further symptoms since study inclusion. Please use a new page for each symptome complex. Symptoms with which you have visited your general physician do not have to be noted.
Alias
- UMLS CUI-1
- C1457887
Description
Further Symptoms
Data type
boolean
Alias
- UMLS CUI [1]
- C1457887
Description
Further Symptoms: Specification
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C2348235
Description
Further Symptoms: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0808070
Description
Further Symptoms: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0806020
Description
Affected by Further Symptoms
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0392760
Description
Further Symptoms: Office Visit
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0028900
Description
Further Symptoms: Physicians
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0031831
Description
Further Symptoms: Treatment
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0087111
Description
Further Symptoms: Referral
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0034927
Description
Further Symptoms: Treatment Specification
Data type
text
Alias
- UMLS CUI [1,1]
- C1457887
- UMLS CUI [1,2]
- C0087111
- UMLS CUI [1,3]
- C2348235
Description
Pharmacotherapy: Further Symptoms - Please note every medication you have taken for this symptom.
Alias
- UMLS CUI-1
- C0013216
- UMLS CUI-2
- C1457887
Description
Antibiotics
Data type
text
Alias
- UMLS CUI [1]
- C0003232
Description
Antibiotics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0178602
Description
Antibiotics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C3476109
Description
Antibiotics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0808070
Description
Antibiotics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0003232
- UMLS CUI [1,2]
- C0806020
Description
Analgesics
Data type
text
Alias
- UMLS CUI [1]
- C0002771
Description
Analgesics: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0178602
Description
Analgesics: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C3476109
Description
Analgesics: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0808070
Description
Anagesics: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C0002771
- UMLS CUI [1,2]
- C0806020
Description
Other Medication
Data type
text
Alias
- UMLS CUI [1]
- C1115771
Description
Other Medication: Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0178602
Description
Other Medication: Medication Frequency
Data type
text
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C3476109
Description
Other Medication: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0808070
Description
Other Medication: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1,1]
- C1115771
- UMLS CUI [1,2]
- C0806020
Description
Study Medication
Alias
- UMLS CUI-1
- C0304229
Description
Adverse Event
Alias
- UMLS CUI-1
- C0877248
Description
Adverse Event Symptom
Data type
text
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C1457887
Description
Adverse Event Diagnosis
Data type
text
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0011900
Description
Adverse Event ICD-10-Code
Data type
text
Alias
- UMLS CUI [1,1]
- C2598420
- UMLS CUI [1,2]
- C0877248
Description
Adverse Event: Start Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1]
- C2697888
Description
Adverse Event: End Date
Data type
date
Measurement units
- tt.mm.jjjj
Alias
- UMLS CUI [1]
- C2697886
Description
Adverse Event: Ongoing
Data type
boolean
Alias
- UMLS CUI [1]
- C2826663
Description
Serious Adverse Event
Data type
text
Alias
- UMLS CUI [1]
- C1519255
Description
Adverse Event Outcome
Data type
text
Alias
- UMLS CUI [1]
- C1705586
Description
Severity of Adverse Event
Data type
text
Alias
- UMLS CUI [1]
- C1710066
Description
Adverse Event Action Taken
Data type
text
Alias
- UMLS CUI [1]
- C2826626
Description
Concomitant Medication: Pharmaceutical Preparations
Data type
text
Alias
- UMLS CUI [1,1]
- C2347852
- UMLS CUI [1,2]
- C0013227
Description
Concomitant Medication: Daily Dosage
Data type
text
Alias
- UMLS CUI [1,1]
- C0178602
- UMLS CUI [1,2]
- C2347852
Description
Relation to Fosfomycin
Data type
text
Alias
- UMLS CUI [1,1]
- C0439849
- UMLS CUI [1,2]
- C0016610
Description
Relation to Bearberry preparation
Data type
text
Alias
- UMLS CUI [1,1]
- C0439849
- UMLS CUI [1,2]
- C0885849
Description
Date of Adverse Event
Data type
date
Measurement units
- dd-mmm-yyyy
Alias
- UMLS CUI [1]
- C2985916
Description
Investigator's Signature
Data type
text
Alias
- UMLS CUI [1]
- C2346576
Similar models
Questionnaire Day 28 REGATTA NCT03151603
- StudyEvent: ODM
C0042029 (UMLS CUI-2)
C0042029 (UMLS CUI [1,2])
C0205156 (UMLS CUI [1,2])
C0042029 (UMLS CUI [1,3])
C0042029 (UMLS CUI [1,2])
C0042029 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0028900 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,2])
C0948233 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C1517331 (UMLS CUI-2)
C1517331 (UMLS CUI [1,2])
C0042029 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,3])
C0042029 (UMLS CUI [1,2])
C0028900 (UMLS CUI [1,3])
C0042029 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,3])
C0042029 (UMLS CUI [1,2])
C0948233 (UMLS CUI [1,3])
C0042029 (UMLS CUI-2)
C1517331 (UMLS CUI-3)
C1517331 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C1517331 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,3])
C1517331 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0392760 (UMLS CUI [1,2])
C0028900 (UMLS CUI [1,2])
C0031831 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,2])
C0034927 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C1457887 (UMLS CUI-2)
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,2])
C0011900 (UMLS CUI [1,2])
C0877248 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C2347852 (UMLS CUI [1,2])
C0016610 (UMLS CUI [1,2])
C0885849 (UMLS CUI [1,2])