Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Date Diary Card return
Item
PLEASE DO NOT FORGET TO BRING BACK THE DIARY CARD ON
date
C0011008 (UMLS CUI [1,1])
C3890583 (UMLS CUI [1,2])
C0545082 (UMLS CUI [1,3])
C1548100 (UMLS CUI [1,4])
Item
Has the subject experienced any of the following signs/symptoms during the solicited period?
text
C0037088 (UMLS CUI [1])
Code List
Has the subject experienced any of the following signs/symptoms during the solicited period?
CL Item
Information not available (U)
CL Item
No vaccine administered (NA)
CL Item
Yes, please tick No/Yes for each symptom. If yes is ticked, please complete all items. (Y)
Fever
Item
Fever
boolean
C0015967 (UMLS CUI [1])
Item
Location of fever measurement
text
C0449687 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Code List
Location of fever measurement
Fever
Item
Fever Day 0
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 1 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 2 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 3 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 4 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 5 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 6 Evening
float
C0015967 (UMLS CUI [1])
Fever
Item
Fever Day 7 Evening
float
C0015967 (UMLS CUI [1])
Ongoing symptom
Item
Ongoing after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
C0015967 (UMLS CUI [1,3])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0015967 (UMLS CUI [1,3])
Irritability
Item
Irritability/ Fussiness
boolean
C0022107 (UMLS CUI [1])
Item
Irritability/Fussiness Intensity Day 0
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Irritability/Fussiness Intensity Day 0
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of Irritability/fussiness Day 1 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of Irritability/fussiness Day 1 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of Irritability/fussiness Day 2 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of Irritability/fussiness Day 2 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of irritability/fussiness day 3 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of irritability/fussiness day 3 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of irritability/fussiness day 4 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of irritability/fussiness day 4 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of irritability/fussiness Day 5 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of irritability/fussiness Day 5 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of irritability/fussiness Day 6 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of irritability/fussiness Day 6 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Item
Intensity of irritability/fussiness Day 7 Evening
integer
C0518690 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Code List
Intensity of irritability/fussiness Day 7 Evening
CL Item
Behavior as usual (0)
CL Item
Crying more than usual / no effect on normal activity (1)
CL Item
Crying more than usual / interferes with normal activity (2)
CL Item
Crying that cannot be comforted / prevents normal activity (3)
Ongoing symptom
Item
Ongoing after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
C0022107 (UMLS CUI [1,3])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0022107 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C1386497 (UMLS CUI [1,3])
C0022107 (UMLS CUI [1,4])
Drowsiness
Item
Drowsiness
boolean
C0013144 (UMLS CUI [1])
Item
Drowsiness Intensity Day 0
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Drowsiness Intensity Day 0
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 1 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 1 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of drowsiness Day 2 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of drowsiness Day 2 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 3 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 3 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 4 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 4 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 5 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 5 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 6 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 6 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Item
Intensity of Drowsiness Day 7 Evening
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of Drowsiness Day 7 Evening
CL Item
Behavior as usual (0)
CL Item
Drowsiness easily tolerated (1)
CL Item
Drowsiness that interferes with normal activity (2)
CL Item
Drowsiness that prevents normal activity (3)
Ongoing symptom?
Item
Ongoing after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
C0013144 (UMLS CUI [1,3])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0013144 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0013144 (UMLS CUI [1,3])
Contact information
Item
IN CASE OF HOSPITALISATION, PLEASE INFORM
text
C1880174 (UMLS CUI [1,1])
C0019993 (UMLS CUI [1,2])
Loss of appetite
Item
Loss of appetite
boolean
C1971624 (UMLS CUI [1])
Item
Loss of appetite, Intensity Day 0
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 0
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 1 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 1 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity day 2 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity day 2 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 3 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 3 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 4 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 4 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 5 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 5 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 6 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 6 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Item
Loss of appetite, Intensity Day 7 Evening
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Loss of appetite, Intensity Day 7 Evening
CL Item
Appetite as usual (0)
CL Item
Eating less than usual / no effect on normal activity (1)
CL Item
Eating less than usual / interferes with normal activity (2)
CL Item
Not eating at all (3)
Ongoing symptom
Item
Ongoing after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
C1971624 (UMLS CUI [1,3])
Date of last day of symptoms
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C1971624 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C1971624 (UMLS CUI [1,3])
Description
Item
Description - please give details below
text
C0678257 (UMLS CUI [1,1])
C0029625 (UMLS CUI [1,2])
Item
Intensity
text
C1710066 (UMLS CUI [1,1])
C0159028 (UMLS CUI [1,2])
Start date
Item
Start date
date
C0808070 (UMLS CUI [1,1])
C0159028 (UMLS CUI [1,2])
End date
Item
End date
text
C0806020 (UMLS CUI [1,1])
C0159028 (UMLS CUI [1,2])
Ongoing Symptom
Item
Check box if continuing
boolean
C0159028 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0159028 (UMLS CUI [1,3])
Medication
Item
Trade/Generic name
text
C0013227 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Reason
Item
Reason
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Total Daily Dose
Item
Total Daily Dose
text
C2348070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Start date
Item
Start date
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
End date
Item
End date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Ongoing medication
Item
Check box if continuing
boolean
C2826666 (UMLS CUI [1])