Medical History
Item
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject since the last visit of the previous study MenACWY-TT-010 (103533) ? Please tick appropriate box(es) and give diagnosis
boolean
C0262926 (UMLS CUI [1])
C0205476 (UMLS CUI [2,1])
C0348080 (UMLS CUI [2,2])
C1457887 (UMLS CUI [3])
Item
Organ system
integer
C0678852 (UMLS CUI [1])
CL Item
Ears-Nose-Throat (6)
CL Item
Cardiovascular (2)
CL Item
Gastrointestinal (1)
CL Item
Muskuloskeletal (7)
CL Item
Genitourinary (12)
CL Item
Other (specify) (99)
Diagnosis
Item
Diagnosis
text
C0011900 (UMLS CUI [1])
Item
Ongoing disease?
text
C0699749 (UMLS CUI [1,1])
C0037274 (UMLS CUI [1,2])
Code List
Ongoing disease?
CL Item
Current (Current)
Item
Is the subject's previous vaccination status known or changed against meningococcal vaccines and investigational or non-registered vaccines since the last visit of the previous study MenACWY-TT-010 (103533) ?
text
C1443394 (UMLS CUI [1,1])
C0700144 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
C1517586 (UMLS CUI [1,4])
Code List
Is the subject's previous vaccination status known or changed against meningococcal vaccines and investigational or non-registered vaccines since the last visit of the previous study MenACWY-TT-010 (103533) ?
CL Item
Unknown (Unknown)
CL Item
Yes, if yes, please complete the following table (Yes, if yes, please complete the following table)
Name
Item
Trade / (Generic) Name
text
C0027365 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Route
Item
Route
text
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Date
Item
Administration date
date
C0011008 (UMLS CUI [1,1])
C0042196 (UMLS CUI [1,2])
Investigator Use
Item
For GSK
text
C0008961 (UMLS CUI [1,1])
C0457083 (UMLS CUI [1,2])
Item
Have any medications/treatments included any investigational or non-registered product(s), any immunosuppressant(s) or other immune-modifying drug(s), immunoglobulins and/or any blood product been administered since the last visit of the previous study MenACWY-TT-010 (103533) ?
text
C0580105 (UMLS CUI [1])
Code List
Have any medications/treatments included any investigational or non-registered product(s), any immunosuppressant(s) or other immune-modifying drug(s), immunoglobulins and/or any blood product been administered since the last visit of the previous study MenACWY-TT-010 (103533) ?
CL Item
Yes, please complete the following table (Yes, please complete the following table)
Name
Item
Trade/Generic name
text
C2360065 (UMLS CUI [1])
Medical indication
Item
Medical indication
text
C3146298 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Item
Medical Indication
text
C3146298 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Code List
Medical Indication
CL Item
Prophylactic (Prophylactic)
CL Item
Non Prophylactic (Non Prophylactic)
Total 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
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
Tick box if continuing medication at the beginning of this study
boolean
C2826666 (UMLS CUI [1])
Investigator use
Item
For GSK
text
C0008961 (UMLS CUI [1,1])
C0457083 (UMLS CUI [1,2])
Blood sample
Item
Has a blood sample been taken ?
boolean
C0005834 (UMLS CUI [1,1])
C1277698 (UMLS CUI [1,2])
Date of blood sample
Item
Please complete only if different from visit date:
date
C0005834 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])