English

Diary Card Part 1 Booster Vaccination 12-14 months of age

1 forms  
Administrative Documentation
Description

Administrative Documentation

Alias
UMLS CUI-1
C1320722
Subject Number
Description

Subject Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Local Symptoms (at injection site)
Description

Local Symptoms (at injection site)

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0205276
UMLS CUI-3
C2700396
UMLS CUI-4
C0042196
Redness
Description

Redness

Data type

boolean

Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C2700396
Redness, size (mm) Day 0
Description

Size of redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 1 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 2 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 3 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 4 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 5 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 6 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Redness, size (mm) Day 7 Evening
Description

Size of Redness

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0456389
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
mm
Ongoing redness after day 7?
Description

Ongoing symptom

Data type

boolean

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C3174772
UMLS CUI [1,3]
C0332575
UMLS CUI [1,4]
C2700396
Date of last day of symptoms
Description

Date

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1457887
UMLS CUI [1,3]
C0332575
UMLS CUI [1,4]
C2700396
Medically attended visit
Description

Medically attended visit

Data type

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
Swelling (SW)
Description

Swelling

Data type

boolean

Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C2700396
Swelling, size (mm) Day 0
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 1 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 2 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 3 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 4 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 5 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 6 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling, size (mm) Day 7 Evening
Description

Swelling

Data type

float

Measurement units
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Ongoing swelling after day 7?
Description

Ongoing symptom

Data type

boolean

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0549178
UMLS CUI [1,3]
C0038999
UMLS CUI [1,4]
C2700396
Date of last day of symptoms
Description

Date

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
UMLS CUI [1,4]
C0806020
Medically attended visit
Description

Medically attended visit

Data type

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0038999
Pain
Description

Pain

Data type

boolean

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C2700396
Pain, intensity Day 0
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 1 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 2 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 3 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 4 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 5 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 6 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain, intensity Day 7 Evening
Description

Pain

Data type

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Ongoing after day 7?
Description

Ongoing symptom

Data type

boolean

Alias
UMLS CUI [1,1]
C0521491
UMLS CUI [1,2]
C0549178
Date of last day of symptoms
Description

Date

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C2700396
Medically attended visit
Description

Medically attended visit

Data type

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0332575
Other Local Symptoms (Day 0 to day 30)
Description

Other Local Symptoms (Day 0 to day 30)

Alias
UMLS CUI-1
C1457887
UMLS CUI-2
C0205276
UMLS CUI-3
C0042196
Description - please specify side(s) and site(s)
Description

Description

Data type

text

Alias
UMLS CUI [1,1]
C0678257
UMLS CUI [1,2]
C1457887
UMLS CUI [1,3]
C0205276
Intensity
Description

Intensity

Data type

text

Alias
UMLS CUI [1]
C0518690
Start date
Description

Start date

Data type

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C1457887
UMLS CUI [1,3]
C0205276
End date
Description

End date

Data type

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C1457887
UMLS CUI [1,3]
C0205276
Check box if continuing
Description

Ongoing symptom

Data type

boolean

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C3174772
Medically attended visit
Description

Medically attended visit

Data type

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0205276
UMLS CUI [1,4]
C1457887
Back to the top of the page

Similar models

Diary Card Part 1 Booster Vaccination 12-14 months of age

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Documentation
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item Group
Local Symptoms (at injection site)
C1457887 (UMLS CUI-1)
C0205276 (UMLS CUI-2)
C2700396 (UMLS CUI-3)
C0042196 (UMLS CUI-4)
Redness
Item
Redness
boolean
C0332575 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Size of redness
Item
Redness, size (mm) Day 0
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 1 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 2 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 3 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 4 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 5 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 6 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Size of Redness
Item
Redness, size (mm) Day 7 Evening
float
C0456389 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing symptom
Item
Ongoing redness after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C3174772 (UMLS CUI [1,2])
C0332575 (UMLS CUI [1,3])
C2700396 (UMLS CUI [1,4])
Date
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C0332575 (UMLS CUI [1,3])
C2700396 (UMLS CUI [1,4])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
Swelling
Item
Swelling (SW)
boolean
C0038999 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Swelling
Item
Swelling, size (mm) Day 0
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 1 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 2 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 3 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 4 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 5 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 6 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Swelling
Item
Swelling, size (mm) Day 7 Evening
float
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing symptom
Item
Ongoing swelling after day 7?
boolean
C1457887 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C0038999 (UMLS CUI [1,3])
C2700396 (UMLS CUI [1,4])
Date
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
C0806020 (UMLS CUI [1,4])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0038999 (UMLS CUI [1,3])
Pain
Item
Pain
boolean
C0030193 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Item
Pain, intensity Day 0
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain intensity
Code List
Pain, intensity Day 0
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 1 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 1 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 2 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 2 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 3 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 3 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 4 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 4 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 5 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 5 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 6 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 6 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Item
Pain, intensity Day 7 Evening
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain
Code List
Pain, intensity Day 7 Evening
CL Item
Absent (0)
CL Item
Minor reaction to touch (1)
CL Item
Cries/protests on touch (2)
CL Item
Cries when limb is moved /spontaneously painful (3)
Ongoing symptom
Item
Ongoing after day 7?
boolean
C0521491 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date
Item
Date of last day of symptoms
date
C0011008 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Medically attended visit
Item
Medically attended visit
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0332575 (UMLS CUI [1,3])
Item Group
Other Local Symptoms (Day 0 to day 30)
C1457887 (UMLS CUI-1)
C0205276 (UMLS CUI-2)
C0042196 (UMLS CUI-3)
Description
Item
Description - please specify side(s) and site(s)
text
C0678257 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
Item
Intensity
text
C0518690 (UMLS CUI [1])
Intensity
Code List
Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Start date
Item
Start date
date
C0808070 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
End date
Item
End date
date
C0806020 (UMLS CUI [1,1])
C1457887 (UMLS CUI [1,2])
C0205276 (UMLS CUI [1,3])
Ongoing symptom
Item
Check box if continuing
boolean
C1457887 (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])
C0205276 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,4])
Back to the top of the page