ID

28998

Beschreibung

A phase IV, open, multicentre study to assess the immunogenicity and reactogenicity of GlaxoSmithKline Biologicals’ DTPa-HBV-IPV/Hib vaccine (Infanrix hexa) given as a booster at 18-24 months of age to pre-term children who have received a three-dose primary immunization course with the same vaccine in study 217744/090.

Stichworte

Versionen (1)
  1. 20.02.18 20.02.18 -
Rechteinhaber

GlaxoSmithKline (GSK)

Hochgeladen am

20. Februar 2018

DOI

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Lizenz

Creative Commons BY-NC 3.0
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Biologicals’ DTPa-HBV-IPV/Hib vaccine (Infanrix-hexa) Study ID: 101518

Englisch

Diary Card, local and general symptoms

2 Formulare  
Redness day and size
Beschreibung

Redness day and size

Alias
UMLS CUI-1
C0332575
UMLS CUI-2
C0456389
UMLS CUI-3
C2700396
Redness day
Beschreibung

Redness day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0439228
UMLS CUI [1,2]
C0332575
Redness size
Beschreibung

Redness size

Datentyp

integer

Maßeinheiten
  • mm
Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Redness
Beschreibung

Redness

Alias
UMLS CUI-1
C0332575
UMLS CUI-2
C2700396
Ongoing after Day 3?
Beschreibung

Ongoing redness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0332575
UMLS CUI [1,2]
C0549178
UMLS CUI [1,3]
C2700396
Date of last day of symptoms of redness:
Beschreibung

If you answered the previous question with yes, please specify

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0332575
UMLS CUI [1,3]
C2700396
Medically attended visit concerning redness
Beschreibung

Medically attended visit concerning redness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0332575
Swelling day and size
Beschreibung

Swelling day and size

Alias
UMLS CUI-1
C0038999
UMLS CUI-2
C0456389
UMLS CUI-3
C2700396
Swelling day
Beschreibung

Swelling day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0439228
UMLS CUI [1,2]
C0038999
Swelling size
Beschreibung

Swelling size

Datentyp

integer

Maßeinheiten
  • mm
Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0456389
UMLS CUI [1,3]
C2700396
mm
Swelling
Beschreibung

Swelling

Alias
UMLS CUI-1
C0038999
Swelling ongoing after day 3?
Beschreibung

Ongoing Swelling

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0038999
UMLS CUI [1,2]
C0549178
UMLS CUI [1,3]
C2700396
Date of last day of symptoms of swelling:
Beschreibung

If you answered the previous question with yes, please specify

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0038999
UMLS CUI [1,3]
C2700396
Medically attended visit concerning swelling
Beschreibung

Medically attended visit concerning swelling

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0038999
Pain day and intensity
Beschreibung

Pain day and intensity

Alias
UMLS CUI-1
C0030193
UMLS CUI-2
C0522510
UMLS CUI-3
C2700396
Pain day
Beschreibung

Pain day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0439228
UMLS CUI [1,2]
C0030193
Pain intensity
Beschreibung

Pain intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0522510
UMLS CUI [1,3]
C2700396
Pain
Beschreibung

Pain

Alias
UMLS CUI-1
C0030193
Pain ongoing after day 3?
Beschreibung

Ongoing pain

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0030193
UMLS CUI [1,2]
C0549178
UMLS CUI [1,3]
C2700396
Date of last day of symptoms of pain:
Beschreibung

If you answered the previous question with yes, please specify

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0030193
UMLS CUI [1,3]
C2700396
Medically attended visit concerning pain
Beschreibung

Medically attended visit concerning pain

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0030193
Other local symptoms
Beschreibung

Other local symptoms

Alias
UMLS CUI-1
C0205394
UMLS CUI-2
C1457887
UMLS CUI-3
C0205276
Description - please specify side(s) and site(s)
Beschreibung

Description

Datentyp

text

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

Intensity

Datentyp

integer

Alias
UMLS CUI [1]
C0518690
Start date
Beschreibung

Start date

Datentyp

date

Alias
UMLS CUI [1]
C0808070
End date
Beschreibung

End date

Datentyp

date

Alias
UMLS CUI [1]
C0806020
Check box if continuing
Beschreibung

Continuing symptoms

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0549178
Temperature day and °C
Beschreibung

Temperature day and °C

Alias
UMLS CUI-1
C0518690
UMLS CUI-2
C0039476
Temperature day
Beschreibung

Temperature day

Datentyp

integer

Temperature °C axillary, evening
Beschreibung

Temperature °C axillary

Datentyp

integer

Maßeinheiten
  • °C
Alias
UMLS CUI [1]
C1531924
°C
Temperature
Beschreibung

Temperature

Alias
UMLS CUI-1
C0005903
Fever ongoing after day 3?
Beschreibung

Ongoing fever

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0015967
UMLS CUI [1,2]
C0549178
Date of last day of symptoms of fever
Beschreibung

If you answered the previous question with yes, please specify

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0015967
Medically attended visit concerning fever
Beschreibung

Medically attended visit concerning fever

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0015967
Irritability/Fussiness day and intensity
Beschreibung

Irritability/Fussiness day and intensity

Alias
UMLS CUI-1
C0022107
UMLS CUI-2
C0522510
Irritability/Fussiness day
Beschreibung

Irritability/Fussiness day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0022107
UMLS CUI [1,2]
C0439228
Irritability/Fussiness intensity
Beschreibung

Irritability/Fussiness intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C0022107
UMLS CUI [1,2]
C0522510
Irritability / Fussiness
Beschreibung

Irritability / Fussiness

Alias
UMLS CUI-1
C0022107
Irritability / Fussiness ongoing after day 3?
Beschreibung

Ongoing Irritability / Fussiness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0022107
UMLS CUI [1,2]
C0549178
Date of last Irritability / Fussiness
Beschreibung

Date of last Irritability / Fussiness

Datentyp

date

Alias
UMLS CUI [1,1]
C0022107
UMLS CUI [1,2]
C0011008
Medically attended visit concerning Irritability / Fussiness
Beschreibung

Medically attended visit concerning Irritability / Fussiness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0022107
Drowsiness day and intensity
Beschreibung

Drowsiness day and intensity

Alias
UMLS CUI-1
C0013144
UMLS CUI-2
C0522510
Drowsiness day
Beschreibung

Drowsiness day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0013144
UMLS CUI [1,2]
C0439228
Drowsiness intensity
Beschreibung

Drowsiness intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C0013144
UMLS CUI [1,2]
C0522510
Drowsiness
Beschreibung

Drowsiness

Alias
UMLS CUI-1
C0013144
Ongoing after Day 3?
Beschreibung

Ongoing drowsiness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0013144
UMLS CUI [1,2]
C0549178
Date of last Day of Symptoms
Beschreibung

Date of last Day of Symptoms

Datentyp

date

Alias
UMLS CUI [1,1]
C0013144
UMLS CUI [1,2]
C0011008
Medically attended visit concerning drowsiness
Beschreibung

Medically attended visit concerning drowsiness

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0013144
Loss of appetite day and intensity
Beschreibung

Loss of appetite day and intensity

Alias
UMLS CUI-1
C1971624
UMLS CUI-2
C0522510
Loss of appetite day
Beschreibung

Loss of appetite day

Datentyp

integer

Alias
UMLS CUI [1,1]
C0439228
UMLS CUI [1,2]
C1971624
Loss of appetite intensity
Beschreibung

Loss of appetite intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C1971624
UMLS CUI [1,2]
C0522510
Loss of appetite
Beschreibung

Loss of appetite

Alias
UMLS CUI-1
C1971624
Ongoing after Day 3?
Beschreibung

Ongoing loss of appetite

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1971624
UMLS CUI [1,2]
C0549178
Date of last Day of Symptoms
Beschreibung

Date of last Day of Symptoms

Datentyp

date

Alias
UMLS CUI [1,1]
C1971624
UMLS CUI [1,2]
C0011008
Medically attended visit concerning loss of appetite
Beschreibung

Medically attended visit concerning loss of appetite

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C1971624
Other general symptoms
Beschreibung

Other general symptoms

Alias
UMLS CUI-1
C0029625
Description - please give details below
Beschreibung

Description

Datentyp

text

Alias
UMLS CUI [1,1]
C0678257
UMLS CUI [1,2]
C0029625
Intensity
Beschreibung

Intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C0518690
UMLS CUI [1,2]
C0159028
Start date
Beschreibung

Start date

Datentyp

date

Alias
UMLS CUI [1]
C0808070
End date
Beschreibung

End date

Datentyp

date

Alias
UMLS CUI [1]
C0806020
Check box if continuing
Beschreibung

Continuing general symptoms

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0029625
UMLS CUI [1,2]
C0549178
Medically attended visit?
Beschreibung

Medically attended visit

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0545082
UMLS CUI [1,2]
C1386497
UMLS CUI [1,3]
C0029625
Medication
Beschreibung

Medication

Alias
UMLS CUI-1
C0013227
Trade/Generic name
Beschreibung

Please fill in below if any medication has been taken since the vaccination

Datentyp

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C2360065
Reason
Beschreibung

Reason

Datentyp

text

Alias
UMLS CUI [1]
C0392360
Total daily dose
Beschreibung

Total daily dose

Datentyp

integer

Alias
UMLS CUI [1]
C2348070
Start date
Beschreibung

Start date

Datentyp

date

Alias
UMLS CUI [1]
C0808070
End date
Beschreibung

End date

Datentyp

date

Alias
UMLS CUI [1]
C0806020
Check box if continuing
Beschreibung

Continuing medication

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
General information Dairy card
Beschreibung

General information Dairy card

Alias
UMLS CUI-1
C1508263
Please do not forget to bring back the diary card on:
Beschreibung

Return of Diary card

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C3890583
UMLS CUI [1,3]
C0545082
UMLS CUI [1,4]
C1548100
In case of hospitalization please inform:
Beschreibung

Hospitalisation information

Datentyp

text

Alias
UMLS CUI [1]
C0019993
In case of hospitalization please inform:
Beschreibung

Hospitalisation information

Datentyp

integer

Alias
UMLS CUI [1]
C0019993
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Ähnliche Modelle

Diary Card, local and general symptoms

2 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Redness day and size
C0332575 (UMLS CUI-1)
C0456389 (UMLS CUI-2)
C2700396 (UMLS CUI-3)
Item
Redness day
integer
C0439228 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
Redness day
Code List
Redness day
CL Item
Day 0 (1)
CL Item
Day 1 (2)
CL Item
Day 2 (3)
CL Item
Day 3  (4)
Redness size
Item
Redness size
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Item Group
Redness
C0332575 (UMLS CUI-1)
C2700396 (UMLS CUI-2)
Ongoing redness
Item
Ongoing after Day 3?
boolean
C0332575 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing redness
Item
Date of last day of symptoms of redness:
date
C0011008 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Medically attended visit concerning redness
Item
Medically attended visit concerning redness
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0332575 (UMLS CUI [1,3])
Item Group
Swelling day and size
C0038999 (UMLS CUI-1)
C0456389 (UMLS CUI-2)
C2700396 (UMLS CUI-3)
Item
Swelling day
integer
C0439228 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
Swelling day
Code List
Swelling day
CL Item
Day 0  (1)
CL Item
Day 1  (2)
CL Item
Day 2  (3)
CL Item
Day 3 (4)
Swelling size
Item
Swelling size
integer
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Item Group
Swelling
C0038999 (UMLS CUI-1)
Ongoing Swelling
Item
Swelling ongoing after day 3?
boolean
C0038999 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing swelling
Item
Date of last day of symptoms of swelling:
date
C0011008 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Medically attended visit concerning swelling
Item
Medically attended visit concerning swelling
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0038999 (UMLS CUI [1,3])
Item Group
Pain day and intensity
C0030193 (UMLS CUI-1)
C0522510 (UMLS CUI-2)
C2700396 (UMLS CUI-3)
Item
Pain day
integer
C0439228 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
Pain day
Code List
Pain day
CL Item
Day 0  (1)
CL Item
Day 1  (2)
CL Item
Day 2  (3)
CL Item
Day 3 (4)
Item
Pain intensity
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Pain intensity
Code List
Pain intensity
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 Group
Pain
C0030193 (UMLS CUI-1)
Ongoing pain
Item
Pain ongoing after day 3?
boolean
C0030193 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing pain
Item
Date of last day of symptoms of pain:
date
C0011008 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Medically attended visit concerning pain
Item
Medically attended visit concerning pain
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0030193 (UMLS CUI [1,3])
Item Group
Other local symptoms
C0205394 (UMLS CUI-1)
C1457887 (UMLS CUI-2)
C0205276 (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
integer
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])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
Continuing symptoms
Item
Check box if continuing
boolean
C1457887 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Item Group
Temperature day and °C
C0518690 (UMLS CUI-1)
C0039476 (UMLS CUI-2)
Item
Temperature day
integer
Temperature day
Code List
Temperature day
CL Item
Day 0 (1)
CL Item
Day 1 (2)
CL Item
Day 2 (3)
CL Item
Day 3 (4)
Temperature °C axillary
Item
Temperature °C axillary, evening
integer
C1531924 (UMLS CUI [1])
Item Group
Temperature
C0005903 (UMLS CUI-1)
Ongoing fever
Item
Fever ongoing after day 3?
boolean
C0015967 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Last date of fever
Item
Date of last day of symptoms of fever
date
C0011008 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Medically attended visit concerning fever
Item
Medically attended visit concerning fever
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0015967 (UMLS CUI [1,3])
Item Group
Irritability/Fussiness day and intensity
C0022107 (UMLS CUI-1)
C0522510 (UMLS CUI-2)
Item
Irritability/Fussiness day
integer
C0022107 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
Irritability/Fussiness day
Code List
Irritability/Fussiness day
CL Item
Day 0  (1)
CL Item
Day 1  (2)
CL Item
Day 2  (3)
CL Item
Day 3 (4)
Item
Irritability/Fussiness intensity
integer
C0022107 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Irritability/Fussiness intensity
Code List
Irritability/Fussiness intensity
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 Group
Irritability / Fussiness
C0022107 (UMLS CUI-1)
Ongoing Irritability / Fussiness
Item
Irritability / Fussiness ongoing after day 3?
boolean
C0022107 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last Irritability / Fussiness
Item
Date of last Irritability / Fussiness
date
C0022107 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Medically attended visit concerning Irritability / Fussiness
Item
Medically attended visit concerning Irritability / Fussiness
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0022107 (UMLS CUI [1,3])
Item Group
Drowsiness day and intensity
C0013144 (UMLS CUI-1)
C0522510 (UMLS CUI-2)
Item
Drowsiness day
integer
C0013144 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
Drowsiness day
Code List
Drowsiness day
CL Item
Day 0  (1)
CL Item
Day 1  (2)
CL Item
Day 2  (3)
CL Item
Day 3 (4)
Item
Drowsiness intensity
integer
C0013144 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Drowsiness intensity
Code List
Drowsiness intensity
CL Item
Behavior as usual (1)
(Comment:en)
CL Item
Drowsiness easily tolerated (2)
(Comment:en)
CL Item
Drowsiness that interferes with normal activity (3)
(Comment:en)
CL Item
Drowsiness that prevents normal activity (4)
(Comment:en)
Item Group
Drowsiness
C0013144 (UMLS CUI-1)
Ongoing drowsiness
Item
Ongoing after Day 3?
boolean
C0013144 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last Day of Symptoms
Item
Date of last Day of Symptoms
date
C0013144 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Medically attended visit concerning drowsiness
Item
Medically attended visit concerning drowsiness
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0013144 (UMLS CUI [1,3])
Item Group
Loss of appetite day and intensity
C1971624 (UMLS CUI-1)
C0522510 (UMLS CUI-2)
Item
Loss of appetite day
integer
C0439228 (UMLS CUI [1,1])
C1971624 (UMLS CUI [1,2])
Loss of appetite day
Code List
Loss of appetite day
CL Item
Day 0 (1)
CL Item
Day 1 (2)
CL Item
Day 2 (3)
CL Item
Day 3 (4)
Item
Loss of appetite intensity
integer
C1971624 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Loss of appetite intensity
Code List
Loss of appetite intensity
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 normalactivity (2)
CL Item
Not eating at all (3)
Item Group
Loss of appetite
C1971624 (UMLS CUI-1)
Ongoing loss of appetite
Item
Ongoing after Day 3?
boolean
C1971624 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last Day of Symptoms
Item
Date of last Day of Symptoms
date
C1971624 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Medically attended visit concerning loss of appetite
Item
Medically attended visit concerning loss of appetite
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C1971624 (UMLS CUI [1,3])
Item Group
Other general symptoms
C0029625 (UMLS CUI-1)
Description
Item
Description - please give details below
text
C0678257 (UMLS CUI [1,1])
C0029625 (UMLS CUI [1,2])
Item
Intensity
integer
C0518690 (UMLS CUI [1,1])
C0159028 (UMLS CUI [1,2])
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])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
Continuing general symptoms
Item
Check box if continuing
boolean
C0029625 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Medically attended visit
Item
Medically attended visit?
boolean
C0545082 (UMLS CUI [1,1])
C1386497 (UMLS CUI [1,2])
C0029625 (UMLS CUI [1,3])
Item Group
Medication
C0013227 (UMLS CUI-1)
Trade/Generic name
Item
Trade/Generic name
text
C0013227 (UMLS CUI [1,1])
C2360065 (UMLS CUI [1,2])
Reason
Item
Reason
text
C0392360 (UMLS CUI [1])
Total daily dose
Item
Total daily dose
integer
C2348070 (UMLS CUI [1])
Start date
Item
Start date
date
C0808070 (UMLS CUI [1])
End date
Item
End date
date
C0806020 (UMLS CUI [1])
Continuing medication
Item
Check box if continuing
boolean
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Item Group
General information Dairy card
C1508263 (UMLS CUI-1)
Return of Diary card
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])
Hospitalisation information
Item
In case of hospitalization please inform:
text
C0019993 (UMLS CUI [1])
Hospitalisation information
Item
In case of hospitalization please inform:
integer
C0019993 (UMLS CUI [1])
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