Temperature
Item
Pre-vaccination temperature
integer
C0039476 (UMLS CUI [1])
Item
Route
integer
C0005903 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Urine Sample
Item
Has a urine sample been taken?
boolean
C0200354 (UMLS CUI [1])
Item
Urine sample results (Pregnancy test – HCG)
integer
C0200354 (UMLS CUI [1,1])
C0456984 (UMLS CUI [1,2])
C0430056 (UMLS CUI [2])
Code List
Urine sample results (Pregnancy test – HCG)
Item
Vaccine administration (only one box must be checked)
integer
C2368628 (UMLS CUI [1])
Code List
Vaccine administration (only one box must be checked)
CL Item
Engerix™-B (20 mg) Thiomersal Free or Engerix™-B (10 mg) Preservative Free (1)
CL Item
Replacement vial (*) (2)
CL Item
Wrong vial number (*) (3)
CL Item
Not administered (*) (4)
Item
Side / site Route Non dominant Deltoid Deep I.M. (Please check appropriate box)
integer
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Code List
Side / site Route Non dominant Deltoid Deep I.M. (Please check appropriate box)
Vaccine administration according to protocol
Item
Has the study vaccine been administered according to the protocol?
boolean
C2368628 (UMLS CUI [1,1])
C2348563 (UMLS CUI [1,2])
Item
If you answered the previous question with 'No', please check all items: Site
integer
C1515974 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Code List
If you answered the previous question with 'No', please check all items: Site
Item
If you answered the previous question with 'No', please check all items: Route
integer
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Code List
If you answered the previous question with 'No', please check all items: Route
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Item
Has the subject experienced any of the following local (at administration site) solicited signs/symptoms during the solicited period?
integer
C1457887 (UMLS CUI [1,1])
C0205276 (UMLS CUI [1,2])
Code List
Has the subject experienced any of the following local (at administration site) solicited signs/symptoms during the solicited period?
CL Item
Yes, please check a No/Yes box for each symptom. If Yes is checked, please fill in the complete line. (3)
Redness
Item
Redness?
boolean
C0332575 (UMLS CUI [1,1])
C2700396 (UMLS CUI [1,2])
Item
Redness day
integer
C0439228 (UMLS CUI [1,1])
C0332575 (UMLS CUI [1,2])
CL Item
Day 0 6 hours after vaccin. (1)
Redness size
Item
Size of local redness
integer
C0332575 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing redness
Item
Redness ongoing after day 3?
boolean
C0332575 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Last symptoms of 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])
Swelling
Item
Swelling?
boolean
C0038999 (UMLS CUI [1])
Item
Swelling day
integer
C0439228 (UMLS CUI [1,1])
C0038999 (UMLS CUI [1,2])
CL Item
Day 0 6 hours after vaccin. (1)
Swelling size
Item
Size of local swelling
integer
C0038999 (UMLS CUI [1,1])
C0456389 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing swelling
Item
Swelling ongoing after day 3?
boolean
C0038999 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Last Symptoms of 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])
Pain
Item
Pain?
boolean
C1457887 (UMLS CUI [1,1])
C0205276 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Item
Pain day
integer
C0439228 (UMLS CUI [1,1])
C0030193 (UMLS CUI [1,2])
CL Item
Day 0 6 hours after vaccin. (1)
Item
Pain intensity
integer
C0030193 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Ongoing pain
Item
Pain ongoing after day 3?
boolean
C0030193 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
C2700396 (UMLS CUI [1,3])
Last symptoms of 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])
Item
Has the subject experienced any of the following general solicited signs/symptoms during the solicited period?
integer
C1457887 (UMLS CUI [1,1])
C0042196 (UMLS CUI [1,2])
C0877248 (UMLS CUI [1,3])
Code List
Has the subject experienced any of the following general solicited signs/symptoms during the solicited period?
CL Item
Yes, please check a No/Yes box for each symptom. If Yes is checked, please fill in the complete line. (3)
Fever
Item
Fever?
boolean
C0015967 (UMLS CUI [1])
Item
Route Fever
integer
C0005903 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Fever not taken
Item
Fever not taken?
boolean
C0015967 (UMLS CUI [1])
Item
Fever Day
integer
C0015967 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
CL Item
Day 0 6 hours after vaccin. (1)
Item
Fever Day
integer
C0015967 (UMLS CUI [1,1])
C0439228 (UMLS CUI [1,2])
CL Item
Day 0 6 hours after vaccin. (1)
Temperature
Item
Temperature
integer
C0005903 (UMLS CUI [1])
Ongoing fever
Item
Ongoing after day 3?
boolean
C0015967 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last fever symptoms
Item
Date of last fever symptoms
date
C0015967 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,4])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1,1])
C0015967 (UMLS CUI [1,2])
Fatigue
Item
Fatigue?
boolean
C0015672 (UMLS CUI [1])
Item
Day of fatigue
integer
C0015672 (UMLS CUI [1])
CL Item
Day 0 6 hours after vaccin. (1)
Item
Intensity of fatigue
integer
C0015672 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Intensity of fatigue
Ongoing fatigue
Item
Ongoing after day 3?
boolean
C0015672 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last fatigue symptoms
Item
Date of last symptoms
date
C0015672 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,4])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1,1])
C0015672 (UMLS CUI [1,2])
Headache
Item
Headache?
boolean
C0018681 (UMLS CUI [1])
Item
Headache day
integer
C0018681 (UMLS CUI [1])
CL Item
Day 0 6 hours after vaccin. (1)
Item
Headache intensity
integer
C0018681 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Headache intensity
Ongoing headache
Item
Ongoing after day 3?
boolean
C0018681 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last headache symptoms
Item
Date of last symptoms
date
C0018681 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
C1457887 (UMLS CUI [1,4])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1,1])
C0018681 (UMLS CUI [1,2])
Gastrointestinal symptoms
Item
Gastrointestinal symptoms?
boolean
C0426576 (UMLS CUI [1])
Item
Gastrointestinal symptoms Day
integer
C0426576 (UMLS CUI [1])
Code List
Gastrointestinal symptoms Day
CL Item
Day 0 6 hours after vaccin. (1)
Item
Gastrointestinal symptoms Intensity
integer
C0426576 (UMLS CUI [1,1])
C0522510 (UMLS CUI [1,2])
Code List
Gastrointestinal symptoms Intensity
Ongoing Gastrointestinal symptoms
Item
Ongoing after day 3?
boolean
C0426576 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
Date of last Gastrointestinal symptoms
Item
Date of last symptoms
date
C0011008 (UMLS CUI [1,1])
C0426576 (UMLS CUI [1,2])
Causality
Item
Causality?
boolean
C0015127 (UMLS CUI [1,1])
C0426576 (UMLS CUI [1,2])