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Visit 1: Temperature Form

1 Formulär  
Post-Dose Temperature
Beskrivning

Post-Dose Temperature

Please record below all temperatures within 15 days post-vaccination
Beskrivning

If fever occurs after the solicited period, please complete the Non-SAE form; Complete Medication form for any antibiotics or antipyretics taken

Datatyp

text

Route
Beskrivning

Route

Datatyp

text

Temperature Log
Beskrivning

Temperature Log

Episode Number
Beskrivning

Episode Number

Datatyp

text

Temperature
Beskrivning

Temperature

Datatyp

float

Måttenheter
  • °C
°C
not taken
Beskrivning

not taken

Datatyp

text

If fever, Causality
Beskrivning

If fever, Causality

Datatyp

boolean

Medical advice
Beskrivning

Medical advice

Datatyp

boolean

Fever Screen
Beskrivning

Fever Screen

Day
Beskrivning

Day

Datatyp

text

Fever
Beskrivning

Fever (Axillary ≥ 37.5 °C; Rectal ≥ 38 °C)

Datatyp

text

If Yes, record Temperature
Beskrivning

If Yes, record Temperature

Datatyp

float

Måttenheter
  • °C
°C
Causality
Beskrivning

Causality

Datatyp

boolean

Medical Advice
Beskrivning

Medical Advice

Datatyp

boolean

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Similar models

Visit 1: Temperature Form

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Post-Dose Temperature
Item
Please record below all temperatures within 15 days post-vaccination
text
Please record below all temperatures within 15 days post-vaccination
Code List
Please record below all temperatures within 15 days post-vaccination
CL Item
Fever (Axillary ≥ 37.5 °C; Rectal ≥ 38 °C) (1)
Item
Route
text
Route
Code List
Route
CL Item
Axillary (A)
CL Item
Rectal (R)
Item Group
Temperature Log
Item
Episode Number
text
Episode Number
Code List
Episode Number
CL Item
Day 0 (1)
CL Item
Day 1 (2)
CL Item
Day 2 (3)
CL Item
Day 3 (4)
CL Item
Day 4 (5)
CL Item
Day 5 (6)
CL Item
Day 6 (7)
CL Item
Day 7 (8)
CL Item
Day 8 (9)
CL Item
Day 9 (10)
CL Item
Day 10 (11)
CL Item
Day 11 (12)
CL Item
Day 12 (13)
CL Item
Day 13 (14)
CL Item
Day 14 (15)
Temperature
Item
Temperature
float
Item
not taken
text
not taken
Code List
not taken
CL Item
confirm (1)
If fever, Causality
Item
If fever, Causality
boolean
Medical advice
Item
Medical advice
boolean
Item Group
Fever Screen
Item
Day
text
Day
Code List
Day
CL Item
Day 15 (1)
CL Item
Day 16 (2)
CL Item
Day 17 (3)
CL Item
Day 18 (4)
CL Item
Day 19 (5)
CL Item
Day 20 (6)
CL Item
Day 21 (7)
CL Item
Day 22  (8)
CL Item
Day 23 (9)
CL Item
Day 24 (10)
CL Item
Day 25 (11)
CL Item
Day 26 (12)
CL Item
Day 27 (13)
CL Item
Day 28 (14)
CL Item
Day 29 (15)
CL Item
Day 30 (16)
CL Item
Day 31 (17)
CL Item
Day 32 (18)
CL Item
Day 33 (19)
CL Item
Day 34 (20)
CL Item
Day 35 (21)
CL Item
Day 36 (22)
CL Item
Day 37 (23)
CL Item
Day 38 (24)
CL Item
Day 39 (25)
CL Item
Day 40 (26)
CL Item
Day 41 (27)
CL Item
Day 42 (28)
Item
Fever
text
Fever
Code List
Fever
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
If Yes, record Temperature
Item
If Yes, record Temperature
float
Causality
Item
Causality
boolean
Medical Advice
Item
Medical Advice
boolean
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