Inglese

Visit 2: Solicited Adverse Events - General Symptoms (All Groups)

1 moduli  
Administrative data
Descrizione

Administrative data

Visit Number
Descrizione

Visit Number

Tipo di dati

text

Date of Visit
Descrizione

Date of Visit

Tipo di dati

date

Subject Number
Descrizione

Subject Number

Tipo di dati

integer

General Symptoms
Descrizione

General Symptoms

Has the subject experienced any of the following signs/symptoms during the solicited period?
Descrizione

Has the subject experienced any of the following signs/symptoms during the solicited period?

Tipo di dati

text

General Symptom 1
Descrizione

General Symptom 1

Fever
Descrizione

Fever

Tipo di dati

boolean

In any case, please complete the Temperature form
Descrizione

In any case, please complete the Temperature form

Tipo di dati

text

Symptom 2
Descrizione

Symptom 2

General rash/exanthema
Descrizione

General rash/exanthema

Tipo di dati

boolean

If YES, please complete the Rash/Exanthema form
Descrizione

If YES, please complete the Rash/Exanthema form

Tipo di dati

text

Symptom 3
Descrizione

Symptom 3

Parotid/Salivary gland swelling
Descrizione

Parotid/Salivary gland swelling

Tipo di dati

boolean

If YES, please complete the Parotid/Salivary Gland Swelling form
Descrizione

If YES, please complete the Parotid/Salivary Gland Swelling form

Tipo di dati

text

Symptom 4
Descrizione

Symptom 4

Febrile convulsions - suspected signs of meningism
Descrizione

Febrile convulsions - suspected signs of meningism

Tipo di dati

boolean

If Yes, please complete the Febrile Convulsions - Suspected Signs of Meningism form
Descrizione

If Yes, please complete the Febrile Convulsions - Suspected Signs of Meningism form

Tipo di dati

text

Please report serious adverse events to GSK by telephone within 24 hours
Descrizione

Please report serious adverse events to GSK by telephone within 24 hours

Ritorna all'inizio della pagina

Similar models

Visit 2: Solicited Adverse Events - General Symptoms (All Groups)

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative data
Item
Visit Number
text
Visit Number
Code List
Visit Number
CL Item
Visit 2 (1)
Date of Visit
Item
Date of Visit
date
Subject Number
Item
Subject Number
integer
Item Group
General Symptoms
Item
Has the subject experienced any of the following signs/symptoms during the solicited period?
text
Has the subject experienced any of the following signs/symptoms during the solicited period?
Code List
Has the subject experienced any of the following signs/symptoms during the solicited period?
CL Item
Information not available (1)
CL Item
No vaccine administered (2)
CL Item
No (3)
CL Item
Yes, please tick YES for each symptom. If Yes is ticked, please complete all items. (4)
Item Group
General Symptom 1
Fever
Item
Fever
boolean
In any case, please complete the Temperature form
Item
In any case, please complete the Temperature form
text
Item Group
Symptom 2
General rash/exanthema
Item
General rash/exanthema
boolean
If YES, please complete the Rash/Exanthema form
Item
If YES, please complete the Rash/Exanthema form
text
Item Group
Symptom 3
Parotid/Salivary gland swelling
Item
Parotid/Salivary gland swelling
boolean
If YES, please complete the Parotid/Salivary Gland Swelling form
Item
If YES, please complete the Parotid/Salivary Gland Swelling form
text
Item Group
Symptom 4
Febrile convulsions - suspected signs of meningism
Item
Febrile convulsions - suspected signs of meningism
boolean
If Yes, please complete the Febrile Convulsions - Suspected Signs of Meningism form
Item
If Yes, please complete the Febrile Convulsions - Suspected Signs of Meningism form
text
Item Group
Please report serious adverse events to GSK by telephone within 24 hours
Ritorna all'inizio della pagina