Inglês

Concomitant Vaccination Form

1 Formulários  
Administrative data
Descrição

Administrative data

Subject Number
Descrição

Subject Number

Tipo de dados

integer

Concomitant Vaccination
Descrição

Concomitant Vaccination

Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
Descrição

Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?

Tipo de dados

boolean

If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
Descrição

If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date

Tipo de dados

text

Trade Name / Generic Name
Descrição

Trade Name / Generic Name

Trade / Generic Name
Descrição

Trade / Generic Name

Tipo de dados

text

Route
Descrição

Route

Tipo de dados

text

Administration Date
Descrição

Administration Date

Tipo de dados

date

Voltar ao início da página

Similar models

Concomitant Vaccination Form

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
Concomitant Vaccination
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
Item
Has any vaccine other than the study vaccine(s) been administered during the timeframe as specified in the protocol?
boolean
If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
Item
If Yes, please record concomitant vaccination with trade name and /or generic name, route and vaccine administration date
text
Item Group
Trade Name / Generic Name
Trade / Generic Name
Item
Trade / Generic Name
text
Item
Route
text
Route
Code List
Route
CL Item
Intradermal (ID) (1)
CL Item
Inhalation (IH) (2)
CL Item
Intramuscular (IM) (3)
CL Item
Intravenous (IV) (4)
CL Item
Intranasal (NA) (5)
CL Item
Other (OTH) (6)
CL Item
Parenteral (PE) (7)
CL Item
Oral (PO) (8)
CL Item
Subcutaneous (SC) (9)
CL Item
Sublingual (SL) (10)
CL Item
Transdermal (TD) (11)
CL Item
Unknown (UNK) (12)
Administration Date
Item
Administration Date
date
Voltar ao início da página