Englisch

Diary Card: Local Symptoms

1 Formulare  
Administrative data
Beschreibung

Administrative data

Dose Number
Beschreibung

Dose Number

Datentyp

text

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Local Symptoms (at injection site)
Beschreibung

Local Symptoms (at injection site)

please fill in below and assess the occurrence of any of the following signs or symptoms according to the criteria listed hereafter
Beschreibung

please fill in below and assess the occurrence of any of the following signs or symptoms according to the criteria listed hereafter

Datentyp

text

Local Symptoms
Beschreibung

Local Symptoms

Day
Beschreibung

Day

Datentyp

integer

Redness
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Swelling
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Pain
Beschreibung

intensity; please measure the greatest diameter

Datentyp

text

Ongoing after Day 3?
Beschreibung

Ongoing after Day 3?

Datentyp

boolean

If Yes, record the date of last day of symptoms
Beschreibung

If Yes, record the date of last day of symptoms

Datentyp

date

Local Symptoms (Group Priorix)
Beschreibung

Local Symptoms (Group Priorix)

Day
Beschreibung

Day

Datentyp

integer

Redness
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Swelling
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Pain
Beschreibung

intensity

Datentyp

integer

Ongoing after Day 3
Beschreibung

Ongoing after Day 3

Datentyp

boolean

If Yes, date of last day of symptoms
Beschreibung

If Yes, date of last day of symptoms

Datentyp

date

for investigator only (Priorix vaccine)
Beschreibung

for investigator only (Priorix vaccine)

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

Local Symptoms (Group Varilrix)
Beschreibung

Local Symptoms (Group Varilrix)

Day
Beschreibung

Day

Datentyp

integer

Redness
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Swelling
Beschreibung

size

Datentyp

float

Maßeinheiten
  • mm
mm
Pain
Beschreibung

intensity

Datentyp

integer

Ongoing after day 3?
Beschreibung

Ongoing after day 3?

Datentyp

boolean

If Yes, record the date of last day of symptoms
Beschreibung

If Yes, record the date of last day of symptoms

Datentyp

date

for investigator only (Varilrix vaccine)
Beschreibung

for investigator only (Varilrix vaccine)

Side
Beschreibung

Side

Datentyp

integer

Site
Beschreibung

Site

Datentyp

integer

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Ähnliche Modelle

Diary Card: Local Symptoms

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Item
Dose Number
text
Dose Number
Code List
Dose Number
CL Item
Dose 1 (1)
Subject Number
Item
Subject Number
integer
Item Group
Local Symptoms (at injection site)
please fill in below and assess the occurrence of any of the following signs or symptoms according to the criteria listed hereafter
Item
please fill in below and assess the occurrence of any of the following signs or symptoms according to the criteria listed hereafter
text
Item Group
Local Symptoms
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (Evening) (2)
CL Item
Day 2 (Evening) (3)
CL Item
Day 3 (Evening) (4)
Redness
Item
Redness
float
Swelling
Item
Swelling
float
Item
Pain
text
Pain
Code List
Pain
CL Item
Absent (1)
CL Item
Minor reaction to touch (2)
CL Item
Cries/protests on touch (3)
CL Item
Cries when limb is moved/spontaneously painful (4)
Ongoing after Day 3?
Item
Ongoing after Day 3?
boolean
If Yes, record the date of last day of symptoms
Item
If Yes, record the date of last day of symptoms
date
Item Group
Local Symptoms (Group Priorix)
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (Evening) (2)
CL Item
Day 2 (Evening) (3)
CL Item
Day 3 (Evening) (4)
Redness
Item
Redness
float
Swelling
Item
Swelling
float
Item
Pain
integer
Pain
Code List
Pain
CL Item
Absent (1)
CL Item
Minor reaction to touch (2)
CL Item
Cries/protests on touch (3)
CL Item
Cries when limb is moved/spontaneously painful (4)
Ongoing after Day 3
Item
Ongoing after Day 3
boolean
If Yes, date of last day of symptoms
Item
If Yes, date of last day of symptoms
date
Item Group
for investigator only (Priorix vaccine)
Item
Side
text
Side
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Site
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
Item Group
Local Symptoms (Group Varilrix)
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (Evening) (2)
CL Item
Day 2 (Evening) (3)
CL Item
Day 3 (Evening) (4)
Redness
Item
Redness
float
Swelling
Item
Swelling
float
Item
Pain
integer
Pain
Code List
Pain
CL Item
Absent (1)
CL Item
Minor reaction to touch (2)
CL Item
Cries/protests on touch (3)
CL Item
Cries when limb is moved/spontaneously painful (4)
Ongoing after day 3?
Item
Ongoing after day 3?
boolean
If Yes, record the date of last day of symptoms
Item
If Yes, record the date of last day of symptoms
date
Item Group
for investigator only (Varilrix vaccine)
Item
Side
integer
Side
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
integer
Site
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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