Inglés

Diary Card: Rash/Exanthem + Parotid/Salivary gland swelling + Febrile Convulsions

1 formularios  
Administrative data
Descripción

Administrative data

Dose Number
Descripción

Dose Number

Tipo de datos

text

Subject Number
Descripción

Subject Number

Tipo de datos

integer

Please do not forget to bring back the diary card on
Descripción

fill the date below

Tipo de datos

date

In case rash/exanthem or Parotid/Salivary gland swelling or Febrile convulsions (suspected signs of meningism) is observed, bring the child to visit the investigators for clinical examination.
Descripción

If rash occurs, please also record the event below

Tipo de datos

text

Rash Episode
Descripción

Rash Episode

Rash Episode Number
Descripción

Rash Episode Number

Tipo de datos

integer

Description
Descripción

Description

Tipo de datos

text

Vaccination site
Descripción

Vaccination site

Tipo de datos

text

Date Started
Descripción

Date Started

Tipo de datos

date

Date Stopped
Descripción

Date Stopped

Tipo de datos

date

Intensity
Descripción

Intensity

Tipo de datos

text

Temperature
Descripción

Temperature

Tipo de datos

text

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Similar models

Diary Card: Rash/Exanthem + Parotid/Salivary gland swelling + Febrile Convulsions

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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
Please do not forget to bring back the diary card on
Item
Please do not forget to bring back the diary card on
date
In case rash/exanthem or Parotid/Salivary gland swelling or Febrile convulsions (suspected signs of meningism) is observed, bring the child to visit the investigators for clinical examination.
Item
In case rash/exanthem or Parotid/Salivary gland swelling or Febrile convulsions (suspected signs of meningism) is observed, bring the child to visit the investigators for clinical examination.
text
Item Group
Rash Episode
Item
Rash Episode Number
integer
Rash Episode Number
Code List
Rash Episode Number
CL Item
RA 1 (1)
CL Item
RA 2 (2)
CL Item
RA 3 (3)
Description
Item
Description
text
Item
Vaccination site
text
Vaccination site
Code List
Vaccination site
CL Item
Left arm (1)
CL Item
Right arm (2)
CL Item
Non-administration site (3)
Date Started
Item
Date Started
date
Date Stopped
Item
Date Stopped
date
Item
Intensity
text
Intensity
Code List
Intensity
CL Item
1-50 lesions (1)
CL Item
51-150 lesions (2)
CL Item
>150 lesions (3)
Item
Temperature
text
Temperature
Code List
Temperature
CL Item
Please complete the Temperature diary card (1)
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