Englisch

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

1 Formulare  
Administrative data
Beschreibung

Administrative data

Dose Number
Beschreibung

Dose Number

Datentyp

text

Subject Number
Beschreibung

Subject Number

Datentyp

integer

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

fill the date below

Datentyp

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.
Beschreibung

If rash occurs, please also record the event below

Datentyp

text

Rash Episode
Beschreibung

Rash Episode

Rash Episode Number
Beschreibung

Rash Episode Number

Datentyp

integer

Description
Beschreibung

Description

Datentyp

text

Vaccination site
Beschreibung

Vaccination site

Datentyp

text

Date Started
Beschreibung

Date Started

Datentyp

date

Date Stopped
Beschreibung

Date Stopped

Datentyp

date

Intensity
Beschreibung

Intensity

Datentyp

text

Temperature
Beschreibung

Temperature

Datentyp

text

Zum Seitenanfang zurückkehren

Ähnliche Modelle

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

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
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)
Zum Seitenanfang zurückkehren