Englisch

Diary Card: Unsolicited Symptoms (All Groups) - Dose 2

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

Other Symptoms (Day 0-42)
Beschreibung

Other Symptoms (Day 0-42)

Symptom
Beschreibung

Symptom

Datentyp

integer

Description
Beschreibung

Description

Datentyp

text

Intensity
Beschreibung

Intensity

Datentyp

text

Start day
Beschreibung

Start day

Datentyp

date

End date
Beschreibung

End date

Datentyp

date

Ongoing?
Beschreibung

Ongoing?

Datentyp

boolean

Medication
Beschreibung

Medication

Trade/Generic name
Beschreibung

Please fill in below if any medication has been taken since the vaccination

Datentyp

text

Reason
Beschreibung

Reason

Datentyp

text

Total daily dose
Beschreibung

Total daily dose

Datentyp

text

Start date
Beschreibung

Start date

Datentyp

date

End date
Beschreibung

End date

Datentyp

date

Still taking medication?
Beschreibung

Still taking medication?

Datentyp

boolean

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Ähnliche Modelle

Diary Card: Unsolicited Symptoms (All Groups) - Dose 2

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 2 (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
Item Group
Other Symptoms (Day 0-42)
Symptom
Item
Symptom
integer
Description
Item
Description
text
Item
Intensity
text
Intensity
Code List
Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Start day
Item
Start day
date
End date
Item
End date
date
Ongoing?
Item
Ongoing?
boolean
Item Group
Medication
Trade/Generic name
Item
Trade/Generic name
text
Reason
Item
Reason
text
Total daily dose
Item
Total daily dose
text
Start date
Item
Start date
date
End date
Item
End date
date
Still taking medication?
Item
Still taking medication?
boolean
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