Anglais

Concomitant Vaccination Form

1 Formulaires  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Type de données

text

Concomitant Vaccination
Description

Concomitant Vaccination

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

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

Type de données

boolean

If Yes, please record the concomitant vaccination details below
Description

If Yes, please record the concomitant vaccination details below

Type de données

text

Vaccination details
Description

Vaccination details

Trade/Generic Name
Description

Trade/Generic Name

Type de données

text

Route
Description

Route

Type de données

text

Administration Date
Description

Administration Date

Type de données

date

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Similar models

Concomitant Vaccination Form

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
text
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 the concomitant vaccination details below
Item
If Yes, please record the concomitant vaccination details below
text
Item Group
Vaccination details
Trade/Generic Name
Item
Trade/Generic Name
text
Item
Route
text
Route
Code List
Route
CL Item
Intradermal (1)
CL Item
Inhalation (2)
CL Item
Intramuscular (3)
CL Item
Intravenous (4)
CL Item
Intranasal (5)
CL Item
Other (6)
CL Item
Parenteral (7)
CL Item
Oral (8)
CL Item
Subcutaneous (9)
CL Item
Sublingual (10)
CL Item
Transdermal (11)
CL Item
Unknown (12)
Administration Date
Item
Administration Date
date
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