Englisch

Diary Card 2: Local Symptoms (TritanrixTM-HepB Group and ZilbrixTM Group)

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Dose
Beschreibung

Dose

Datentyp

text

Local Symptoms (at injection site)
Beschreibung

Local Symptoms (at injection site)

Day
Beschreibung

Day

Datentyp

text

1. Redness
Beschreibung

size; please measure the greatest diameter

Datentyp

integer

Maßeinheiten
  • mm
mm
Ongoing after Day 7?
Beschreibung

Ongoing after Day 7?

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

Medically attended visit
Beschreibung

Medically attended visit

Datentyp

boolean

2. Swelling
Beschreibung

size; please measure the greatest diameter

Datentyp

integer

Maßeinheiten
  • mm
mm
Ongoing after Day 7?
Beschreibung

Ongoing after Day 7?

Datentyp

boolean

if Yes, record, day of the last day of symptoms
Beschreibung

if Yes, record, day of the last day of symptoms

Datentyp

date

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

3. Pain
Beschreibung

intensity

Datentyp

text

Ongoing after Day 7?
Beschreibung

Ongoing after Day 7?

Datentyp

boolean

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

If Yes, record date of the last day of symptoms

Datentyp

date

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

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Ähnliche Modelle

Diary Card 2: Local Symptoms (TritanrixTM-HepB Group and ZilbrixTM Group)

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Dose
text
Dose
Code List
Dose
CL Item
Dose 2 (1)
Item Group
Local Symptoms (at injection site)
Item
Day
text
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (2)
CL Item
Day 2 (3)
CL Item
Day 3 (4)
CL Item
Day 4 (5)
CL Item
Day 5 (6)
CL Item
Day 6 (7)
CL Item
Day 7 (8)
1. Redness
Item
1. Redness
integer
Ongoing after Day 7?
Item
Ongoing after Day 7?
boolean
If yes, record the date of last day of symptoms
Item
If yes, record the date of last day of symptoms
date
Medically attended visit
Item
Medically attended visit
boolean
2. Swelling
Item
2. Swelling
integer
Ongoing after Day 7?
Item
Ongoing after Day 7?
boolean
if Yes, record, day of the last day of symptoms
Item
if Yes, record, day of the last day of symptoms
date
Medically attended visit?
Item
Medically attended visit?
boolean
Item
3. Pain
text
3. Pain
Code List
3. Pain
CL Item
Absent (1)
CL Item
Minor reaction to touch (2)
CL Item
Cries/protests to touch (3)
CL Item
Cries when limb is moved/spontaneously painful (4)
Ongoing after Day 7?
Item
Ongoing after Day 7?
boolean
If Yes, record date of the last day of symptoms
Item
If Yes, record date of the last day of symptoms
date
Medically attended visit?
Item
Medically attended visit?
boolean
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