Englisch

Diary Card 2: Local Symptoms (Triple AntigenTM+EngerixTM-B 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) Triple AntigenTM Vaccine
Beschreibung

Local Symptoms (at injection site) Triple AntigenTM Vaccine

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

for investigator only
Beschreibung

for investigator only

Side of Injection
Beschreibung

Side of Injection

Datentyp

text

Site of Injection
Beschreibung

Site of Injection

Datentyp

text

Local Symptoms (at injection site) EngerixTM Vaccine
Beschreibung

Local Symptoms (at injection site) EngerixTM Vaccine

Day
Beschreibung

Day

Datentyp

integer

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, 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

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

Pain
Beschreibung

intensity

Datentyp

text

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

text

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

for investigator only
Beschreibung

for investigator only

Side of Injection
Beschreibung

Side of Injection

Datentyp

text

Site of Injection
Beschreibung

Site of Injection

Datentyp

text

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Ähnliche Modelle

Diary Card 2: Local Symptoms (Triple AntigenTM+EngerixTM-B 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) Triple AntigenTM Vaccine
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
Item Group
for investigator only
Item
Side of Injection
text
Side
Code List
Side of Injection
CL Item
Left (1)
CL Item
Right (2)
Item
Site of Injection
text
Site of Injection
Code List
Site of Injection
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
Item Group
Local Symptoms (at injection site) EngerixTM Vaccine
Item
Day
integer
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)
Redness
Item
Redness
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
Swelling
Item
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
Pain
text
Pain
Code List
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, day of the last day of symptoms
Item
if Yes, record, day of the last day of symptoms
text
Medically attended visit?
Item
Medically attended visit?
boolean
Item Group
for investigator only
Item
Side of Injection
text
Side of Injection
Code List
Side of Injection
CL Item
Left (1)
CL Item
Right (2)
Item
Site of Injection
text
Site of Injection
Code List
Site of Injection
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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