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Diary Card 3: Local Symptoms (TritanrixTM-HepB Group and ZilbrixTM Group)

1 forms  
Administrative data
Description

Administrative data

Subject Number
Description

Subject Number

Data type

integer

Dose
Description

Dose

Data type

text

Local Symptoms (at injection site)
Description

Local Symptoms (at injection site)

Day
Description

Day

Data type

text

1. Redness
Description

size; please measure the greatest diameter

Data type

integer

Measurement units
  • mm
mm
Ongoing after Day 7?
Description

Ongoing after Day 7?

Data type

boolean

If yes, record the date of last day of symptoms
Description

If yes, record the date of last day of symptoms

Data type

date

Medically attended visit
Description

Medically attended visit

Data type

boolean

2. Swelling
Description

size; please measure the greatest diameter

Data type

integer

Measurement units
  • mm
mm
Ongoing after Day 7?
Description

Ongoing after Day 7?

Data type

boolean

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

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

Data type

date

Medically attended visit?
Description

Medically attended visit?

Data type

boolean

3. Pain
Description

intensity

Data type

text

Ongoing after Day 7?
Description

Ongoing after Day 7?

Data type

boolean

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

If Yes, record date of the last day of symptoms

Data type

date

Medically attended visit?
Description

Medically attended visit?

Data type

boolean

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Similar models

Diary Card 3: Local Symptoms (TritanrixTM-HepB Group and ZilbrixTM Group)

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Dose
text
Dose
Code List
Dose
CL Item
Dose 3 (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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