Engels

Visit 4: Solicited Adverse Events

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Administrative data
Beschrijving

Administrative data

Subject Number
Beschrijving

Subject Number

Datatype

integer

Protocol Number
Beschrijving

Protocol Number

Datatype

integer

Date of Visit
Beschrijving

Date of Visit

Datatype

date

Solicited Adverse Events
Beschrijving

Solicited Adverse Events

Has the subject experienced any of the following signs/symptoms at the administration site during the solicited period?
Beschrijving

Has the subject experienced any of the following signs/symptoms at the administration site during the solicited period?

Datatype

text

Local Symptoms - Redness
Beschrijving

Local Symptoms - Redness

Day
Beschrijving

Day

Datatype

integer

Redness
Beschrijving

Redness

Datatype

boolean

If Yes, record the size
Beschrijving

If Yes, record the size

Datatype

integer

Maateenheden
  • mm
mm
Ongoing after day 7?
Beschrijving

Ongoing after day 7?

Datatype

boolean

If Yes, record date of last day of symptoms
Beschrijving

If Yes, record date of last day of symptoms

Datatype

date

Medically attended visit
Beschrijving

Medically attended visit

Datatype

boolean

If Yes, record the visit type
Beschrijving

If Yes, record the visit type

Datatype

text

Local Symptoms - Swelling
Beschrijving

Local Symptoms - Swelling

Day
Beschrijving

Day

Datatype

integer

Swelling
Beschrijving

Swelling

Datatype

boolean

If Yes, record the size
Beschrijving

If Yes, record the size

Datatype

integer

Maateenheden
  • mm
mm
Ongoing after day 7?
Beschrijving

Ongoing after day 7?

Datatype

boolean

If Yes, record date of last day of symptoms
Beschrijving

If Yes, record date of last day of symptoms

Datatype

date

Medically attended visit
Beschrijving

Medically attended visit

Datatype

boolean

If Yes, record the visit type
Beschrijving

If Yes, record the visit type

Datatype

text

Local Symptoms - Pain
Beschrijving

Local Symptoms - Pain

Day
Beschrijving

Day

Datatype

integer

Pain
Beschrijving

Pain

Datatype

boolean

If Yes, record the intensity
Beschrijving

If Yes, record the intensity

Datatype

text

Ongoing after day 7?
Beschrijving

Ongoing after day 7?

Datatype

boolean

If Yes, record date of last day of symptoms
Beschrijving

If Yes, record date of last day of symptoms

Datatype

date

Medically attended visit
Beschrijving

Medically attended visit

Datatype

boolean

If Yes, record the visit type
Beschrijving

If Yes, record the visit type

Datatype

text

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Similar models

Visit 4: Solicited Adverse Events

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Protocol Number
Item
Protocol Number
integer
Date of Visit
Item
Date of Visit
date
Item Group
Solicited Adverse Events
Item
Has the subject experienced any of the following signs/symptoms at the administration site during the solicited period?
text
Has the subject experienced any of the following signs/symptoms at the administration site during the solicited period?
Code List
Has the subject experienced any of the following signs/symptoms at the administration site during the solicited period?
CL Item
Information not available (1)
CL Item
No Vaccine administered (2)
CL Item
No (3)
CL Item
Yes (please tick No/Yes for each symptom) (4)
Item Group
Local Symptoms - Redness
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
boolean
If Yes, record the size
Item
If Yes, record the size
integer
Ongoing after day 7?
Item
Ongoing after day 7?
boolean
If Yes, record date of last day of symptoms
Item
If Yes, record date of last day of symptoms
date
Medically attended visit
Item
Medically attended visit
boolean
Item
If Yes, record the visit type
text
If Yes, record the visit type
Code List
If Yes, record the visit type
CL Item
Hospitalisation (1)
CL Item
Emergency room (2)
CL Item
Medical personnel (3)
Item Group
Local Symptoms - Swelling
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)
Swelling
Item
Swelling
boolean
If Yes, record the size
Item
If Yes, record the size
integer
Ongoing after day 7?
Item
Ongoing after day 7?
boolean
If Yes, record date of last day of symptoms
Item
If Yes, record date of last day of symptoms
date
Medically attended visit
Item
Medically attended visit
boolean
Item
If Yes, record the visit type
text
If Yes, record the visit type
Code List
If Yes, record the visit type
CL Item
Hospitalisation (1)
CL Item
Emergency room (2)
CL Item
Medical personnel (3)
Item Group
Local Symptoms - Pain
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)
Pain
Item
Pain
boolean
Item
If Yes, record the intensity
text
If Yes, record the intensity
Code List
If Yes, record the intensity
CL Item
None (1)
CL Item
Mild (2)
CL Item
Moderate (3)
CL Item
Severe (4)
Ongoing after day 7?
Item
Ongoing after day 7?
boolean
If Yes, record date of last day of symptoms
Item
If Yes, record date of last day of symptoms
date
Medically attended visit
Item
Medically attended visit
boolean
Item
If Yes, record the visit type
text
If Yes, record the visit type
Code List
If Yes, record the visit type
CL Item
Hospitalisation (1)
CL Item
Emergency room (2)
CL Item
Medical personnel (3)
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