Englisch

Diary Card 2: Local Symptoms (Plain PRP followed by BTPw-HBV Kft)

1 Formulare  
Administrative data
Beschreibung

Administrative data

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Visit
Beschreibung

Visit

Datentyp

text

Protocol Number
Beschreibung

Protocol Number

Datentyp

integer

Local Symptoms - Redness (at injection site)
Beschreibung

Local Symptoms - Redness (at injection site)

Day
Beschreibung

Day

Datentyp

integer

Size
Beschreibung

please measure the greatest diameter

Datentyp

integer

Maßeinheiten
  • mm
mm
Ongoing after Day 3?
Beschreibung

Ongoing after Day 3?

Datentyp

boolean

If Yes, record date of last day of symptoms
Beschreibung

If Yes, record date of last day of symptoms

Datentyp

date

Medical attended visit?
Beschreibung

Medical attended visit?

Datentyp

boolean

Local Symptoms - Swelling (at injection site)
Beschreibung

Local Symptoms - Swelling (at injection site)

Day
Beschreibung

Day

Datentyp

integer

Size
Beschreibung

please measure the greatest diameter

Datentyp

integer

Maßeinheiten
  • mm
mm
Ongoing after Day 3?
Beschreibung

Ongoing after Day 3?

Datentyp

boolean

If Yes, record date of last day of symptoms
Beschreibung

If Yes, record date of last day of symptoms

Datentyp

date

Medical attended visit?
Beschreibung

Medical attended visit?

Datentyp

boolean

Local Symptoms - Pain (at injection site)
Beschreibung

Local Symptoms - Pain (at injection site)

Day
Beschreibung

Day

Datentyp

integer

Intensity
Beschreibung

Intensity

Datentyp

integer

Ongoing after day 3?
Beschreibung

Ongoing after day 3?

Datentyp

boolean

If Yes, record date of last day of symptoms
Beschreibung

If Yes, record date of last day of symptoms

Datentyp

date

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

Other Local Symptoms
Beschreibung

Other Local Symptoms

Description
Beschreibung

please specify side(s) and site(s)

Datentyp

text

Intensity
Beschreibung

Intensity

Datentyp

text

Start date
Beschreibung

Start date

Datentyp

date

End date
Beschreibung

End date

Datentyp

date

Ongoing?
Beschreibung

Ongoing?

Datentyp

boolean

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

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Ähnliche Modelle

Diary Card 2: Local Symptoms (Plain PRP followed by BTPw-HBV Kft)

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Visit
text
Visit
Code List
Visit
CL Item
Vaccination 2 (1)
Protocol Number
Item
Protocol Number
integer
Item Group
Local Symptoms - Redness (at injection site)
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (evening) (2)
CL Item
Day 2 (evening) (3)
CL Item
Day 3 (evening) (4)
Size
Item
Size
integer
Ongoing after Day 3?
Item
Ongoing after Day 3?
boolean
If Yes, record date of last day of symptoms
Item
If Yes, record date of last day of symptoms
date
Medical attended visit?
Item
Medical attended visit?
boolean
Item Group
Local Symptoms - Swelling (at injection site)
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (evening) (2)
CL Item
Day 2 (evening) (3)
CL Item
Day 3 (evening) (4)
Size
Item
Size
integer
Ongoing after Day 3?
Item
Ongoing after Day 3?
boolean
If Yes, record date of last day of symptoms
Item
If Yes, record date of last day of symptoms
date
Medical attended visit?
Item
Medical attended visit?
boolean
Item Group
Local Symptoms - Pain (at injection site)
Item
Day
integer
Day
Code List
Day
CL Item
Day 0 (1)
CL Item
Day 1 (evening) (2)
CL Item
Day 2 (evening) (3)
CL Item
Day 3 (evening) (4)
Item
Intensity
integer
Intensity
Code List
Intensity
CL Item
Absent (1)
CL Item
Minor reaction to touch (2)
CL Item
Cries/protests on touch (3)
CL Item
Cries when limb is moved/spontaneously painful (4)
Ongoing after day 3?
Item
Ongoing after day 3?
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 Group
Other Local Symptoms
Description
Item
Description
text
Item
Intensity
text
Intensity
Code List
Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Start date
Item
Start date
date
End date
Item
End date
date
Ongoing?
Item
Ongoing?
boolean
Medically attended visit?
Item
Medically attended visit?
boolean
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