Diary Card: Local Symptoms (DTPwHBV Kft + HiberixTM)

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) DTPw-HBV Kft Vaccine
Beschreibung

Local Symptoms - Redness (at injection site) DTPw-HBV Kft Vaccine

Day
Beschreibung

Day

Datentyp

integer

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

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

Medically attended visit?
Beschreibung

Medicalyl attended visit?

Datentyp

boolean

Local Symptoms - Swelling (at injection site)
Beschreibung

Local Symptoms - Swelling (at injection site)

Day
Beschreibung

Day

Datentyp

integer

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

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

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

Local Symptoms - Pain (at injection site)
Beschreibung

Local Symptoms - Pain (at injection site)

Day
Beschreibung

Day

Datentyp

integer

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

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

Local Symptoms - Redness (at injection site) HiberixTM Vaccine
Beschreibung

Local Symptoms - Redness (at injection site) HiberixTM Vaccine

Day
Beschreibung

Day

Datentyp

text

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

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

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

Local Symptoms - Swelling (at injection site) HiberixTM Vaccine
Beschreibung

Local Symptoms - Swelling (at injection site) HiberixTM Vaccine

Day
Beschreibung

Day

Datentyp

text

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

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

Medically attended visit?
Beschreibung

Medically attended visit?

Datentyp

boolean

Local Symptoms - Pain (at injection site) HiberixTM Vaccine
Beschreibung

Local Symptoms - Pain (at injection site) HiberixTM Vaccine

Day
Beschreibung

Day

Datentyp

integer

Side
Beschreibung

Side

Datentyp

text

Site
Beschreibung

Site

Datentyp

text

Intensity
Beschreibung

Intensity

Datentyp

text

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

Ähnliche Modelle

Diary Card: Local Symptoms (DTPwHBV Kft + HiberixTM)

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item
Visit
text
Code List
Visit
CL Item
Vaccination 1 (1)
Protocol Number
Item
Protocol Number
integer
Item Group
Local Symptoms - Redness (at injection site) DTPw-HBV Kft Vaccine
Item
Day
integer
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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
Medicalyl attended visit?
Item
Medically attended visit?
boolean
Item Group
Local Symptoms - Swelling (at injection site)
Item
Day
integer
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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
Medically attended visit?
Item
Medically attended visit?
boolean
Item Group
Local Symptoms - Pain (at injection site)
Item
Day
integer
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
Item
Intensity
integer
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
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
Item Group
Local Symptoms - Redness (at injection site) HiberixTM Vaccine
Item
Day
text
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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
Medically attended visit?
Item
Medically attended visit?
boolean
Item Group
Local Symptoms - Swelling (at injection site) HiberixTM Vaccine
Item
Day
text
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
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
Medically attended visit?
Item
Medically attended visit?
boolean
Item Group
Local Symptoms - Pain (at injection site) HiberixTM Vaccine
Item
Day
integer
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
Side
text
Code List
Side
CL Item
Upper left (1)
CL Item
Lower left (2)
CL Item
Upper right (3)
CL Item
Lower right (4)
Item
Site
text
Code List
Site
CL Item
Arm (1)
CL Item
Thigh (2)
CL Item
Buttock (3)
Item
Intensity
text
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
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