Inglés

Visit 3: Study Continuation Check

1 formularios  
Administrative data
Descripción

Administrative data

Protocol Number
Descripción

Protocol Number

Tipo de datos

integer

Subject Number
Descripción

Subject Number

Tipo de datos

integer

Date of Visit
Descripción

Date of Visit

Tipo de datos

date

Period
Descripción

Period

Tipo de datos

text

Check for Study Continuation
Descripción

Check for Study Continuation

Did the subject return for visit 3?
Descripción

Did the subject return for visit 3?

Tipo de datos

boolean

If No, please tick one most appropriate reason
Descripción

If No, please tick one most appropriate reason

Tipo de datos

text

If Serious adverse event, please specify the SAE number
Descripción

If Serious adverse event, please specify the SAE number

Tipo de datos

integer

If Other, please specify
Descripción

If Other, please specify

Tipo de datos

text

Please tick who took the decision
Descripción

Please tick who took the decision

Tipo de datos

text

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Similar models

Visit 3: Study Continuation Check

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
Protocol Number
Item
Protocol Number
integer
Subject Number
Item
Subject Number
integer
Date of Visit
Item
Date of Visit
date
Item
Period
text
Period
Code List
Period
CL Item
45 months post dose 1 in Malaria-026 (12 months after visit 2) (1)
Item Group
Check for Study Continuation
Did the subject return for visit 3?
Item
Did the subject return for visit 3?
boolean
Item
If No, please tick one most appropriate reason
text
If No, please tick one most appropriate reason
Code List
If No, please tick one most appropriate reason
CL Item
Serious adverse event (1)
CL Item
Other (2)
If Serious adverse event, please specify the SAE number
Item
If Serious adverse event, please specify the SAE number
integer
If Other, please specify
Item
If Other, please specify
text
Item
Please tick who took the decision
text
Please tick who took the decision
Code List
Please tick who took the decision
CL Item
Investigator (I)
CL Item
Parents/Guardians (P)
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