Engels

Visit 3: Study Continuation Check

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Administrative data
Beschrijving

Administrative data

Protocol Number
Beschrijving

Protocol Number

Datatype

integer

Subject Number
Beschrijving

Subject Number

Datatype

integer

Date of Visit
Beschrijving

Date of Visit

Datatype

date

Period
Beschrijving

Period

Datatype

text

Check for Study Continuation
Beschrijving

Check for Study Continuation

Did the subject return for visit 3?
Beschrijving

Did the subject return for visit 3?

Datatype

boolean

If No, please tick one most appropriate reason
Beschrijving

If No, please tick one most appropriate reason

Datatype

text

If Serious adverse event, please specify the SAE number
Beschrijving

If Serious adverse event, please specify the SAE number

Datatype

integer

If Other, please specify
Beschrijving

If Other, please specify

Datatype

text

Please tick who took the decision
Beschrijving

Please tick who took the decision

Datatype

text

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Similar models

Visit 3: Study Continuation Check

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Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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