Dose 3 - Local Symptoms - Vaccine 1
Redness (Local Symptoms)
Day
integer
please measure the greatest diameter
float
Ongoing after day 3?
boolean
last day of symptoms
date
medically attended visit
boolean
Swelling (Local Symptoms)
Day
text
please measure the greatest diameter
float
Ongoing after day 3?
boolean
last day of symptoms
date
medically attended visit?
boolean
Pain (Local Symptoms)
Day
integer
Intensity
integer
Ongoing after day 3?
boolean
last day of symptom
date
medically attended visit?
boolean
Dose 3 - Local Symptoms - Vaccine 2
Redness (Local Symptoms)
Day
integer
please measure the greatest diameter
float
Ongoing after day 3?
boolean
the last day of symptom
date
medically attended visit
boolean
Swelling (Local Symptoms)
Day
integer
please measure the greatest diameter
float
Ongoing after day 3?
boolean
last day of symptom
date
medically attended visit?
boolean
Pain (Local Symptoms)
Day
integer
Intensity
integer
Ongoing after day 3?
boolean
last day of symptom
date
medically attended visit
boolean
Dose 3 - Other Local Symptoms
Description
text
Mild (an adverse event which is easily tolerated by the subject, causing minimal discomfort and not interfering with everyday activities). Moderate (an adverse event which is sufficiently discomforting to interfere with normal everyday activities). Severe (an adverse event which prevents normal, everyday activities; in a young child, such an adverse event would, for example, prevent attendance at school/kindergarten/a day-care center and would cause the parents/guardians to seek medical advice).
integer
Start date
date
End date
date
Ongoing?
boolean
Medically attended visit?
boolean
Dose 3 - General Symptoms
Temperature (General Symptoms)
Day
integer
Body Temperature
float
Type of temperature taking
text
Ongoing after day 3?
boolean
last day of symptoms
date
Medically attended visit?
boolean
Irritability / Fussiness (General Symptoms)
Day
integer
Intensity
integer
Ongoing after day 3?
boolean
last day of symptoms
date
medically attended visit?
boolean
Drowsiness (General Symptoms)
Day
integer
Intensity
integer
Ongoing after day 3?
boolean
last day of symptoms
date
medically attended visit?
boolean
Loss of Appetite (General Symptoms)
Day
text
Intensity
integer
ongoing after day 3?
boolean
last day of symptoms
date
Medically attended visit?
boolean
Dose 3 - Other General Symptoms
Symptom description
text
Mild (an adverse event which is easily tolerated by the subject, causing minimal discomfort and not interfering with everyday activities). Moderate (an adverse event which is sufficiently discomforting to interfere with normal everyday activities). Severe (an adverse event which prevents normal, everyday activities; in a young child, such an adverse event would, for example, prevent attendance at school/kindergarten/a day-care center and would cause the parents/guardians to seek medical advice).
text
Start date
date
End date
boolean
ongoing
boolean
medically attended visit
boolean
Dose 3 - Medication
Please fill in if any medication has been taken since the vaccination
text
Reason
text
Total Daily Dose
text
Start Date
date
End Date
date
Ongoing?
boolean
Reminder