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Concomitant Vaccination

1 forms  
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Description

Subject Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Workbook number
Description

Workbook number

Data type

integer

Alias
UMLS CUI [1]
C2986015
Visit type
Description

Check/update for each study visit

Data type

integer

Alias
UMLS CUI [1,1]
C0332307
UMLS CUI [1,2]
C0545082
Concomitant Vaccination
Description

Concomitant Vaccination

Alias
UMLS CUI-1
C0042196
UMLS CUI-2
C2347852
Collection Date
Description

day month year

Data type

date

Alias
UMLS CUI [1]
C1317250
Has any vaccine other than the study vaccine(s) been administered during the time frame as specified by the protocol?
Description

If you tick "yes" please fill in following items. At each study visit/contact, the investigator should question the subject about any vaccination(s) administered.

Data type

text

Alias
UMLS CUI [1,1]
C0042210
UMLS CUI [1,2]
C1444655
UMLS CUI [1,3]
C2348563
Trade/ (Generic) Name
Description

Trade/ (Generic) Name

Data type

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C0042210
Route of administration
Description

Route of administration

Data type

text

Alias
UMLS CUI [1,1]
C0013153
UMLS CUI [1,2]
C0042210
Administration date
Description

day month year

Data type

date

Alias
UMLS CUI [1,1]
C1533734
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C0042210
Comment
Description

For GSK

Data type

text

Alias
UMLS CUI [1]
C0947611
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Similar models

Concomitant Vaccination

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Item
Workbook number
integer
C2986015 (UMLS CUI [1])
Workbook number
Code List
Workbook number
CL Item
WB 1 (1)
CL Item
WB 2 (2)
CL Item
WB 3 (3)
CL Item
WB 4 (4)
Item
Visit type
integer
C0332307 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
Visit type
Code List
Visit type
CL Item
Core Analysis 1 (1)
CL Item
Core Analysis 2 (2)
CL Item
Study conclusion  (3)
Item Group
Concomitant Vaccination
C0042196 (UMLS CUI-1)
C2347852 (UMLS CUI-2)
Collection Date
Item
Collection Date
date
C1317250 (UMLS CUI [1])
Item
Has any vaccine other than the study vaccine(s) been administered during the time frame as specified by the protocol?
text
C0042210 (UMLS CUI [1,1])
C1444655 (UMLS CUI [1,2])
C2348563 (UMLS CUI [1,3])
Administration of other vaccines
Code List
Has any vaccine other than the study vaccine(s) been administered during the time frame as specified by the protocol?
CL Item
Yes (Y)
CL Item
No (N)
Trade/ (Generic) Name
Item
Trade/ (Generic) Name
text
C0027365 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Item
Route of administration
text
C0013153 (UMLS CUI [1,1])
C0042210 (UMLS CUI [1,2])
Route of administration
Code List
Route of administration
CL Item
Intradermal (ID)
CL Item
Inhalation (IH)
CL Item
Intramuscular (IM)
CL Item
Intravenous (IV)
CL Item
Intranasal (NA)
CL Item
Parenteral (PE)
CL Item
Oral (PO)
CL Item
Subcutaneous (SC)
CL Item
Sublingual (SL)
CL Item
Transdermal (TD)
CL Item
Other (OTH)
CL Item
Unknown (UNK)
Administration date
Item
Administration date
date
C1533734 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0042210 (UMLS CUI [1,3])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
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