Center number
Item
Center number
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Gender
text
C0079399 (UMLS CUI [1])
Item
Could the subject's parents/guardians be contacted after the end of the active phase?
text
C0332158 (UMLS CUI [1,1])
C0030551 (UMLS CUI [1,2])
C0332282 (UMLS CUI [1,3])
C0008976 (UMLS CUI [1,4])
C0332158 (UMLS CUI [2,1])
C1274041 (UMLS CUI [2,2])
C0332282 (UMLS CUI [2,3])
C0008976 (UMLS CUI [2,4])
Code List
Could the subject's parents/guardians be contacted after the end of the active phase?
Date of last contact
Item
If contact, note the Date of last contact
date
C0805839 (UMLS CUI [1])
Item
If contact: Has the subject received any other investigational and/or non-registered vaccine and/or drug since the end of the active phase?
text
C2368628 (UMLS CUI [1,1])
C1517586 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0013230 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Code List
If contact: Has the subject received any other investigational and/or non-registered vaccine and/or drug since the end of the active phase?
Item
If no contact, give reason
text
C1298908 (UMLS CUI [1,1])
C0332158 (UMLS CUI [1,2])
C0030551 (UMLS CUI [1,3])
C0566251 (UMLS CUI [1,4])
C1298908 (UMLS CUI [2,1])
C0332158 (UMLS CUI [2,2])
C1274041 (UMLS CUI [2,3])
C0566251 (UMLS CUI [2,4])
Code List
If no contact, give reason
CL Item
Consent withdrawal (CWS)
CL Item
Lost to follow-up (LFU)
Item
Did the subject experience any serious adverse event(s) (SAE(s) since the end of the active phase?
text
C1519255 (UMLS CUI [1,1])
C0332282 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
Code List
Did the subject experience any serious adverse event(s) (SAE(s) since the end of the active phase?
CL Item
Subject could not be contacted (NA)
Item
Has the subject experienced any meningitis ?
text
C0025289 (UMLS CUI [1])
Code List
Has the subject experienced any meningitis ?
CL Item
Subject could not be contacted (NA)
Investigator's signature
Item
Investigator's signature
text
C2346576 (UMLS CUI [1])
Printed Investigator's name
Item
Printed Investigator's name
text
C2826892 (UMLS CUI [1])
Date of signature
Item
Date of signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])