Engelsk

Visit 3 - Laboratory Tests; Phone Contact Month 5; Visit 4 - Pre-Vacciantion Asessment

1 Formulär  
Administrative
Beskrivning

Administrative

Alias
UMLS CUI-1
C1320722
Date of visit
Beskrivning

Date of visit

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Subject number
Beskrivning

Subject number

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Laboratory Tests
Beskrivning

Laboratory Tests

Alias
UMLS CUI-1
C0022885
Has a blood sample been taken?
Beskrivning

Has a blood sample been taken?

Datatyp

boolean

Alias
UMLS CUI [1]
C0005834
Month 5 - Phone Contact
Beskrivning

Month 5 - Phone Contact

Alias
UMLS CUI-1
C0337611
UMLS CUI-2
C0039457
UMLS CUI-3
C0439231
Has the information been obtained?
Beskrivning

Please contact the subject by phone to query about the occurrence of any SAE's using the scripted provided.

Datatyp

boolean

Alias
UMLS CUI [1]
C3244127
Pre-Vaccination Assessment
Beskrivning

Pre-Vaccination Assessment

Alias
UMLS CUI-1
C0042196
UMLS CUI-2
C0220825
UMLS CUI-3
C0332152
Pre- vaccination temperature
Beskrivning

Pre- vaccination temperature

Datatyp

float

Måttenheter
  • °F
Alias
UMLS CUI [1,1]
C0042196
UMLS CUI [1,2]
C0332152
UMLS CUI [2]
C0005903
°F
Temperature Route
Beskrivning

Temperature Route

Datatyp

integer

Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C0449687
Vaccine Administration
Beskrivning

Vaccine Administration

Alias
UMLS CUI-1
C2368628
Vaccine Administration
Beskrivning

(only one box must be checked)

Datatyp

integer

Alias
UMLS CUI [1]
C2368628
Vaccination Side/ Site Route
Beskrivning

Vaccination Side/ Site Route

Datatyp

integer

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C1515974
UMLS CUI [1,3]
C0013153
UMLS CUI [1,4]
C0441987
Has the study vaccine been administered according to the Protocol?
Beskrivning

Has the study vaccine been administered according to the Protocol?

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C2348563
If study vaccine has not been administered according to the Protocol, please check all items that apply
Beskrivning

Please check all items

Datatyp

integer

Alias
UMLS CUI [1,1]
C2368628
UMLS CUI [1,2]
C234856
Comments
Beskrivning

Comments

Datatyp

text

Alias
UMLS CUI [1]
C0947611
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Similar models

Visit 3 - Laboratory Tests; Phone Contact Month 5; Visit 4 - Pre-Vacciantion Asessment

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Subject number
Item
Subject number
text
C2348585 (UMLS CUI [1])
Item Group
Laboratory Tests
C0022885 (UMLS CUI-1)
Has a blood sample been taken?
Item
Has a blood sample been taken?
boolean
C0005834 (UMLS CUI [1])
Item Group
Month 5 - Phone Contact
C0337611 (UMLS CUI-1)
C0039457 (UMLS CUI-2)
C0439231 (UMLS CUI-3)
Has the information been obtained?
Item
Has the information been obtained?
boolean
C3244127 (UMLS CUI [1])
Item Group
Pre-Vaccination Assessment
C0042196 (UMLS CUI-1)
C0220825 (UMLS CUI-2)
C0332152 (UMLS CUI-3)
Pre- vaccination temperature
Item
Pre- vaccination temperature
float
C0042196 (UMLS CUI [1,1])
C0332152 (UMLS CUI [1,2])
C0005903 (UMLS CUI [2])
Item
Temperature Route
integer
C0005903 (UMLS CUI [1,1])
C0449687 (UMLS CUI [1,2])
Temperature Route
Code List
Temperature Route
CL Item
Rectal (1)
CL Item
Axillary (2)
CL Item
Tympanic oral (3)
CL Item
Tympanic rectal (4)
Item Group
Vaccine Administration
C2368628 (UMLS CUI-1)
Item
Vaccine Administration
integer
C2368628 (UMLS CUI [1])
Vaccine Administration
Code List
Vaccine Administration
CL Item
Engerix-B Vaccine (1)
CL Item
Replacement vial (comment) (2)
CL Item
Wrong vial number (comment) (3)
CL Item
Not administered (comment) (4)
Item
Vaccination Side/ Site Route
integer
C2368628 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
C0013153 (UMLS CUI [1,3])
C0441987 (UMLS CUI [1,4])
Vaccination Side/ Site Route
Code List
Vaccination Side/ Site Route
CL Item
Upper left Anterolateral thigh I.M. (1)
Has the study vaccine been administered according to the Protocol?
Item
Has the study vaccine been administered according to the Protocol?
boolean
C2368628 (UMLS CUI [1,1])
C2348563 (UMLS CUI [1,2])
Item
If study vaccine has not been administered according to the Protocol, please check all items that apply
integer
C2368628 (UMLS CUI [1,1])
C234856 (UMLS CUI [1,2])
If study vaccine has not been administered according to the Protocol, please check all items that apply
Code List
If study vaccine has not been administered according to the Protocol, please check all items that apply
CL Item
Upper Left (1)
CL Item
Lower Left (2)
CL Item
Upper Right (3)
CL Item
Lower Right (4)
CL Item
Deltoid (5)
CL Item
Thigh (6)
CL Item
s.c. (7)
CL Item
i.m. (8)
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
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