ID

9699

Descrição

AMC-052 Vaccine Administration Form Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection NCT00513526 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39520C70-99B3-4542-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=39520C70-99B3-4542-E044-0003BA3F9857

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 16/01/2015 16/01/2015 - Martin Dugas
Transferido a

16 de janeiro de 2015

DOI

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Licença

Creative Commons BY-NC 3.0 Legacy
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Vaccine Administration Form (NCT00513526)

Alemão Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: AMC-052 Vaccine Administration Form
    1. No Instruction available.
Vaccine Module
Descrição

Vaccine Module

Alias
UMLS CUI-1
C0042196
Date of vaccination
Descrição

VaccineAdministeredDate

Tipo de dados

date

Unidades de medida
  • MM DD YYYY
Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C923
NCI Thesaurus Property
C25382
UMLS CUI-1
C1115436
MM DD YYYY
Vaccination Site
Descrição

VaccineAdministeredSite

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C13717
NCI Thesaurus ObjectClass
C923
NCI Thesaurus Property
C25382
UMLS CUI-1
C1116171
Amount of vaccine administered
Descrição

VaccineAdministeredAmount

Tipo de dados

float

Unidades de medida
  • ml
Alias
NCI Thesaurus ObjectClass
C923
NCI Thesaurus Property
C25382
NCI Thesaurus ValueDomain
C25417
UMLS CUI-1
C0042210
UMLS CUI-2
C1265611
ml
Time vaccine administered
Descrição

VaccineAdministeredTime

Tipo de dados

time

Unidades de medida
  • hh:mm (24 hour clock)
Alias
NCI Thesaurus ObjectClass
C923
NCI Thesaurus ValueDomain
C25207
NCI Thesaurus Property
C25382
UMLS CUI-1
C1115436
hh:mm (24 hour clock)
Were there any delays in dose administration (If yes,)
Descrição

DoseDelayedInd-3

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25477
NCI Thesaurus ObjectClass
C25488
UMLS CUI-1
C0178602
UMLS CUI-2
C0205421
Duration Delay (If dose delay was due to an adverse event, submit an Adverse Event AE form)
Descrição

AgentDelayedAdministrationDelayDuration

Tipo de dados

durationDatetime

Alias
NCI Thesaurus Property
C25477
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property-2
C25409
NCI Thesaurus ValueDomain
C25330
UMLS CUI-1
C2985752
Did the participant experience syncope following vaccination
Descrição

VaccinationAdverseEventSyncopeInd-2

Tipo de dados

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C41331
NCI Thesaurus ObjectClass-2
C15346
NCI Thesaurus Property
C35053
UMLS CUI-1
C0039070
UMLS CUI-2
C0042196
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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: AMC-052 Vaccine Administration Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Vaccine Module
C0042196 (UMLS CUI-1)
Vaccination Date
Item
Date of vaccination
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C923 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1115436 (UMLS CUI-1)
Item
Vaccination Site
text
C13717 (NCI Thesaurus ValueDomain)
C923 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1116171 (UMLS CUI-1)
CL.1
Code List
Vaccination Site
CL Item
Dominant Arm (Dominant arm)
CL Item
Nondominant Arm (Nondominant arm)
CL Item
Right Thigh (Right thigh)
CL Item
Left Thigh (Left thigh)
Vaccine amount
Item
Amount of vaccine administered
float
C923 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C25417 (NCI Thesaurus ValueDomain)
C0042210 (UMLS CUI-1)
C1265611 (UMLS CUI-2)
Vaccination Time
Item
Time vaccine administered
time
C923 (NCI Thesaurus ObjectClass)
C25207 (NCI Thesaurus ValueDomain)
C25382 (NCI Thesaurus Property)
C1115436 (UMLS CUI-1)
Dose deferred
Item
Were there any delays in dose administration (If yes,)
boolean
C38148 (NCI Thesaurus ValueDomain)
C25477 (NCI Thesaurus Property)
C25488 (NCI Thesaurus ObjectClass)
C0178602 (UMLS CUI-1)
C0205421 (UMLS CUI-2)
Delay Duration
Item
Duration Delay (If dose delay was due to an adverse event, submit an Adverse Event AE form)
durationDatetime
C25477 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C25409 (NCI Thesaurus Property-2)
C25330 (NCI Thesaurus ValueDomain)
C2985752 (UMLS CUI-1)
Syncope following vaccination
Item
Did the participant experience syncope following vaccination
boolean
C38147 (NCI Thesaurus ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C15346 (NCI Thesaurus ObjectClass-2)
C35053 (NCI Thesaurus Property)
C0039070 (UMLS CUI-1)
C0042196 (UMLS CUI-2)
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