ID

9699

Beskrivning

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

Länk

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

Nyckelord

Versioner (2)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-16 2015-01-16 - Martin Dugas
Uppladdad den

16 januari 2015

DOI

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Licens

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

Tysk Engelsk

No Instruction available.

1 Formulär  
  1. StudyEvent: AMC-052 Vaccine Administration Form
    1. No Instruction available.
Vaccine Module
Beskrivning

Vaccine Module

Alias
UMLS CUI-1
C0042196
Date of vaccination
Beskrivning

VaccineAdministeredDate

Datatyp

date

Måttenheter
  • 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
Beskrivning

VaccineAdministeredSite

Datatyp

text

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

VaccineAdministeredAmount

Datatyp

float

Måttenheter
  • 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
Beskrivning

VaccineAdministeredTime

Datatyp

time

Måttenheter
  • 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,)
Beskrivning

DoseDelayedInd-3

Datatyp

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)
Beskrivning

AgentDelayedAdministrationDelayDuration

Datatyp

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
Beskrivning

VaccinationAdverseEventSyncopeInd-2

Datatyp

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 Formulär
  1. StudyEvent: AMC-052 Vaccine Administration Form
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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