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  1. StudyEvent: AMC-052 Vaccine Administration Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
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)
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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