- 20-09-21 - 1 Formulier, 12 Itemgroepen, 101 Data-elementen, 1 Taal
Itemgroepen: Administration, Demographics, General Medical History / Physical Examination, Medical Condition, Laboratory Tests, HCG Urine Pregnancy Test, Blood Sample Conclusion, Vaccine Administration, Vaccine Administration, Unsolicited Adverse Events, Solicited Adverse Events - Local Symptoms, Solicited Adverse Events - General Symptoms
- 11-03-19 - 1 Formulier, 29 Itemgroepen, 196 Data-elementen, 1 Taal
Itemgroepen: Administrative data, ELIMINATION CRITERIA, INFORMED CONSENT, DEMOGRAPHICS, ELIGIBILITY CHECK, INCLUSION CRITERIA, EXCLUSION CRITERIA, TREATMENT ALLOCATION, GENERAL MEDICAL HISTORY / PHYSICAL EXAMINATION, HISTORY OF INFLUENZA VACCINATION, LABORATORY TESTS, HCG URINE PREGNANCY TEST, VACCINE ADMINISTRATION, VACCINE NON-ADMINISTRATION, SOLICITED ADVERSE EVENTS - LOCAL SYMPTOMS, Local Symptoms - Redness, Local Symptoms - Swelling, Local Symptoms - Induration, Local Symptoms - Ecchymosis, Local Symptoms - Pain, SOLICITED ADVERSE EVENTS - GENERAL SYMPTOMS, General Symptoms - Temperature, General Symptoms - Fatigue, General Symptoms - Headache, General Symptoms - Myalgia, General Symptoms - Shivering, General Symptoms - Arthralgia, General Symptoms - Sweating increase, UNSOLICITED ADVERSE EVENTS
- 09-01-19 - 1 Formulier, 23 Itemgroepen, 137 Data-elementen, 1 Taal
Itemgroepen: Administrative data, Elimination Criteria During The Study, Contraindications To Subsequent Vaccination, Absolute Contraindications for InfanrixTM-IPV and Aventis PediacelTM Combination Vaccines, Precautions for Vaccination, Informed Consent, Demographics, Eligibility Check, Inclusion Criteria, Exclusion Criteria, Randomisation / Treatment Allocation, Physical Examination, Vaccine History, Laboratory Tests - Blood, Vaccine Administration, Vaccine, Vaccine 2, Non-administration, Unsolicited Adverse Events, Solicited Adverse Events - Local Symptoms, Solicited Adverse Events - Local Symptoms - Vaccine 2, Solicited Adverse Events, General Symptoms
- 03-06-18 - 1 Formulier, 24 Itemgroepen, 95 Data-elementen, 1 Taal
Itemgroepen: Header, investigational product discontinuation, PGx-Pharmacogenetic Research, Concomitant Medications, If Yes to Concominant Medication, Non-serious adverse events, Non-serious adverse events, Serious adverse event, Serious adverse events description, Seriousness, Document section Demography data, SECTION 4, Section 5, Relevant Medical Conditions, Document section Risk factors, Document section Concomitant Medications, Drug Details, Assessments, Document section, Pregnancy information, Death, Study Conclusion, Investigator comment log, Investigators Signature

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