Variables in Adverse Event Form (AEF) | ||||||||
Question# | Question | Field name | Response nature | Response options | ||||
1 | PID Number | aef_A | ### | |||||
2 | Initials of the participation | aef_B | XX | |||||
3 | Researcher Code | aef_C | ## | |||||
4 | Today's
Date (According to English calender) |
aef_D | ##-XXX-## | dd-mmm-yy | ||||
5 | What is the adverse event? | aef_1 | # | 1=Illness/hospitalization, 2=Miscarriage, 3=Abortion/medical termination, 4=Still birth, 5=Accident/injury, 6=Others | ||||
6 | If others, specify. | aef_1txt | TXT | TEXT
if aef_1=6 NA if aef_1ǂ6 |
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7 | Did the adverse event result in death? | aef_2 | # | 1=Yes, 2=No | ||||
8 | Date
of adverse event (According to English calender) |
aef_3 | ##-XXX-## | dd-mmm-yy | ||||
9 | Date
of event resolved (if
applicable) (According to English calender) |
aef_4 | ##-XXX-## | dd-mmm-yy | ||||
10 | Is the adverse event possibly study related? | aef_5 | # | 1=Yes, 2=No, 3=Unknown | ||||
11 | Description of event | TXT |