| 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 |
||||
| 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 | ||||||