11.1
Visit date
11.2
Biobank samples collected?
11.3
Biobank samples collected according to protocol?
Only shown if field 11.2 is equal to 1
11.4
Date biobank samples taken
Only shown if field 11.2 is equal to 1
11.5
Were the samples sent?
Only shown if field 11.2 is equal to 1
11.6
Date samples sent:
Only shown if field 11.5 is equal to 1
11.7
Reason samples were not sent:
Only shown if field 11.5 is equal to 2
11.8
Protocol deviation - samples not sent
Only shown if field 11.5 is equal to 2
11.9
Protocol deviation - samples not collected
Only shown if field 11.2 is equal to 2
11.10
Imaging performed?
11.11
What type of imaging was performed?
Only shown if field 11.10 is equal to 1
11.12
Specify type of X-ray
Only shown if field 11.11 is equal to 1
11.13
Date imaging performed
Only shown if field 11.10 is equal to 1
11.14
Result imaging
Only shown if field 11.10 is equal to 1
11.15
Protocol deviation - imaging not performed
Only shown if field 11.10 is equal to 2
11.16
Vital signs measured?
11.17
Date vital signs measured
Only shown if field 11.16 is equal to 1
11.18
What vital signs were measured? *(check all that apply)*
Only shown if field 11.16 is equal to 1
11.19
Systolic blood pressure (mmHg):
Only shown if field 11.18 is equal to 1
11.20
Diastolic blood pressure (mmHg):
Only shown if field 11.18 is equal to 1
11.21
Body temperature (°C):
Only shown if field 11.18 is equal to 2
11.22
Respiratory rate (/min):
Only shown if field 11.18 is equal to 3
11.23
Heart rate (bpm):
Only shown if field 11.18 is equal to 4
11.24
Weight (kg):
Only shown if field 11.18 is equal to 5
11.25
Protocol deviation - vital signs not measured
Only shown if field 11.16 is equal to 2
11.26
Physical examination
11.27
Date physical examination
Only shown if field 11.26 is equal to 1
11.28
Clinically significant finding
Only shown if field 11.26 is equal to 1
11.29
Which finding is clinically significant? *(check all that apply)*
Only shown if field 11.28 is equal to 1
11.30
Specify finding general impression:
Only shown if field 11.29 is equal to 1
11.31
Specify finding head/neck/throat:
Only shown if field 11.29 is equal to 2
11.32
Specify finding heart:
Only shown if field 11.29 is equal to 3
11.33
Specify finding lungs:
Only shown if field 11.29 is equal to 4
11.34
Specify finding abdomen:
Only shown if field 11.29 is equal to 5
11.35
Specify finding extremities:
Only shown if field 11.29 is equal to 6
11.36
Specify finding other:
Only shown if field 11.29 is equal to 7
11.37
Protocol deviation - physical examination not measured
Only shown if field 11.26 is equal to 2
11.38
Other measurements
11.39
Define other measurements:
Only shown if field 11.38 is equal to 1
11.40
Date other measurements
Only shown if field 11.38 is equal to 1
11.41
Result other measurements
Only shown if field 11.38 is equal to 1
11.42
Protocol deviation - other measurements not measured
Only shown if field 11.38 is equal to 2
YesNo
1: Yes
2: No
monsters not used
1: Lost
2: Destroyed
3: Thawed
type prot deviation
1: Major / important deviation *- document on protocol deviation form*
2: Minor / not important deviation *- document on protocol deviation log or add comment using gear option*
Type of imaging
1: X-ray
2: US
3: CT-scan
4: PET-scan
5: MRI
Vital signs
1: Blood pressure
2: Body temperature
3: Respiratory rate
4: Heart rate
5: Weight
type lichamelijk onderzoek
1: General impression
2: Head / neck / throat
3: Heart
4: Lungs
5: Abdomen
6: Extremities
7: Other