| # | Question | Response / annotation |
|---|---|---|
|
1
|
Did the subject experience any unusual physical activity or stress because of wearing the device?
field_001
|
[NOT SUBMITTED] |
|
2
|
Did the subject experience any unusual physical activity or stress because of wearing the device?
field_002
|
[NOT SUBMITTED] |
|
3
|
Did the subject experience unusual physical activity?
field_003
|
CEOCCUR when CETERM = PHYSICAL ACTIVITY |
|
4
|
Start date of unusual physical activity
field_004
|
CESTDTC when CETERM = PHYSICAL ACTIVITY |
|
5
|
Start time of unusual physical activity
field_005
|
CESTDTC when CETERM = PHYSICAL ACTIVITY |
|
6
|
Stop date of unusual physical activity
field_006
|
CEENDTC when CETERM = PHYSICAL ACTIVITY |
|
7
|
Stop time of unusual physical activity
field_007
|
CEENDTC when CETERM = PHYSICAL ACTIVITY |
|
8
|
Did the subject experience a stressful event?
field_008
|
CEOCCUR when CETERM = STRESS |
|
9
|
Start date of stressful event
field_009
|
CESTDTC when CETERM = STRESS |
|
10
|
Start time of stressful event
field_010
|
CESTDTC when CETERM = STRESS |
|
11
|
Stop date of stressful event
field_011
|
CEENDTC when CETERM = STRESS |
|
12
|
Stop time of stressful event
field_012
|
CEENDTC when CETERM = STRESS |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Did the patient fall since last visit?
field_001
|
CEOCCUR when CETERM = FALL |
|
2
|
Date of fall
field_002
|
CESTDTC |
|
3
|
Time of the day
field_003
|
FAORRES when FATESTCD = FALL1 |
|
4
|
Environment (of fall)
field_004
|
FAORRES when FATESTCD = FALL2 |
|
5
|
Activity at the time of fall
field_005
|
FAORRES when FATESTCD = FALL3 |
|
6
|
Fall Mechanism
field_006
|
FAORRES when FATESTCD = FALL4 |
|
7
|
Did the fall result in injury
field_007
|
FAORRES when FATESTCD = FALL5 |
|
8
|
Severity of the injury
field_008
|
FAORRES when FATESTCD = FALL6 |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Did subject have any hypoglycemic events since the last visit?
field_001
|
CEOCCUR when CETERM = HYPOGLYCEMIC EVENT |
|
2
|
Sequence Identifier
field_002
|
CESPID |
|
3
|
Hypoglycemic event start date
field_003
|
CESTDTC |
|
4
|
Hypoglycemic event start time
field_004
|
CESTDTC |
|
5
|
What was the date of last study treatment before the event?
field_005
|
FAORRES when FATESTCD = LDOSDTC |
|
6
|
What was the time of last study treatment before the event?
field_006
|
FAORRES when FATESTCD = LDOSDTC |
|
7
|
What was the subject's awareness of the hypoglycemic event?
field_007
|
FAORRES when FATESTCD = HYPOR1 |
|
8
|
Blood glucose concentration measured prior to treating the event?
field_008
|
FAORRES when FATESTCD = HYPOR2 |
|
9
|
If measured, what is the blood glucose concentration
field_009
|
FAORRES when FATESTCD = HYPOR3 |
|
10
|
Unit of blood glucose concentration measurement
field_010
|
FAORRESU when FATESTCD = HYPOR3 |
|
11
|
Were signs/symptoms of hypoglycemia present, other than the blood glucose reading?
field_011
|
FAORRES when FATESTCD = HYPOR4 |
|
12
|
What was the hypoglycemic event outcome?
field_012
|
FAORRES when FATESTCD = HYPOR5 |
|
13
|
Specify if outcome is other
field_013
|
FAORRES when FATESTCD = HYPOR5S |
|
14
|
Was treatment given because of the occurrence of the event?
field_014
|
FAORRES when FATESTCD = HYPOR6 |
|
15
|
If yes, how was the hypoglycemic event treated?
field_015
|
FAORRES when FATEST = Treatment of Hypoglycemic Event |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Date of assessment
field_001
|
FADTC |
|
2
|
Did the subject have any injection site reaction events?
field_002
|
CEOCCUR when CETERM = INJECTION SITE REACTION |
|
3
|
What is the date of the injection?
field_003
|
INJDTC in SUPPCE |
|
4
|
What date did the injection site reaction start?
field_004
|
CESTDTC |
|
5
|
At what time did the injection site reaction start?
field_005
|
CESTDTC |
|
6
|
What date did the injection site reaction end?
field_006
|
CEENDTC |
|
7
|
At what time did the injection site reaction end?
field_007
|
CEENDTC |
|
8
|
Was there pain (including burning) at the injection site?
field_008
|
FAORRES when FATESTCD = SEV and FAOBJ = INJECTION SITE PAIN |
|
9
|
Was there itching at the injection site?
field_009
|
FAORRES when FATESTCD = SEV and FAOBJ = INJECTION SITE ITCHING |
|
10
|
Was there a rash (or redness) at the injection site?
field_010
|
FAORRES when FATESTCD = SEV and FAOBJ = INJECTION SITE RASH |
|
12
|
Was there an open sore at the injection site?
field_012
|
FAORRES when FATESTCD = OCCUR and FAOBJ = INJECTION SITE OPEN SORE |
|
14
|
What was the anatomical location of the injection site reaction?
field_014
|
CELOC |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Was the Investigator's assessment of overall response obtained?
field_001
|
[NOT SUBMITTED] |
|
2
|
Investigator's assessment of overall response
field_002
|
RSORRES when RSTESTCD = OVRLRESP |
|
3
|
Response Assessment Date
field_003
|
RSDTC when RSTESTCD = OVRLRESP |
|
4
|
Reason the Investigator's assessment of overall response was not obtained
field_004
|
RSORRES = NE when RSTESTCD = OVRLRESP RSSTAT = NOT DONE when RSTESTCD = OVRLRESP RSORRES / RSSTAT when RSTESTCD = OVRLRESP |
|
5
|
Did the patient experience symptomatic deterioration?
field_005
|
CEOCCUR when CETERM = SYMPTOMATIC DETERIORATION CEPRESP = Y |
|
6
|
Date of Symptomatic Deterioration
field_006
|
CESTDTC when CETERM = SYMPTOMATIC DETERIORATION |