Vaccination History


This example CRF was used to collect vaccination data. In this study, the sponsor collected vaccinations in a separate CRF using the category "Vaccinations", rather than in a general Concomitant/Prior Medications (CM) CRF.


The CRF is designed to use electronic data collection (EDC) dynamic navigation. At the initial visit, the question about vaccination history is shown. At all subsequent visits, the question about vaccinations received during the study are shown. The CRF questions used to report the vaccinations were the same at all visits.


Vaccination History
Baseline Visit
Has the subject had any vaccinations within the 6 months prior to study entry?Yes  No  
Subsequent Visits
Has the subject had any vaccinations during the study?Yes  No  
Vaccination Details
Concomitant Medication Category
What vaccination did the subject receive?
Start Date
01 Jan 2000
* Mandatory field

Package(s)
Vaccination_History_2023_06_27.zip