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Xformpusher
OrderCDASHIG VariableQuestion TextPromptData TypeCRF Completion InstructionsSDTMIG TargetSDTM Variable MappingControlled Terminology Codelist NamePermissible ValuesPre-populated ValueQuery DisplayList StyleHidden
1SPTOBIDWhat was the tobacco product identifier? Tobacco Product Identifier textIndicate the tobacco product that  was involved in the incident.SPTOBID


VAPE-Z01
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6TETERM

Describe What was the device event.event associated with this tobacco product? 

Tobacco Product Device EventtextRecord a description of the device event that occurred.TETERM






7TESTDATWhat was the start date when the event first occurred or was identified?Start DatetextRecord the date that the device event first occurred or was noted using this using this format (DD-MON-YYYY).TESTDTC






10TEPATTHow frequently did the event occur?Event FrequencytextRecord how often the incident event occurred.TEPATT

Single Event; Intermittent; Continuous

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11TEACNDEVWhat action was taken with the study device?Action Taken With DevicetextRecord what action was taken with the device tobacco product as a result of the incidentevent.TEACNDEV
(DEACNDEV)No change; Device replacedChange; Tobacco Product Replaced


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12TEAENO(n)What was the identifier for the primary adverse event(s) associated with or related to this device event?Related Adverse Event IDtextRecord the ID of the primary AE associated with the device event, if any.N/AASSOCIATE WITH RELATED RECORD VIA RELREC





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