| # | Question | Response |
|---|---|---|
|
1
|
Did the subject experience any unusual physical activity or stress because of wearing the device?
field_001
|
|
|
2
|
Did the subject any unusual physical activity or stress because of wearing the device?
field_002
|
|
|
3
|
Did the subject experience unusual physical activity?
field_003
|
|
|
4
|
Start date of unusual physical activity
field_004
|
|
|
5
|
Start time of unusual physical activity
field_005
|
|
|
6
|
Stop date of unusual physical activity
field_006
|
|
|
7
|
Stop time of unusual physical activity
field_007
|
|
|
8
|
Did the subject experience a stressful event?
field_008
|
|
|
9
|
Start date of stressful event
field_009
|
|
|
10
|
Start time of stressful event
field_010
|
|
|
11
|
Stop date of stressful event
field_011
|
|
|
12
|
Stop time of stressful event
field_012
|
| # | Question | Response |
|---|---|---|
|
1
|
Did the patient fall since last visit?
field_001
|
|
|
2
|
Date of fall
field_002
|
|
|
3
|
Time of the day
field_003
|
|
|
4
|
Environment (of fall)
field_004
|
|
|
5
|
Activity at the time of fall
field_005
|
|
|
6
|
Fall Mechanism
field_006
|
|
|
7
|
Did the fall result in injury
field_007
|
|
|
8
|
Severity of the injury
field_008
|
|
|
9
|
field_009
|
| # | Question | Response |
|---|---|---|
|
1
|
Did subject have any hypoglycemic events since the last visit?
field_001
|
|
|
2
|
Sequence Identifier
field_002
|
|
|
3
|
Hypoglycemic event start date
field_003
|
|
|
4
|
Hypoglycemic event start time
field_004
|
|
|
5
|
What was the date of last study treatment before the event?
field_005
|
|
|
6
|
What was the time of last study treatment before the event?
field_006
|
|
|
7
|
What was the subject's awareness of the hypoglycemic event?
field_007
|
|
|
8
|
Blood glucose concentration measured prior to treating the event?
field_008
|
|
|
9
|
If measured, what is the blood glucose concentration
field_009
|
|
|
10
|
Unit of blood glucose concentration measurement
field_010
|
|
|
11
|
Were signs/symptoms of hypoglycemia present, other than the blood glucose reading?
field_011
|
|
|
12
|
What was the hypoglycemic event outcome?
field_012
|
|
|
13
|
Specify if outcome is other
field_013
|
|
|
14
|
Was treatment given because of the occurrence of the event?
field_014
|
|
|
15
|
If yes, how was the hypoglycemic event treatment
field_015
|
|
|
16
|
field_016
|