Form: Device related physical activity and stress
| Question | Response |
|---|---|
| Did the subject experience any unusual physical activity or stress because of wearing the device? | |
| Did the subject any unusual physical activity or stress because of wearing the device? | |
| Did the subject experience unusual physical activity? | |
| Start date of unusual physical activity | |
| Start time of unusual physical activity | |
| Stop date of unusual physical activity | |
| Stop time of unusual physical activity | |
| Did the subject experience a stressful event? | |
| Start date of stressful event | |
| Start time of stressful event | |
| Stop date of stressful event | |
| Stop time of stressful event |
Form: Falls
| Question | Response |
|---|---|
| Did the patient fall since last visit? | |
| Date of fall | |
| Time of the day | |
| Environment (of fall) | |
| Activity at the time of fall | |
| Fall Mechanism | |
| Did the fall result in injury | |
| Severity of the injury | |
Form:
| Question | Response |
|---|---|
| Did subject have any hypoglycemic events since the last visit? | |
| Sequence Identifier | |
| Hypoglycemic event start date | |
| Hypoglycemic event start time | |
| What was the date of last study treatment before the event? | |
| What was the time of last study treatment before the event? | |
| What was the subject's awareness of the hypoglycemic event? | |
| Blood glucose concentration measured prior to treating the event? | |
| If measured, what is the blood glucose concentration | |
| Unit of blood glucose concentration measurement | |
| Were signs/symptoms of hypoglycemia present, other than the blood glucose reading? | |
| What was the hypoglycemic event outcome? | |
| Specify if outcome is other | |
| Was treatment given because of the occurrence of the event? | |
| If yes, how was the hypoglycemic event treatment | |