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Induction Period - Visit 1 Observation Period UK Essen Therapy of Chronic Cold Agglutinin Disease With Eculizumab NCT01303952

1 Formulaires  
Datum der Visite
Description

Datum der Visite

Alias
UMLS CUI-1
C1320303
Datum der Visite
Description

Date of Visit

Type de données

text

Unités de mesure
  • YYYY-MM-DD
Alias
UMLS CUI [1]
C1320303
YYYY-MM-DD
Patient ist für die Studie geeignet
Description

eligibility

Type de données

integer

Alias
UMLS CUI [1]
C1302261
Wurde die Studie vorzeitig beendet?
Description

early termination

Type de données

integer

Alias
UMLS CUI [1]
C2718058
LDH
Description

LDH

Alias
UMLS CUI-1
C0202113
LDH
Description

LDH

Type de données

float

Unités de mesure
  • U/l
Alias
UMLS CUI [1]
C0202113
U/l
Vital signs
Description

Vital signs

Alias
UMLS CUI-1
C0518766
1. Systolischer Blutdruck
Description

1. Systolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
1. Diastolischer Blutdruck
Description

1. Diastolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
2. Systolischer Blutdruck
Description

2. Systolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
2. Diastolischer Blutdruck
Description

2. Diastolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
3. Systolischer Blutdruck
Description

3. Systolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
3. Diastolischer Blutdruck
Description

3. Diastolic blood pressure

Type de données

integer

Unités de mesure
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Herzfrequenz, sitzend
Description

Sitting heart rate

Type de données

integer

Unités de mesure
  • beats per minute
Alias
UMLS CUI [1]
C2029904
beats per minute
Körpertemperatur
Description

Body temperature

Type de données

float

Unités de mesure
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Sechs Minuten Gehtest
Description

Sechs Minuten Gehtest

Alias
UMLS CUI-1
C0430515
Gehdistanz
Description

Walk distance

Type de données

integer

Unités de mesure
  • Meter
Alias
UMLS CUI [1]
C3854161
Meter
Zeigt der Patient Zeichen von Dyspnoe?
Description

dyspnea

Type de données

integer

Alias
UMLS CUI [1]
C0013404
Kardiovaskuläre Symptome
Description

Kardiovaskuläre Symptome

Alias
UMLS CUI-1
C0476270
Thrombophlebitis/Tiefe Beinvenenthrombose
Description

Thrombophlebitis/Deep Vein Thrombosis

Type de données

integer

Alias
UMLS CUI [1]
C0040046
UMLS CUI [2]
C0149871
Lungenembolie
Description

Pulmonary Embolus

Type de données

integer

Alias
UMLS CUI [1]
C0034065
Zerebrovaskuläres Ereignis
Description

Cerebrovascular Accident

Type de données

integer

Alias
UMLS CUI [1]
C0038454
Amputation
Description

Amputation

Type de données

integer

Alias
UMLS CUI [1]
C0002688
Myocardial Infarction
Description

Myocardial Infarction

Type de données

integer

Alias
UMLS CUI [1]
C0027051
Transient Ischemic Attack
Description

Transient Ischemic Attack

Type de données

integer

Alias
UMLS CUI [1]
C0007787
Unstable Angina
Description

Unstable Angina

Type de données

integer

Alias
UMLS CUI [1]
C0002965
Renal Vein Thrombosis
Description

Renal Vein Thrombosis

Type de données

integer

Alias
UMLS CUI [1]
C0238457
Mesenteric Vein Thrombosis
Description

Mesenteric Vein Thrombosis

Type de données

integer

Alias
UMLS CUI [1]
C0267412
Portal Vein Thrombosis (Budd-Chiari)
Description

Portal Vein Thrombosis (Budd-Chiari)

Type de données

integer

Alias
UMLS CUI [1]
C0155773
Gangrene
Description

Gangrene

Type de données

integer

Alias
UMLS CUI [1]
C0017086
Acute Peripheral Vascular Occlusion
Description

Acute Peripheral Vascular Occlusion

Type de données

integer

Alias
UMLS CUI [1]
C0240728
Sudden Death
Description

Sudden Death

Type de données

integer

Alias
UMLS CUI [1]
C0011071
Patient suffers from other accompanying illnesses?
Description

Patient suffers from other accompanying illnesses?

Type de données

integer

Alias
UMLS CUI [1]
C0009488
Only for Woman (under 50): Is the pregnancy test negativ?
Description

Only for Woman (under 50): Is the pregnancy test negativ?

Type de données

integer

Alias
UMLS CUI [1]
C0032976
Comments
Description

Comments

Type de données

text

Alias
UMLS CUI [1]
C0947611
Signature date
Description

Signature date

Type de données

date

Alias
UMLS CUI [1]
C0807937
Investigators signature
Description

Investigators signature

Type de données

integer

Alias
UMLS CUI [1]
C2346576
Signature principal investigator
Description

Signature principal investigator

Alias
UMLS CUI-1
C1519316
UMLS CUI-2
C1521895
Signature date
Description

Signature date

Type de données

text

Unités de mesure
  • YYYY-MM-DD
Alias
UMLS CUI [1]
C0807937
YYYY-MM-DD
Signature investigator
Description

Signature investigator

Type de données

integer

Alias
UMLS CUI [1]
C2346576
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Similar models

Induction Period - Visit 1 Observation Period UK Essen Therapy of Chronic Cold Agglutinin Disease With Eculizumab NCT01303952

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Datum der Visite
C1320303 (UMLS CUI-1)
Date of Visit
Item
Datum der Visite
text
C1320303 (UMLS CUI [1])
Item
Patient ist für die Studie geeignet
integer
C1302261 (UMLS CUI [1])
eligibility
Code List
Patient ist für die Studie geeignet
CL Item
Nein (0)
CL Item
Ja (1)
Item
Wurde die Studie vorzeitig beendet?
integer
C2718058 (UMLS CUI [1])
dyspnea
Code List
Wurde die Studie vorzeitig beendet?
CL Item
Nein (0)
CL Item
Ja (1)
Item Group
LDH
C0202113 (UMLS CUI-1)
LDH
Item
LDH
float
C0202113 (UMLS CUI [1])
Item Group
C0518766 (UMLS CUI-1)
1. Systolic blood pressure
Item
1. Systolischer Blutdruck
integer
C0871470 (UMLS CUI [1])
1. Diastolic blood pressure
Item
1. Diastolischer Blutdruck
integer
C0428883 (UMLS CUI [1])
2. Systolic blood pressure
Item
2. Systolischer Blutdruck
integer
C0871470 (UMLS CUI [1])
2. Diastolic blood pressure
Item
2. Diastolischer Blutdruck
integer
C0428883 (UMLS CUI [1])
3. Systolic blood pressure
Item
3. Systolischer Blutdruck
integer
C0871470 (UMLS CUI [1])
3. Diastolic blood pressure
Item
3. Diastolischer Blutdruck
integer
C0428883 (UMLS CUI [1])
Sitting heart rate
Item
Herzfrequenz, sitzend
integer
C2029904 (UMLS CUI [1])
Body temperature
Item
Körpertemperatur
float
C0005903 (UMLS CUI [1])
Item Group
Sechs Minuten Gehtest
C0430515 (UMLS CUI-1)
Walk distance
Item
Gehdistanz
integer
C3854161 (UMLS CUI [1])
Item
Zeigt der Patient Zeichen von Dyspnoe?
integer
C0013404 (UMLS CUI [1])
dyspnea
Code List
Zeigt der Patient Zeichen von Dyspnoe?
CL Item
Nein (0)
CL Item
Ja (1)
Item Group
Kardiovaskuläre Symptome
C0476270 (UMLS CUI-1)
Item
Thrombophlebitis/Tiefe Beinvenenthrombose
integer
C0040046 (UMLS CUI [1])
C0149871 (UMLS CUI [2])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Thrombophlebitis/Tiefe Beinvenenthrombose
CL Item
Nein (0)
CL Item
Ja (1)
Item
Lungenembolie
integer
C0034065 (UMLS CUI [1])
Pulmonary Embolus
Code List
Lungenembolie
CL Item
Nein (0)
CL Item
Ja (1)
Item
Zerebrovaskuläres Ereignis
integer
C0038454 (UMLS CUI [1])
Cerebrovascular Accident
Code List
Zerebrovaskuläres Ereignis
CL Item
Nein (0)
CL Item
Ja (1)
Item
Amputation
integer
C0002688 (UMLS CUI [1])
Amputation
Code List
Amputation
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0027051 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Myocardial Infarction
CL Item
 (0)
CL Item
 (1)
Item
integer
C0007787 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Transient Ischemic Attack
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0002965 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Unstable Angina
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0238457 (UMLS CUI [1])
Pulmonary Embolus
Code List
Renal Vein Thrombosis
CL Item
 (0)
CL Item
 (1)
Item
integer
C0267412 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Mesenteric Vein Thrombosis
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0155773 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Portal Vein Thrombosis (Budd-Chiari)
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0017086 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Gangrene
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0240728 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Acute Peripheral Vascular Occlusion
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0011071 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Sudden Death
CL Item
Nein (0)
CL Item
Ja (1)
Item
integer
C0009488 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Patient suffers from other accompanying illnesses?
CL Item
Nein (0)
CL Item
Ja (1)
Thrombophlebitis/Deep Vein Thrombosis
Code List
Only for Woman (under 50): Is the pregnancy test negativ?
CL Item
Nein (0)
CL Item
Ja (1)
Comments
Item
text
C0947611 (UMLS CUI [1])
Signature date
Item
date
C0807937 (UMLS CUI [1])
Item
integer
C2346576 (UMLS CUI [1])
Are all inclusion criteria fulfilled?
Code List
Investigators signature
CL Item
 (0)
CL Item
 (1)
Item Group
C1519316 (UMLS CUI-1)
C1521895 (UMLS CUI-2)
Signature date
Item
text
C0807937 (UMLS CUI [1])
Item
integer
C2346576 (UMLS CUI [1])
Thrombophlebitis/Deep Vein Thrombosis
Code List
Signature investigator
CL Item
Nein (0)
CL Item
Ja (1)
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