ID
25768
Description
Study ID: 101468/207 Clinical Study ID: SKF-101468/207 Study Title:A double-blind, randomized, placebo-controlled, parallel-group study to investigate the tolerability of a dose-escalating regimen of ropinirole in patients suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 2 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication : Restless Legs Syndrome Serious Adverse Event (SAE)
Keywords
Versions (1)
- 9/18/17 9/18/17 -
Copyright Holder
GlaxoSmithKline
Uploaded on
September 18, 2017
DOI
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License
Creative Commons BY-NC-ND 3.0
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Serious Adverse Event (SAE) GSK Ropinirole Restless Legs Syndrome 101468
Serious Adverse Event (SAE) GSK Ropinirole Restless Legs Syndrome 101468
Description
Serious Adverse Event - Complete the SAE Pages. Please complete these pages fully and accurately as possible in order to minimise the time you spend dealing with data queries. If the SAE is still ongoing at the time of reporting, please leave 'Event Course' blank and update it later. Sign and date the SAE page. Please ensure that all of the information on the following CRF pages is complete (Demography, significant Medical/Surgical History and Physiology Examination, Study Medication Record, Concomitant Medication, Form D (if applicable). Photocophy the SAE pages and the CRF pages specified above (Do not separate the NCR pages). Fax a copy of the SAE pages and all of the CRF pages specified above to: Your local GSK CRA/Medical Monitor (see Investigator Site File for appropriate fax number). If no photocopier OR fax is available please telephone your local GSK CRA/Medical monitor within 24 hours.
Alias
- UMLS CUI-1
- C1519255
Description
Investigator's Name
Data type
text
Alias
- UMLS CUI [1]
- C2826892
Description
Number
Data type
text
Alias
- UMLS CUI [1]
- C0237753
Description
Serious Adverse Event
Data type
text
Alias
- UMLS CUI [1]
- C1519255
Description
Reason
Data type
text
Alias
- UMLS CUI [1]
- C0566251
Description
Reason: Specification
Data type
text
Alias
- UMLS CUI [1,1]
- C0566251
- UMLS CUI [1,2]
- C2348235
Description
Onset Date
Data type
date
Measurement units
- dd-mmm-yyyy
Alias
- UMLS CUI [1]
- C0574845
Description
Onset Time
Data type
time
Measurement units
- 24hr:min
Alias
- UMLS CUI [1]
- C0449244
Description
End Date
Data type
date
Measurement units
- dd-mmm-yyyy
Alias
- UMLS CUI [1]
- C0806020
Description
End Time
Data type
time
Measurement units
- 24hr:min
Description
* If subject died, please inform GSK within 24 hours and complete Form D
Data type
text
Alias
- UMLS CUI [1,1]
- C1705586
- UMLS CUI [1,2]
- C1519255
Description
Event Course
Data type
text
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0750729
Description
Number of Episodes
Data type
float
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C4086638
Description
Intensity
Data type
text
Alias
- UMLS CUI [1]
- C1710066
Description
Action taken
Data type
text
Alias
- UMLS CUI [1]
- C2826626
Description
Relationship
Data type
text
Alias
- UMLS CUI [1]
- C0439849
Description
Assessment
Data type
text
Alias
- UMLS CUI [1]
- C0220825
Description
Assessment Specification
Data type
text
Alias
- UMLS CUI [1,1]
- C0220825
- UMLS CUI [1,2]
- C2348235
Description
If 'YES', Please record on Concomitant Medication form
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0087111
Description
Withdrawal
Data type
boolean
Alias
- UMLS CUI [1,1]
- C2349954
- UMLS CUI [1,2]
- C1519255
Description
Ablation
Data type
boolean
Alias
- UMLS CUI [1]
- C0547070
Description
Retreatment with study medication
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0376495
- UMLS CUI [1,2]
- C0304229
Description
Recurrence
Data type
boolean
Alias
- UMLS CUI [1]
- C0034897
Description
Serious Adverse Event (SAE) - Relevant Laboratory Data (Please provide relevant abnormal laboratory data below)
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0587081
Description
Laboratory Test
Data type
text
Alias
- UMLS CUI [1]
- C0022885
Description
Laboratory Test Date
Data type
date
Measurement units
- dd-mmm-yyyy
Alias
- UMLS CUI [1]
- C2826641
Description
Laboratory Value
Data type
text
Alias
- UMLS CUI [1]
- C0587081
Description
Measurement Unit
Data type
text
Alias
- UMLS CUI [1]
- C1519795
Description
Normal Range
Data type
text
Alias
- UMLS CUI [1]
- C0086715
Description
Remarks
Data type
text
Description
Randomization
Data type
boolean
Alias
- UMLS CUI [1]
- C0034656
Description
Randomization Number
Data type
float
Alias
- UMLS CUI [1]
- C2986235
Description
Investigator's Name
Data type
text
Alias
- UMLS CUI [1]
- C2826892
Description
Date of Report
Data type
date
Measurement units
- dd-mmm-yyyy
Alias
- UMLS CUI [1]
- C1302584
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Serious Adverse Event (SAE) GSK Ropinirole Restless Legs Syndrome 101468
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