ID
13049
Description
Placebo controlled,double blind and randomized parallel group trial to verify effectivity and tolerability of moxaverine p.o. in patients with central nervous vertigo. Sponsor: URSAPHARM Industriestrasse 66129 Saarbrücken Phone 06805-9292-0 Fax 06805- 929288 Head of clinical trial: Univ.-Prof.Dr.med. Ralph Mösges Medical Faculty, University of Cologne Phone 0221-4783456 Fax 0221-4783465
Keywords
Versions (2)
- 1/12/16 1/12/16 -
- 1/13/16 1/13/16 -
Uploaded on
January 13, 2016
DOI
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License
Creative Commons BY-NC 3.0
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Moxaverine 200mg p.o. in patients with central nervous vertigo 2
Case report form Visit 2
- StudyEvent: ODM
Description
otorhinolaryngologic examination
Description
Otoscopy
Data type
text
Alias
- UMLS CUI [1]
- C0419361
Description
Rinne test
Data type
text
Alias
- UMLS CUI [1]
- C0278245
Description
Webers test
Data type
text
Alias
- UMLS CUI [1]
- C0278247
Description
Nystagmus testing with frenzel lens eyeglasses
Data type
text
Alias
- UMLS CUI [1]
- C0028738
Description
Nystagmus testing with frenzel lens eyeglasses
Data type
text
Alias
- UMLS CUI [1]
- C0028738
Description
Nystagmus testing with frenzel lens eyeglasses
Data type
text
Alias
- UMLS CUI [1]
- C0028738
Description
Nystagmus testing with frenzel lens eyeglasses
Data type
text
Alias
- UMLS CUI [1]
- C0012833
Description
Otoscopy
Data type
text
Alias
- UMLS CUI [1]
- C0419361
Description
Rinne test
Data type
text
Alias
- UMLS CUI [1]
- C0278245
Description
Webers test
Data type
text
Alias
- UMLS CUI [1]
- C0278247
Description
Posturography
Description
Computerized dynamic posturography procedure
Data type
text
Alias
- UMLS CUI [1]
- C0519978
Description
Computerized dynamic posturography procedure report has to be enclosed
Data type
text
Alias
- UMLS CUI [1]
- C0519978
Description
Tasks of investigator during this visit
Description
Questionnaire
Data type
boolean
Alias
- UMLS CUI [1]
- C0034394
Description
Trial medication
Data type
boolean
Alias
- UMLS CUI [1]
- C0013227
Description
Trial medication
Data type
integer
Alias
- UMLS CUI [1]
- C0013227
Description
Trial medication
Data type
boolean
Alias
- UMLS CUI [1]
- C0013227
Description
Patient questions
Data type
boolean
Alias
- UMLS CUI [1]
- C0547398
Description
Patient questions
Data type
text
Alias
- UMLS CUI [1]
- C0547398
Description
Date
Data type
date
Alias
- UMLS CUI [1]
- C0011008
Description
Signature
Data type
text
Alias
- UMLS CUI [1]
- C1519316
Description
Comorbidities and concomitant Medication
Description
Comorbidities
Data type
boolean
Alias
- UMLS CUI [1]
- C0009488
Description
Comorbidities
Data type
text
Alias
- UMLS CUI [1]
- C0009488
Description
prohibited medication: -aminoglycoside antibiotics -vasoactive agents -stimulants to the central nervous system -tranquilizer -agents aiming at cell metabolism -antihistamines -Antiplatelet Agents -anticoagulants
Data type
boolean
Alias
- UMLS CUI [1]
- C2347852
Description
Concomitant Agent
Data type
text
Alias
- UMLS CUI [1]
- C2347852
Description
additional comments
Data type
text
Alias
- UMLS CUI [1]
- C1830770
Description
General impression regarding the trial
Description
Tolerance
Data type
text
Alias
- UMLS CUI [1]
- C0556444
Description
Therapeutic effectiveness
Data type
text
Alias
- UMLS CUI [1]
- C0087113
Description
Date
Data type
date
Alias
- UMLS CUI [1]
- C0011008
Description
Signature
Data type
text
Alias
- UMLS CUI [1]
- C1519316
Description
Adverse reactions
Description
If yes, please give further detailed information below
Data type
boolean
Alias
- UMLS CUI [1]
- C0559546
Description
Adverse event
Data type
text
Alias
- UMLS CUI [1]
- C0877248
Description
In case of severe or life-threatening AE, please notify URSAPHARM GmbH (ASAP< 24h) and fill in the enclosed pharmacovigilance form. Phone 06805-9292130, Fax 06805-929288
Data type
text
Alias
- UMLS CUI [1]
- C1710066
Description
If patient has been discontinued from trial,please enclose final report.
Data type
text
Alias
- UMLS CUI [1]
- C0087111
Description
Development
Data type
text
Alias
- UMLS CUI [1]
- C0243107
Description
Drug association
Data type
text
Alias
- UMLS CUI [1]
- C0544075
Description
additional comments
Data type
text
Alias
- UMLS CUI [1]
- C1830770
Description
Date
Data type
date
Alias
- UMLS CUI [1]
- C0011008
Description
Signature
Data type
text
Alias
- UMLS CUI [1]
- C1519316
Similar models
Case report form Visit 2
- StudyEvent: ODM