ID

13258

Descrição

Prospective,multicentric,double blind and placebo-controlled Phase III clinical trial to determine efficacy and tolerability of subcutaneous hyposensitization with CLUSTOID in patients with allergic rhinoconjunctivits caused by grass or rye pollen. EudraCT-Nr. 2008-000513-29 Study-code:CLU-2008-001 Sponsor: ROXALL Medizin GmbH Carl-Petersen-Straße 4 20535 Hamburg Phone:040-8972520 Fax:040-89725223 Project coordinator: Dr.Jenny Uhlig ROXALL Medizin GmbH Head of clinical investigation: Prof.Dr.med.Ludger Klimek An den Quellen 10 65183 Wiesbaden Phone:0611-8904381 Fax:0611-3082360 Monitoring,data management and statistical evaluation: IMSIE- Institut for medical statistics,computer sciences and epidemiology University hospital Cologne Lindenburger Allee 42 50931 Cologne Phone:0221-4783456 Fax:0221-4783465

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Versões (1)
  1. 27/01/2016 27/01/2016 -
Transferido a

27 de janeiro de 2016

DOI

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Licença

Creative Commons BY-NC 3.0
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Efficacy and tolerability of subcutaneous hyposensitization with CLUSTOID in Patients with allergic rhinoconjunctivitis Telephone Visit 1

Inglês

Case report form: Telephone Visit 1

1 Formulários  
Telephone Visit
Descrição

Telephone Visit

Please give Patient ID composed of Study site Nr and Patient Nr
Descrição

Patient Identification

Tipo de dados

integer

Alias
UMLS CUI [1]
C1269815
Date of phone contact
Descrição

Date of phone contact

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Safety laboratory results of visit 14 have been completed. If yes, please inform your patient of the results.
Descrição

Safety laboratory results

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C1269689
Laboratory results are without findings, no additional visit required
Descrição

Safety laboratory results

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C1269689
One or more laboratory results are abnormal: this is an AE, please arrange for an additional visit, note the date of appointment below and complete the AE report form.
Descrição

Safety laboratory result

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C1269689
Please fill in the date of the additional appointment
Descrição

Appointment date

Tipo de dados

date

Alias
UMLS CUI [1]
C0585085
Date of completion of this form
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Signature
Descrição

Signature

Tipo de dados

text

Alias
UMLS CUI [1]
C1519316
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Similar models

Case report form: Telephone Visit 1

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Telephone Visit
Patient Identification
Item
Please give Patient ID composed of Study site Nr and Patient Nr
integer
C1269815 (UMLS CUI [1])
Date of phone contact
Item
Date of phone contact
date
C0011008 (UMLS CUI [1])
Safety laboratory results
Item
Safety laboratory results of visit 14 have been completed. If yes, please inform your patient of the results.
boolean
C1254595 (UMLS CUI [1,1])
C1269689 (UMLS CUI [1,2])
Safety laboratory results
Item
Laboratory results are without findings, no additional visit required
boolean
C1254595 (UMLS CUI [1,1])
C1269689 (UMLS CUI [1,2])
Safety laboratory result
Item
One or more laboratory results are abnormal: this is an AE, please arrange for an additional visit, note the date of appointment below and complete the AE report form.
boolean
C1254595 (UMLS CUI [1,1])
C1269689 (UMLS CUI [1,2])
Appointment date
Item
Please fill in the date of the additional appointment
date
C0585085 (UMLS CUI [1])
Date
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature
Item
Signature
text
C1519316 (UMLS CUI [1])
Voltar ao início da página 

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