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SacBo PZ: Case Report Form AE Termination Signature AE NCT01143272

1 Formulários  
Adverse event
Descrição

Adverse event

Alias
UMLS CUI-1
C0877248
Adverse event number
Descrição

Adverse event number

Tipo de dados

integer

Alias
UMLS CUI [1]
C0877248
Adverse event:
Descrição

Adverse event

Tipo de dados

text

Alias
UMLS CUI [1]
C0877248
Adverse event starting date
Descrição

Adverse event starting date

Tipo de dados

date

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0808070
Severe adverse event?
Descrição

Severe adverse event

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0205082
Measures taken regarding investigational agent
Descrição

Measures taken regarding investigational agent

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0079809
Does the adverse event lead to study termination?
Descrição

Adverse event leads to study termination

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C2348581
Connection between adverse event and investigational agent
Descrição

Connection between adverse event and investigational agent

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C1875319
UMLS CUI [1,2]
C0877248
UMLS CUI [1,3]
C0449379
intensitiy of the adverse event
Descrição

intensitiy of the adverse event

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0522510
UMLS CUI [1,2]
C0877248
end date of adverse event
Descrição

end date of adverse event

Tipo de dados

date

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0806020
Adverse event still ongoing at transferal
Descrição

Adverse event still ongoing at transferal

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0030704
UMLS CUI [1,3]
C0549178
Outcome of the adverse event
Descrição

Outcome of the adverse event

Tipo de dados

integer

Alias
UMLS CUI [1]
C1705586
Any further adverse event subject to documentation
Descrição

Any further adverse event subject to documentation

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0877248
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Similar models

SacBo PZ: Case Report Form AE Termination Signature AE NCT01143272

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Adverse event
C0877248 (UMLS CUI-1)
Adverse event number
Item
Adverse event number
integer
C0877248 (UMLS CUI [1])
Adverse event
Item
Adverse event:
text
C0877248 (UMLS CUI [1])
Adverse event starting date
Item
Adverse event starting date
date
C0877248 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Item
Severe adverse event?
integer
C0877248 (UMLS CUI [1,1])
C0205082 (UMLS CUI [1,2])
Severe adverse event
Code List
Severe adverse event?
CL Item
Yes, severe adverse event documented (1)
CL Item
Yes, but due to protocol 10.2 no severe adverse event documentation necessary (2)
CL Item
No (3)
Item
Measures taken regarding investigational agent
integer
C0013227 (UMLS CUI [1,1])
C0079809 (UMLS CUI [1,2])
Measures taken regarding investigational agent
Code List
Measures taken regarding investigational agent
CL Item
No change of dose (1)
CL Item
Medication momentarily stopped (2)
CL Item
Medication definitely stopped (3)
CL Item
Unknown (4)
CL Item
Not applicable (5)
Adverse event leads to study termination
Item
Does the adverse event lead to study termination?
boolean
C0877248 (UMLS CUI [1,1])
C2348581 (UMLS CUI [1,2])
Item
Connection between adverse event and investigational agent
integer
C1875319 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
C0449379 (UMLS CUI [1,3])
Connection between adverse event and investigational agent
Code List
Connection between adverse event and investigational agent
CL Item
no suspicion of there being a connection between adverse event and investigational agent (1)
CL Item
suspicion of there being a connection between adverse event and investigational agent (2)
Item
intensitiy of the adverse event
integer
C0522510 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
intensity
Code List
intensitiy of the adverse event
CL Item
light (activities of daily living are not affected) (1)
CL Item
medium (activities of daily living are affected) (2)
CL Item
severe (activities of daily living or work is impossible) (3)
end date of adverse event
Item
end date of adverse event
date
C0877248 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Adverse event still ongoing at transferal
Item
Adverse event still ongoing at transferal
boolean
C0877248 (UMLS CUI [1,1])
C0030704 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,3])
Item
Outcome of the adverse event
integer
C1705586 (UMLS CUI [1])
Outcome of the adverse event
Code List
Outcome of the adverse event
CL Item
restored (1)
CL Item
improved (2)
CL Item
not improved yet (3)
CL Item
restored with damage (4)
CL Item
unknown (5)
CL Item
death (6)
Any further adverse event subject to documentation
Item
Any further adverse event subject to documentation
boolean
C0877248 (UMLS CUI [1])
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