Visit number
Item
Visit number
text
C1549755 (UMLS CUI [1])
Date of kit allocation
Item
Date of kit allocation
date
C1706778 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Kit number assigned by IWRS
Item
Kit number assigned by IWRS
text
C0237753 (UMLS CUI [1])
Kit number from medication tear off label to be dispensed to subject
Item
Kit number from medication tear off label to be dispensed to subject
text
C0237753 (UMLS CUI [1])
Item
Was this kit assigned by IWRS dispensed to the subject?
integer
Code List
Was this kit assigned by IWRS dispensed to the subject?
CL Item
No, misallocated (please contact monitor immediately) (2)
CL Item
No, study medication discontinued (after kit was assigned but prior to dispensation) (3)
CL Item
No, kit not available at site (please contact IWRS for new kit assignment) (4)
CL Item
No, other please specify (5)
Item
Date of dispensation
integer
C0011008 (UMLS CUI [1])
Code List
Date of dispensation
CL Item
Same as date of kit allocation by IWRS (1)
CL Item
other, specify: (2)
Number of syringes
Item
Number of syringes taken by subject
text
C0039142 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item
Kit number returned by subject to site
integer
C0237753 (UMLS CUI [1])
Code List
Kit number returned by subject to site
CL Item
N/A (kit never returned) (2)
Date when kit was returned by subject to site
Item
Date when kit was returned by subject to site
date
C0011008 (UMLS CUI [1])
Number of syringes in kit
Item
Number of syringes in kit returned by subject to site
text
C0039142 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Office use only
Item
Office use only
text