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Nerventra Study Visit 3

1 forms  
Demographic Information Visit 3
Description

Demographic Information Visit 3

Protocol Number
Description

Protocol Number

Data type

text

Alias
UMLS CUI [1,1]
C0008971
UMLS CUI [1,2]
C0600091
Visit Type
Description

i.e "Screening"

Data type

text

Alias
UMLS CUI [1]
C0545082
Date of visit
Description

Visit date

Data type

date

Alias
UMLS CUI [1]
C1320303
Study site number
Description

Study site

Data type

integer

Alias
UMLS CUI [1]
C2825164
Subject number:
Description

Subject number

Data type

integer

Alias
UMLS CUI [1]
C1709561
Section blank?
Description

Blank

Data type

boolean

Alias
UMLS CUI [1]
C0750479
Frequent MRI Scan Performance Visit 3
Description

Frequent MRI Scan Performance Visit 3

Date of MRI
Description

date MRI

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0024485
MRI not done
Description

MRI

Data type

boolean

Alias
UMLS CUI [1]
C0024485
Type of Gadolinium-based contrast agent used
Description

Contrast agent

Data type

integer

Alias
UMLS CUI [1]
C0009924
Other contrast agent used
Description

Contrast agent

Data type

text

Alias
UMLS CUI [1]
C0009924
Was MRI completed according to the protocol?
Description

MRI performed

Data type

boolean

Alias
UMLS CUI [1]
C0024485
Reason MRI was not completed
Description

MRI

Data type

text

Alias
UMLS CUI [1]
C0024485
Where there any pathological,non-MS findings?
Description

Findings

Data type

boolean

Alias
UMLS CUI [1]
C0243095
Please specify pathological findings
Description

If an adverse event occurs during the MRI performance, please inform the investigator in order to record on adverse event log

Data type

text

Alias
UMLS CUI [1]
C0243095
Repeated Frequent MRI Scan Performance Visit 3
Description

Repeated Frequent MRI Scan Performance Visit 3

Date of MRI
Description

date MRI

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0024485
MRI not done
Description

MRI

Data type

boolean

Alias
UMLS CUI [1]
C0024485
Type of Gadolinium-based contrast agent used
Description

Contrast agent

Data type

integer

Alias
UMLS CUI [1]
C0009924
Other contrast agent used
Description

Contrast agent

Data type

text

Alias
UMLS CUI [1]
C0009924
Was MRI completed according to the protocol?
Description

MRI performed

Data type

boolean

Alias
UMLS CUI [1]
C0024485
Reason MRI was not completed
Description

MRI

Data type

text

Alias
UMLS CUI [1]
C0024485
Where there any pathological,non-MS findings?
Description

Findings

Data type

boolean

Alias
UMLS CUI [1]
C0243095
Please specify pathological findings
Description

If an adverse event occurs during the MRI performance, please inform the investigator in order to record on adverse event log

Data type

text

Alias
UMLS CUI [1]
C0243095
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Similar models

Nerventra Study Visit 3

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Demographic Information Visit 3
Protocol Number
Item
Protocol Number
text
C0008971 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Visit
Item
Visit Type
text
C0545082 (UMLS CUI [1])
Visit date
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Study site
Item
Study site number
integer
C2825164 (UMLS CUI [1])
Subject number
Item
Subject number:
integer
C1709561 (UMLS CUI [1])
Blank
Item
Section blank?
boolean
C0750479 (UMLS CUI [1])
Item Group
Frequent MRI Scan Performance Visit 3
date MRI
Item
Date of MRI
date
C0011008 (UMLS CUI [1,1])
C0024485 (UMLS CUI [1,2])
MRI
Item
MRI not done
boolean
C0024485 (UMLS CUI [1])
Item
Type of Gadolinium-based contrast agent used
integer
C0009924 (UMLS CUI [1])
Contrast agent
Code List
Type of Gadolinium-based contrast agent used
CL Item
Magnevist (1)
CL Item
Omniscan (2)
CL Item
Dotarem (3)
CL Item
Other (specify) (4)
Contrast agent
Item
Other contrast agent used
text
C0009924 (UMLS CUI [1])
MRI performed
Item
Was MRI completed according to the protocol?
boolean
C0024485 (UMLS CUI [1])
MRI
Item
Reason MRI was not completed
text
C0024485 (UMLS CUI [1])
Findings
Item
Where there any pathological,non-MS findings?
boolean
C0243095 (UMLS CUI [1])
Findings
Item
Please specify pathological findings
text
C0243095 (UMLS CUI [1])
Item Group
Repeated Frequent MRI Scan Performance Visit 3
date MRI
Item
Date of MRI
date
C0011008 (UMLS CUI [1,1])
C0024485 (UMLS CUI [1,2])
MRI
Item
MRI not done
boolean
C0024485 (UMLS CUI [1])
Item
Type of Gadolinium-based contrast agent used
integer
C0009924 (UMLS CUI [1])
Contrast agent
Code List
Type of Gadolinium-based contrast agent used
CL Item
Magnevist (1)
CL Item
Omniscan (2)
CL Item
Dotarem (3)
CL Item
Other (specify) (4)
Contrast agent
Item
Other contrast agent used
text
C0009924 (UMLS CUI [1])
MRI performed
Item
Was MRI completed according to the protocol?
boolean
C0024485 (UMLS CUI [1])
MRI
Item
Reason MRI was not completed
text
C0024485 (UMLS CUI [1])
Findings
Item
Where there any pathological,non-MS findings?
boolean
C0243095 (UMLS CUI [1])
Findings
Item
Please specify pathological findings
text
C0243095 (UMLS CUI [1])
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