ID

15872

Description

The primary objective of this study is to evaluate the long-term safety profile of BG00012 (dimethyl fumarate). Secondary objectives of this study are to evaluate the long-term efficacy of BG00012 using clinical endpoints and disability progression, to evaluate further the long-term effects of BG00012 on multiple sclerosis (MS) brain lesions on magnetic resonance imaging (MRI) scans in participants who had MRI scans as part of Studies 109MS301 (NCT00420212) and 109MS302 (NCT00451451) and to evaluate the long-term effects of BG00012 on health economics assessments and the visual function test. NCT00835770 Part: Protocol deviation and Investigator Sign off

Keywords

Versions (1)
  1. 6/17/16 6/17/16 -
Uploaded on

June 17, 2016

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License

Creative Commons BY-NC 3.0
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Protocol deviation and Investigator Sign off BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

English

Protocol deviation and Investigator Sign off BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

1 forms  
Subject Identification
Description

Subject Identification

Number of Facility
Description

Site number

Data type

integer

Alias
UMLS CUI [1,1]
C0018704
UMLS CUI [1,2]
C0600091
Subject number
Description

Subject number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Description

Subject Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Protocol deviations
Description

Protocol deviations

Deviation number
Description

Deviation number

Data type

integer

Category Code
Description

Protocol deviation Category Code

Data type

integer

Alias
UMLS CUI [1,1]
C1705236
UMLS CUI [1,2]
C2985755
Timed point or visit name (if appropriate)
Description

Timed point or visit name

Data type

text

Alias
UMLS CUI [1]
C2826704
UMLS CUI [2]
C0011008
Deviation
Description

Protocol deviation

Data type

text

Alias
UMLS CUI [1]
C1705236
Action
Description

Action taken

Data type

text

Alias
UMLS CUI [1]
C0441472
Investigator sign off
Description

Investigator sign off

Investigating physician's signature
Description

I confirm that the entries on the case report from pages corresonding to this case book accurately and completely represent the results of these examinations, tests and evaluations performed on the dates specified.

Data type

text

Alias
UMLS CUI [1]
C0807938
Date of signature
Description

Date of signature

Data type

date

Alias
UMLS CUI [1]
C0807937
Investigating physician (print name)
Description

Investigator

Data type

text

Alias
UMLS CUI [1]
C2826892
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Similar models

Protocol deviation and Investigator Sign off BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Subject Identification
Site number
Item
Number of Facility
integer
C0018704 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
Protocol deviations
Deviation number
Item
Deviation number
integer
Item
Category Code
integer
C1705236 (UMLS CUI [1,1])
C2985755 (UMLS CUI [1,2])
Protocol deviation Category Code
Code List
Category Code
CL Item
Eligibility Criteria violation (1)
CL Item
All dosing issues including missed partial or incorrect doses as well as non-compliance (2)
CL Item
Prohibited concomitant treatment (3)
CL Item
Evalutation performed outside of acceptable visit window (4)
CL Item
Efficacy evaluation not performed or not valid (5)
CL Item
Safety evaluation not performed or not valid (6)
CL Item
Missed study visit  (7)
CL Item
Other (8)
Timed point or visit name
Item
Timed point or visit name (if appropriate)
text
C2826704 (UMLS CUI [1])
C0011008 (UMLS CUI [2])
Protocol deviation
Item
Deviation
text
C1705236 (UMLS CUI [1])
Action taken
Item
Action
text
C0441472 (UMLS CUI [1])
Item Group
Investigator sign off
Investigating physician's signature
Item
Investigating physician's signature
text
C0807938 (UMLS CUI [1])
Date of signature
Item
Date of signature
date
C0807937 (UMLS CUI [1])
Investigator
Item
Investigating physician (print name)
text
C2826892 (UMLS CUI [1])
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