Engelsk

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

1 Formulär  
Subject Identification
Beskrivning

Subject Identification

Number of Facility
Beskrivning

Site number

Datatyp

integer

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

Subject number

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Beskrivning

Subject Initials

Datatyp

text

Alias
UMLS CUI [1]
C2986440
Protocol deviations
Beskrivning

Protocol deviations

Deviation number
Beskrivning

Deviation number

Datatyp

integer

Category Code
Beskrivning

Protocol deviation Category Code

Datatyp

integer

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

Timed point or visit name

Datatyp

text

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

Protocol deviation

Datatyp

text

Alias
UMLS CUI [1]
C1705236
Action
Beskrivning

Action taken

Datatyp

text

Alias
UMLS CUI [1]
C0441472
Investigator sign off
Beskrivning

Investigator sign off

Investigating physician's signature
Beskrivning

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.

Datatyp

text

Alias
UMLS CUI [1]
C0807938
Date of signature
Beskrivning

Date of signature

Datatyp

date

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

Investigator

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Tillbaka till toppen

Similar models

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

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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])
Tillbaka till toppen