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End of Study Form 5 Tolerability of QUTENZA™ When Applied After Pre-treatment With Lidocaine or Tramadol in Subjects With Peripheral Neuropathic Pain - A Randomized, Multi-center, Assessor-blinded Study NCT01416116

1 forms  
End of Study
Description

End of Study

Did subject complete the study?
Description

If 'NO', please provide details below.

Data type

integer

Alias
UMLS CUI [1]
C2348577
Withdrawal Date
Description

Withdrawal Date

Data type

date

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0011008
Primary Reason for Withdrawal
Description

If 'Primary Reason for Withdrawal' is 'Adverse Event', please provide details on 'Adverse Event' form.

Data type

text

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0392360
undefined item
Description

undefined item

Data type

integer

If 'Protocol Violation', specify
Description

Protocol Violation

Data type

text

Alias
UMLS CUI [1]
C1709750
If 'Other', specify
Description

Other

Data type

text

Alias
UMLS CUI [1]
C0205394
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Similar models

End of Study Form 5 Tolerability of QUTENZA™ When Applied After Pre-treatment With Lidocaine or Tramadol in Subjects With Peripheral Neuropathic Pain - A Randomized, Multi-center, Assessor-blinded Study NCT01416116

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
End of Study
Item
Did subject complete the study?
integer
C2348577 (UMLS CUI [1])
study complete
Code List
Did subject complete the study?
CL Item
no (0)
CL Item
yes (1)
Withdrawal Date
Item
Withdrawal Date
date
C2349954 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Reason for Withdrawal
Item
Primary Reason for Withdrawal
text
C2349954 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Item
integer
undefined item
Code List
undefined item
CL Item
Adverse event (1 )
CL Item
Withdrawal of consent (2 )
CL Item
Subject lost to follow up (3 )
CL Item
Protocol violation (4 )
CL Item
Pregnancy (5 )
CL Item
Other (6 )
Protocol Violation
Item
If 'Protocol Violation', specify
text
C1709750 (UMLS CUI [1])
Other
Item
If 'Other', specify
text
C0205394 (UMLS CUI [1])
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