ID

18585

Description

A Randomized, Open-Label Study to Compare the Efficacy and Safety of AT1001 and Enzyme Replacement Therapy (ERT) in Patients With Fabry Disease and AT1001-Responsive GLA Mutations, Who Were Previously Treated With ERT Visit 12

Keywords

Versions (2)
  1. 11/2/16 11/2/16 -
  2. 11/11/16 11/11/16 -
Uploaded on

November 11, 2016

DOI

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License

Creative Commons BY-NC 3.0
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Visit 12 Galafold (migalastat) AT1001-012 NCT01218659

English

Visit 12 Galafold (migalastat) AT1001-012 NCT01218659

1 forms  
Date of visit
Description

Date of visit

Alias
UMLS CUI-1
C1320303
Date of visit
Description

Date of visit

Data type

date

Alias
UMLS CUI [1]
C1320303
12 Lead ECG
Description

12 Lead ECG

Alias
UMLS CUI-1
C1623258
Date ECG was performed
Description

ECG Date

Data type

date

Alias
UMLS CUI [1,1]
C0013798
UMLS CUI [1,2]
C0011008
ECG results
Description

ECG results

Data type

integer

Alias
UMLS CUI [1]
C1623258
Hematology/Coagulation
Description

Hematology/Coagulation

Alias
UMLS CUI-1
C0474523
Hematology Sample Collection Date
Description

Hematology Sample Collection Date

Data type

date

Alias
UMLS CUI [1,1]
C0474523
UMLS CUI [1,2]
C0011008
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Hematology?
Description

Hematology finding; Laboratory test finding

Data type

integer

Alias
UMLS CUI [1,1]
C0474523
UMLS CUI [1,2]
C0587081
Hematology: clinically significant abnormal laboratory values, please sepcify
Description

Hematology: clinically significant abnormal laboratory values, please sepcify

Alias
UMLS CUI-1
C0474523
UMLS CUI-2
C1853129
UMLS CUI-3
C2826293
Hematology: clinically significant abnormal laboratory values, please sepcify
Description

If lab abnormalities=Yes

Data type

integer

Alias
UMLS CUI [1,1]
C0474523
UMLS CUI [1,2]
C1853129
UMLS CUI [1,3]
C2826293
Chemistry, Laboratory findings
Description

Chemistry, Laboratory findings

Alias
UMLS CUI-1
C0005774
Chemistry Sample Collection Date
Description

Chemistry Sample Collection Date

Data type

date

Alias
UMLS CUI [1]
C0005774
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Chemistry?
Description

Science of Chemistry; Laboratory test finding

Data type

integer

Alias
UMLS CUI [1,1]
C0005774
UMLS CUI [1,2]
C0587081
Chemistry: clinically significant abnormal laboratory values, please specify
Description

Chemistry: clinically significant abnormal laboratory values, please specify

Alias
UMLS CUI-1
C0005774
UMLS CUI-2
C2826293
Chemistry: clinically significant abnormal laboratory values, please specify
Description

If lab abnormalities=Yes

Data type

integer

Alias
UMLS CUI [1,1]
C0005774
UMLS CUI [1,2]
C2826293
Urinanalysis
Description

Urinanalysis

Alias
UMLS CUI-1
C0042014
Urinalysis Sample Collection Date
Description

Urinalysis Sample Collection Date

Data type

date

Alias
UMLS CUI [1,1]
C0042014
UMLS CUI [1,2]
C0022877
UMLS CUI [1,3]
C0011008
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Urinalysis?
Description

Urinalysis; Laboratory test finding

Data type

integer

Alias
UMLS CUI [1,1]
C0042014
UMLS CUI [1,2]
C0587081
Urinalysis: clinically significant abnormal laboratory values
Description

Urinalysis: clinically significant abnormal laboratory values

Alias
UMLS CUI-1
C0042014
UMLS CUI-2
C1853129
UMLS CUI-3
C2826293
Urinalysis: clinically significant abnormal laboratory values, please specify
Description

If lab abnormalities=Yes

Data type

integer

Alias
UMLS CUI [1,1]
C0042014
UMLS CUI [1,2]
C1853129
UMLS CUI [1,3]
C2826293
24-Hr Urine Collection
Description

24-Hr Urine Collection

Alias
UMLS CUI-1
C0455060
24-Hr Urine Collection Start Date
Description

24-Hr Urine Collection Start Date

Data type

date

Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C0808070
24-Hr Urine Collection Start Time
Description

24-Hr Urine Collection Start Time

Data type

time

Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C1301880
24-Hr Urine Collection Stop Date
Description

24-Hr Urine Collection Stop Date

Data type

date

Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C0806020
24-Hr Urine Collection Stop Time
Description

24-Hr Urine Collection Stop Time

Data type

time

Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C1522314
24-Hr Urine Collection Total Volume
Description

24-Hr Urine Collection Total Volume

Data type

float

Measurement units
  • ml
Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C2700258
ml
24-Hr Urine Collection Date Sent to Laboratory
Description

24-Hr Urine Collection Date Sent to Laboratory

Data type

date

Alias
UMLS CUI [1,1]
C0455060
UMLS CUI [1,2]
C1515023
UMLS CUI [1,3]
C0011008
Additional Observations
Description

Additional Observations

Alias
UMLS CUI-1
C0700325
Reference date
Description

reference date

Data type

date

Alias
UMLS CUI [1]
C1719096
Visit Type
Description

Visit

Data type

text

Alias
UMLS CUI [1]
C0545082
electronic case report form
Description

eCRF

Data type

text

Alias
UMLS CUI [1]
C1516308
Comment
Description

Comment

Data type

text

Alias
UMLS CUI [1]
C0947611
Vital Signs
Description

Vital Signs

Alias
UMLS CUI-1
C0518766
Date of Assessment
Description

Assessment Date

Data type

date

Alias
UMLS CUI [1]
C2985720
Body weight
Description

Weight

Data type

float

Measurement units
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Blood pressure measurement systolic
Description

Blood pressure

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0005823
mmHg
Blood pressure measurement diastolic
Description

Blood pressure

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0005823
mmHg
Heart rate
Description

Heart rate

Data type

integer

Measurement units
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Respiration rate, Breathing rate (BR)
Description

Respiration Rate

Data type

integer

Measurement units
  • /min
Alias
UMLS CUI [1]
C0231832
/min
Echocardiography
Description

Echocardiography

Alias
UMLS CUI-1
C0013516
Date of echocardiography
Description

Date echocardiography

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0013516
SF-36 Health Survey
Description

SF-36 Health Survey

Alias
UMLS CUI-1
C0451287
Was the health survey completed?
Description

SF-36 Health Survey

Data type

integer

Alias
UMLS CUI [1]
C0451287
Modified Brief Pain Inventory
Description

Modified Brief Pain Inventory

Date of Assessment
Description

Assessment Date

Data type

date

Alias
UMLS CUI [1]
C2985720
Please rate your pain by circling the number that best describes your pain at its worst in the past 24 hours.
Description

pain at its worst

Data type

integer

Alias
UMLS CUI [1]
C0030193
Please rate your pain by circling the number that best describes your pain at its least in the past 24 hours.
Description

Pain at its least

Data type

integer

Alias
UMLS CUI [1]
C0030193
Please rate your pain by circling the number that best describes your pain on the average
Description

pain on average

Data type

integer

Alias
UMLS CUI [1]
C0030193
Please rate your pain by circling the number that best describes how much pain you have right now.
Description

pain right now

Data type

integer

Alias
UMLS CUI [1]
C0030193
Secondary Endpoint Criteria
Description

Secondary Endpoint Criteria

Since the last visit, did the subject have a cardiac event that meets the secondary endpoint criteria?
Description

cardiovascular event

Data type

integer

Alias
UMLS CUI [1]
C1320716
Was the subject sent for a cardiac consult?
Description

cardiac consult

Data type

integer

Alias
UMLS CUI [1,1]
C0009818
UMLS CUI [1,2]
C0007226
Since the last visit, did the subject have a cerebrovascular event that meets the secondary endpoint criteria?
Description

cerebrovascular event

Data type

integer

Alias
UMLS CUI [1]
C0038454
Was the subject sent for a neurological consult?
Description

neurological consult

Data type

integer

Alias
UMLS CUI [1]
C0849229
Drug log
Description

Drug log

Alias
UMLS CUI-1
C0013227
UMLS CUI-2
C0920316
Visit Summary: Date and time of dose of last active drug
Description

Date and time of dose of last active drug

Data type

text

Visit Summary: Did the subject take all required active study drug over the last 7 days?
Description

Did the subject take all required active study drug over the last 7 days

Data type

text

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0013227
UMLS CUI [1,3]
C0008972
Visit Summary: Number of actives capsules the subject should have taken over the last 7 days
Description

Number of actives capsules the subject should have taken over the last 7 days

Data type

integer

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0006935
Visit Summary: Number of actives capsules actually taken by the subject over the last 7 days
Description

Number of actives capsules actually taken by the subject over the last 7 days

Data type

integer

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0006935
Visit Summary: If the subject was not 100% compliant when taking active drug over the last 7 days - please explain.
Description

compliant when taking active drug

Data type

text

Alias
UMLS CUI [1]
C1321605
Blister pack information: Lot number
Description

Lot number

Data type

integer

Alias
UMLS CUI [1]
C2826710
Blister pack information: Blister pack number
Description

Blister pack number

Data type

integer

Alias
UMLS CUI [1,1]
C1706080
UMLS CUI [1,2]
C0449788
Blister pack information: Date Dispensed
Description

Date Dispensed

Data type

date

Alias
UMLS CUI [1]
C0011008
Blister pack information: Number of active capsules dispensed
Description

Number of active capsules dispensed

Data type

integer

Alias
UMLS CUI [1,1]
C0805077
UMLS CUI [1,2]
C0205177
UMLS CUI [1,3]
C0006935
Blister pack information: Date of first dose from blister pack
Description

Date of first dose from blister pack

Data type

date

Alias
UMLS CUI [1]
C3173309
Blister pack information: Date blister pack returned
Description

Date blister pack returned

Data type

date

Alias
UMLS CUI [1]
C0011008
Blister pack information: Number of active drug capsules to be taken
Description

Number of active drug capsules to be taken

Data type

integer

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0006935
Blister pack information: Actual number of active drug capsules taken
Description

Actual number of active drug capsules taken

Data type

integer

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0006935
Blister pack information: Number of active capsules returned
Description

Number of active capsules returned

Data type

integer

Alias
UMLS CUI [1,1]
C0205177
UMLS CUI [1,2]
C0006935
Blister pack information: Dates of missed active doses
Description

Dates of missed active doses

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1705492
UMLS CUI [1,3]
C0178602
Physical Examination
Description

Physical Examination

Alias
UMLS CUI-1
C0031809
Date Physical Examination performed:
Description

Date of Examination

Data type

date

Alias
UMLS CUI [1]
C2826643
Physical Exam Status
Description

Physical Exam Status

Data type

integer

Alias
UMLS CUI [1]
C0031809
Physical Exam Findings, Body Systems
Description

If Clinically significant findings, please specify

Data type

integer

Alias
UMLS CUI [1]
C0031809
Physical Exam Findings
Description

If Clinically significant findings, please specify

Data type

text

Alias
UMLS CUI [1]
C0031809
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Similar models

Visit 12 Galafold (migalastat) AT1001-012 NCT01218659

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Date of visit
C1320303 (UMLS CUI-1)
Date of visit
Item
Date of visit
date
C1320303 (UMLS CUI [1])
Item Group
12 Lead ECG
C1623258 (UMLS CUI-1)
ECG Date
Item
Date ECG was performed
date
C0013798 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
ECG results
integer
C1623258 (UMLS CUI [1])
ECG results
Code List
ECG results
CL Item
Normal (1)
CL Item
Abnormal, not clinically significant (2)
CL Item
Abnormal, clinically significant (3)
Item Group
C0474523 (UMLS CUI-1)
Hematology Sample Collection Date
Item
Hematology Sample Collection Date
date
C0474523 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Hematology?
integer
C0474523 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Hematology finding; Laboratory test finding
Code List
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Hematology?
CL Item
Yes (1)
CL Item
No (2)
Item Group
Hematology: clinically significant abnormal laboratory values, please sepcify
C0474523 (UMLS CUI-1)
C1853129 (UMLS CUI-2)
C2826293 (UMLS CUI-3)
Item
Hematology: clinically significant abnormal laboratory values, please sepcify
integer
C0474523 (UMLS CUI [1,1])
C1853129 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
clinically significant abnormal laboratory values Hematology
Code List
Hematology: clinically significant abnormal laboratory values, please sepcify
CL Item
Total Hemoglobin (1)
CL Item
Hematocrit (2)
CL Item
Erythrocyte (3)
CL Item
Platelet Count (4)
CL Item
Leukocyte (5)
CL Item
MCV (6)
CL Item
MCH (7)
CL Item
MCHC (8)
CL Item
RDW (9)
CL Item
Neutrophils (10)
CL Item
Lymphocytes (11)
CL Item
Monocytes (12)
CL Item
Eosinophils (13)
CL Item
Basophils (14)
CL Item
Neutrophils, ABS (15)
CL Item
Lymphocytes, ABS (16)
CL Item
Monocytes, ABS (17)
CL Item
Eosinophils, ABS (18)
CL Item
Basophils, ABS (19)
CL Item
Morphology (20)
CL Item
Co-Ag, INR (Screening only) (21)
CL Item
Co-Ag, aPTT (Screening only) (22)
Item Group
Chemistry, Laboratory findings
C0005774 (UMLS CUI-1)
Chemistry Sample Collection Date
Item
Chemistry Sample Collection Date
date
C0005774 (UMLS CUI [1])
Item
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Chemistry?
integer
C0005774 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Science of Chemistry; Laboratory test finding
Code List
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Chemistry?
CL Item
Yes (1)
CL Item
No (2)
Item Group
Chemistry: clinically significant abnormal laboratory values, please specify
C0005774 (UMLS CUI-1)
C2826293 (UMLS CUI-2)
Item
Chemistry: clinically significant abnormal laboratory values, please specify
integer
C0005774 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
clinically significant abnormal laboratory values Chemistry
Code List
Chemistry: clinically significant abnormal laboratory values, please specify
CL Item
AST (1)
CL Item
ALT (2)
CL Item
Alkaline Phosphate (3)
CL Item
Total Bilirubin (4)
CL Item
Creatinine (5)
CL Item
Urea (6)
CL Item
Non-Fasting Glucose (7)
CL Item
Calcium (8)
CL Item
Calcium (Albumin Corrected) (9)
CL Item
Sodium (10)
CL Item
Potassium (11)
CL Item
Magnesium (12)
CL Item
Total Protein (13)
CL Item
Albumin (14)
CL Item
Bicarbonate (15)
CL Item
LDH (16)
CL Item
Blood Urea Nitrogen (BUN) (17)
CL Item
Chloride (18)
CL Item
Phosphorus (19)
CL Item
eGFR MDRD, ID MS Traceable (20)
CL Item
Cholesterol  (21)
CL Item
Creatinine Phosphokinase (CPK) (22)
CL Item
Glutamyltransferase (23)
CL Item
Triglyceride (24)
CL Item
Uric Acid (25)
Item Group
C0042014 (UMLS CUI-1)
Urinalysis Sample Collection Date
Item
Urinalysis Sample Collection Date
date
C0042014 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Urinalysis?
integer
C0042014 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Urinalysis; Laboratory test finding
Code List
Are there any laboratory abnormalities, deemed clinically significant by the PI, noted for Urinalysis?
CL Item
Yes (1)
CL Item
No (2)
Item Group
Urinalysis: clinically significant abnormal laboratory values
C0042014 (UMLS CUI-1)
C1853129 (UMLS CUI-2)
C2826293 (UMLS CUI-3)
Item
Urinalysis: clinically significant abnormal laboratory values, please specify
integer
C0042014 (UMLS CUI [1,1])
C1853129 (UMLS CUI [1,2])
C2826293 (UMLS CUI [1,3])
Urinalysis: clinically significant abnormal laboratory values, please specify
Code List
Urinalysis: clinically significant abnormal laboratory values, please specify
CL Item
Specific Gravity (1)
CL Item
pH (2)
CL Item
Protein (3)
CL Item
Glucose (4)
CL Item
Ketones (5)
CL Item
Blood (6)
CL Item
Leukocyte Esterase (7)
CL Item
Nitrite (8)
CL Item
Bilirubin (9)
CL Item
Urobilinogen (10)
CL Item
WBC (11)
CL Item
RBC (12)
CL Item
Color (13)
CL Item
Apperance (14)
CL Item
Microalbumin, 24-HR Urine (mg/day) (15)
CL Item
Protein, 24-HR Urine (mg/day) (16)
CL Item
Microscopic (17)
CL Item
WBC Casts (18)
CL Item
Epithelial Cells (19)
CL Item
Renal Tubular Cells (20)
CL Item
Transitional Epithelial Cells (21)
CL Item
Bacterial Casts (22)
CL Item
Epithelial Casts (23)
CL Item
Fatty Casts (24)
CL Item
Granular Casts (25)
CL Item
Hyaline Casts (26)
CL Item
Mixed Casts (27)
CL Item
RBC Casts (28)
CL Item
Waxy Casts (29)
CL Item
Amorphous Urate Crystals (30)
CL Item
Acid Urate Crystals (31)
CL Item
Ammonium Biurate Crystals (32)
CL Item
Amorphous Crystals (33)
CL Item
Ammonium Oxalate Crystals (34)
CL Item
Ammonium Phosphate Crystals (35)
CL Item
Bilirubin Crystals (36)
CL Item
Calcium Oxalate Crystals (37)
CL Item
Calcium Phospate Crystals (38)
CL Item
Calcium Carbonate Crystals (39)
CL Item
Cystine Crystals (40)
CL Item
Cholesterol Crystals (41)
CL Item
Hippuric Acid Crystals (42)
CL Item
Leucine Crystals (43)
CL Item
Monosodium Urate Crystals (44)
CL Item
Sulfa Crystals (45)
CL Item
Triple Phosphate Crystals (46)
CL Item
Tyrosine Crystals (47)
CL Item
Uric Acid Crystals (48)
CL Item
Bacteria (49)
CL Item
Fat Bodies (50)
CL Item
Starch Granules (51)
CL Item
Trichomonas (52)
CL Item
Yeast (53)
CL Item
Microalbumin, Urine Conc (54)
CL Item
Creatinine, Urine 24-Hr (55)
CL Item
Creatinine, Urine Conc (56)
CL Item
Protein, Urine 24-Hr (57)
CL Item
Urine total protein, random (58)
Item Group
24-Hr Urine Collection
C0455060 (UMLS CUI-1)
24-Hr Urine Collection Start Date
Item
24-Hr Urine Collection Start Date
date
C0455060 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
24-Hr Urine Collection Start Time
Item
24-Hr Urine Collection Start Time
time
C0455060 (UMLS CUI [1,1])
C1301880 (UMLS CUI [1,2])
24-Hr Urine Collection Stop Date
Item
24-Hr Urine Collection Stop Date
date
C0455060 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
24-Hr Urine Collection Stop Time
Item
24-Hr Urine Collection Stop Time
time
C0455060 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])
24-Hr Urine Collection Total Volume
Item
24-Hr Urine Collection Total Volume
float
C0455060 (UMLS CUI [1,1])
C2700258 (UMLS CUI [1,2])
24-Hr Urine Collection Date Sent to Laboratory
Item
24-Hr Urine Collection Date Sent to Laboratory
date
C0455060 (UMLS CUI [1,1])
C1515023 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
C0700325 (UMLS CUI-1)
reference date
Item
Reference date
date
C1719096 (UMLS CUI [1])
Visit
Item
Visit Type
text
C0545082 (UMLS CUI [1])
eCRF
Item
electronic case report form
text
C1516308 (UMLS CUI [1])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item Group
Vital Signs
C0518766 (UMLS CUI-1)
Assessment Date
Item
Date of Assessment
date
C2985720 (UMLS CUI [1])
Weight
Item
Body weight
float
C0005910 (UMLS CUI [1])
Blood pressure
Item
Blood pressure measurement systolic
integer
C0005823 (UMLS CUI [1])
Blood pressure
Item
Blood pressure measurement diastolic
integer
C0005823 (UMLS CUI [1])
Heart rate
Item
Heart rate
integer
C0018810 (UMLS CUI [1])
Respiration Rate
Item
Respiration rate, Breathing rate (BR)
integer
C0231832 (UMLS CUI [1])
Item Group
C0013516 (UMLS CUI-1)
Date echocardiography
Item
Date of echocardiography
date
C0011008 (UMLS CUI [1,1])
C0013516 (UMLS CUI [1,2])
Item Group
SF-36 Health Survey
C0451287 (UMLS CUI-1)
Item
Was the health survey completed?
integer
C0451287 (UMLS CUI [1])
SF-36 Health Survey
Code List
Was the health survey completed?
CL Item
Yes (1)
CL Item
No (2)
Assessment Date
Item
Date of Assessment
date
C2985720 (UMLS CUI [1])
Item
Please rate your pain by circling the number that best describes your pain at its worst in the past 24 hours.
integer
C0030193 (UMLS CUI [1])
undefined item
Code List
Please rate your pain by circling the number that best describes your pain at its worst in the past 24 hours.
CL Item
0, No pain (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10, Pain as bad a you can imagine (10)
Item
Please rate your pain by circling the number that best describes your pain at its least in the past 24 hours.
integer
C0030193 (UMLS CUI [1])
undefined item
Code List
Please rate your pain by circling the number that best describes your pain at its least in the past 24 hours.
CL Item
0, No pain (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10, Pain as bad a you can imagine (10)
Item
Please rate your pain by circling the number that best describes your pain on the average
integer
C0030193 (UMLS CUI [1])
undefined item
Code List
Please rate your pain by circling the number that best describes your pain on the average
CL Item
0, No pain (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10, Pain as bad a you can imagine (10)
Item
Please rate your pain by circling the number that best describes how much pain you have right now.
integer
C0030193 (UMLS CUI [1])
undefined item
Code List
Please rate your pain by circling the number that best describes how much pain you have right now.
CL Item
0, No pain (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
6 (6)
CL Item
7 (7)
CL Item
8 (8)
CL Item
9 (9)
CL Item
10, Pain as bad a you can imagine (10)
Item
Since the last visit, did the subject have a cardiac event that meets the secondary endpoint criteria?
integer
C1320716 (UMLS CUI [1])
undefined item
Code List
Since the last visit, did the subject have a cardiac event that meets the secondary endpoint criteria?
CL Item
Yes (1)
CL Item
No (2)
Item
Was the subject sent for a cardiac consult?
integer
C0009818 (UMLS CUI [1,1])
C0007226 (UMLS CUI [1,2])
cardiac consult
Code List
Was the subject sent for a cardiac consult?
CL Item
Yes (1)
CL Item
No (2)
Item
Since the last visit, did the subject have a cerebrovascular event that meets the secondary endpoint criteria?
integer
C0038454 (UMLS CUI [1])
undefined item
Code List
Since the last visit, did the subject have a cerebrovascular event that meets the secondary endpoint criteria?
CL Item
Yes (1)
CL Item
No (2)
Item
Was the subject sent for a neurological consult?
integer
C0849229 (UMLS CUI [1])
neurological consult
Code List
Was the subject sent for a neurological consult?
CL Item
Yes (1)
CL Item
No (2)
Item Group
Drug log
C0013227 (UMLS CUI-1)
C0920316 (UMLS CUI-2)
Date and time of dose of last active drug
Item
Visit Summary: Date and time of dose of last active drug
text
Did the subject take all required active study drug over the last 7 days
Item
Visit Summary: Did the subject take all required active study drug over the last 7 days?
text
C0205177 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C0008972 (UMLS CUI [1,3])
Number of actives capsules the subject should have taken over the last 7 days
Item
Visit Summary: Number of actives capsules the subject should have taken over the last 7 days
integer
C0205177 (UMLS CUI [1,1])
C0006935 (UMLS CUI [1,2])
Number of actives capsules actually taken by the subject over the last 7 days
Item
Visit Summary: Number of actives capsules actually taken by the subject over the last 7 days
integer
C0205177 (UMLS CUI [1,1])
C0006935 (UMLS CUI [1,2])
compliant when taking active drug
Item
Visit Summary: If the subject was not 100% compliant when taking active drug over the last 7 days - please explain.
text
C1321605 (UMLS CUI [1])
Lot number
Item
Blister pack information: Lot number
integer
C2826710 (UMLS CUI [1])
Blister pack number
Item
Blister pack information: Blister pack number
integer
C1706080 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Date Dispensed
Item
Blister pack information: Date Dispensed
date
C0011008 (UMLS CUI [1])
Number of active capsules dispensed
Item
Blister pack information: Number of active capsules dispensed
integer
C0805077 (UMLS CUI [1,1])
C0205177 (UMLS CUI [1,2])
C0006935 (UMLS CUI [1,3])
Date of first dose from blister pack
Item
Blister pack information: Date of first dose from blister pack
date
C3173309 (UMLS CUI [1])
Date blister pack returned
Item
Blister pack information: Date blister pack returned
date
C0011008 (UMLS CUI [1])
Number of active drug capsules to be taken
Item
Blister pack information: Number of active drug capsules to be taken
integer
C0205177 (UMLS CUI [1,1])
C0006935 (UMLS CUI [1,2])
Actual number of active drug capsules taken
Item
Blister pack information: Actual number of active drug capsules taken
integer
C0205177 (UMLS CUI [1,1])
C0006935 (UMLS CUI [1,2])
Number of active capsules returned
Item
Blister pack information: Number of active capsules returned
integer
C0205177 (UMLS CUI [1,1])
C0006935 (UMLS CUI [1,2])
Dates of missed active doses
Item
Blister pack information: Dates of missed active doses
date
C0011008 (UMLS CUI [1,1])
C1705492 (UMLS CUI [1,2])
C0178602 (UMLS CUI [1,3])
Item Group
Physical Examination
C0031809 (UMLS CUI-1)
Date of Examination
Item
Date Physical Examination performed:
date
C2826643 (UMLS CUI [1])
Item
Physical Exam Status
integer
C0031809 (UMLS CUI [1])
Physical Exam Status
Code List
Physical Exam Status
CL Item
No clinically significant findings since previous Physical Examination (1)
CL Item
Clinically significant findings (2)
CL Item
Not done (3)
Item
Physical Exam Findings, Body Systems
integer
C0031809 (UMLS CUI [1])
Body Systems Physical Exam Findings
Code List
Physical Exam Findings, Body Systems
CL Item
Head/Eyes/Ears/Nose/Throat (1)
CL Item
Respiratory (2)
CL Item
Cardiovascular (3)
CL Item
Dermatological (4)
CL Item
Lymphatics/Lymph nodes (5)
CL Item
Gastrointestinal (6)
CL Item
Neurological (7)
CL Item
Genitourinary (8)
CL Item
Musculoskeletal (9)
CL Item
General (10)
Physical Exam Findings
Item
Physical Exam Findings
text
C0031809 (UMLS CUI [1])
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