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Throughout: Mortality Report [MO_1] NCT01117584

1 forms  
General Information
Description

General Information

Date of Death
Description

Date of Death

Data type

date

Cause of Death
Description

Cause of Death

Data type

text

Relationship of Study Drug to Subject´s Death?
Description

Relationship to Study Drug

Data type

integer

Was Autopsy performed?
Description

If Yes, submit copy of autopsy report.

Data type

text

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Similar models

Throughout: Mortality Report [MO_1] NCT01117584

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General Information
Date of Death
Item
Date of Death
date
Cause of Death
Item
Cause of Death
text
Item
Relationship of Study Drug to Subject´s Death?
integer
Relationship to Study Drug
Code List
Relationship of Study Drug to Subject´s Death?
CL Item
Not related (1)
CL Item
Possible (2)
CL Item
Probable (3)
Item
Was Autopsy performed?
text
Autopsy
Code List
Was Autopsy performed?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
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