Engelsk

Screen Failure Log: Screening Failure [SF_1] NCT01117584

1 Formulär  
General Information
Beskrivning

General Information

Birth Date
Beskrivning

Birth Date

Datatyp

date

Age
Beskrivning

Age

Datatyp

integer

Age Unit
Beskrivning

Age Unit

Datatyp

boolean

Sex
Beskrivning

Sex

Datatyp

text

Race
Beskrivning

Race

Datatyp

text

If Other, please specify
Beskrivning

Other

Datatyp

text

Ethnicity
Beskrivning

Ethnicity

Datatyp

text

Reason for not meeting admission criteria
Beskrivning

Reason for not meeting admission criteria

Datatyp

text

If Other, please specify
Beskrivning

Other

Datatyp

text

FPG > 270 mg/dL on 2 consecutive measurements
Beskrivning

If Reason is "Not meet inclusion/exclusion criteria", select all that apply

Datatyp

boolean

FPG > 350 mg/dL
Beskrivning

FPG > 350 mg/dL

Datatyp

boolean

FPG < 40 mg/dL
Beskrivning

FPG < 40 mg/dL

Datatyp

boolean

Other Inclusion/Exclusion Criteria Not Met, please specify
Beskrivning

Specification

Datatyp

text

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Screen Failure Log: Screening Failure [SF_1] NCT01117584

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
General Information
Birth Date
Item
Birth Date
date
Age
Item
Age
integer
Age Unit
Item
Age Unit
boolean
Item
Sex
text
Sex
Code List
Sex
CL Item
Male (1)
CL Item
Female (2)
Item
Race
text
Race
Code List
Race
CL Item
White (1)
CL Item
Black or African American (2)
CL Item
Asian (3)
CL Item
Amerikan Indian or Alaska Native (4)
CL Item
Native Hawaiian or Other Pacific Islander (5)
CL Item
Other (6)
Other
Item
If Other, please specify
text
Item
Ethnicity
text
Ethnicity
Code List
Ethnicity
CL Item
Not Hispanic or Latino (1)
CL Item
Hispanic or Latino (2)
Item
Reason for not meeting admission criteria
text
Reason for not meeting admission criteria
Code List
Reason for not meeting admission criteria
CL Item
Not fulfill inclusion or exclusion criteria (1)
CL Item
Adverse Event (2)
CL Item
Withdrawal of consent  (3)
CL Item
Subject lost to follow up (4)
CL Item
Other (5)
Other
Item
If Other, please specify
text
FPG > 270 mg/dL on 2 consecutive measurements
Item
FPG > 270 mg/dL on 2 consecutive measurements
boolean
FPG > 350 mg/dL
Item
FPG > 350 mg/dL
boolean
FPG < 40 mg/dL
Item
FPG < 40 mg/dL
boolean
Specification
Item
Other Inclusion/Exclusion Criteria Not Met, please specify
text
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