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Screen Failure Log: Screening Failure [SF_1] NCT01117584

1 Formulaires  
General Information
Description

General Information

Birth Date
Description

Birth Date

Type de données

date

Age
Description

Age

Type de données

integer

Age Unit
Description

Age Unit

Type de données

boolean

Sex
Description

Sex

Type de données

text

Race
Description

Race

Type de données

text

If Other, please specify
Description

Other

Type de données

text

Ethnicity
Description

Ethnicity

Type de données

text

Reason for not meeting admission criteria
Description

Reason for not meeting admission criteria

Type de données

text

If Other, please specify
Description

Other

Type de données

text

FPG > 270 mg/dL on 2 consecutive measurements
Description

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

Type de données

boolean

FPG > 350 mg/dL
Description

FPG > 350 mg/dL

Type de données

boolean

FPG < 40 mg/dL
Description

FPG < 40 mg/dL

Type de données

boolean

Other Inclusion/Exclusion Criteria Not Met, please specify
Description

Specification

Type de données

text

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Screen Failure Log: Screening Failure [SF_1] NCT01117584

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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