ID

19979

Beschreibung

An open-label extension to study AVA100193, to assess the long-term safety and efficacy of rosiglitazone (extended release tablets) in subjects with mild to moderate Alzheimer's disease Medicine: rosiglitazone, Condition: Alzheimer's Disease, Phase: 2, Clinical Study ID: AVA100468, Sponsor: GSK

Stichworte

Versionen (2)
  1. 02.02.17 02.02.17 -
  2. 06.02.17 06.02.17 -
Hochgeladen am

2. Februar 2017

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0
Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

Englisch

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

1 Formulare  
Serious Adverse Event
Beschreibung

Serious Adverse Event

Alias
UMLS CUI-1
C1519255
Event (diagnosis only, otherwise sign/symptom)
Beschreibung

Event

Datentyp

text

Alias
UMLS CUI [1]
C1519255
Start Date
Beschreibung

Start Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C1519255
Outcome
Beschreibung

Outcome

Datentyp

integer

Alias
UMLS CUI [1]
C1705586
End Date
Beschreibung

End Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C1519255
Maximum Intensity
Beschreibung

Maximum Intensity

Datentyp

integer

Alias
UMLS CUI [1,1]
C0518690
UMLS CUI [1,2]
C1519255
Action Taken with Investigational Product(s) as a Result of the Serious AE
Beschreibung

Investigational product(s) withdrawn = Administration of investigational product(s) was permanently discontinued. Dose reduced = Dose is reduced for one or more investigational product(s). Dose increased = Dose increased for one or more investigational product(s). Dose not changed = Investigational product(s) continues even though an adverse event has occured. Dose interrupted = Administration of one or more investigational product(s) was stopped temporarily but then restarted. Not applicable = Subject was not receiving investigational product(s) when the event occurred (e.g., pre- or post-dosing).

Datentyp

integer

Alias
UMLS CUI [1]
C1704758
Did the subject withdraw from study as a result of this SAE?
Beschreibung

Withdrawal

Datentyp

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C1519255
Is there a reasonable possibility that the AE may have been caused by the investigational product?
Beschreibung

Relationship to investigational products

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0085978
UMLS CUI [1,2]
C1519255
Seriousness
Beschreibung

Seriousness

Alias
UMLS CUI-1
C0871902
UMLS CUI-2
C1519255
Seriousness: Specify reason(s) for considering this a SAE, tick all that apply:
Beschreibung

Seriousness

Datentyp

integer

Alias
UMLS CUI [1]
C1710056
Seriousness: If other, specify:
Beschreibung

Seriousness Other

Datentyp

text

Alias
UMLS CUI [1]
C1710056
Demography Data
Beschreibung

Demography Data

Alias
UMLS CUI-1
C1704791
Date of birth
Beschreibung

Date of birth

Datentyp

date

Alias
UMLS CUI [1]
C0421451
Sex
Beschreibung

Sex

Datentyp

integer

Alias
UMLS CUI [1]
C0079399
Weight
Beschreibung

Weight

Datentyp

float

Maßeinheiten
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Investigational Product
Beschreibung

Investigational Product

Alias
UMLS CUI-1
C0304229
UMLS CUI-2
C1519255
If Investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further Investigational Product(s) were Administered?
Beschreibung

Investigational Product

Datentyp

integer

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C1519255
Cause of SAE
Beschreibung

Cause of SAE

Alias
UMLS CUI-1
C0015127
UMLS CUI-2
C1519255
Possible Cause of SAE other than investigational Product(s), tick all that apply:
Beschreibung

Possible Cause of SAE

Datentyp

integer

Alias
UMLS CUI [1,1]
C0015127
UMLS CUI [1,2]
C1519255
Possible Cause of SAE other than investigational Product(s), if other, specify:
Beschreibung

Possible Cause of SAE Other

Datentyp

text

Alias
UMLS CUI [1,1]
C0015127
UMLS CUI [1,2]
C1519255
Relevant Medical Conditions
Beschreibung

Relevant Medical Conditions

Alias
UMLS CUI-1
C0262926
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
Beschreibung

medical condition

Datentyp

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C1519255
Date of Onset
Beschreibung

medical condition date

Datentyp

date

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C1519255
Condition present at the time of the SAE?
Beschreibung

medical condition presence

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C1519255
If no, Date of last occurence:
Beschreibung

medical condition occurence

Datentyp

date

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0011008
UMLS CUI [1,3]
C1519255
Risk Factors
Beschreibung

Risk Factors

Alias
UMLS CUI-1
C0035648
Other RELEVANT Risk Factors (e.g. smoking, alcohol, diet, drug abuse, accupational hazard) relevant to the SAE
Beschreibung

Risk Factors

Datentyp

text

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C1519255
Concomitant medications
Beschreibung

Concomitant medications

Alias
UMLS CUI-1
C2347852
Drug name (Trade Name preferred)
Beschreibung

Drug name

Datentyp

text

Alias
UMLS CUI [1]
C0013227
Dose
Beschreibung

Dose

Datentyp

text

Alias
UMLS CUI [1]
C3174092
Unit
Beschreibung

Unit

Datentyp

text

Alias
UMLS CUI [1]
C1519795
Frequency
Beschreibung

Medication frequency

Datentyp

text

Alias
UMLS CUI [1]
C3476109
Route
Beschreibung

Route

Datentyp

text

Alias
UMLS CUI [1]
C0013153
Taken Prior to Study?
Beschreibung

Taken Prior to Study

Datentyp

boolean

Alias
UMLS CUI [1]
C2826667
Start Date
Beschreibung

Start Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C2347852
Stop Date
Beschreibung

Stop Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C2347852
Ongoing Medication?
Beschreibung

Ongoing Medication

Datentyp

boolean

Alias
UMLS CUI [1]
C2826666
Reason for Medication (e.g. Gastric Ulcer)
Beschreibung

Reason for Medication

Datentyp

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0013227
Investigational Product
Beschreibung

Investigational Product

Alias
UMLS CUI-1
C0304229
Details of Investigational Product(s)
Beschreibung

Investigational Product

Datentyp

text

Alias
UMLS CUI [1]
C0304229
Was randomisation code broken at investigational site?
Beschreibung

Investigational Product randomisation

Datentyp

integer

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C0034656
Assessments
Beschreibung

Assessments

Alias
UMLS CUI-1
C0220825
Details of RELEVANT assessments.
Beschreibung

Assessment

Datentyp

text

Alias
UMLS CUI [1,1]
C1516048
UMLS CUI [1,2]
C1519255
Narrative Remarks
Beschreibung

Narrative Remarks

Alias
UMLS CUI-1
C0947611
Narrative Remarks (provide a brief narrative description of the SAE and details of tretment given).
Beschreibung

Narrative Remarks

Datentyp

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C1519255
Zum Seitenanfang zurückkehren

Ähnliche Modelle

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Serious Adverse Event
C1519255 (UMLS CUI-1)
Event
Item
Event (diagnosis only, otherwise sign/symptom)
text
C1519255 (UMLS CUI [1])
Start Date
Item
Start Date
date
C0808070 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item
Outcome
integer
C1705586 (UMLS CUI [1])
Outcome
Code List
Outcome
CL Item
Recovered/Resolved (1)
CL Item
Recovering/Resolving (2)
CL Item
Not Recovered/Not Resolved (3)
End Date
Item
End Date
date
C0806020 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item
Maximum Intensity
integer
C0518690 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Maximum Intensity
Code List
Maximum Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
CL Item
Not applicable (4)
Item
Action Taken with Investigational Product(s) as a Result of the Serious AE
integer
C1704758 (UMLS CUI [1])
Action Taken with Investigational Product
Code List
Action Taken with Investigational Product(s) as a Result of the Serious AE
CL Item
Investigational product(s) withdrawn  (1)
CL Item
Dose reduced (2)
CL Item
Dose increased (3)
CL Item
Dose not changed (4)
CL Item
Dose interrupted (5)
CL Item
Not applicable (6)
Withdrawal
Item
Did the subject withdraw from study as a result of this SAE?
boolean
C2349954 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Relationship to investigational products
Item
Is there a reasonable possibility that the AE may have been caused by the investigational product?
boolean
C0085978 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
Seriousness
C0871902 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
Item
Seriousness: Specify reason(s) for considering this a SAE, tick all that apply:
integer
C1710056 (UMLS CUI [1])
Seriousness
Code List
Seriousness: Specify reason(s) for considering this a SAE, tick all that apply:
CL Item
Results in death (1)
CL Item
Is life-threatening (2)
CL Item
Requires hospitalisation or prolongation of existing hospitalisation (3)
CL Item
Results in disability/incapacity (4)
CL Item
Congenital anomaly/birth defect (5)
CL Item
Other (6)
Seriousness Other
Item
Seriousness: If other, specify:
text
C1710056 (UMLS CUI [1])
Item Group
Demography Data
C1704791 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Sex
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
CL Item
Female (2)
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Item Group
Investigational Product
C0304229 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
Item
If Investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further Investigational Product(s) were Administered?
integer
C0304229 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Investigational Product
Code List
If Investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further Investigational Product(s) were Administered?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown at this time (3)
CL Item
Not applicable (4)
Item Group
Cause of SAE
C0015127 (UMLS CUI-1)
C1519255 (UMLS CUI-2)
Item
Possible Cause of SAE other than investigational Product(s), tick all that apply:
integer
C0015127 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Possible Cause of SAE
Code List
Possible Cause of SAE other than investigational Product(s), tick all that apply:
CL Item
Disease under study (1)
CL Item
Medical Condition(s) (record in nect section) (2)
CL Item
Lack of efficacy (3)
CL Item
Withdrawal of Investigational Product(s) (4)
CL Item
Concomitant medication (record) (5)
CL Item
Activity related to study participation (e.g. procedures) (6)
CL Item
Other (7)
Possible Cause of SAE Other
Item
Possible Cause of SAE other than investigational Product(s), if other, specify:
text
C0015127 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
Relevant Medical Conditions
C0262926 (UMLS CUI-1)
medical condition
Item
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
text
C0262926 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
medical condition date
Item
Date of Onset
date
C0012634 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
medical condition presence
Item
Condition present at the time of the SAE?
boolean
C0012634 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
medical condition occurence
Item
If no, Date of last occurence:
date
C0012634 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Item Group
Risk Factors
C0035648 (UMLS CUI-1)
Risk Factors
Item
Other RELEVANT Risk Factors (e.g. smoking, alcohol, diet, drug abuse, accupational hazard) relevant to the SAE
text
C0035648 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
Concomitant medications
C2347852 (UMLS CUI-1)
Drug name
Item
Drug name (Trade Name preferred)
text
C0013227 (UMLS CUI [1])
Dose
Item
Dose
text
C3174092 (UMLS CUI [1])
Unit
Item
Unit
text
C1519795 (UMLS CUI [1])
Medication frequency
Item
Frequency
text
C3476109 (UMLS CUI [1])
Route
Item
Route
text
C0013153 (UMLS CUI [1])
Taken Prior to Study
Item
Taken Prior to Study?
boolean
C2826667 (UMLS CUI [1])
Start Date
Item
Start Date
date
C0808070 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Stop Date
Item
Stop Date
date
C0806020 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Ongoing Medication
Item
Ongoing Medication?
boolean
C2826666 (UMLS CUI [1])
Reason for Medication
Item
Reason for Medication (e.g. Gastric Ulcer)
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Item Group
Investigational Product
C0304229 (UMLS CUI-1)
Investigational Product
Item
Details of Investigational Product(s)
text
C0304229 (UMLS CUI [1])
Item
Was randomisation code broken at investigational site?
integer
C0304229 (UMLS CUI [1,1])
C0034656 (UMLS CUI [1,2])
Investigational Product randomisation
Code List
Was randomisation code broken at investigational site?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not applicable (3)
Item Group
Assessments
C0220825 (UMLS CUI-1)
Assessment
Item
Details of RELEVANT assessments.
text
C1516048 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
Narrative Remarks
C0947611 (UMLS CUI-1)
Narrative Remarks
Item
Narrative Remarks (provide a brief narrative description of the SAE and details of tretment given).
text
C0947611 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video