ID

19979

Descrição

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

Palavras-chave

  1. 02/02/2017 02/02/2017 -
  2. 06/02/2017 06/02/2017 -
Transferido a

2 de fevereiro de 2017

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

Serious Adverse Event
Descrição

Serious Adverse Event

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

Event

Tipo de dados

text

Alias
UMLS CUI [1]
C1519255
Start Date
Descrição

Start Date

Tipo de dados

date

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

Outcome

Tipo de dados

integer

Alias
UMLS CUI [1]
C1705586
End Date
Descrição

End Date

Tipo de dados

date

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

Maximum Intensity

Tipo de dados

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
Descrição

Investigational product(s) withdrawn = Administration of investigational product(s) was permanently discontinued.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).

Tipo de dados

integer

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

Withdrawal

Tipo de dados

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?
Descrição

Relationship to investigational products

Tipo de dados

boolean

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

Seriousness

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

Seriousness

Tipo de dados

integer

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

Seriousness Other

Tipo de dados

text

Alias
UMLS CUI [1]
C1710056
Demography Data
Descrição

Demography Data

Alias
UMLS CUI-1
C1704791
Date of birth
Descrição

Date of birth

Tipo de dados

date

Alias
UMLS CUI [1]
C0421451
Sex
Descrição

Sex

Tipo de dados

integer

Alias
UMLS CUI [1]
C0079399
Weight
Descrição

Weight

Tipo de dados

float

Unidades de medida
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Investigational Product
Descrição

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?
Descrição

Investigational Product

Tipo de dados

integer

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

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:
Descrição

Possible Cause of SAE

Tipo de dados

integer

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

Possible Cause of SAE Other

Tipo de dados

text

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

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
Descrição

medical condition

Tipo de dados

text

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

medical condition date

Tipo de dados

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?
Descrição

medical condition presence

Tipo de dados

boolean

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

medical condition occurence

Tipo de dados

date

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

Risk Factors

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

Risk Factors

Tipo de dados

text

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

Concomitant medications

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

Drug name

Tipo de dados

text

Alias
UMLS CUI [1]
C0013227
Dose
Descrição

Dose

Tipo de dados

text

Alias
UMLS CUI [1]
C3174092
Unit
Descrição

Unit

Tipo de dados

text

Alias
UMLS CUI [1]
C1519795
Frequency
Descrição

Medication frequency

Tipo de dados

text

Alias
UMLS CUI [1]
C3476109
Route
Descrição

Route

Tipo de dados

text

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

Taken Prior to Study

Tipo de dados

boolean

Alias
UMLS CUI [1]
C2826667
Start Date
Descrição

Start Date

Tipo de dados

date

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

Stop Date

Tipo de dados

date

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

Ongoing Medication

Tipo de dados

boolean

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

Reason for Medication

Tipo de dados

text

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

Investigational Product

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

Investigational Product

Tipo de dados

text

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

Investigational Product randomisation

Tipo de dados

integer

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

Assessments

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

Assessment

Tipo de dados

text

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

Narrative Remarks

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

Narrative Remarks

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C1519255

Similar models

Running Logs Serious Adverse Events GSK-AVA100468 NCT00381238

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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])
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])
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])
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])
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])
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])
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])
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])
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])

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial