ID

22460

Beschreibung

Study part: PGx- Pharmacogenetic Research.A Phase 2 Multicenter, Double-blind, Placebo-controlled, Study to to Evaluate the Corticosteroid- sparing effects of Mepolizumab in Subjects with Hypereosinophilic Syndromes (HES) and Evaluate Efficacy and Safety of Mepolizumab in Controlling the Clinical Signs and Symptoms of subjects with HES Patient Level Data: Study Listed on ClinicalStudyDataRequest.com. Sponsor: GlaxoSmithKline. Study ID: 100185, Clinical Study ID:MHE100185.

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  1. 05.06.17 05.06.17 -
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GlaxoSmithKline

Hochgeladen am

5. Juni 2017

DOI

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Lizenz

Creative Commons BY-NC 3.0
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Pharmacogenetic Research Mepolizumab HES NCT00086658

Englisch

PGx- Pharmacogenetic Research

1 Formulare  
CONSENT FOR PGx-PHARMACOGENETIC RESEARCH
Beschreibung

CONSENT FOR PGx-PHARMACOGENETIC RESEARCH

Alias
UMLS CUI-1
C0021430
UMLS CUI-2
C2347500
Study ID
Beschreibung

Study ID

Datentyp

text

Alias
UMLS CUI [1]
C2826693
Has informed consent been obtained for PGx-Pharmacogenetic research?
Beschreibung

informed consent Pharmacogenetic Test

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0021430
UMLS CUI [1,2]
C2347500
If Yes,the date informed consent obtained for PGx-Pharmacogenetic research
Beschreibung

date Pharmacogenetic Test

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C2347500
If No,reason:
Beschreibung

reason Pharmacogenetic Test

Datentyp

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C2347500
If other, please specify
Beschreibung

Other

Datentyp

text

Alias
UMLS CUI [1]
C0205394
BLOOD SAMPLE COLLECTION (DNA)
Beschreibung

BLOOD SAMPLE COLLECTION (DNA)

Alias
UMLS CUI-1
C0005834
Has a blood sample been collected for PGx-pharmacogenetic research?
Beschreibung

BLOOD SAMPLE COLLECTION

Datentyp

boolean

Alias
UMLS CUI [1]
C0005834
If Yes, the date sample taken
Beschreibung

date BLOOD SAMPLE COLLECTION

Datentyp

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0005834
WITHDRAWAL OF CONSENT
Beschreibung

WITHDRAWAL OF CONSENT

Alias
UMLS CUI-1
C1707492
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Beschreibung

WITHDRAWAL OF CONSENT

Datentyp

boolean

Alias
UMLS CUI [1]
C1707492
BLOOD SAMPLE DESTRUCTION
Beschreibung

BLOOD SAMPLE DESTRUCTION

Alias
UMLS CUI-1
C1948029
UMLS CUI-2
C0178913
Has a request been made for sample destruction?
Beschreibung

BLOOD SAMPLE DESTRUCTION

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1948029
UMLS CUI [1,2]
C0178913
If Yes,reason:
Beschreibung

reason BLOOD SAMPLE DESTRUCTION

Datentyp

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C1948029
UMLS CUI [1,3]
C0178913
If other, please specify
Beschreibung

Other

Datentyp

text

Alias
UMLS CUI [1]
C0205394
Zum Seitenanfang zurückkehren

Ähnliche Modelle

PGx- Pharmacogenetic Research

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
CONSENT FOR PGx-PHARMACOGENETIC RESEARCH
C0021430 (UMLS CUI-1)
C2347500 (UMLS CUI-2)
Study ID
Item
Study ID
text
C2826693 (UMLS CUI [1])
informed consent Pharmacogenetic Test
Item
Has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
C0021430 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
date Pharmacogenetic Test
Item
If Yes,the date informed consent obtained for PGx-Pharmacogenetic research
date
C0011008 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
Item
If No,reason:
text
C0392360 (UMLS CUI [1,1])
C2347500 (UMLS CUI [1,2])
reason
Code List
If No,reason:
CL Item
Subject declined (Subject declined)
CL Item
Subject not asked by Investigator (Subject not asked by Investigator)
CL Item
Other, specify (Other, specify)
Other
Item
If other, please specify
text
C0205394 (UMLS CUI [1])
Item Group
BLOOD SAMPLE COLLECTION (DNA)
C0005834 (UMLS CUI-1)
BLOOD SAMPLE COLLECTION
Item
Has a blood sample been collected for PGx-pharmacogenetic research?
boolean
C0005834 (UMLS CUI [1])
date BLOOD SAMPLE COLLECTION
Item
If Yes, the date sample taken
date
C0011008 (UMLS CUI [1,1])
C0005834 (UMLS CUI [1,2])
Item Group
WITHDRAWAL OF CONSENT
C1707492 (UMLS CUI-1)
WITHDRAWAL OF CONSENT
Item
Has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
C1707492 (UMLS CUI [1])
Item Group
BLOOD SAMPLE DESTRUCTION
C1948029 (UMLS CUI-1)
C0178913 (UMLS CUI-2)
BLOOD SAMPLE DESTRUCTION
Item
Has a request been made for sample destruction?
boolean
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
Item
If Yes,reason:
text
C0392360 (UMLS CUI [1,1])
C1948029 (UMLS CUI [1,2])
C0178913 (UMLS CUI [1,3])
reason BLOOD SAMPLE DESTRUCTION
Code List
If Yes,reason:
CL Item
Subject requested (Subject requested)
CL Item
Screen failure (Screen failure)
C1710476 (UMLS CUI-1)
CL Item
Other, specify (Other, specify)
C0205394 (UMLS CUI-1)
Other
Item
If other, please specify
text
C0205394 (UMLS CUI [1])
Zum Seitenanfang zurückkehren 

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