ID

22654

Description

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4170g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

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  1. 08/06/2017 08/06/2017 -
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4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

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4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

1 Formulaires  
Patient administration
Description

Patient administration

Subject Number
Description

PT

Type de données

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Description

PTINIT

Type de données

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Report Date:
Description

VDT

Type de données

date

Alias
UMLS CUI [1,1]
C1302584
4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CONTINUED
Description

4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CONTINUED

Test Date:
Description

EXAM_DT [EXMDT]

Type de données

date

Unités de mesure
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0200150
UMLS CUI [1,2]
C0229090
UMLS CUI [1,3]
C0011008
DD/MMM/YY
Examiner Name (print):
Description

RATER_NAME [RATNM]

Type de données

text

Alias
UMLS CUI [1]
C2826892
SECTION I = 4 Meter Test
Description

SECTION I = 4 Meter Test

Number correct at 4 meters, Chart 1 Letters D S R K N
Description

Row 1, Snellen Equivalent 20/200

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters C K Z O H
Description

Row 1, Snellen Equivalent 20/160

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters O N R K D
Description

Row 1, Snellen Equivalent 20/125

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters K Z V D C
Description

Row 1, Snellen Equivalent 20/100

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters V S H Z O
Description

Row 1, Snellen Equivalent 20/80

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters H D K C R
Description

Row 1, Snellen Equivalent 20/63

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters C S R H N
Description

Row 1, Snellen Equivalent 20/50

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters S V Z D K
Description

Row 1, Snellen Equivalent 20/40

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters N C V O Z
Description

Row 1, Snellen Equivalent 20/32

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters R H S D V
Description

Row 1, Snellen Equivalent 20/25

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters S N R O H
Description

Row 1, Snellen Equivalent 20/20

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters O D H K R
Description

Row 1, Snellen Equivalent 20/16

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters Z K C S N
Description

Row 1, Snellen Equivalent 20/12.5

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 4 meters, Chart 1 Letters C R H D V
Description

Row 1, Snellen Equivalent 20/10

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Total number correct at 4 meters
Description

SCORE [SCORE1]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
SECTION II = 1 Meter Test
Description

SECTION II = 1 Meter Test

Number correct at 1 meter, Chart 1 Letters D S R K N
Description

Row 1, Snellen Equivalent 20/800

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 1 meter, Chart 1 Letters C K Z O H
Description

Row 2, Snellen Equivalent 20/640

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 1 meter, Chart 1 Letters O N R K D
Description

Row 3, Snellen Equivalent 20/500

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 1 meter, Chart 1 Letters K Z V D C
Description

Row 4, Snellen Equivalent 20/400

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 1 meter, Chart 1 Letters V S H Z O
Description

Row 5, Snellen Equivalent 20/320

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Number correct at 1 meter, Chart 1 Letters H D K C R
Description

Row 6, Snellen Equivalent 20/250

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
Total number correct at 1 meter
Description

SCORE [SCORE2]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
SECTION III = Computing VA Score & Snellen Equivalent
Description

SECTION III = Computing VA Score & Snellen Equivalent

A. Total number correct at 4 meters: (SECTION I)
Description

SEGMENT_NUMBER [SEGNO1]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
B. If A >=4, write 30; otherwise, write zero
Description

SEGMENT_NUMBER [SEGNO2]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
C. Total correct at 1 meter (SECTION II) (If not tested, write zero)
Description

SEGMENT_NUMBER [SEGNO3]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
A + B + C =
Description

SCORE [SCORE3]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442746
UMLS CUI [1,2]
C0229090
SNELLEN EQUIVALENT Left Eye 20/_ _ _
Description

SNELLEN_VALUE [SNLVAL]

Type de données

integer

Alias
UMLS CUI [1,1]
C1827708
UMLS CUI [1,2]
C0229090
(Most difficult line with 1 or no errors) OR Snellen Equivalent worse than 20/800
Description

SNELLEN_WORSE [SNLWRS]

Type de données

boolean

Alias
UMLS CUI [1,1]
C1827708
UMLS CUI [1,2]
C0229090
SECTION IV = Low Vision Testing
Description

SECTION IV = Low Vision Testing

Count fingers?
Description

COUNT_FINGERS [CTFGR]

Type de données

integer

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0229090
UMLS CUI [1,3]
C0449804
If Yes, maximum distance:
Description

MAXIMUM_DISTANCE [MAXDST]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442747
UMLS CUI [1,2]
C0042793
UMLS CUI [1,3]
C0229090
Hand movement?
Description

HAND_MOVEMENT [HDMVT]

Type de données

integer

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0229090
UMLS CUI [1,3]
C0575809
If Yes:
Description

HAND_MOVEMENT_DESC [HDMVTD]

Type de données

integer

Alias
UMLS CUI [1,1]
C0575809
UMLS CUI [1,2]
C0229090
Light Perception?
Description

LIGHT_PERCEPTION [LIPEC]

Type de données

integer

Alias
UMLS CUI [1,1]
C0042793
UMLS CUI [1,2]
C0229090
UMLS CUI [1,3]
C1154616
If Yes:
Description

LIGHT_PERCEPTION_DES [LIPECD]

Type de données

integer

Alias
UMLS CUI [1,1]
C0442772
UMLS CUI [1,2]
C0229090
Retour au début de la page

Similar models

4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Patient administration
PT
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
PTINIT
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
VDT
Item
Report Date:
date
C1302584 (UMLS CUI [1,1])
Item Group
4 METER VISUAL ACUITY / LEFT EYE CHART 2 (SCREENING) CONTINUED
EXAM_DT [EXMDT]
Item
Test Date:
date
C0200150 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
RATER_NAME [RATNM]
Item
Examiner Name (print):
text
C2826892 (UMLS CUI [1])
Item Group
SECTION I = 4 Meter Test
CORRECT_READING [COTRD1]
Item
Number correct at 4 meters, Chart 1 Letters D S R K N
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD2]
Item
Number correct at 4 meters, Chart 1 Letters C K Z O H
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD3]
Item
Number correct at 4 meters, Chart 1 Letters O N R K D
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD4]
Item
Number correct at 4 meters, Chart 1 Letters K Z V D C
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD5]
Item
Number correct at 4 meters, Chart 1 Letters V S H Z O
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD6]
Item
Number correct at 4 meters, Chart 1 Letters H D K C R
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD7]
Item
Number correct at 4 meters, Chart 1 Letters C S R H N
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD8]
Item
Number correct at 4 meters, Chart 1 Letters S V Z D K
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD9]
Item
Number correct at 4 meters, Chart 1 Letters N C V O Z
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD10]
Item
Number correct at 4 meters, Chart 1 Letters R H S D V
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD11]
Item
Number correct at 4 meters, Chart 1 Letters S N R O H
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD12]
Item
Number correct at 4 meters, Chart 1 Letters O D H K R
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD13]
Item
Number correct at 4 meters, Chart 1 Letters Z K C S N
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD14]
Item
Number correct at 4 meters, Chart 1 Letters C R H D V
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SCORE [SCORE1]
Item
Total number correct at 4 meters
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item Group
SECTION II = 1 Meter Test
CORRECT_READING [COTRD15]
Item
Number correct at 1 meter, Chart 1 Letters D S R K N
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD16]
Item
Number correct at 1 meter, Chart 1 Letters C K Z O H
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD17]
Item
Number correct at 1 meter, Chart 1 Letters O N R K D
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD18]
Item
Number correct at 1 meter, Chart 1 Letters K Z V D C
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD19]
Item
Number correct at 1 meter, Chart 1 Letters V S H Z O
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
CORRECT_READING [COTRD20]
Item
Number correct at 1 meter, Chart 1 Letters H D K C R
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SCORE [SCORE2]
Item
Total number correct at 1 meter
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item Group
SECTION III = Computing VA Score & Snellen Equivalent
SEGMENT_NUMBER [SEGNO1]
Item
A. Total number correct at 4 meters: (SECTION I)
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item
B. If A >=4, write 30; otherwise, write zero
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SLIT_LAMP_AQ_CELL [SLAQC]
Code List
B. If A >=4, write 30; otherwise, write zero
CL Item
N/A (1)
CL Item
0 (2)
CL Item
Trace (3)
CL Item
1+ (4)
CL Item
2+ (5)
CL Item
3+ (6)
CL Item
4+ (7)
SEGMENT_NUMBER [SEGNO3]
Item
C. Total correct at 1 meter (SECTION II) (If not tested, write zero)
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SCORE [SCORE3]
Item
A + B + C =
integer
C0442746 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SNELLEN_VALUE [SNLVAL]
Item
SNELLEN EQUIVALENT Left Eye 20/_ _ _
integer
C1827708 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
SNELLEN_WORSE [SNLWRS]
Item
(Most difficult line with 1 or no errors) OR Snellen Equivalent worse than 20/800
boolean
C1827708 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
Item Group
SECTION IV = Low Vision Testing
Item
Count fingers?
integer
C0042793 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
C0449804 (UMLS CUI [1,3])
COUNT_FINGERS [CTFGR]
Code List
Count fingers?
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not Done (3)
Item
If Yes, maximum distance:
integer
C0442747 (UMLS CUI [1,1])
C0042793 (UMLS CUI [1,2])
C0229090 (UMLS CUI [1,3])
MAXIMUM_DISTANCE [MAXDST]
Code List
If Yes, maximum distance:
CL Item
4 ft (1)
CL Item
2 ft (2)
CL Item
1 ft (3)
Item
Hand movement?
integer
C0042793 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
C0575809 (UMLS CUI [1,3])
COUNT_FINGERS [CTFGR]
Code List
Hand movement?
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not Done (3)
Item
If Yes:
integer
C0575809 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
HAND_MOVEMENT_DESC [HDMVTD]
Code List
If Yes:
CL Item
With Direction (1)
CL Item
Without Direction (2)
Item
Light Perception?
integer
C0042793 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
C1154616 (UMLS CUI [1,3])
COUNT_FINGERS [CTFGR]
Code List
Light Perception?
CL Item
Yes (1)
CL Item
No  (2)
CL Item
Not Done (3)
Item
If Yes:
integer
C0442772 (UMLS CUI [1,1])
C0229090 (UMLS CUI [1,2])
LIGHT_PERCEPTION [LIPEC]
Code List
If Yes:
CL Item
With Projection (1)
CL Item
Without Projection (2)
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