ID

22688

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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Versions (2)
  1. 09/06/2017 09/06/2017 -
  2. 09/06/2017 09/06/2017 -
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9 juin 2017

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STUDY DRUG ADMINISTRATION DAY 0 CRFs Roche FVF4170G Macular Edema NCT00473382

Anglais

STUDY DRUG ADMINISTRATION DAY 0 CRFs Roche FVF4170G Macular Edema 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
STUDY DRUG ADMINISTRATION (DAY 0)
Description

STUDY DRUG ADMINISTRATION (DAY 0)

Eye Treated:
Description

EYE [EYE]

Type de données

integer

Alias
UMLS CUI [1,1]
C0087111
UMLS CUI [1,2]
C0229089
UMLS CUI [2,1]
C0087111
UMLS CUI [2,2]
C0229090
Was treatment (Ranibizumab or sham procedure) administered?
Description

TREATMENT_RECEIVED [TXREC]

Type de données

boolean

Alias
UMLS CUI [1]
C1725180
UMLS CUI [2]
C0032042
If Yes, Record kit # administered:
Description

KIT [KIT]

Type de données

integer

Alias
UMLS CUI [1]
C2981406
Date Administered:
Description

TREATMENT_DT [TXDT]

Type de données

date

Unités de mesure
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C1533734
UMLS CUI [1,2]
C0011008
DD/MMM/YY
Time Administered:
Description

TREATMENT_TIME [TXTM]

Type de données

time

Unités de mesure
  • 24 hr clock
Alias
UMLS CUI [1,1]
C1533734
UMLS CUI [1,2]
C0040223
24 hr clock
Was lidocaine injection administered?
Description

LIDOCAINE [LDOCN]

Type de données

boolean

Alias
UMLS CUI [1]
C0360095
Were preoperative antimicrobials given?
Description

ANTIBIOTICS_CURRENT [ABXCR]

Type de données

boolean

Alias
UMLS CUI [1]
C0338237
If No, Was treatment held due to any of the Study Drug Dose-Holding Criteria?
Description

TX_HELD [TXHELD]

Type de données

boolean

Alias
UMLS CUI [1]
C0557960
If Yes, check the corresponding event(s) for holding treatment: Intraocular inflammation
Description

TREATMENT_HELD_CRITERIA [TXHLDC1]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0042164
Visual acuity loss
Description

TREATMENT_HELD_CRITERIA [TXHLDC2]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0234632
Intraocular pressure (IOP)
Description

TREATMENT_HELD_CRITERIA [TXHLDC3]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0578862
Sensory rhegmatogenous retinal break or detachment
Description

TREATMENT_HELD_CRITERIA [TXHLDC4]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C2880797
Local or systemic infection
Description

TREATMENT_HELD_CRITERIA [TXHLDC5]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C3714514
Intraocular surgery
Description

TREATMENT_HELD_CRITERIA [TXHLDC6]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0038901
Other:
Description

TREATMENT_HELD_CRITERIA [TXHLDC7]

Type de données

boolean

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
Other:
Description

OTHER_SPECIFY (OTHSP)

Type de données

text

Alias
UMLS CUI [1,1]
C0557960
UMLS CUI [1,2]
C0566251
Retour au début de la page

Similar models

STUDY DRUG ADMINISTRATION DAY 0 CRFs Roche FVF4170G Macular Edema 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
STUDY DRUG ADMINISTRATION (DAY 0)
Item
Eye Treated:
integer
C0087111 (UMLS CUI [1,1])
C0229089 (UMLS CUI [1,2])
C0087111 (UMLS CUI [2,1])
C0229090 (UMLS CUI [2,2])
EYE [EYE]
Code List
Eye Treated:
CL Item
Right Eye  (1)
CL Item
Left Eye (2)
TREATMENT_RECEIVED [TXREC]
Item
Was treatment (Ranibizumab or sham procedure) administered?
boolean
C1725180 (UMLS CUI [1])
C0032042 (UMLS CUI [2])
KIT [KIT]
Item
If Yes, Record kit # administered:
integer
C2981406 (UMLS CUI [1])
TREATMENT_DT [TXDT]
Item
Date Administered:
date
C1533734 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
TREATMENT_TIME [TXTM]
Item
Time Administered:
time
C1533734 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
LIDOCAINE [LDOCN]
Item
Was lidocaine injection administered?
boolean
C0360095 (UMLS CUI [1])
ANTIBIOTICS_CURRENT [ABXCR]
Item
Were preoperative antimicrobials given?
boolean
C0338237 (UMLS CUI [1])
TX_HELD [TXHELD]
Item
If No, Was treatment held due to any of the Study Drug Dose-Holding Criteria?
boolean
C0557960 (UMLS CUI [1])
TREATMENT_HELD_CRITERIA [TXHLDC1]
Item
If Yes, check the corresponding event(s) for holding treatment: Intraocular inflammation
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0042164 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC2]
Item
Visual acuity loss
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0234632 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC3]
Item
Intraocular pressure (IOP)
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0578862 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC4]
Item
Sensory rhegmatogenous retinal break or detachment
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C2880797 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC5]
Item
Local or systemic infection
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C3714514 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC6]
Item
Intraocular surgery
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0038901 (UMLS CUI [1,3])
TREATMENT_HELD_CRITERIA [TXHLDC7]
Item
Other:
boolean
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
OTHER_SPECIFY (OTHSP)
Item
Other:
text
C0557960 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Retour au début de la page 

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