ID

23039

Description

NCT00340080 / VIIV-CNA106030 https://clinicaltrials.gov/ct2/show/NCT00340080 A phase IV, randomised, multicentre, double-blind, study to evaluate the clinical utility of prospective genetic screening (HLA-B*5701) for susceptibility to abacavir hypersensitivity Assessment: Pregnancy Notification Form Medicine: abacavir, Condition: Infection, Human Immunodeficiency Virus, Phase: 4, Clinical Study ID: CNA106030, Sponsor: ViiV

Link

https://clinicaltrials.gov/ct2/show/NCT00340080

Keywords

Versions (2)
  1. 6/20/17 6/20/17 -
  2. 6/20/17 6/20/17 -
Uploaded on

June 20, 2017

DOI

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License

Creative Commons BY 4.0
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Genetic Screening For HLA-B*5701 Pregnancy Notification Form NCT00340080

English

Genetic Screening For HLA-B*5701 Pregnancy Notification Form NCT00340080

1 forms  
Pregnancy Notification Form
Description

Pregnancy Notification Form

Alias
UMLS CUI-1
C0032961
Subject Identifier
Description

Subject Identifier

Data type

text

Alias
UMLS CUI [1]
C2348585
Mothers date of birth
Description

Mothers date of birth

Data type

date

Alias
UMLS CUI [1,1]
C0026591
UMLS CUI [1,2]
C0421451
Date of last menstrual period
Description

Date of last menstrual period

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0025329
Estimated date of delivery
Description

Estimated date of delivery

Data type

date

Alias
UMLS CUI [1]
C1287845
Was the mother using a method of contraception?
Description

contraception

Data type

boolean

Alias
UMLS CUI [1]
C0700589
If Yes, please specify
Description

Was the mother using a method of contraception?

Data type

text

Alias
UMLS CUI [1]
C0700589
Type of conception, check one:
Description

Type of conception

Data type

integer

Alias
UMLS CUI [1]
C2598844
Relevant laboratory tests
Description

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Data type

text

Alias
UMLS CUI [1]
C0022885
laboratory test date
Description

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Data type

date

Alias
UMLS CUI [1,1]
C0022885
UMLS CUI [1,2]
C0011008
Relevant procedures
Description

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Data type

text

Alias
UMLS CUI [1]
C0430022
procedure date
Description

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Data type

date

Alias
UMLS CUI [1,1]
C0430022
UMLS CUI [1,2]
C0011008
Number of previous pregnancies: Pre-term
Description

Pre-term pregnancies

Data type

integer

Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C1547235
UMLS CUI [1,3]
C0449788
Number of previous pregnancies: Full-term
Description

Full-term pregnancy

Data type

integer

Alias
UMLS CUI [1,1]
C2114495
UMLS CUI [1,2]
C0449788
Number of: Normal births
Description

Normal births

Data type

integer

Alias
UMLS CUI [1,1]
C3665337
UMLS CUI [1,2]
C0449788
Number of: Stillbirths
Description

Stillbirths

Data type

integer

Alias
UMLS CUI [1,1]
C0595939
UMLS CUI [1,2]
C0449788
Number of: Children born with defects
Description

Children born with defects

Data type

integer

Alias
UMLS CUI [1,1]
C0000768
UMLS CUI [1,2]
C0449788
Record details of children born with defects
Description

Children born with defects

Data type

text

Alias
UMLS CUI [1]
C0000768
Number of: Spontaneous abortion
Description

Spontaneous abortion

Data type

integer

Alias
UMLS CUI [1,1]
C0000786
UMLS CUI [1,2]
C0449788
Number of: Elective abortion
Description

Elective abortion

Data type

integer

Alias
UMLS CUI [1,1]
C0269439
UMLS CUI [1,2]
C0449788
Number of: Other
Description

other birth

Data type

integer

Alias
UMLS CUI [1,1]
C0005615
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C0449788
Are there any additional factors that may have an impact on the outcome of this pregnancy?
Description

impact on the outcome of this pregnancy

Data type

boolean

Alias
UMLS CUI [1,1]
C0032972
UMLS CUI [1,2]
C1521761
If Yes, please specify
Description

Are there any additional factors that may have an impact on the outcome of this pregnancy?

Data type

text

Alias
UMLS CUI [1,1]
C0032972
UMLS CUI [1,2]
C1521761
Fathers relevant medical/family history
Description

Fathers relevant medical/family history

Data type

text

Alias
UMLS CUI [1,1]
C0015671
UMLS CUI [1,2]
C0262926
UMLS CUI [2]
C0241889
Was the subject withdrawn from the study as a result of this pregnancy?
Description

withdrawn from the study

Data type

boolean

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C0032961
Drug exposures
Description

Drug exposures

Alias
UMLS CUI-1
C0743284
UMLS CUI-2
C0032961
Drug Name
Description

Drug Name

Data type

text

Alias
UMLS CUI [1,1]
C2360065
UMLS CUI [1,2]
C0013227
Route of Admin. or Formulation
Description

Route

Data type

text

Alias
UMLS CUI [1]
C0013153
Total Daily Dose
Description

Total Daily Dose

Data type

text

Alias
UMLS CUI [1,1]
C2348070
UMLS CUI [1,2]
C0013227
Units
Description

Units

Data type

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0013227
Started Pre-Study
Description

Started Pre-Study

Data type

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0451613
Start Date
Description

Start Date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
Stop Date
Description

Stop Date

Data type

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
Ongoing Medication
Description

Ongoing Medication

Data type

boolean

Alias
UMLS CUI [1]
C2826666
Reason for Medication
Description

Reason for Medication

Data type

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0013227
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Similar models

Genetic Screening For HLA-B*5701 Pregnancy Notification Form NCT00340080

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Pregnancy Notification Form
C0032961 (UMLS CUI-1)
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Mothers date of birth
Item
Mothers date of birth
date
C0026591 (UMLS CUI [1,1])
C0421451 (UMLS CUI [1,2])
Date of last menstrual period
Item
Date of last menstrual period
date
C0011008 (UMLS CUI [1,1])
C0025329 (UMLS CUI [1,2])
Estimated date of delivery
Item
Estimated date of delivery
date
C1287845 (UMLS CUI [1])
contraception
Item
Was the mother using a method of contraception?
boolean
C0700589 (UMLS CUI [1])
contraception
Item
If Yes, please specify
text
C0700589 (UMLS CUI [1])
Item
Type of conception, check one:
integer
C2598844 (UMLS CUI [1])
Type of conception
Code List
Type of conception, check one:
CL Item
Normal (includes use of fertility drugs) (1)
CL Item
IVF (in vitro fertilisation) (2)
laboratory tests
Item
Relevant laboratory tests
text
C0022885 (UMLS CUI [1])
laboratory test date
Item
laboratory test date
date
C0022885 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
procedure
Item
Relevant procedures
text
C0430022 (UMLS CUI [1])
procedure date
Item
procedure date
date
C0430022 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Pre-term pregnancies
Item
Number of previous pregnancies: Pre-term
integer
C0032961 (UMLS CUI [1,1])
C1547235 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,3])
Full-term pregnancy
Item
Number of previous pregnancies: Full-term
integer
C2114495 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Normal births
Item
Number of: Normal births
integer
C3665337 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Stillbirths
Item
Number of: Stillbirths
integer
C0595939 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Children born with defects
Item
Number of: Children born with defects
integer
C0000768 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Children born with defects
Item
Record details of children born with defects
text
C0000768 (UMLS CUI [1])
Spontaneous abortion
Item
Number of: Spontaneous abortion
integer
C0000786 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Elective abortion
Item
Number of: Elective abortion
integer
C0269439 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
other birth
Item
Number of: Other
integer
C0005615 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,3])
impact on the outcome of this pregnancy
Item
Are there any additional factors that may have an impact on the outcome of this pregnancy?
boolean
C0032972 (UMLS CUI [1,1])
C1521761 (UMLS CUI [1,2])
impact on the outcome of this pregnancy
Item
If Yes, please specify
text
C0032972 (UMLS CUI [1,1])
C1521761 (UMLS CUI [1,2])
Fathers relevant medical/family history
Item
Fathers relevant medical/family history
text
C0015671 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
C0241889 (UMLS CUI [2])
withdrawn from the study
Item
Was the subject withdrawn from the study as a result of this pregnancy?
boolean
C0422727 (UMLS CUI [1,1])
C0032961 (UMLS CUI [1,2])
Item Group
Drug exposures
C0743284 (UMLS CUI-1)
C0032961 (UMLS CUI-2)
Drug Name
Item
Drug Name
text
C2360065 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Route
Item
Route of Admin. or Formulation
text
C0013153 (UMLS CUI [1])
Total Daily Dose
Item
Total Daily Dose
text
C2348070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Units
Item
Units
text
C1519795 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Started Pre-Study
Item
Started Pre-Study
boolean
C0013227 (UMLS CUI [1,1])
C0451613 (UMLS CUI [1,2])
Start Date
Item
Start Date
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Stop Date
Item
Stop Date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Ongoing Medication
Item
Ongoing Medication
boolean
C2826666 (UMLS CUI [1])
Reason for Medication
Item
Reason for Medication
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
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