Inglês

STUDY COMPLETION / EARLY DISCONTINUATION (UNSCHEDULED) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulários  
Patient administration
Descrição

Patient administration

Subject Number
Descrição

PT

Tipo de dados

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Descrição

PTINIT

Tipo de dados

text

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

VDT

Tipo de dados

date

Alias
UMLS CUI [1,1]
C1302584
STUDY COMPLETION / EARLY DISCONTINUATION (UNSCHEDULED)
Descrição

STUDY COMPLETION / EARLY DISCONTINUATION (UNSCHEDULED)

Indicate if the subject completed the study or discontinued early (check one only):
Descrição

DISC_COMPLETED_STUDY [DCCMP]

Tipo de dados

integer

Alias
UMLS CUI [1]
C2826674
Date Subject Completed or Discontinued Early from Study:
Descrição

DISC_COMP_DT [DCCDT]

Tipo de dados

date

Unidades de medida
  • DD/MMM/YY
Alias
UMLS CUI [1]
C2983670
DD/MMM/YY
Check the PRIMARY reason the subject discontinued early from the study (check one only):
Descrição

DISC_PRIMARY_REASON [DCRS]

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C2348571
UMLS CUI [1,2]
C0566251
Please specify intervention:
Descrição

DISC_PRIMARY_REAS_SP [DCRSP]

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2348571
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0184661
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Similar models

STUDY COMPLETION / EARLY DISCONTINUATION (UNSCHEDULED) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
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 COMPLETION / EARLY DISCONTINUATION (UNSCHEDULED)
Item
Indicate if the subject completed the study or discontinued early (check one only):
integer
C2826674 (UMLS CUI [1])
TX_DRUG_DISC [TXDISC]
Code List
Indicate if the subject completed the study or discontinued early (check one only):
CL Item
Subject Completed Study  (1)
CL Item
Subject Discontinued Early (2)
DISC_COMP_DT [DCCDT]
Item
Date Subject Completed or Discontinued Early from Study:
date
C2983670 (UMLS CUI [1])
Item
Check the PRIMARY reason the subject discontinued early from the study (check one only):
integer
C2348571 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
TX_DRUG_DISC_REASON [TXREAS]
Code List
Check the PRIMARY reason the subject discontinued early from the study (check one only):
CL Item
Adverse Event (complete appropriate Adverse Event CRF) (1)
CL Item
Death (complete Study Completion / Early Discontinuation CRF) (2)
CL Item
Lost to follow-up (3)
CL Item
Physician’s decision to discontinue treatment (for reasons other than AE) (4)
CL Item
Subject’s decision to withdraw (for reasons other than AE) (5)
CL Item
Sponsor’s decision to terminate study (6)
CL Item
Pregnancy (complete Pregnancy CRF) (7)
CL Item
Subject non-compliance (8)
CL Item
Subject’s condition mandated other therapeutic intervention (9)
DISC_PRIMARY_REAS_SP [DCRSP]
Item
Please specify intervention:
text
C2348571 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0184661 (UMLS CUI [1,3])
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