ID

24382

Description

GSK study: Ropinirole in RLS patients 101468/243 - Form Death Study ID: 101468/243 Clinical Study ID: 101468/243 Study Title: A 52 Week Open-Label Extension Study of the Long-Term Safety of Ropinirole in Subjects Suffering from Restless Legs Syndrome (RLS) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: N/A Sponsor:GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Modutab,ZIPEREVE,ZEPREVE,REPREVE,ADARTREL,REQUIP,Zygara; Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication: Restless Legs Syndrome

Keywords

Versions (1)
  1. 7/30/17 7/30/17 -
Copyright Holder

glaxoSmithKline

Uploaded on

July 30, 2017

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

GSK study: Ropinirole in RLS patients 101468/243 - Form Death

English

GSK study: Ropinirole in RLS patients 101468/243 - Form Death

1 forms  
Death Form
Description

Death Form

Alias
UMLS CUI-1
C1306577
Certified cause of death
Description

Certified cause of death

Data type

text

Alias
UMLS CUI [1]
C3262229
Date of death
Description

Date of death

Data type

date

Alias
UMLS CUI [1]
C1148348
Please complete Serious Adverse Experience section with regard to death.
Description

Please complete Serious Adverse Experience section with regard to death.

Data type

text

Alias
UMLS CUI [1]
C1519255
Was an autopsy carried out?
Description

If ‘Yes’ please summarize findings (include diagnosis):

Data type

boolean

Alias
UMLS CUI [1]
C0004398
Please summarize findings of autopsy (include diagnosis):
Description

Only fill in if you answered previous question with ‘Yes’.

Data type

text

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C0243095
UMLS CUI [2,1]
C0004398
UMLS CUI [2,2]
C0011900
Reporting Physician’s Signature
Description

Reporting Physician’s Signature

Data type

text

Alias
UMLS CUI [1]
C2346576
Reporting Physician’s Signature Date
Description

Investigator signature date

Data type

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Back to the top of the page

Similar models

GSK study: Ropinirole in RLS patients 101468/243 - Form Death

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Death Form
C1306577 (UMLS CUI-1)
Certified cause of death
Item
Certified cause of death
text
C3262229 (UMLS CUI [1])
Date of death
Item
Date of death
date
C1148348 (UMLS CUI [1])
Serious Adverse Event
Item
Please complete Serious Adverse Experience section with regard to death.
text
C1519255 (UMLS CUI [1])
autopsy
Item
Was an autopsy carried out?
boolean
C0004398 (UMLS CUI [1])
autopsy findings
Item
Please summarize findings of autopsy (include diagnosis):
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
C0004398 (UMLS CUI [2,1])
C0011900 (UMLS CUI [2,2])
Reporting Physician’s Signature
Item
Reporting Physician’s Signature
text
C2346576 (UMLS CUI [1])
Investigator signature date
Item
Reporting Physician’s Signature Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial