ID

24574

Descrição

Study ID: 100716 Clinical Study ID: NKP100716 Study Title: An open label repeat dose study to investigate the effect of GW597599 (15 mg) and paroxetine (10 mg) given in combination for 15 days on the pharmacokinetics of midazolam and dextromethorphan in healthy male and female volunteers Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 1 Study Recruitment Status: Completed Generic Name: vestipitant Trade Name: paroxetine and vestipitant Study Indication: Depressive Disorder and Anxiety Disorders Documentation part: Follow-Up Serious Adverse Event, Form D, Investigator Comment Log, Investigator's Statement

Palavras-chave

Versões (1)
  1. 06/08/2017 06/08/2017 -
Titular dos direitos

GlaxoSmithKline

Transferido a

6 de agosto de 2017

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0
Comentários do modelo :

Aqui pode comentar o modelo. Pode comentá-lo especificamente através dos balões de texto nos grupos de itens e itens.

Voltar para os comentários do modelo
Comentários do grupo de itens para :

Comentários do item para :

Para descarregar formulários, precisa de ter uma sessão iniciada. Por favor faça login ou registe-se gratuitamente.

GW597599 and paroxetine on the pharmacokinetics of midazolam and dextromethorphan 100716 Follow-Up Serious Adverse Event, Form D, Investigator Comment Log, Investigator's Statement

Inglês

GW597599 and paroxetine on the pharmacokinetics of midazolam and dextromethorphan 100716 Follow-Up Serious Adverse Event, Form D, Investigator Comment Log, Investigator's Statement

1 Formulários  
Serious Adverse Event (SAE)
Descrição

Serious Adverse Event (SAE)

Alias
UMLS CUI-1
C1519255
Person Reporting SAE
Descrição

person reporting sae

Tipo de dados

text

Alias
UMLS CUI [1]
C0008961
Serious Adverse Event
Descrição

serious adverse event

Tipo de dados

text

Alias
UMLS CUI [1]
C1519255
Onset Date and Time
Descrição

serious adverse event onset

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2826806
End Date and Time
Descrição

serious adverse event end

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2826793
Outcome
Descrição

If subject died, please inform GSK within 24 hours and complete Form D.

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1705586
UMLS CUI [1,2]
C1519255
Event Course
Descrição

serious adverse event course

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0750729
Number of episodes
Descrição

serious adverse event episodes

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C4086638
Intensity (maximum)
Descrição

serious adverse event intensity

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0518690
Specify reason(s) for considering this a serious AE. Mark all that apply.
Descrição

serious adverse event reason

Tipo de dados

text

Alias
UMLS CUI [1]
C3828190
Please specify other:
Descrição

serious adverse event reason

Tipo de dados

text

Alias
UMLS CUI [1]
C3828190
Action Taken with Respect to Investigational Drug
Descrição

action taken

Tipo de dados

text

Alias
UMLS CUI [1]
C2826626
Did the SAE abate?
Descrição

SAE abate

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C3853704
If study medication was interrupted, stopped or dose reduced: Was study medication reintroduced (or dose increased)?
Descrição

study medication reintroduced

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0013230
UMLS CUI [1,2]
C0580673
If yes, did SAE recur?
Descrição

SAE recur

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0034897
Relationship to Investigational Drug
Descrição

relationship to investigational drug

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
The SAE is probably associated with:
Descrição

SAE association

Tipo de dados

text

Alias
UMLS CUI [1]
C1706737
Please specify:
Descrição

SAE association

Tipo de dados

text

Alias
UMLS CUI [1]
C1706737
Corrective Therapy
Descrição

If YES, please record on Concomitant Medication form

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0087111
Was subject withdrawn due to this AE?
Descrição

subject withdrawn due to adverse event

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0877248
Remarks
Descrição

Please provide a brief narrative description of the SAE, attaching extra pages e.g. hospital discharge summary if necessary)

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0947611
If applicable, was randomisation code broken at investigational site?
Descrição

randomisation code broken

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0034656
Randomisation/ Study Medication Number
Descrição

randomisation number

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Relevant Laboratory Data
Descrição

Relevant Laboratory Data

Alias
UMLS CUI-1
C0022885
Test
Descrição

laboratory test

Tipo de dados

text

Alias
UMLS CUI [1]
C0022885
Date
Descrição

laboratory date

Tipo de dados

date

Alias
UMLS CUI [1,1]
C0022877
UMLS CUI [1,2]
C0011008
Value
Descrição

laboratory value

Tipo de dados

text

Alias
UMLS CUI [1]
C0022877
Units
Descrição

unit

Tipo de dados

text

Alias
UMLS CUI [1]
C1519795
Normal Range
Descrição

normal range

Tipo de dados

text

Alias
UMLS CUI [1]
C0086715
Form D
Descrição

Form D

Alias
UMLS CUI-1
C1306577
Certified Cause of Death
Descrição

cause of death

Tipo de dados

text

Alias
UMLS CUI [1]
C0007465
Date of Death
Descrição

date of death

Tipo de dados

date

Alias
UMLS CUI [1]
C1148348
Was an autopsy done?
Descrição

autopsy

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0004398
If YES, please summarize findings (include diagnosis):
Descrição

autopsy

Tipo de dados

text

Alias
UMLS CUI [1]
C0004398
Investigator Comment LOG
Descrição

Investigator Comment LOG

Alias
UMLS CUI-1
C0008961
UMLS CUI-2
C0947611
Date of comment
Descrição

date of comment

Tipo de dados

date

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C0011008
CRF page number if applicable
Descrição

page number

Tipo de dados

integer

Alias
UMLS CUI [1]
C1704732
Comment
Descrição

comment

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Investigator's Checklist
Descrição

Investigator's Checklist

Alias
UMLS CUI-1
C1707357
UMLS CUI-2
C0008961
Check all Adverse Event forms are up to date and complete
Descrição

adverse event forms completed

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0920316
UMLS CUI [1,3]
C0205197
Check that the Concomitant Medication form is up to date
Descrição

concomitant medication form up to date

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C0920316
UMLS CUI [1,3]
C0237400
Check that all appropriate pages are signed (thus indicating completition) an dated
Descrição

signing

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1519316
Check that laboratory results are included
Descrição

laboratory results included

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1254595
UMLS CUI [1,2]
C0920316
Voltar ao início da página

Similar models

GW597599 and paroxetine on the pharmacokinetics of midazolam and dextromethorphan 100716 Follow-Up Serious Adverse Event, Form D, Investigator Comment Log, Investigator's Statement

1 Formulários
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Serious Adverse Event (SAE)
C1519255 (UMLS CUI-1)
person reporting sae
Item
Person Reporting SAE
text
C0008961 (UMLS CUI [1])
serious adverse event
Item
Serious Adverse Event
text
C1519255 (UMLS CUI [1])
serious adverse event onset
Item
Onset Date and Time
datetime
C2826806 (UMLS CUI [1])
serious adverse event end
Item
End Date and Time
datetime
C2826793 (UMLS CUI [1])
Item
Outcome
text
C1705586 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
serious adverse event outcome
Code List
Outcome
CL Item
Resolved (Resolved)
CL Item
Ongoing (Ongoing)
CL Item
Died (Died)
Item
Event Course
text
C1519255 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
serious adverse event course
Code List
Event Course
CL Item
Intermittent (Intermittent)
CL Item
Constant (Constant)
serious adverse event episodes
Item
Number of episodes
integer
C1519255 (UMLS CUI [1,1])
C4086638 (UMLS CUI [1,2])
Item
Intensity (maximum)
text
C1519255 (UMLS CUI [1,1])
C0518690 (UMLS CUI [1,2])
serious adverse event intensity
Code List
Intensity (maximum)
CL Item
Mild (Mild)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
Item
Specify reason(s) for considering this a serious AE. Mark all that apply.
text
C3828190 (UMLS CUI [1])
serious adverse event reason
Code List
Specify reason(s) for considering this a serious AE. Mark all that apply.
CL Item
results in Death (A)
CL Item
life threatening (B)
CL Item
requires hospitalisation or prolongation of existing hospitalisation (C)
CL Item
results in disability/ incapacity (D)
CL Item
congenital anomaly/ birth defect (E)
CL Item
other (see definition) (F)
serious adverse event reason
Item
Please specify other:
text
C3828190 (UMLS CUI [1])
Item
Action Taken with Respect to Investigational Drug
text
C2826626 (UMLS CUI [1])
action taken
Code List
Action Taken with Respect to Investigational Drug
CL Item
None (None)
CL Item
Dose reduced (Dose reduced)
CL Item
Dose increased (Dose increased)
CL Item
Drug interrupted/restarted (Drug interrupted/restarted)
CL Item
Drug stopped (Drug stopped)
SAE abate
Item
Did the SAE abate?
boolean
C1519255 (UMLS CUI [1,1])
C3853704 (UMLS CUI [1,2])
study medication reintroduced
Item
If study medication was interrupted, stopped or dose reduced: Was study medication reintroduced (or dose increased)?
boolean
C0013230 (UMLS CUI [1,1])
C0580673 (UMLS CUI [1,2])
SAE recur
Item
If yes, did SAE recur?
boolean
C1519255 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
Item
Relationship to Investigational Drug
text
C1519255 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
relationship to investigational drug
Code List
Relationship to Investigational Drug
CL Item
Not related (Not related)
CL Item
Unlikely (Unlikely)
CL Item
Suspected (reasonable possibility) (Suspected (reasonable possibility))
CL Item
Probable (Probable)
Item
The SAE is probably associated with:
text
C1706737 (UMLS CUI [1])
SAE association
Code List
The SAE is probably associated with:
CL Item
Protocol design or procedures (but not to study drug) (Protocol design or procedures (but not to study drug))
CL Item
Another condition (e.g. condition under study, intercurrent illness) (Another condition (e.g. condition under study, intercurrent illness))
CL Item
Another drug (Another drug)
SAE association
Item
Please specify:
text
C1706737 (UMLS CUI [1])
corrective therapy
Item
Corrective Therapy
boolean
C1519255 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
subject withdrawn due to adverse event
Item
Was subject withdrawn due to this AE?
boolean
C2349954 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
SAE remarks
Item
Remarks
text
C1519255 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
randomisation code broken
Item
If applicable, was randomisation code broken at investigational site?
boolean
C0034656 (UMLS CUI [1])
randomisation number
Item
Randomisation/ Study Medication Number
integer
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item Group
Relevant Laboratory Data
C0022885 (UMLS CUI-1)
laboratory test
Item
Test
text
C0022885 (UMLS CUI [1])
laboratory date
Item
Date
date
C0022877 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
laboratory value
Item
Value
text
C0022877 (UMLS CUI [1])
unit
Item
Units
text
C1519795 (UMLS CUI [1])
normal range
Item
Normal Range
text
C0086715 (UMLS CUI [1])
Item Group
Form D
C1306577 (UMLS CUI-1)
cause of death
Item
Certified Cause of Death
text
C0007465 (UMLS CUI [1])
date of death
Item
Date of Death
date
C1148348 (UMLS CUI [1])
autopsy
Item
Was an autopsy done?
boolean
C0004398 (UMLS CUI [1])
autopsy
Item
If YES, please summarize findings (include diagnosis):
text
C0004398 (UMLS CUI [1])
Item Group
Investigator Comment LOG
C0008961 (UMLS CUI-1)
C0947611 (UMLS CUI-2)
date of comment
Item
Date of comment
date
C0947611 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
page number
Item
CRF page number if applicable
integer
C1704732 (UMLS CUI [1])
comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item Group
Investigator's Checklist
C1707357 (UMLS CUI-1)
C0008961 (UMLS CUI-2)
adverse event forms completed
Item
Check all Adverse Event forms are up to date and complete
boolean
C0877248 (UMLS CUI [1,1])
C0920316 (UMLS CUI [1,2])
C0205197 (UMLS CUI [1,3])
concomitant medication form up to date
Item
Check that the Concomitant Medication form is up to date
boolean
C2347852 (UMLS CUI [1,1])
C0920316 (UMLS CUI [1,2])
C0237400 (UMLS CUI [1,3])
signing
Item
Check that all appropriate pages are signed (thus indicating completition) an dated
boolean
C1519316 (UMLS CUI [1])
laboratory results included
Item
Check that laboratory results are included
boolean
C1254595 (UMLS CUI [1,1])
C0920316 (UMLS CUI [1,2])
Voltar ao início da página 

Contacto

Use este formulário para feedback, perguntas e sugestões de aperfeiçoamento.

Campos marcados com * são obrigatórios.

Ajuda

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