end of study
Item
Date of subject completion or withdrawal.
date
C2983670 (UMLS CUI [1])
Item
Was the subject withdrawn from the study?
text
C0422727 (UMLS CUI [1])
Code List
Was the subject withdrawn from the study?
Item
If "yes" to patient withdram from study, record the primary reason for withdrawal.
text
C0422727 (UMLS CUI [1])
Code List
If "yes" to patient withdram from study, record the primary reason for withdrawal.
CL Item
Adverse event (1)
CL Item
Record details on the Non-Serious Adverse Events or Serious Adverse Event pages as appropriate. (Record details on the Non-Serious Adverse Events or Serious Adverse Event pages as appropriate.)
CL Item
Lost to follow-up (2)
CL Item
Protocol violation (3)
CL Item
Subject decided to withdraw from the study (4)
CL Item
Lack of efficacy (5)
CL Item
Exacerbation (14)
CL Item
Did not meet treatment elig bility criteria (24)
CL Item
Other, specify _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ (Z)
Item
Did the subject experience an incident or near-incident with GSK medical devices provided for use during this study?
text
C0025080 (UMLS CUI [1,1])
C1551358 (UMLS CUI [1,2])
Code List
Did the subject experience an incident or near-incident with GSK medical devices provided for use during this study?
Item
Did the subject become pregnant during the study?
text
C0032961 (UMLS CUI [1])
Code List
Did the subject become pregnant during the study?
CL Item
Not Applicable (not of childbearing potential or male) (X)
page number of case report
Item
CRF page number if applicable
integer
C1704732 (UMLS CUI [1,1])
C1516308 (UMLS CUI [1,2])
investigator's comment
Item
Comment
text
C0947611 (UMLS CUI [1,1])
C0008961 (UMLS CUI [1,2])
investigator's signature
Item
Investigator’s signature
text
C2346576 (UMLS CUI [1])
Investigator´s name
Item
Investigator´s name (print)
text
C2826892 (UMLS CUI [1])
date
Item
Date
date
C0011008 (UMLS CUI [1])