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Non-serious adverse events GSK study Dyskinesia in Parkinson's disease NCT00363727

1 Formulär  
General information
Beskrivning

General information

Protocol indentifier
Beskrivning

Protocol indentifier

Datatyp

text

Subject Identifier
Beskrivning

Subject Identifier

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Visit date
Beskrivning

Visit date

Datatyp

date

Visit Description
Beskrivning

Visit Description

Datatyp

text

Non-serious adverse events
Beskrivning

Non-serious adverse events

Did the subject experience any non-serious adverse events during the study?
Beskrivning

If Yes, record details below. Note: If this is a Serious Adverse Event (SAE), do not complete this form, go to the SAE section and complete the SAE form.

Datatyp

boolean

Event
Beskrivning

Diagnosis Only (if known). Otherwise Sign/Symptom

Datatyp

text

Start date
Beskrivning

Start date

Datatyp

date

Outcome
Beskrivning

Outcome

Datatyp

integer

End Date
Beskrivning

End Date

Datatyp

date

Maximum Intensity
Beskrivning

Maximum Intensity

Datatyp

text

Action Taken with Investigational Product(s) as a Result of the Non-Serious AE
Beskrivning

Action Taken

Datatyp

text

Did the subject withdraw from study as a result of this AE?
Beskrivning

withdrawal

Datatyp

boolean

Is there a reasonable possibility that the AE may have been caused by the investigational product?
Beskrivning

AE caused by the investigational product

Datatyp

boolean

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Similar models

Non-serious adverse events GSK study Dyskinesia in Parkinson's disease NCT00363727

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
General information
Protocol indentifier
Item
Protocol indentifier
text
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Visit date
Item
Visit date
date
Visit Description
Item
Visit Description
text
Item Group
Non-serious adverse events
non-serious adverse events
Item
Did the subject experience any non-serious adverse events during the study?
boolean
Event
Item
Event
text
Start date
Item
Start date
date
Item
Outcome
integer
Outcome
Code List
Outcome
CL Item
Recovered/Resolved (1)
CL Item
Recovering/Resolving (2)
CL Item
Not recovered/Not resolved (3)
CL Item
Recovered/Resolved withsequelae (4)
End Date
Item
End Date
date
Item
Maximum Intensity
text
Maximum Intensity
Code List
Maximum Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
CL Item
Not applicable (X)
Item
Action Taken with Investigational Product(s) as a Result of the Non-Serious AE
text
Action Taken
Code List
Action Taken with Investigational Product(s) as a Result of the Non-Serious AE
CL Item
Investigational product(s) withdrawn (1)
CL Item
Dose reduced (2)
CL Item
Dose increased (3)
CL Item
Dose not changed (4)
CL Item
Dose interrupted (5)
CL Item
Not applicable (X)
withdrawal
Item
Did the subject withdraw from study as a result of this AE?
boolean
AE caused by the investigational product
Item
Is there a reasonable possibility that the AE may have been caused by the investigational product?
boolean
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