ID

25038

Beschrijving

Study part: CRF Tracking/ Review Form (TRF). 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. 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. Study ID: 101468/192. Clinical Study ID: 101468/192

Trefwoorden

Versies (2)
  1. 24.08.17 24.08.17 -
  2. 15.03.19 15.03.19 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

24. August 2017

DOI

Voor een aanvraag inloggen.

Licentie

Creative Commons BY-NC 3.0
Model Commentaren :

Hier kunt u commentaar leveren op het model. U kunt de tekstballonnen bij de itemgroepen en items gebruiken om er specifiek commentaar op te geven.

Terug naar het model Commentaren
Itemgroep Commentaren voor :

Item Commentaren voor :

U moet ingelogd zijn om formulieren te downloaden. AUB inloggen of schrijf u gratis in.

CRF Tracking/ Review Form (TRF) Ropinirole Restless Legs Syndrom 101468/192

Engels

CRF Tracking/ Review Form (TRF)

1 Formulieren  
CRF TRACKING/REVIEW FORM (TRF)
Beschrijving

CRF TRACKING/REVIEW FORM (TRF)

Alias
UMLS CUI-1
C3258859
Centre Number
Beschrijving

Centre Number

Datatype

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Investigator
Beschrijving

Investigator

Datatype

text

Alias
UMLS CUI [1]
C2826892
Screening Failure (archive only)
Beschrijving

Screening Failure

Datatype

boolean

Alias
UMLS CUI [1]
C1512714
MOD1
Beschrijving

Module Description: Enrolment

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD3
Beschrijving

Module Description: Baseline, Day 2, Wk 1-8-Cont/Wthd

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD4
Beschrijving

Module Description: Baseline Patient Rating Scales

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD5
Beschrijving

Module Description: Baseline, Day 2, Wk1-8 RLS Scales

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
SAE1
Beschrijving

Module Description: Serious Adverse Experiences

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
SAE2
Beschrijving

Module Description: Serious Adverse Experiences

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
FORMD
Beschrijving

Module Description: Form D

Datatype

text

Alias
UMLS CUI [1]
C1709061
Missing pages (if applicable)
Beschrijving

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
Site Monitor’s comments (eg. protocol violations or deviations)
Beschrijving

comment

Datatype

text

Alias
UMLS CUI [1]
C0947611
Site Monitor’s Name
Beschrijving

Name

Datatype

text

Alias
UMLS CUI [1]
C0027365
Site Monitor’s Signature
Beschrijving

Signature

Datatype

text

Alias
UMLS CUI [1]
C1519316
Date Submitted
Beschrijving

Date Submitted

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1515022
Terug naar het begin van de pagina

Similar models

CRF Tracking/ Review Form (TRF)

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
CRF TRACKING/REVIEW FORM (TRF)
C3258859 (UMLS CUI-1)
Centre Number
Item
Centre Number
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Investigator
Item
Investigator
text
C2826892 (UMLS CUI [1])
Screening Failure
Item
Screening Failure (archive only)
boolean
C1512714 (UMLS CUI [1])
Item
MOD1
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD1
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD3
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD3
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD4
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD4
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD5
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD5
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
SAE1
text
C1709061 (UMLS CUI [1])
Module
Code List
SAE1
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
SAE2
text
C1709061 (UMLS CUI [1])
Module
Code List
SAE2
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
FORMD
text
C1709061 (UMLS CUI [1])
Module
Code List
FORMD
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
comment
Item
Site Monitor’s comments (eg. protocol violations or deviations)
text
C0947611 (UMLS CUI [1])
Name
Item
Site Monitor’s Name
text
C0027365 (UMLS CUI [1])
Signature
Item
Site Monitor’s Signature
text
C1519316 (UMLS CUI [1])
Date Submitted
Item
Date Submitted
date
C0011008 (UMLS CUI [1,1])
C1515022 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

Contact

Gebruik dit formulier voor feedback, vragen en verbeteringsvoorstellen.

Velden gemarkeerd met een * zijn verplicht.

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