Englisch

Study conclusion GSK study Dyskinesia in Parkinson's disease NCT00363727

1 Formulare  
General information
Beschreibung

General information

Protocol identifier
Beschreibung

Protocol identifier

Datentyp

text

Subject Identifier
Beschreibung

Subject Identifier

Datentyp

text

Alias
UMLS CUI [1]
C2348585
Visit Description
Beschreibung

Visit Description

Datentyp

text

Pregnancy information
Beschreibung

Pregnancy information

Did the subject become pregnant during the study?
Beschreibung

If Yes, complete Pregnancy Notification form.

Datentyp

text

Study conclusion
Beschreibung

Study conclusion

Date of subject completion or withdrawal
Beschreibung

Date

Datentyp

date

Was the subject withdrawn from the study?
Beschreibung

Withdrawal

Datentyp

boolean

If Yes, check the primary reason for withdrawal:
Beschreibung

reason withdrawal

Datentyp

text

If other reason, specify
Beschreibung

other reason withdrawal

Datentyp

text

Investigator comment log
Beschreibung

Investigator comment log

CRF page number if applicable
Beschreibung

CRF page number

Datentyp

integer

Comment
Beschreibung

Comment

Datentyp

text

Investigator's signature
Beschreibung

Investigator's signature

Investigator’s Signature
Beschreibung

Investigator Signature

Datentyp

text

Date
Beschreibung

signature date

Datentyp

date

Investigator’s name (print)
Beschreibung

Investigator name

Datentyp

text

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Study conclusion GSK study Dyskinesia in Parkinson's disease NCT00363727

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
General information
Protocol identifier
Item
Protocol identifier
text
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Visit Description
Item
Visit Description
text
Item Group
Pregnancy information
Item
Did the subject become pregnant during the study?
text
Did the subject become pregnant during the study?
Code List
Did the subject become pregnant during the study?
CL Item
Yes (Y)
CL Item
No (N)
CL Item
Not Applicable (not of childbearing potential or male) (x)
Item Group
Study conclusion
Date
Item
Date of subject completion or withdrawal
date
Withdrawal
Item
Was the subject withdrawn from the study?
boolean
Item
If Yes, check the primary reason for withdrawal:
text
reason withdrawal
Code List
If Yes, check the primary reason for withdrawal:
CL Item
Adverse event (record details on the Non-Serious Adverse Event or Serious Adverse Event pages as appropriate) (1)
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
Sponsor terminated study (6)
CL Item
Dyskinesia (28)
CL Item
Other (Z)
other reason withdrawal
Item
If other reason, specify
text
Item Group
Investigator comment log
CRF page number
Item
CRF page number if applicable
integer
Comment
Item
Comment
text
Item Group
Investigator's signature
Investigator Signature
Item
Investigator’s Signature
text
signature date
Item
Date
date
Investigator name
Item
Investigator’s name (print)
text
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