ID

25205

Beschrijving

Study part: CRF Tracking/ Review Form (TRF) Study Conclusion. 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. 28-08-17 28-08-17 -
  2. 15-03-19 15-03-19 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

28 augustus 2017

DOI

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Licentie

Creative Commons BY-NC 3.0
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CRF Tracking/ Review Form (TRF) Study Conclusion Ropinirole Restless Legs Syndrom 101468/192

Engels

CRF Tracking/ Review Form (TRF) Study Conclusion

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
MOD6
Beschrijving

Module Description: Wk 12 - Wk 24 to Cont/Wthd

Datatype

text

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

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD6A
Beschrijving

Module Description: Wk 12

Datatype

text

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

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD6B
Beschrijving

Module Description: Wk 24

Datatype

text

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

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD7
Beschrijving

Module Description: Wk 12 - Wk 24 RLS Scale

Datatype

text

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

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
MOD8
Beschrijving

Module Description: Wk 12 - Wk 24 Patient Rating Scale

Datatype

text

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

pages

Datatype

text

Alias
UMLS CUI [1]
C1548329
SAE3
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
SAE4
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
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Similar models

CRF Tracking/ Review Form (TRF) Study Conclusion

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
MOD6
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD6
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD6A
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD6A
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD6B
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD6B
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD7
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD7
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
MOD8
text
C1709061 (UMLS CUI [1])
Module
Code List
MOD8
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
SAE3
text
C1709061 (UMLS CUI [1])
Module
Code List
SAE3
CL Item
Sent to DM (Sent to DM)
CL Item
Unused (Unused)
pages
Item
Missing pages (if applicable)
text
C1548329 (UMLS CUI [1])
Item
SAE4
text
C1709061 (UMLS CUI [1])
Module
Code List
SAE4
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 

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