Inglese

GSK Ropinirole in Subjects with Restless Legs Syndrome 101468/191 Early Withdrawal Day -2 (Form 17)

1 moduli  
General Information
Descrizione

General Information

Center Number
Descrizione

Center Number

Tipo di dati

integer

Patient Number
Descrizione

Patient Number

Tipo di dati

integer

Patient Initials
Descrizione

Patient Initials

Tipo di dati

text

Visit Date
Descrizione

Visit Date

Tipo di dati

date

Orthostatic Vital Signs
Descrizione

Orthostatic Vital Signs

Time of dose
Descrizione

Time of dose

Tipo di dati

time

Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
Descrizione

Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)

Tipo di dati

integer

Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
Descrizione

Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)

Tipo di dati

integer

Pre-Dose (Reading 1) After 10 minutes semi-supine Pulse
Descrizione

Pre-Dose (Reading 1) After 10 minutes semi-supine Pulse

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Descrizione

Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)

Tipo di dati

integer

Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
Descrizione

Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)

Tipo di dati

integer

Pre-Dose (Reading 1) pulse after erect for 1 minute
Descrizione

Pre-Dose (Reading 1) pulse after erect for 1 minute

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Descrizione

Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)

Tipo di dati

integer

Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
Descrizione

Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)

Tipo di dati

integer

Pre-Dose (Reading 2) After 10 minutes semi-supine Pulse
Descrizione

Pre-Dose (Reading 2) After 10 minutes semi-supine Pulse

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Descrizione

Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)

Tipo di dati

integer

Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
Descrizione

Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)

Tipo di dati

integer

Pre-Dose (Reading 2) Pulse after erect for 1 minute
Descrizione

Pre-Dose (Reading 2) Pulse after erect for 1 minute

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
Descrizione

2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
Descrizione

2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 1) After 10 minutes semi-supine Pulse
Descrizione

2 hours Post-Dose (Reading 1) After 10 minutes semi-supine Pulse

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Descrizione

2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
Descrizione

2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 1) Pulse after erect for 1 minute
Descrizione

2 hours Post-Dose (Reading 1) Pulse after erect for 1 minute

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Descrizione

2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
Descrizione

2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 2) After 10 minutes semi-supine Pulse
Descrizione

2 hours Post-Dose (Reading 2) After 10 minutes semi-supine Pulse

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Descrizione

2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
Descrizione

2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)

Tipo di dati

integer

2 hours Post-Dose (Reading 2) Pulse after erect for 1 minute
Descrizione

2 hours Post-Dose (Reading 2) Pulse after erect for 1 minute

Tipo di dati

integer

Unità di misura
  • beats/min
beats/min
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Similar models

GSK Ropinirole in Subjects with Restless Legs Syndrome 101468/191 Early Withdrawal Day -2 (Form 17)

1 moduli
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
General Information
Center Number
Item
Center Number
integer
Patient Number
Item
Patient Number
integer
Patient Initials
Item
Patient Initials
text
Visit Date
Item
Visit Date
date
Item Group
Orthostatic Vital Signs
Time of dose
Item
Time of dose
time
Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
Item
Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
integer
Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
Item
Pre-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
integer
Pre-Dose (Reading 1) After 10 minutes semi-supine Pulse
Item
Pre-Dose (Reading 1) After 10 minutes semi-supine Pulse
integer
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Item
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
integer
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
Item
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
integer
Pre-Dose (Reading 1) pulse after erect for 1 minute
Item
Pre-Dose (Reading 1) pulse after erect for 1 minute
integer
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Item
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
integer
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
Item
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
integer
Pre-Dose (Reading 2) After 10 minutes semi-supine Pulse
Item
Pre-Dose (Reading 2) After 10 minutes semi-supine Pulse
integer
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Item
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
integer
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
Item
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
integer
Pre-Dose (Reading 2) Pulse after erect for 1 minute
Item
Pre-Dose (Reading 2) Pulse after erect for 1 minute
integer
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
Item
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
integer
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
Item
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (diastolic)
integer
2 hours Post-Dose (Reading 1) After 10 minutes semi-supine Pulse
Item
2 hours Post-Dose (Reading 1) After 10 minutes semi-supine Pulse
integer
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Item
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
integer
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
Item
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (diastolic)
integer
2 hours Post-Dose (Reading 1) Pulse after erect for 1 minute
Item
2 hours Post-Dose (Reading 1) Pulse after erect for 1 minute
integer
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Item
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
integer
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
Item
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (diastolic)
integer
2 hours Post-Dose (Reading 2) After 10 minutes semi-supine Pulse
Item
2 hours Post-Dose (Reading 2) After 10 minutes semi-supine Pulse
integer
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Item
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
integer
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
Item
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (diastolic)
integer
2 hours Post-Dose (Reading 2) Pulse after erect for 1 minute
Item
2 hours Post-Dose (Reading 2) Pulse after erect for 1 minute
integer
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