Engelsk

GSK Ropinirole in Subjects with Restless Legs Syndrome 101468/191 Early Withdrawal Day -1 (Form 18)

1 Formulär  
General Information
Beskrivning

General Information

Center Number
Beskrivning

Center Number

Datatyp

integer

Patient Number
Beskrivning

Patient Number

Datatyp

integer

Patient Initials
Beskrivning

Patient Initials

Datatyp

text

Visit Date
Beskrivning

Visit Date

Datatyp

date

Orthostatic Vital Signs
Beskrivning

Orthostatic Vital Signs

Time of dose
Beskrivning

Time of dose

Datatyp

time

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

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
Pre-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
Pre-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
Pre-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
2 hours Post-Dose (Reading 1) Blood pressure after 10 minutes semi-supine (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
2 hours Post-Dose (Reading 1) Blood pressure after erect for 1 minute (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
2 hours Post-Dose (Reading 2) Blood pressure after 10 minutes semi-supine (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
2 hours Post-Dose (Reading 2) Blood pressure after erect for 1 minute (systolic)
Beskrivning

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

Datatyp

integer

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

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

Datatyp

integer

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

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

Datatyp

integer

Måttenheter
  • beats/min
beats/min
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Similar models

GSK Ropinirole in Subjects with Restless Legs Syndrome 101468/191 Early Withdrawal Day -1 (Form 18)

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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