ID

25642

Description

Study part: Form D. A Single Blind, Parallel Group, Up-titration, Phase 1 Study in Healthy Volunteers to Determine a Starting Dose and Select an Up-titration Regimen for a new Formulation of Ropinirole. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com. Phase: phase 1. 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: 101468/201. Clinical Study ID: 101468/201

Keywords

Versions (2)
  1. 9/8/17 9/8/17 -
  2. 5/10/19 5/10/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

September 8, 2017

DOI

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License

Creative Commons BY-NC 3.0
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Form D Ropinirole Restless Legs Syndrome 101468/201

English

Form D

1 forms  
  1. StudyEvent: ODM
    1. Form D
FORM D
Description

FORM D

Alias
UMLS CUI-1
C1306577
Subject number
Description

Subject number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Certified cause of death: _
Description

cause of death

Data type

text

Alias
UMLS CUI [1]
C0007465
Date of death:
Description

Date of death

Data type

date

Alias
UMLS CUI [1]
C1148348
Was an autopsy done?
Description

autopsy was performed

Data type

boolean

Alias
UMLS CUI [1]
C3656695
Please summarize findings (including diagnosis)
Description

Findings autopsy

Data type

text

Alias
UMLS CUI [1,1]
C0243095
UMLS CUI [1,2]
C0004398
Physician’s signature:
Description

Physician signature

Data type

text

Alias
UMLS CUI [1]
C1519316
Date
Description

Date

Data type

date

Alias
UMLS CUI [1]
C0011008
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Similar models

Form D

1 forms
  1. StudyEvent: ODM
    1. Form D
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
FORM D
C1306577 (UMLS CUI-1)
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
cause of death
Item
Certified cause of death: _
text
C0007465 (UMLS CUI [1])
Date of death
Item
Date of death:
date
C1148348 (UMLS CUI [1])
autopsy was performed
Item
Was an autopsy done?
boolean
C3656695 (UMLS CUI [1])
Findings autopsy
Item
Please summarize findings (including diagnosis)
text
C0243095 (UMLS CUI [1,1])
C0004398 (UMLS CUI [1,2])
Physician signature
Item
Physician’s signature:
text
C1519316 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
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