GSK LKA204 Ropinirole in Subjects with Restless Legs Syndrome INFORM SCREENING (SCREEN)

Inform Screening
Beschreibung

Inform Screening

Subject initials
Beschreibung

initials

Datentyp

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Beschreibung

Date of birth

Datentyp

date

Alias
UMLS CUI [1]
C0421451
Was this subject a screen failure?
Beschreibung

screening failure

Datentyp

integer

Alias
UMLS CUI [1]
C1512714
If other, please specify
Beschreibung

screening failure other reason

Datentyp

text

Alias
UMLS CUI [1]
C1512714

Ähnliche Modelle

GSK LKA204 Ropinirole in Subjects with Restless Legs Syndrome INFORM SCREENING (SCREEN)

Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Inform Screening
initials
Item
Subject initials
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Was this subject a screen failure?
integer
C1512714 (UMLS CUI [1])
Code List
Was this subject a screen failure?
CL Item
No (1)
CL Item
Yes, Adverse Event (Record details on the Non-Serious Adverse Events or Serious Adverse Events forms as appropriate.) (2)
CL Item
Yes, Lost to follow-up (4)
CL Item
Yes, Protocol violation (5)
CL Item
Yes, Subject decided to withdraw from the study (6)
CL Item
Yes, Prohibited medication use (7)
CL Item
Yes, Did not fulfill eligibility criteria (8)
CL Item
Yes, Exacerbation of medical condition under investigation. (9)
CL Item
Yes, Non-compliance (10)
CL Item
Yes, Genotype quota filled (11)
CL Item
Yes, Did not fulfill continuation criteria (12)
CL Item
Other, specify (13)
screening failure other reason
Item
If other, please specify
text
C1512714 (UMLS CUI [1])