ID

26025

Beschrijving

Study ID: 100601 Clinical Study ID: LPL100601 Study Title: LPL100601, A Clinical Outcomes Study of Darapladib versus Placebo in Subjects with Chronic Coronary Heart Disease to Compare the Incidence of Major Adverse Cardiovascular Events (MACE) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00799903 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: darapladib Trade Name: darapladib Study Indication: Atherosclerosis Study part: Cancer Report Form - Repeating form (Scheduled visits)

Trefwoorden

Versies (4)
  1. 04-10-17 04-10-17 -
  2. 13-10-17 13-10-17 -
  3. 23-10-17 23-10-17 -
  4. 01-01-18 01-01-18 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

4 oktober 2017

DOI

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Licentie

Creative Commons BY-NC 3.0
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Cancer Report Form Repeating form GSK study Chronic Coronary Heart Disease NCT00799903

Engels

Cancer Report Form Repeating form GSK study Chronic Coronary Heart Disease NCT00799903

1 Formulieren  
1. Diagnosis of a new, recurrence of, or metastatic cancer
Beschrijving

1. Diagnosis of a new, recurrence of, or metastatic cancer

Diagnosis of a new, recurrence of, or metastatic cancer
Beschrijving

Cancer diagnosis

Datatype

integer

2. New cancer details
Beschrijving

2. New cancer details

Date of diagnosis
Beschrijving

Date of diagnosis new cancer

Datatype

date

Site
Beschrijving

Site new cancer

Datatype

integer

Other site
Beschrijving

Other site new cancer

Datatype

boolean

Other site, specify
Beschrijving

Other site new cancer specification

Datatype

text

Was the pathology report obtained for the source documentation?
Beschrijving

pathology report new cancer

Datatype

boolean

3. Recurrence of cancer details
Beschrijving

3. Recurrence of cancer details

Date of recurrence
Beschrijving

Date of recurrence

Datatype

date

Site
Beschrijving

Site recurrence

Datatype

integer

Other site
Beschrijving

Other site recurrence

Datatype

boolean

Other site, specify
Beschrijving

Other site recurrence specification

Datatype

text

Was the pathology report obtained for the source documentation?
Beschrijving

pathology report recurrence

Datatype

boolean

Was the pathology report for primary diagnosis obtained for the source documentation?
Beschrijving

pathology report primary diagnosis recurrence

Datatype

boolean

4. Metastatic cancer details
Beschrijving

4. Metastatic cancer details

Date of diagnosis of metastasis
Beschrijving

Date of diagnosis of metastasis

Datatype

date

Site
Beschrijving

Site of metastasis

Datatype

integer

Other site
Beschrijving

Other site metastasis

Datatype

boolean

Other site, specify
Beschrijving

Other site specification

Datatype

text

Was the pathology report obtained for the source documentation?
Beschrijving

pathology report metastasis

Datatype

boolean

Date of diagnosis of primary site
Beschrijving

Date of diagnosis primary site

Datatype

date

Primary site
Beschrijving

Primary site metastasis

Datatype

integer

Other primary site
Beschrijving

Other primary site

Datatype

boolean

Other primary site, specify
Beschrijving

Other primary site specification

Datatype

text

Was the pathology report for primary diagnosis obtained for the source documentation?
Beschrijving

pathology report primary diagnosis metastasis

Datatype

boolean

5. Was the subject hospitalised related to this diagnosis?
Beschrijving

5. Was the subject hospitalised related to this diagnosis?

Was the subject hospitalised related to this diagnosis?
Beschrijving

Hospitalisation related to diagnosis

Datatype

boolean

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Similar models

Cancer Report Form Repeating form GSK study Chronic Coronary Heart Disease NCT00799903

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
1. Diagnosis of a new, recurrence of, or metastatic cancer
Item
Diagnosis of a new, recurrence of, or metastatic cancer
integer
Cancer diagnosis
Code List
Diagnosis of a new, recurrence of, or metastatic cancer
CL Item
New cancer (1)
CL Item
Recurrence of cancer (2)
CL Item
Metastatic cancer (3)
Item Group
2. New cancer details
Date of diagnosis new cancer
Item
Date of diagnosis
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site new cancer
Item
Other site
boolean
Other site new cancer specification
Item
Other site, specify
text
pathology report new cancer
Item
Was the pathology report obtained for the source documentation?
boolean
Item Group
3. Recurrence of cancer details
Date of recurrence
Item
Date of recurrence
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site recurrence
Item
Other site
boolean
Other site recurrence specification
Item
Other site, specify
text
pathology report recurrence
Item
Was the pathology report obtained for the source documentation?
boolean
pathology report primary diagnosis recurrence
Item
Was the pathology report for primary diagnosis obtained for the source documentation?
boolean
Item Group
4. Metastatic cancer details
Date of diagnosis of metastasis
Item
Date of diagnosis of metastasis
date
Item
Site
integer
Site new cancer
Code List
Site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other site metastasis
Item
Other site
boolean
Other site specification
Item
Other site, specify
text
pathology report metastasis
Item
Was the pathology report obtained for the source documentation?
boolean
Date of diagnosis primary site
Item
Date of diagnosis of primary site
date
Item
Primary site
integer
Site new cancer
Code List
Primary site
CL Item
Benign neoplasm (1)
CL Item
Bile duct cancer (2)
CL Item
Bladder cancer (3)
CL Item
Bowel cancer (4)
CL Item
Breast cancer (5)
CL Item
Cervical cancer (6)
CL Item
Endometrial cancer (7)
CL Item
Esophageal cancer (8)
CL Item
Fallopian tube cancer (9)
CL Item
Gallbladder cancer (10)
CL Item
Gastric cancer (11)
CL Item
Hodgkin's disease (12)
CL Item
Leukemia (13)
CL Item
Lip cancer (14)
CL Item
Liver cancer (15)
CL Item
Lung cancer (16)
CL Item
Lymphoma (17)
CL Item
Multiple myeloma (18)
CL Item
Myelodysplastic syndrome (19)
CL Item
Non-melanoma skin cancer (20)
CL Item
Oral cancer (21)
CL Item
Ovarian cancer (22)
CL Item
Pancreatic cancer (23)
CL Item
Penile cancer (24)
CL Item
Pharyngeal cancer (25)
CL Item
Prostate cancer (26)
CL Item
Renal cancer (27)
CL Item
Scrotum cancer (28)
CL Item
Skin melanoma (29)
CL Item
Testicular cancer (30)
CL Item
Vaginal cancer (31)
CL Item
Vulval cancer (32)
Other primary site
Item
Other primary site
boolean
Other primary site specification
Item
Other primary site, specify
text
pathology report primary diagnosis metastasis
Item
Was the pathology report for primary diagnosis obtained for the source documentation?
boolean
Item Group
5. Was the subject hospitalised related to this diagnosis?
Hospitalisation related to diagnosis
Item
Was the subject hospitalised related to this diagnosis?
boolean
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