ID
26285
Description
Concomitant Medication, Adverse Event, SAE - Ropinirole and the effect of food in early stage Parkinson’s disease subjects 101468/164 Study ID: 101468/164 Clinical Study ID: 101468/164 Study Title: An open-label, randomised, two part study to investigate the relative bioavailability of Ropinirole new and standard, marketed formulations and the effect of food on the pharmacokinetics of Ropinirole new formulation in early stage Parkinson’s disease subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A 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
Mots-clés
Versions (1)
- 15/10/2017 15/10/2017 -
Détendeur de droits
glaxoSmithKline
Téléchargé le
15 octobre 2017
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0
Modèle Commentaires :
Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.
Groupe Item commentaires pour :
Item commentaires pour :
Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.
Concomitant Medication, Adverse Event, SAE - Ropinirole and the effect of food in early stage Parkinson’s disease subjects 101468/164
Concomitant Medication, Adverse Event, SAE - Ropinirole and the effect of food in early stage Parkinson’s disease subjects 101468/164
Description
Concomitant Medication
Alias
- UMLS CUI-1
- C2347852
Description
Use Generic Name
Type de données
text
Alias
- UMLS CUI [1,1]
- C2360065
- UMLS CUI [1,2]
- C0592502
Description
Date medication started
Type de données
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0808070
Description
Date medication stopped
Type de données
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0806020
Description
Medication continuous
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0549178
Description
eg. 10mg tid
Type de données
text
Alias
- UMLS CUI [1,1]
- C3174092
- UMLS CUI [1,2]
- C3476109
Description
medication administration route
Type de données
integer
Alias
- UMLS CUI [1]
- C0013153
Description
Specify other route of administration
Type de données
text
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C0013153
Description
Indication of medication
Type de données
text
Alias
- UMLS CUI [1,1]
- C3146298
- UMLS CUI [1,2]
- C0013227
Description
Adverse event
Alias
- UMLS CUI-1
- C0877248
Description
Adverse event
Alias
- UMLS CUI-1
- C0877248
Description
Adverse event
Type de données
text
Alias
- UMLS CUI [1]
- C0877248
Description
A Serious Adverse Event is any AE that is fatal, life-threatening, disabling/incapacitating, results in inpatient hospitalization or prolongation of existing hospitalization, or a congenital anomaly/birth defect. Important medical events that may not result in death, be life-threatening, or require hospitalization may be considered a serious adverse drug experience when, based upon appropriate medical judgement, they may jeopardise the patient and may require medical or surgical intervention to prevent one of the outcomes listed in this definition. Cancer, overdose and pregnancy must also be reported on SAE form. Record any Serious Adverse Events on the Serious Adverse Event form and notify the PAREXEL Clinical Trial Safety Center within 24 hours of learning of its occurence.
Type de données
boolean
Alias
- UMLS CUI [1]
- C1519255
Description
Start date adverse event
Type de données
date
Alias
- UMLS CUI [1]
- C2697888
Description
Start time adverse event
Type de données
time
Alias
- UMLS CUI [1]
- C2697889
Description
Stop date adverse event
Type de données
date
Alias
- UMLS CUI [1]
- C2697886
Description
Stop time adverse event
Type de données
time
Alias
- UMLS CUI [1]
- C2826658
Description
Intensity adverse event
Type de données
integer
Alias
- UMLS CUI [1]
- C1710066
Description
adverse event Relationship to drug
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0013230
- UMLS CUI [1,3]
- C0439849
Description
Adverse event action taken
Type de données
integer
Alias
- UMLS CUI [1]
- C2826626
Description
If Yes, record on Other (non-study) Medications Form
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0087111
Description
If Intermittent, record number of episodes in box
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0750729
Description
Adverse event number of episodes
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C4086638
Description
Adverse event outcome
Type de données
integer
Alias
- UMLS CUI [1]
- C1705586
Description
Subject death
Alias
- UMLS CUI-1
- C0011065
Description
Date of death
Type de données
date
Alias
- UMLS CUI [1]
- C1148348
Description
If YES, attach a copy of the autopsy report
Type de données
integer
Alias
- UMLS CUI [1]
- C0004398
Description
Primary cause of death
Type de données
text
Alias
- UMLS CUI [1]
- C0007465
Description
Underlying causes of death
Type de données
text
Alias
- UMLS CUI [1]
- C0007465
Description
death related to study drug
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0011065
- UMLS CUI [1,2]
- C0304229
Description
Signature of investigator
Type de données
text
Alias
- UMLS CUI [1]
- C2346576
Description
Date of investigator's signature
Type de données
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Description
Serious adverse event
Alias
- UMLS CUI-1
- C1519255
Description
Person reporting SAE
Type de données
text
Alias
- UMLS CUI [1,1]
- C0008961
- UMLS CUI [1,2]
- C1519255
Description
Serious adverse event
Type de données
text
Alias
- UMLS CUI [1]
- C1519255
Description
reason for SAE
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0679228
- UMLS CUI [1,2]
- C1519255
Description
Onset date serious adverse event
Type de données
date
Alias
- UMLS CUI [1]
- C2985916
Description
Onset time serious adverse event
Type de données
time
Alias
- UMLS CUI [1]
- C2697889
Description
If ongoing please leave blank
Type de données
date
Alias
- UMLS CUI [1]
- C2697886
Description
End time serious adverse event
Type de données
time
Alias
- UMLS CUI [1]
- C2826658
Description
If patient died, please complete Patient Death form
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1705586
- UMLS CUI [1,2]
- C1519255
Description
Course of serious adverse event
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0750729
Description
Number of episodes serious adverse event
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C4086638
Description
Intensity serious adverse event
Type de données
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
Description
Action Taken with Respect to Study Drug
Type de données
integer
Alias
- UMLS CUI [1]
- C2826626
Description
SAE abate
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3853704
Description
drug reintroduced
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0013230
- UMLS CUI [1,2]
- C0580673
Description
SAE reoccurence
Type de données
boolean
Alias
- UMLS CUI [1]
- C1519255
Description
Relationship to Study Drug
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0439849
- UMLS CUI [1,3]
- C0013227
Description
Assessment
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Description
Assessment
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Description
Assessment
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Description
If Yes, record details in the Concomitant Medication section.
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0087111
Description
withdrawn due to adverse event
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0422727
- UMLS CUI [1,2]
- C1519255
Description
(Please provide relevant abnormal laboratory data below)
Type de données
text
Alias
- UMLS CUI [1]
- C0022885
Description
Date of laboratory test 1
Type de données
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Description
Value of laboratory test 1
Type de données
float
Alias
- UMLS CUI [1]
- C0587081
Description
Unit of laboratory test 1
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Description
Normal range of laboratory test 1
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Description
Laboratory test 2
Type de données
text
Alias
- UMLS CUI [1]
- C0022885
Description
Date of laboratory test 2
Type de données
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Description
laboratory test result 2
Type de données
float
Alias
- UMLS CUI [1]
- C0587081
Description
Unit of laboratory test 2
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Description
Normal range of laboratory test 2
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Description
Laboratory test 3
Type de données
text
Alias
- UMLS CUI [1]
- C0022885
Description
Date of laboratory test 3
Type de données
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Description
laboratory test result 3
Type de données
float
Alias
- UMLS CUI [1]
- C0587081
Description
Unit of laboratory test 3
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Description
Normal range of laboratory test 3
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Description
Laboratory test 4
Type de données
text
Alias
- UMLS CUI [1]
- C0022885
Description
Value of laboratory test 4
Type de données
float
Alias
- UMLS CUI [1]
- C0587081
Description
Date of laboratory test 4
Type de données
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Description
Unit of laboratory test 4
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Description
Normal range of laboratory test 4
Type de données
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Description
Please provide a brief narrative description of the SAE, attaching extra pages, e g hospital discharge summary, if necessary
Type de données
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0947611
Description
randomization broken
Type de données
boolean
Alias
- UMLS CUI [1,1]
- C0034656
- UMLS CUI [1,2]
- C3897431
Description
Please do NOT enter the blister package number
Type de données
integer
Alias
- UMLS CUI [1,1]
- C0034656
- UMLS CUI [1,2]
- C0237753
Description
onfirming that the above data are accurate and complete
Type de données
text
Alias
- UMLS CUI [1]
- C2346576
Description
Investigator's print name
Type de données
text
Alias
- UMLS CUI [1]
- C2826892
Description
Investigator Signature Date
Type de données
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Similar models
Concomitant Medication, Adverse Event, SAE - Ropinirole and the effect of food in early stage Parkinson’s disease subjects 101468/164
C0592502 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0549178 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,2])
C0013153 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
C0087111 (UMLS CUI [1,2])
C4086638 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0750729 (UMLS CUI [1,2])
C4086638 (UMLS CUI [1,2])
C0518690 (UMLS CUI [1,2])
C3853704 (UMLS CUI [1,2])
C0580673 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
C0220825 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,2])
C0220825 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C0022885 (UMLS CUI [1,2])
C0439148 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,2])
C0022885 (UMLS CUI [1,2])
C0439148 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,2])
C0022885 (UMLS CUI [1,2])
C0439148 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,2])
C0022885 (UMLS CUI [1,2])
C0439148 (UMLS CUI [1,2])
C0086715 (UMLS CUI [1,2])
C0947611 (UMLS CUI [1,2])
C3897431 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])