ID
26285
Beschrijving
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
Trefwoorden
Versies (1)
- 15-10-17 15-10-17 -
Houder van rechten
glaxoSmithKline
Geüploaded op
15 oktober 2017
DOI
Voor een aanvraag inloggen.
Licentie
Creative Commons BY-NC 3.0
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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
Beschrijving
Concomitant Medication
Alias
- UMLS CUI-1
- C2347852
Beschrijving
Use Generic Name
Datatype
text
Alias
- UMLS CUI [1,1]
- C2360065
- UMLS CUI [1,2]
- C0592502
Beschrijving
Date medication started
Datatype
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0808070
Beschrijving
Date medication stopped
Datatype
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0806020
Beschrijving
Medication continuous
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0549178
Beschrijving
eg. 10mg tid
Datatype
text
Alias
- UMLS CUI [1,1]
- C3174092
- UMLS CUI [1,2]
- C3476109
Beschrijving
medication administration route
Datatype
integer
Alias
- UMLS CUI [1]
- C0013153
Beschrijving
Specify other route of administration
Datatype
text
Alias
- UMLS CUI [1,1]
- C0205394
- UMLS CUI [1,2]
- C0013153
Beschrijving
Indication of medication
Datatype
text
Alias
- UMLS CUI [1,1]
- C3146298
- UMLS CUI [1,2]
- C0013227
Beschrijving
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beschrijving
Adverse event
Alias
- UMLS CUI-1
- C0877248
Beschrijving
Adverse event
Datatype
text
Alias
- UMLS CUI [1]
- C0877248
Beschrijving
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.
Datatype
boolean
Alias
- UMLS CUI [1]
- C1519255
Beschrijving
Start date adverse event
Datatype
date
Alias
- UMLS CUI [1]
- C2697888
Beschrijving
Start time adverse event
Datatype
time
Alias
- UMLS CUI [1]
- C2697889
Beschrijving
Stop date adverse event
Datatype
date
Alias
- UMLS CUI [1]
- C2697886
Beschrijving
Stop time adverse event
Datatype
time
Alias
- UMLS CUI [1]
- C2826658
Beschrijving
Intensity adverse event
Datatype
integer
Alias
- UMLS CUI [1]
- C1710066
Beschrijving
adverse event Relationship to drug
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1518404
- UMLS CUI [1,2]
- C0013230
- UMLS CUI [1,3]
- C0439849
Beschrijving
Adverse event action taken
Datatype
integer
Alias
- UMLS CUI [1]
- C2826626
Beschrijving
If Yes, record on Other (non-study) Medications Form
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0087111
Beschrijving
If Intermittent, record number of episodes in box
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0750729
Beschrijving
Adverse event number of episodes
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C4086638
Beschrijving
Adverse event outcome
Datatype
integer
Alias
- UMLS CUI [1]
- C1705586
Beschrijving
Subject death
Alias
- UMLS CUI-1
- C0011065
Beschrijving
Date of death
Datatype
date
Alias
- UMLS CUI [1]
- C1148348
Beschrijving
If YES, attach a copy of the autopsy report
Datatype
integer
Alias
- UMLS CUI [1]
- C0004398
Beschrijving
Primary cause of death
Datatype
text
Alias
- UMLS CUI [1]
- C0007465
Beschrijving
Underlying causes of death
Datatype
text
Alias
- UMLS CUI [1]
- C0007465
Beschrijving
death related to study drug
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0011065
- UMLS CUI [1,2]
- C0304229
Beschrijving
Signature of investigator
Datatype
text
Alias
- UMLS CUI [1]
- C2346576
Beschrijving
Date of investigator's signature
Datatype
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Beschrijving
Serious adverse event
Alias
- UMLS CUI-1
- C1519255
Beschrijving
Person reporting SAE
Datatype
text
Alias
- UMLS CUI [1,1]
- C0008961
- UMLS CUI [1,2]
- C1519255
Beschrijving
Serious adverse event
Datatype
text
Alias
- UMLS CUI [1]
- C1519255
Beschrijving
reason for SAE
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0679228
- UMLS CUI [1,2]
- C1519255
Beschrijving
Onset date serious adverse event
Datatype
date
Alias
- UMLS CUI [1]
- C2985916
Beschrijving
Onset time serious adverse event
Datatype
time
Alias
- UMLS CUI [1]
- C2697889
Beschrijving
If ongoing please leave blank
Datatype
date
Alias
- UMLS CUI [1]
- C2697886
Beschrijving
End time serious adverse event
Datatype
time
Alias
- UMLS CUI [1]
- C2826658
Beschrijving
If patient died, please complete Patient Death form
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1705586
- UMLS CUI [1,2]
- C1519255
Beschrijving
Course of serious adverse event
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0750729
Beschrijving
Number of episodes serious adverse event
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C4086638
Beschrijving
Intensity serious adverse event
Datatype
integer
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
Beschrijving
Action Taken with Respect to Study Drug
Datatype
integer
Alias
- UMLS CUI [1]
- C2826626
Beschrijving
SAE abate
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C3853704
Beschrijving
drug reintroduced
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0013230
- UMLS CUI [1,2]
- C0580673
Beschrijving
SAE reoccurence
Datatype
boolean
Alias
- UMLS CUI [1]
- C1519255
Beschrijving
Relationship to Study Drug
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0877248
- UMLS CUI [1,2]
- C0439849
- UMLS CUI [1,3]
- C0013227
Beschrijving
Assessment
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Beschrijving
Assessment
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Beschrijving
Assessment
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0220825
Beschrijving
If Yes, record details in the Concomitant Medication section.
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0087111
Beschrijving
withdrawn due to adverse event
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0422727
- UMLS CUI [1,2]
- C1519255
Beschrijving
(Please provide relevant abnormal laboratory data below)
Datatype
text
Alias
- UMLS CUI [1]
- C0022885
Beschrijving
Date of laboratory test 1
Datatype
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Beschrijving
Value of laboratory test 1
Datatype
float
Alias
- UMLS CUI [1]
- C0587081
Beschrijving
Unit of laboratory test 1
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Beschrijving
Normal range of laboratory test 1
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Beschrijving
Laboratory test 2
Datatype
text
Alias
- UMLS CUI [1]
- C0022885
Beschrijving
Date of laboratory test 2
Datatype
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Beschrijving
laboratory test result 2
Datatype
float
Alias
- UMLS CUI [1]
- C0587081
Beschrijving
Unit of laboratory test 2
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Beschrijving
Normal range of laboratory test 2
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Beschrijving
Laboratory test 3
Datatype
text
Alias
- UMLS CUI [1]
- C0022885
Beschrijving
Date of laboratory test 3
Datatype
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Beschrijving
laboratory test result 3
Datatype
float
Alias
- UMLS CUI [1]
- C0587081
Beschrijving
Unit of laboratory test 3
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Beschrijving
Normal range of laboratory test 3
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Beschrijving
Laboratory test 4
Datatype
text
Alias
- UMLS CUI [1]
- C0022885
Beschrijving
Value of laboratory test 4
Datatype
float
Alias
- UMLS CUI [1]
- C0587081
Beschrijving
Date of laboratory test 4
Datatype
date
Alias
- UMLS CUI [1,1]
- C0011008
- UMLS CUI [1,2]
- C0022885
Beschrijving
Unit of laboratory test 4
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0439148
Beschrijving
Normal range of laboratory test 4
Datatype
text
Alias
- UMLS CUI [1,1]
- C0022885
- UMLS CUI [1,2]
- C0086715
Beschrijving
Please provide a brief narrative description of the SAE, attaching extra pages, e g hospital discharge summary, if necessary
Datatype
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0947611
Beschrijving
randomization broken
Datatype
boolean
Alias
- UMLS CUI [1,1]
- C0034656
- UMLS CUI [1,2]
- C3897431
Beschrijving
Please do NOT enter the blister package number
Datatype
integer
Alias
- UMLS CUI [1,1]
- C0034656
- UMLS CUI [1,2]
- C0237753
Beschrijving
onfirming that the above data are accurate and complete
Datatype
text
Alias
- UMLS CUI [1]
- C2346576
Beschrijving
Investigator's print name
Datatype
text
Alias
- UMLS CUI [1]
- C2826892
Beschrijving
Investigator Signature Date
Datatype
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])