Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C1830427 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Study conclusion
Item
Did the patient complete the study according to the protocol?
boolean
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
Item
Did the patient complete the study according to the protocol?
integer
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
Code List
Did the patient complete the study according to the protocol?
CL Item
Adverse experience (please complete AE page) (1)
CL Item
Insufficient therapeutic effect (2)
CL Item
Protocol deviation (including non-compliance) (3)
CL Item
Lost to follow-up (4)
CL Item
Other - specify (5)
trial completion cause other
Item
Primary Cause - Other, specify:
text
C1707478 (UMLS CUI [1,1])
C0008972 (UMLS CUI [1,2])
C2732579 (UMLS CUI [1,3])
C0392360 (UMLS CUI [1,4])
Investigator’s Signature
Item
Investigator’s Signature
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])