ID

26407

Beschrijving

Study ID: 101468/190 Clinical Study ID: SKF-101468/190 Study Title:A 12 Week, Double-Blind, Placebo-Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Requip Study Indication: Restless Legs Syndrome This is the Form D assessment form.

Trefwoorden

Versies (1)
  1. 17-10-17 17-10-17 -
Houder van rechten

GlaxoSmithKline

Geüploaded op

17 oktober 2017

DOI

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Licentie

Creative Commons BY-NC 3.0
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Form D 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

Engels

Form D 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 Formulieren  
Cause of death
Beschrijving

Cause of death

Alias
UMLS CUI-1
C0007465
Certified Cause of Death
Beschrijving

Certified Cause of Death

Datatype

text

Alias
UMLS CUI [1]
C0007465
Date of Death
Beschrijving

Date of Death

Datatype

date

Alias
UMLS CUI [1]
C1148348
Was a post-mortem carried out?
Beschrijving

Autopsy

Datatype

boolean

Alias
UMLS CUI [1]
C0004398
Please summarize findings of autopsy (include diagnosis):
Beschrijving

autopsy findings

Datatype

text

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C0243095
UMLS CUI [1,3]
C0004398
UMLS CUI [1,4]
C0011900
Reporting Physician’s Signature
Beschrijving

Reporting Physician’s Signature

Datatype

text

Alias
UMLS CUI [1]
C2346576
Date
Beschrijving

Date

Datatype

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Form D 26072_GSK Ropinirole in Patients Suffering from Restless Legs Syndrome 101468/190

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Cause of death
C0007465 (UMLS CUI-1)
Certified Cause of Death
Item
Certified Cause of Death
text
C0007465 (UMLS CUI [1])
Date of Death
Item
Date of Death
date
C1148348 (UMLS CUI [1])
Autopsy
Item
Was a post-mortem carried out?
boolean
C0004398 (UMLS CUI [1])
autopsy findings
Item
Please summarize findings of autopsy (include diagnosis):
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
C0004398 (UMLS CUI [1,3])
C0011900 (UMLS CUI [1,4])
Reporting Physician’s Signature
Item
Reporting Physician’s Signature
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

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