Item
Did patient become pregnant during the study? (mark one box below)
text
C0032961 (UMLS CUI [1])
Code List
Did patient become pregnant during the study? (mark one box below)
CL Item
Not applicable (not of childbearing potential or male) (X)
CL Item
Yes If 'Yes' record details on Pregnancy Notification Form. (Y)
Item
Did the female partner of a male patient become pregnant during the study? (mark one box below)
text
C0919624 (UMLS CUI [1])
Code List
Did the female partner of a male patient become pregnant during the study? (mark one box below)
CL Item
Not applicable (subject is female, female partner not of childbearing potential or female partner) (X)
CL Item
Yes If 'Yes' record details on Pregnancy Notification Form. (Y)
Completed
Item
Did the subject complete the study as planned? If 'NO' , mark the one most appropriate category
boolean
C0205197 (UMLS CUI [1])
Item
Did the subject complete the study as planned? If 'NO' , mark the one most appropriate category
text
C0392360 (UMLS CUI [1,1])
C0008976 (UMLS CUI [1,2])
C0205257 (UMLS CUI [1,3])
Code List
Did the subject complete the study as planned? If 'NO' , mark the one most appropriate category
CL Item
Adverse Event (complete Adverse Event Form) (1)
CL Item
Insufficient therapeutic effect (2)
CL Item
Deviation from Protocol (including non-compliance) (3)
CL Item
Lost to Follow-Up (4)
CL Item
Other, Please specify (5)
Withdrawal Comment
Item
Comments on reason for withdrawal:
text
C0947611 (UMLS CUI [1,1])
C2349954 (UMLS CUI [1,2])
Date of Withdrawal
Item
Date of Withdrawal:
boolean
C2349954 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time of Withdrawal
Item
Time of Withdrawal
time
C2349954 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Date of Final Dose
Item
Date of Final Dose:
date
C1531784 (UMLS CUI [1])
Time of Final Dose
Item
Time of Final Dose:
time
C0013227 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])