ID

26703

Descripción

Study ID: 100601 Clinical Study ID: LPL100601 Study Title: LPL100601, A Clinical Outcomes Study of Darapladib versus Placebo in Subjects with Chronic Coronary Heart Disease to Compare the Incidence of Major Adverse Cardiovascular Events (MACE) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00799903 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: darapladib Trade Name: darapladib Study Indication: Atherosclerosis Study part: Hypersensitivity Reaction Record - Repeating form (Scheduled visits)

Palabras clave

  1. 4/10/17 4/10/17 -
  2. 16/10/17 16/10/17 -
  3. 23/10/17 23/10/17 -
  4. 1/1/18 1/1/18 -
  5. 3/1/18 3/1/18 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

23 de octubre de 2017

DOI

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Licencia

Creative Commons BY-NC 3.0

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Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

1. Event number
Descripción

1. Event number

Event number
Descripción

Enter the Event Number from item 1 on the Anaphylaxis Diagnosis (ANA) form

Tipo de datos

text

Past medical conditions: 2. Food allergies
Descripción

Past medical conditions: 2. Food allergies

Anaphylactic reaction to food
Descripción

Anaphylactic reaction to food

Tipo de datos

integer

Angioedema
Descripción

Angioedema food

Tipo de datos

integer

Urticaria
Descripción

Urticaria food

Tipo de datos

integer

Past medical conditions: 3. Hymenoptera sting allergy
Descripción

Past medical conditions: 3. Hymenoptera sting allergy

Anaphylaxis
Descripción

Anaphylaxis Hymenoptera sting allergy

Tipo de datos

integer

Angioedema
Descripción

Angioedema Hymenoptera sting allergy

Tipo de datos

integer

Urticaria
Descripción

Urticaria Hymenoptera sting allergy

Tipo de datos

integer

Past medical conditions: 4. Latex allergy
Descripción

Past medical conditions: 4. Latex allergy

Anaphylaxis
Descripción

Anaphylaxis Latex

Tipo de datos

integer

Angioedema
Descripción

Angioedema latex

Tipo de datos

integer

Urticaria
Descripción

Urticaria latex

Tipo de datos

integer

Past medical conditions: 5. Penicillin allergy
Descripción

Past medical conditions: 5. Penicillin allergy

Anaphylactic reaction to drug
Descripción

Anaphylactic reaction penicillin

Tipo de datos

integer

Angioedema
Descripción

Angioedema penicillin

Tipo de datos

integer

Drug induced urticaria
Descripción

Drug induced urticaria penicillin

Tipo de datos

integer

Past medical conditions: 6. Cephalosporin allergy
Descripción

Past medical conditions: 6. Cephalosporin allergy

Anaphylactic reaction to drug
Descripción

Anaphylactic reaction to Cephalosporin

Tipo de datos

integer

Angioedema
Descripción

Angioedema Cephalosporin

Tipo de datos

integer

Drug induced urticaria
Descripción

Drug induced urticaria Cephalosporin

Tipo de datos

integer

Past medical conditions: 7. Aspirin allergy
Descripción

Past medical conditions: 7. Aspirin allergy

Anaphylactic reaction to drug
Descripción

Anaphylactic reaction to aspirin

Tipo de datos

integer

Angioedema
Descripción

Angioedema aspirin

Tipo de datos

integer

Drug induced urticaria
Descripción

Drug induced urticaria aspirin

Tipo de datos

integer

Past medical conditions: 8. NSAID allergy
Descripción

Past medical conditions: 8. NSAID allergy

Anaphylactic reaction to drug
Descripción

Anaphylactic reaction to NSAID

Tipo de datos

integer

Angioedema
Descripción

Angioedema NSAID

Tipo de datos

integer

Drug induced urticaria
Descripción

Drug induced urticaria NSAID

Tipo de datos

integer

Past medical conditions: 9. ACE inhibitor allergy
Descripción

Past medical conditions: 9. ACE inhibitor allergy

Anaphylactic reaction to drug
Descripción

Anaphylactic reaction to ACE inhibitor

Tipo de datos

integer

Angioedema
Descripción

Angioedema ACE inhibitor

Tipo de datos

integer

Drug induced urticaria
Descripción

Drug induced urticaria ACE inhibitor

Tipo de datos

integer

Other allergies
Descripción

Other allergies

10.a Specific Condition
Descripción

Specific Condition Other allergies

Tipo de datos

text

10.b Status
Descripción

This item is optional

Tipo de datos

integer

Symptoms associated with this hypersensitivity reaction: 11. Stevens-Johnson syndrome
Descripción

Symptoms associated with this hypersensitivity reaction: 11. Stevens-Johnson syndrome

Symptoms
Descripción

Symptoms Stevens-Johnson syndrome

Tipo de datos

text

Blisters
Descripción

Blisters Stevens-Johnson syndrome

Tipo de datos

boolean

Biopsy confirmed
Descripción

Biopsy confirmed Stevens-Johnson syndrome

Tipo de datos

boolean

Mucous membrane involvement
Descripción

Mucous membrane involvement Stevens-Johnson syndrome

Tipo de datos

boolean

Symptom start date
Descripción

Stevens-Johnson syndrome Symptom start date

Tipo de datos

date

Symptoms associated with this hypersensitivity reaction: 12. Toxic epidermal necrolysis
Descripción

Symptoms associated with this hypersensitivity reaction: 12. Toxic epidermal necrolysis

Symptoms
Descripción

Symptoms Toxic epidermal necrolysis

Tipo de datos

text

Blisters
Descripción

Blisters Toxic epidermal necrolysis

Tipo de datos

boolean

Biopsy confirmed
Descripción

Biopsy confirmed Toxic epidermal necrolysis

Tipo de datos

boolean

Mucous membrane involvement
Descripción

Mucous membrane involvement Toxic epidermal necrolysis

Tipo de datos

boolean

Symptom start date
Descripción

Symptom start date Toxic epidermal necrolysis

Tipo de datos

date

Symptoms associated with this hypersensitivity reaction: 13. Urticaria (hives)
Descripción

Symptoms associated with this hypersensitivity reaction: 13. Urticaria (hives)

Symptoms
Descripción

Symptoms Urticaria (hives)

Tipo de datos

text

Generalised
Descripción

Generalised Urticaria (hives)

Tipo de datos

boolean

Localised
Descripción

Localised Urticaria (hives)

Tipo de datos

boolean

Photosensitivity
Descripción

Photosensitivity Urticaria (hives)

Tipo de datos

boolean

Other
Descripción

Other symptoms Urticaria (hives)

Tipo de datos

boolean

Other, specify
Descripción

Other symptoms Urticaria (hives) specification

Tipo de datos

text

Symptom start date
Descripción

Symptom start date Urticaria (hives)

Tipo de datos

date

Symptoms associated with this hypersensitivity reaction: 14. Angioedema
Descripción

Symptoms associated with this hypersensitivity reaction: 14. Angioedema

Symptoms
Descripción

Symptoms Angioedema

Tipo de datos

text

Face (including eyes, lips)
Descripción

Angioedema Face

Tipo de datos

boolean

Throat (including tongue, larynx)
Descripción

Angioedema Throat

Tipo de datos

boolean

Laryngeal
Descripción

Angioedema Laryngeal

Tipo de datos

boolean

Dyspnoea
Descripción

Angioedema Dyspnoea

Tipo de datos

boolean

Dysphagia
Descripción

Angioedema Dysphagia

Tipo de datos

boolean

Required intubation
Descripción

Angioedema Required intubation

Tipo de datos

boolean

Other
Descripción

Angioedema Other symptoms

Tipo de datos

boolean

Other, specify
Descripción

Angioedema Other symptoms specification

Tipo de datos

text

Symptom start date
Descripción

Symptom start date Angioedema

Tipo de datos

date

Symptoms associated with this hypersensitivity reaction: 15. Anaphylactic/Anaphylactoid reaction
Descripción

Symptoms associated with this hypersensitivity reaction: 15. Anaphylactic/Anaphylactoid reaction

Symptoms
Descripción

Anaphylactic/Anaphylactoid reaction symptoms

Tipo de datos

text

Dyspnoea
Descripción

Dyspnoea Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Bronchospasm
Descripción

Bronchospasm Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Hypotension
Descripción

Hypotension Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Loss of consciousness
Descripción

Loss of consciousness Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
Descripción

Persistent gastrointestinal symptoms Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Other
Descripción

Other symptoms Anaphylactic/Anaphylactoid reaction

Tipo de datos

boolean

Other, specify
Descripción

Other symptoms specidication Anaphylactic/Anaphylactoid reaction

Tipo de datos

text

Symptom start date
Descripción

Symptom start date Anaphylactic/Anaphylactoid reaction

Tipo de datos

date

Symptoms associated with this hypersensitivity reaction: 16. Other symptoms of hypersensitivity reaction
Descripción

Symptoms associated with this hypersensitivity reaction: 16. Other symptoms of hypersensitivity reaction

Symptoms
Descripción

Symptoms Other symptoms of hypersensitivity reaction

Tipo de datos

text

Rash
Descripción

Other symptoms of hypersensitivity reaction Rash

Tipo de datos

boolean

Photosensitivity
Descripción

Other symptoms of hypersensitivity reaction Photosensitivity

Tipo de datos

boolean

Other
Descripción

Other symptoms of hypersensitivity reaction

Tipo de datos

boolean

Other, specify
Descripción

Other symptoms of hypersensitivity reaction specification

Tipo de datos

text

Symptom start date
Descripción

Start date Other symptoms of hypersensitivity reaction

Tipo de datos

date

Similar models

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
1. Event number
Event number
Item
Event number
text
Item Group
Past medical conditions: 2. Food allergies
Item
Anaphylactic reaction to food
integer
Code List
Anaphylactic reaction to food
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Urticaria
integer
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 3. Hymenoptera sting allergy
Code List
Anaphylaxis
CL Item
Past (2)
CL Item
No medical history (3)
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 4. Latex allergy
Item
Anaphylaxis
integer
Code List
Anaphylaxis
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Urticaria
integer
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 5. Penicillin allergy
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 6. Cephalosporin allergy
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 7. Aspirin allergy
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 8. NSAID allergy
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Past medical conditions: 9. ACE inhibitor allergy
Item
Anaphylactic reaction to drug
integer
Code List
Anaphylactic reaction to drug
CL Item
Past (2)
CL Item
No medical history (3)
Item
Angioedema
integer
Code List
Angioedema
CL Item
Past (2)
CL Item
No medical history (3)
Item
Drug induced urticaria
integer
Code List
Drug induced urticaria
CL Item
Past (2)
CL Item
No medical history (3)
Item Group
Other allergies
Specific Condition Other allergies
Item
10.a Specific Condition
text
Item
10.b Status
integer
Code List
10.b Status
CL Item
Past (2)
Item Group
Symptoms associated with this hypersensitivity reaction: 11. Stevens-Johnson syndrome
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Blisters Stevens-Johnson syndrome
Item
Blisters
boolean
Biopsy confirmed Stevens-Johnson syndrome
Item
Biopsy confirmed
boolean
Mucous membrane involvement Stevens-Johnson syndrome
Item
Mucous membrane involvement
boolean
Stevens-Johnson syndrome Symptom start date
Item
Symptom start date
date
Item Group
Symptoms associated with this hypersensitivity reaction: 12. Toxic epidermal necrolysis
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Blisters Toxic epidermal necrolysis
Item
Blisters
boolean
Biopsy confirmed Toxic epidermal necrolysis
Item
Biopsy confirmed
boolean
Mucous membrane involvement Toxic epidermal necrolysis
Item
Mucous membrane involvement
boolean
Symptom start date Toxic epidermal necrolysis
Item
Symptom start date
date
Item Group
Symptoms associated with this hypersensitivity reaction: 13. Urticaria (hives)
Item
Symptoms
text
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Generalised Urticaria (hives)
Item
Generalised
boolean
Localised Urticaria (hives)
Item
Localised
boolean
Photosensitivity Urticaria (hives)
Item
Photosensitivity
boolean
Other symptoms Urticaria (hives)
Item
Other
boolean
Other symptoms Urticaria (hives) specification
Item
Other, specify
text
Symptom start date Urticaria (hives)
Item
Symptom start date
date
Item Group
Symptoms associated with this hypersensitivity reaction: 14. Angioedema
Item
Symptoms
text
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Angioedema Face
Item
Face (including eyes, lips)
boolean
Angioedema Throat
Item
Throat (including tongue, larynx)
boolean
Angioedema Laryngeal
Item
Laryngeal
boolean
Angioedema Dyspnoea
Item
Dyspnoea
boolean
Angioedema Dysphagia
Item
Dysphagia
boolean
Angioedema Required intubation
Item
Required intubation
boolean
Angioedema Other symptoms
Item
Other
boolean
Angioedema Other symptoms specification
Item
Other, specify
text
Symptom start date Angioedema
Item
Symptom start date
date
Item Group
Symptoms associated with this hypersensitivity reaction: 15. Anaphylactic/Anaphylactoid reaction
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Dyspnoea Anaphylactic/Anaphylactoid reaction
Item
Dyspnoea
boolean
Bronchospasm Anaphylactic/Anaphylactoid reaction
Item
Bronchospasm
boolean
Hypotension Anaphylactic/Anaphylactoid reaction
Item
Hypotension
boolean
Loss of consciousness Anaphylactic/Anaphylactoid reaction
Item
Loss of consciousness
boolean
Persistent gastrointestinal symptoms Anaphylactic/Anaphylactoid reaction
Item
Persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
boolean
Other symptoms Anaphylactic/Anaphylactoid reaction
Item
Other
boolean
Other symptoms specidication Anaphylactic/Anaphylactoid reaction
Item
Other, specify
text
Symptom start date Anaphylactic/Anaphylactoid reaction
Item
Symptom start date
date
Item Group
Symptoms associated with this hypersensitivity reaction: 16. Other symptoms of hypersensitivity reaction
CL Item
None (None)
CL Item
Check all that apply (Check all that apply)
Other symptoms of hypersensitivity reaction Rash
Item
Rash
boolean
Other symptoms of hypersensitivity reaction Photosensitivity
Item
Photosensitivity
boolean
Other symptoms of hypersensitivity reaction
Item
Other
boolean
Other symptoms of hypersensitivity reaction specification
Item
Other, specify
text
Start date Other symptoms of hypersensitivity reaction
Item
Symptom start date
date

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