ID

26703

Description

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)

Mots-clés

  1. 04/10/2017 04/10/2017 -
  2. 16/10/2017 16/10/2017 -
  3. 23/10/2017 23/10/2017 -
  4. 01/01/2018 01/01/2018 -
  5. 03/01/2018 03/01/2018 -
Détendeur de droits

GlaxoSmithKline

Téléchargé le

23 octobre 2017

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0

Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

1. Event number
Description

1. Event number

Event number
Description

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

Type de données

text

Past medical conditions: 2. Food allergies
Description

Past medical conditions: 2. Food allergies

Anaphylactic reaction to food
Description

Anaphylactic reaction to food

Type de données

integer

Angioedema
Description

Angioedema food

Type de données

integer

Urticaria
Description

Urticaria food

Type de données

integer

Past medical conditions: 3. Hymenoptera sting allergy
Description

Past medical conditions: 3. Hymenoptera sting allergy

Anaphylaxis
Description

Anaphylaxis Hymenoptera sting allergy

Type de données

integer

Angioedema
Description

Angioedema Hymenoptera sting allergy

Type de données

integer

Urticaria
Description

Urticaria Hymenoptera sting allergy

Type de données

integer

Past medical conditions: 4. Latex allergy
Description

Past medical conditions: 4. Latex allergy

Anaphylaxis
Description

Anaphylaxis Latex

Type de données

integer

Angioedema
Description

Angioedema latex

Type de données

integer

Urticaria
Description

Urticaria latex

Type de données

integer

Past medical conditions: 5. Penicillin allergy
Description

Past medical conditions: 5. Penicillin allergy

Anaphylactic reaction to drug
Description

Anaphylactic reaction penicillin

Type de données

integer

Angioedema
Description

Angioedema penicillin

Type de données

integer

Drug induced urticaria
Description

Drug induced urticaria penicillin

Type de données

integer

Past medical conditions: 6. Cephalosporin allergy
Description

Past medical conditions: 6. Cephalosporin allergy

Anaphylactic reaction to drug
Description

Anaphylactic reaction to Cephalosporin

Type de données

integer

Angioedema
Description

Angioedema Cephalosporin

Type de données

integer

Drug induced urticaria
Description

Drug induced urticaria Cephalosporin

Type de données

integer

Past medical conditions: 7. Aspirin allergy
Description

Past medical conditions: 7. Aspirin allergy

Anaphylactic reaction to drug
Description

Anaphylactic reaction to aspirin

Type de données

integer

Angioedema
Description

Angioedema aspirin

Type de données

integer

Drug induced urticaria
Description

Drug induced urticaria aspirin

Type de données

integer

Past medical conditions: 8. NSAID allergy
Description

Past medical conditions: 8. NSAID allergy

Anaphylactic reaction to drug
Description

Anaphylactic reaction to NSAID

Type de données

integer

Angioedema
Description

Angioedema NSAID

Type de données

integer

Drug induced urticaria
Description

Drug induced urticaria NSAID

Type de données

integer

Past medical conditions: 9. ACE inhibitor allergy
Description

Past medical conditions: 9. ACE inhibitor allergy

Anaphylactic reaction to drug
Description

Anaphylactic reaction to ACE inhibitor

Type de données

integer

Angioedema
Description

Angioedema ACE inhibitor

Type de données

integer

Drug induced urticaria
Description

Drug induced urticaria ACE inhibitor

Type de données

integer

Other allergies
Description

Other allergies

10.a Specific Condition
Description

Specific Condition Other allergies

Type de données

text

10.b Status
Description

This item is optional

Type de données

integer

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

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

Symptoms
Description

Symptoms Stevens-Johnson syndrome

Type de données

text

Blisters
Description

Blisters Stevens-Johnson syndrome

Type de données

boolean

Biopsy confirmed
Description

Biopsy confirmed Stevens-Johnson syndrome

Type de données

boolean

Mucous membrane involvement
Description

Mucous membrane involvement Stevens-Johnson syndrome

Type de données

boolean

Symptom start date
Description

Stevens-Johnson syndrome Symptom start date

Type de données

date

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

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

Symptoms
Description

Symptoms Toxic epidermal necrolysis

Type de données

text

Blisters
Description

Blisters Toxic epidermal necrolysis

Type de données

boolean

Biopsy confirmed
Description

Biopsy confirmed Toxic epidermal necrolysis

Type de données

boolean

Mucous membrane involvement
Description

Mucous membrane involvement Toxic epidermal necrolysis

Type de données

boolean

Symptom start date
Description

Symptom start date Toxic epidermal necrolysis

Type de données

date

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

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

Symptoms
Description

Symptoms Urticaria (hives)

Type de données

text

Generalised
Description

Generalised Urticaria (hives)

Type de données

boolean

Localised
Description

Localised Urticaria (hives)

Type de données

boolean

Photosensitivity
Description

Photosensitivity Urticaria (hives)

Type de données

boolean

Other
Description

Other symptoms Urticaria (hives)

Type de données

boolean

Other, specify
Description

Other symptoms Urticaria (hives) specification

Type de données

text

Symptom start date
Description

Symptom start date Urticaria (hives)

Type de données

date

Symptoms associated with this hypersensitivity reaction: 14. Angioedema
Description

Symptoms associated with this hypersensitivity reaction: 14. Angioedema

Symptoms
Description

Symptoms Angioedema

Type de données

text

Face (including eyes, lips)
Description

Angioedema Face

Type de données

boolean

Throat (including tongue, larynx)
Description

Angioedema Throat

Type de données

boolean

Laryngeal
Description

Angioedema Laryngeal

Type de données

boolean

Dyspnoea
Description

Angioedema Dyspnoea

Type de données

boolean

Dysphagia
Description

Angioedema Dysphagia

Type de données

boolean

Required intubation
Description

Angioedema Required intubation

Type de données

boolean

Other
Description

Angioedema Other symptoms

Type de données

boolean

Other, specify
Description

Angioedema Other symptoms specification

Type de données

text

Symptom start date
Description

Symptom start date Angioedema

Type de données

date

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

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

Symptoms
Description

Anaphylactic/Anaphylactoid reaction symptoms

Type de données

text

Dyspnoea
Description

Dyspnoea Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Bronchospasm
Description

Bronchospasm Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Hypotension
Description

Hypotension Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Loss of consciousness
Description

Loss of consciousness Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
Description

Persistent gastrointestinal symptoms Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Other
Description

Other symptoms Anaphylactic/Anaphylactoid reaction

Type de données

boolean

Other, specify
Description

Other symptoms specidication Anaphylactic/Anaphylactoid reaction

Type de données

text

Symptom start date
Description

Symptom start date Anaphylactic/Anaphylactoid reaction

Type de données

date

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

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

Symptoms
Description

Symptoms Other symptoms of hypersensitivity reaction

Type de données

text

Rash
Description

Other symptoms of hypersensitivity reaction Rash

Type de données

boolean

Photosensitivity
Description

Other symptoms of hypersensitivity reaction Photosensitivity

Type de données

boolean

Other
Description

Other symptoms of hypersensitivity reaction

Type de données

boolean

Other, specify
Description

Other symptoms of hypersensitivity reaction specification

Type de données

text

Symptom start date
Description

Start date Other symptoms of hypersensitivity reaction

Type de données

date

Similar models

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

Name
Type
Description | Question | Decode (Coded Value)
Type de données
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

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial