ID

26703

Beskrivning

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)

Nyckelord

  1. 2017-10-04 2017-10-04 -
  2. 2017-10-16 2017-10-16 -
  3. 2017-10-23 2017-10-23 -
  4. 2018-01-01 2018-01-01 -
  5. 2018-01-03 2018-01-03 -
Rättsinnehavare

GlaxoSmithKline

Uppladdad den

23 oktober 2017

DOI

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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
Beskrivning

1. Event number

Event number
Beskrivning

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

Datatyp

text

Past medical conditions: 2. Food allergies
Beskrivning

Past medical conditions: 2. Food allergies

Anaphylactic reaction to food
Beskrivning

Anaphylactic reaction to food

Datatyp

integer

Angioedema
Beskrivning

Angioedema food

Datatyp

integer

Urticaria
Beskrivning

Urticaria food

Datatyp

integer

Past medical conditions: 3. Hymenoptera sting allergy
Beskrivning

Past medical conditions: 3. Hymenoptera sting allergy

Anaphylaxis
Beskrivning

Anaphylaxis Hymenoptera sting allergy

Datatyp

integer

Angioedema
Beskrivning

Angioedema Hymenoptera sting allergy

Datatyp

integer

Urticaria
Beskrivning

Urticaria Hymenoptera sting allergy

Datatyp

integer

Past medical conditions: 4. Latex allergy
Beskrivning

Past medical conditions: 4. Latex allergy

Anaphylaxis
Beskrivning

Anaphylaxis Latex

Datatyp

integer

Angioedema
Beskrivning

Angioedema latex

Datatyp

integer

Urticaria
Beskrivning

Urticaria latex

Datatyp

integer

Past medical conditions: 5. Penicillin allergy
Beskrivning

Past medical conditions: 5. Penicillin allergy

Anaphylactic reaction to drug
Beskrivning

Anaphylactic reaction penicillin

Datatyp

integer

Angioedema
Beskrivning

Angioedema penicillin

Datatyp

integer

Drug induced urticaria
Beskrivning

Drug induced urticaria penicillin

Datatyp

integer

Past medical conditions: 6. Cephalosporin allergy
Beskrivning

Past medical conditions: 6. Cephalosporin allergy

Anaphylactic reaction to drug
Beskrivning

Anaphylactic reaction to Cephalosporin

Datatyp

integer

Angioedema
Beskrivning

Angioedema Cephalosporin

Datatyp

integer

Drug induced urticaria
Beskrivning

Drug induced urticaria Cephalosporin

Datatyp

integer

Past medical conditions: 7. Aspirin allergy
Beskrivning

Past medical conditions: 7. Aspirin allergy

Anaphylactic reaction to drug
Beskrivning

Anaphylactic reaction to aspirin

Datatyp

integer

Angioedema
Beskrivning

Angioedema aspirin

Datatyp

integer

Drug induced urticaria
Beskrivning

Drug induced urticaria aspirin

Datatyp

integer

Past medical conditions: 8. NSAID allergy
Beskrivning

Past medical conditions: 8. NSAID allergy

Anaphylactic reaction to drug
Beskrivning

Anaphylactic reaction to NSAID

Datatyp

integer

Angioedema
Beskrivning

Angioedema NSAID

Datatyp

integer

Drug induced urticaria
Beskrivning

Drug induced urticaria NSAID

Datatyp

integer

Past medical conditions: 9. ACE inhibitor allergy
Beskrivning

Past medical conditions: 9. ACE inhibitor allergy

Anaphylactic reaction to drug
Beskrivning

Anaphylactic reaction to ACE inhibitor

Datatyp

integer

Angioedema
Beskrivning

Angioedema ACE inhibitor

Datatyp

integer

Drug induced urticaria
Beskrivning

Drug induced urticaria ACE inhibitor

Datatyp

integer

Other allergies
Beskrivning

Other allergies

10.a Specific Condition
Beskrivning

Specific Condition Other allergies

Datatyp

text

10.b Status
Beskrivning

This item is optional

Datatyp

integer

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

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

Symptoms
Beskrivning

Symptoms Stevens-Johnson syndrome

Datatyp

text

Blisters
Beskrivning

Blisters Stevens-Johnson syndrome

Datatyp

boolean

Biopsy confirmed
Beskrivning

Biopsy confirmed Stevens-Johnson syndrome

Datatyp

boolean

Mucous membrane involvement
Beskrivning

Mucous membrane involvement Stevens-Johnson syndrome

Datatyp

boolean

Symptom start date
Beskrivning

Stevens-Johnson syndrome Symptom start date

Datatyp

date

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

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

Symptoms
Beskrivning

Symptoms Toxic epidermal necrolysis

Datatyp

text

Blisters
Beskrivning

Blisters Toxic epidermal necrolysis

Datatyp

boolean

Biopsy confirmed
Beskrivning

Biopsy confirmed Toxic epidermal necrolysis

Datatyp

boolean

Mucous membrane involvement
Beskrivning

Mucous membrane involvement Toxic epidermal necrolysis

Datatyp

boolean

Symptom start date
Beskrivning

Symptom start date Toxic epidermal necrolysis

Datatyp

date

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

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

Symptoms
Beskrivning

Symptoms Urticaria (hives)

Datatyp

text

Generalised
Beskrivning

Generalised Urticaria (hives)

Datatyp

boolean

Localised
Beskrivning

Localised Urticaria (hives)

Datatyp

boolean

Photosensitivity
Beskrivning

Photosensitivity Urticaria (hives)

Datatyp

boolean

Other
Beskrivning

Other symptoms Urticaria (hives)

Datatyp

boolean

Other, specify
Beskrivning

Other symptoms Urticaria (hives) specification

Datatyp

text

Symptom start date
Beskrivning

Symptom start date Urticaria (hives)

Datatyp

date

Symptoms associated with this hypersensitivity reaction: 14. Angioedema
Beskrivning

Symptoms associated with this hypersensitivity reaction: 14. Angioedema

Symptoms
Beskrivning

Symptoms Angioedema

Datatyp

text

Face (including eyes, lips)
Beskrivning

Angioedema Face

Datatyp

boolean

Throat (including tongue, larynx)
Beskrivning

Angioedema Throat

Datatyp

boolean

Laryngeal
Beskrivning

Angioedema Laryngeal

Datatyp

boolean

Dyspnoea
Beskrivning

Angioedema Dyspnoea

Datatyp

boolean

Dysphagia
Beskrivning

Angioedema Dysphagia

Datatyp

boolean

Required intubation
Beskrivning

Angioedema Required intubation

Datatyp

boolean

Other
Beskrivning

Angioedema Other symptoms

Datatyp

boolean

Other, specify
Beskrivning

Angioedema Other symptoms specification

Datatyp

text

Symptom start date
Beskrivning

Symptom start date Angioedema

Datatyp

date

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

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

Symptoms
Beskrivning

Anaphylactic/Anaphylactoid reaction symptoms

Datatyp

text

Dyspnoea
Beskrivning

Dyspnoea Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Bronchospasm
Beskrivning

Bronchospasm Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Hypotension
Beskrivning

Hypotension Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Loss of consciousness
Beskrivning

Loss of consciousness Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Persistent gastrointestinal symptoms (crampy abdominal pain, vomiting)
Beskrivning

Persistent gastrointestinal symptoms Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Other
Beskrivning

Other symptoms Anaphylactic/Anaphylactoid reaction

Datatyp

boolean

Other, specify
Beskrivning

Other symptoms specidication Anaphylactic/Anaphylactoid reaction

Datatyp

text

Symptom start date
Beskrivning

Symptom start date Anaphylactic/Anaphylactoid reaction

Datatyp

date

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

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

Symptoms
Beskrivning

Symptoms Other symptoms of hypersensitivity reaction

Datatyp

text

Rash
Beskrivning

Other symptoms of hypersensitivity reaction Rash

Datatyp

boolean

Photosensitivity
Beskrivning

Other symptoms of hypersensitivity reaction Photosensitivity

Datatyp

boolean

Other
Beskrivning

Other symptoms of hypersensitivity reaction

Datatyp

boolean

Other, specify
Beskrivning

Other symptoms of hypersensitivity reaction specification

Datatyp

text

Symptom start date
Beskrivning

Start date Other symptoms of hypersensitivity reaction

Datatyp

date

Similar models

Hypersensitivity Reaction Record GSK study Chronic Coronary Heart Disease NCT00799903

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
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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