ID

29016

Description

Study part: Serious Adverse Event Reporting. A Phase III, Multicenter, Randomized, Double-Masked, Sham Injection-Controlled Study Of The Efficacy And Safety Of rhuFab V2 (Ranibizumab) In Subjects With Minimally Classic Or Occult Subfoveal Neovascular Age-Related Macular Degeneration.

Mots-clés

Versions (1)
  1. 20/02/2018 20/02/2018 -
Détendeur de droits

Roche

Téléchargé le

20 février 2018

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

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Serious Adverse Event Reporting rhuFab V2 Neovascular Age-Related Macular Degeneration FVF2598g

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Serious Adverse Event Reporting

1 Formulaires  
SERIOUS ADVERSE EVENT REPORTING
Description

SERIOUS ADVERSE EVENT REPORTING

Alias
UMLS CUI-1
C1519255
Subject Number:
Description

Subject Number

Type de données

text

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Description

Subject Initials

Type de données

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Visit Date:
Description

Visit Date

Type de données

date

Alias
UMLS CUI [1]
C1320303
PRIMARY SERIOUS ADVERSE EVENT
Description

Adverse event

Type de données

text

Alias
UMLS CUI [1]
C0877248
Ocular AEs Only Indicate Eye Affected
Description

eye

Type de données

text

Alias
UMLS CUI [1]
C0015392
ONSET
Description

Onset

Type de données

date

Alias
UMLS CUI [1]
C0574845
RESOLUTION
Description

end date

Type de données

date

Alias
UMLS CUI [1]
C0806020
Check if event is ongoing
Description

adverse event ongoing

Type de données

boolean

Alias
UMLS CUI [1]
C2826663
SAE INTENSITY
Description

Adverse Event intensity

Type de données

integer

Alias
UMLS CUI [1]
C1710066
SAE SUSPECTED TO BE CAUSED BY STUDY DRUG?
Description

cause of adverse event

Type de données

boolean

Alias
UMLS CUI [1,1]
C0015127
UMLS CUI [1,2]
C0877248
OTHER SUSPECTED CAUSES OF SAE
Description

cause of adverse event

Type de données

integer

Alias
UMLS CUI [1,1]
C0015127
UMLS CUI [1,2]
C0877248
ACTION TAKEN WITH STUDY DRUG DUE TO AE
Description

Action taken

Type de données

integer

Alias
UMLS CUI [1]
C2826626
TREATMENT FOR AE
Description

adverse event therapy

Type de données

integer

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0087111
Was the subject hospitalized due to serious AE?
Description

Hospitalization

Type de données

boolean

Alias
UMLS CUI [1]
C0019993
If Yes, Admission Date:
Description

Admission date

Type de données

date

Alias
UMLS CUI [1]
C1302393
The primary Adverse Event was considered serious because
Description

reason

Type de données

integer

Alias
UMLS CUI [1]
C0566251
Date of Death:
Description

Date of Death

Type de données

date

Alias
UMLS CUI [1]
C1148348
Autopsy performed?
Description

Autopsy

Type de données

text

Alias
UMLS CUI [1]
C0004398
Relevant Diagnostic Tests Performed (To diagnose or confirm primary SAE):
Description

Relevant Diagnostic Tests Performed (To diagnose or confirm primary SAE):

Alias
UMLS CUI-1
C0086143
Relevant Diagnostic Tests performed?
Description

Diagnostic tests

Type de données

boolean

Alias
UMLS CUI [1]
C0086143
Relevant Diagnostic Test
Description

Diagnostic tests

Type de données

text

Alias
UMLS CUI [1]
C0086143
Date Performed
Description

Date Performed

Type de données

date

Alias
UMLS CUI [1,1]
C0430022
UMLS CUI [1,2]
C0011008
Relevant Diagnostic Test Result
Description

test result

Type de données

text

Alias
UMLS CUI [1]
C0456984
Result Pending
Description

test result

Type de données

boolean

Alias
UMLS CUI [1]
C0456984
Additional Case Details:
Description

• Associated signs and symptoms, if applicable • Clinical course (e.g. sequence of events) • Elaborate on suspected causes of SAE • Any specific treatment for the SAE

Type de données

text

Alias
UMLS CUI [1]
C1546922
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Similar models

Serious Adverse Event Reporting

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
SERIOUS ADVERSE EVENT REPORTING
C1519255 (UMLS CUI-1)
Subject Number
Item
Subject Number:
text
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Visit Date
Item
Visit Date:
date
C1320303 (UMLS CUI [1])
Adverse event
Item
PRIMARY SERIOUS ADVERSE EVENT
text
C0877248 (UMLS CUI [1])
Item
Ocular AEs Only Indicate Eye Affected
text
C0015392 (UMLS CUI [1])
eye
Code List
Ocular AEs Only Indicate Eye Affected
CL Item
Right (Right)
C0229089 (UMLS CUI-1)
(Comment:en)
CL Item
Left (Left)
C0229090 (UMLS CUI-1)
(Comment:en)
Onset
Item
ONSET
date
C0574845 (UMLS CUI [1])
end date
Item
RESOLUTION
date
C0806020 (UMLS CUI [1])
adverse event ongoing
Item
Check if event is ongoing
boolean
C2826663 (UMLS CUI [1])
Item
SAE INTENSITY
integer
C1710066 (UMLS CUI [1])
Adverse Event intensity
Code List
SAE INTENSITY
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
cause of adverse event
Item
SAE SUSPECTED TO BE CAUSED BY STUDY DRUG?
boolean
C0015127 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
Item
OTHER SUSPECTED CAUSES OF SAE
integer
C0015127 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
cause of advese event
Code List
OTHER SUSPECTED CAUSES OF SAE
CL Item
None  (1)
C0549184 (UMLS CUI-1)
(Comment:en)
CL Item
Disease Under Study (2)
C0012634 (UMLS CUI-1)
(Comment:en)
CL Item
Withdrawal of Study Drug (3)
C2349954 (UMLS CUI-1)
C0304229 (UMLS CUI-2)
(Comment:en)
CL Item
Concurrent Illness (4)
C0009488 (UMLS CUI-1)
(Comment:en)
CL Item
Concurrent Medication (5)
C2347852 (UMLS CUI-1)
(Comment:en)
CL Item
Non-Drug Intervention (6)
C3661844 (UMLS CUI-1)
(Comment:en)
CL Item
Treatment Procedure (7)
C0087111 (UMLS CUI-1)
(Comment:en)
Item
ACTION TAKEN WITH STUDY DRUG DUE TO AE
integer
C2826626 (UMLS CUI [1])
Action taken
Code List
ACTION TAKEN WITH STUDY DRUG DUE TO AE
CL Item
None (1)
CL Item
Drug permanently discontinued (2)
CL Item
Dose held (3)
CL Item
Not applicable (4)
Item
TREATMENT FOR AE
integer
C0877248 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
adverse event therapy
Code List
TREATMENT FOR AE
CL Item
None (1)
CL Item
Medication (2)
CL Item
Procedure/ Surgery (3)
CL Item
Subject DC from study (4)
Hospitalization
Item
Was the subject hospitalized due to serious AE?
boolean
C0019993 (UMLS CUI [1])
Admission date
Item
If Yes, Admission Date:
date
C1302393 (UMLS CUI [1])
Item
The primary Adverse Event was considered serious because
integer
C0566251 (UMLS CUI [1])
reason
Code List
The primary Adverse Event was considered serious because
CL Item
It resulted in death (1)
C1306577 (UMLS CUI-1)
(Comment:en)
CL Item
It was life-threatening (i.e., the recorded AE placed subject at immediate risk of death) (2)
C2826244 (UMLS CUI-1)
(Comment:en)
CL Item
It required or prolonged inpatient hospitalization (i.e., the recorded AE caused the subject to behospitalized or prolonged hospitalization beyond the expected length of stay) (3)
C0019993 (UMLS CUI-1)
(Comment:en)
CL Item
It was disabling (i.e., the recorded AE resulted in substantial disruption of the subject’s ability to carry out normal life functions) (4)
C4061999 (UMLS CUI-1)
(Comment:en)
CL Item
It is a congenital anomaly/birth defect in offspring of study subject (5)
C0000768 (UMLS CUI-1)
(Comment:en)
CL Item
It does not meet any of the above serious criteria, but may jeopardize the subject, and may require medical or surgical intervention to prevent one of the outcomes listed above. (6)
C0184661 (UMLS CUI-1)
(Comment:en)
Date of Death
Item
Date of Death:
date
C1148348 (UMLS CUI [1])
Item
Autopsy performed?
text
C0004398 (UMLS CUI [1])
Autopsy
Code List
Autopsy performed?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
Item Group
Relevant Diagnostic Tests Performed (To diagnose or confirm primary SAE):
C0086143 (UMLS CUI-1)
Diagnostic tests
Item
Relevant Diagnostic Tests performed?
boolean
C0086143 (UMLS CUI [1])
Diagnostic tests
Item
Relevant Diagnostic Test
text
C0086143 (UMLS CUI [1])
Date Performed
Item
Date Performed
date
C0430022 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
test result
Item
Relevant Diagnostic Test Result
text
C0456984 (UMLS CUI [1])
test result
Item
Result Pending
boolean
C0456984 (UMLS CUI [1])
additional information
Item
Additional Case Details:
text
C1546922 (UMLS CUI [1])
Retour au début de la page 

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