Date of visit/assessment
Item
Date of visit/assessment
date
C1320303 (UMLS CUI [1])
treatment blind broken
Item
Was the treatment blind broken during the study?
boolean
C3897431 (UMLS CUI [1])
Date blind broken
Item
Date blind broken
integer
C3897431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Reason blind broken
integer
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
Reason blind broken
CL Item
Medical emergency requiring identification of investigational product for further treatment (1)
CL Item
Other, specify (2)
Reason blind broken
Item
Reason blind broken, if other, specify
text
C3897431 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
pregnant
Item
Did the subject become pregnant during the study?
boolean
C0032961 (UMLS CUI [1])
withdrawn consent
Item
Has subject withdrawn consent for PGx research?
boolean
C1707492 (UMLS CUI [1])
Date informed consent withdrawn
Item
Yes, date informed consent withdrawn
date
C1707492 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Sample destruction
Item
Ha a request been made for sample destruction?
boolean
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
Item
Yes, check reason for sample destruction
integer
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Code List
Yes, check reason for sample destruction
CL Item
Subject withdrew consent for PGx (1)
CL Item
Screen failure (2)
CL Item
Other, specify (3)
Reason for sample destruction
Item
If Other Reason for sample destruction, specify
text
C1948029 (UMLS CUI [1,1])
C0178913 (UMLS CUI [1,2])
C0392360 (UMLS CUI [1,3])
Date of subject completion or withdrawal
Item
Date of subject completion or withdrawal
date
C2983670 (UMLS CUI [1])
subject withdrawn
Item
Was the subject withdrawn from the study?
boolean
C0422727 (UMLS CUI [1])
Item
Primary reason for withdrawal
integer
C0422727 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Code List
Primary reason for withdrawal
CL Item
Adverse Event (1)
CL Item
Lack of efficacy (2)
CL Item
Protocol Deviation (3)
CL Item
Subject reached protocol defined stopping criteria (4)
CL Item
Study closed/terminated (5)
CL Item
Lost to Follow-up (6)
CL Item
Withdrew consent (7)
CL Item
Investigator discretion, specify (8)
follow-up
Item
Subject contacted for follow-up?
boolean
C1522577 (UMLS CUI [1,1])
C0332158 (UMLS CUI [1,2])
C0681850 (UMLS CUI [1,3])
Double Blind Start Date
Item
Double Blind Start Date
date
C0013072 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Double Blind Stop Date
Item
Double Blind Stop Date
date
C0013072 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Investigator Signature
Item
Is this casebook ready to sign? Investigator Signature
boolean
C2346576 (UMLS CUI [1])