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12-lead ECG Form

1 forms  
  1. StudyEvent: ODM
    1. 12-lead ECG Form
Administrative data
Description

Administrative data

Site
Description

Site

Data type

text

Patient
Description

Patient

Data type

text

Patient Number
Description

Patient Number

Data type

integer

Screening ECG
Description

Screening ECG

Date of ECG
Description

Date of ECG

Data type

date

Time of ECG
Description

Time of ECG

Data type

time

PR Interval
Description

PR Interval

Data type

float

Measurement units
  • msec
msec
QRS Duration
Description

QRS Duration

Data type

float

Measurement units
  • msec
msec
Uncorrected QT Interval
Description

Uncorrected QT Interval

Data type

float

Measurement units
  • msec
msec
QTc Interval
Description

QTc Interval

Data type

float

Measurement units
  • msec
msec
Result of the ECG
Description

Result of the ECG

Data type

text

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Similar models

12-lead ECG Form

1 forms
  1. StudyEvent: ODM
    1. 12-lead ECG Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
Site
Item
Site
text
Patient
Item
Patient
text
Patient Number
Item
Patient Number
integer
Item Group
Screening ECG
Date of ECG
Item
Date of ECG
date
Time of ECG
Item
Time of ECG
time
PR Interval
Item
PR Interval
float
QRS Duration
Item
QRS Duration
float
Uncorrected QT Interval
Item
Uncorrected QT Interval
float
QTc Interval
Item
QTc Interval
float
Item
Result of the ECG
text
Result of the ECG
Code List
Result of the ECG
CL Item
Normal (1)
CL Item
Abnormal - Not clinically significant (2)
CL Item
Abnormal, clinically significant (complete the AE form if clinically significant abnormalities meet the protocol definition for an AE) (3)
CL Item
No result (not available) (4)
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