ID

32645

Descripción

Study ID: 106904 Clinical Study ID: CRV106904 Study Title: A Randomized, Open-Label, Single-Dose, Four-Period Cross-Over Study to Determine the Effects of Alcohol on the Pharmacokinetics of Carvedilol CR Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier:  Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: carvedilol Trade Name: Coreg CR,Coreg Study Indication: Hypertension

Palabras clave

Versiones (2)
  1. 9/11/18 9/11/18 -
  2. 11/1/19 11/1/19 -
Titular de derechos de autor

GSK group of companies

Subido en

9 de noviembre de 2018

DOI

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Licencia

Creative Commons BY-NC 3.0
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A Cross-Over Study of Alcohol Effect on the Pharmacokinetics of Carvedilol - 106904

Inglés

Pharmacogenetics Research Consent Form

1 formularios  
Administrative data
Descripción

Administrative data

Site
Descripción

Site

Tipo de datos

text

Patient
Descripción

Patient

Tipo de datos

text

Patient Number
Descripción

Patient Number

Tipo de datos

integer

Date of Visit/Assessment
Descripción

Date of Visit/Assessment

Tipo de datos

date

Date of Visit/Assessment
Descripción

Date of Visit/Assessment

Date
Descripción

Date

Tipo de datos

date

PGx Research Consent
Descripción

PGx Research Consent

Has informed consent been obtained for PGx-Pharmacogenetic research?
Descripción

Has informed consent been obtained for PGx-Pharmacogenetic research?

Tipo de datos

boolean

If YES, record date informed consent obtained for PGx-Pharmacogenetic research
Descripción

If YES, record date informed consent obtained for PGx-Pharmacogenetic research

Tipo de datos

date

Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
Descripción

Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research

Tipo de datos

boolean

If YES, record date sample taken
Descripción

If YES, record date sample taken

Tipo de datos

date

If NO informed consent obtained, check reason
Descripción

If NO informed consent obtained, check reason

Tipo de datos

text

If Other, specify
Descripción

If Other, specify

Tipo de datos

text

Genetics Type
Descripción

Genetics Type

Tipo de datos

text

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Similar models

Pharmacogenetics Research Consent Form

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
Site
Item
Site
text
Patient
Item
Patient
text
Patient Number
Item
Patient Number
integer
Date of Visit/Assessment
Item
Date of Visit/Assessment
date
Item Group
Date of Visit/Assessment
Date
Item
Date
date
Item Group
PGx Research Consent
Has informed consent been obtained for PGx-Pharmacogenetic research?
Item
Has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
If YES, record date informed consent obtained for PGx-Pharmacogenetic research
Item
If YES, record date informed consent obtained for PGx-Pharmacogenetic research
date
Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
Item
Has a blood sample been collected for PGx-Pharmacogenetic (DNA) research
boolean
If YES, record date sample taken
Item
If YES, record date sample taken
date
Item
If NO informed consent obtained, check reason
text
If NO informed consent obtained, check reason
Code List
If NO informed consent obtained, check reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other (3)
If Other, specify
Item
If Other, specify
text
Genetics Type
Item
Genetics Type
text
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