0 Evaluaciones
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

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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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