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Visit 1: 12-lead ECG Form

1 forms  
Dosing Schedule
Description

Dosing Schedule

Dosing Date
Description

Dosing Date

Data type

date

Dosing Time
Description

Dosing Time

Data type

time

Timepoint 1
Description

Timepoint 1

Date of ECG
Description

Date of ECG

Data type

date

Time of ECG
Description

Time of ECG

Data type

time

Heart rate
Description

Heart rate

Data type

integer

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

Method of QTc Calculation
Description

Method of QTc Calculation

Data type

text

Result of the ECG
Description

Result of the ECG

Data type

text

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Visit 1: 12-lead ECG Form

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Dosing Schedule
Dosing Date
Item
Dosing Date
date
Dosing Time
Item
Dosing Time
time
Item Group
Timepoint 1
Date of ECG
Item
Date of ECG
date
Time of ECG
Item
Time of ECG
time
Heart rate
Item
Heart rate
integer
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
Method of QTc Calculation
text
Method of QTc Calculation
Code List
Method of QTc Calculation
CL Item
Machine (1)
CL Item
Manual (2)
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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