Date of Final Contact
Item
Date of Final Contact
date
Date of Last Dose
Item
Date of Last Dose
date
Did subject complete the study?
Item
Did subject complete the study?
boolean
Item
If NO, mark one reason
text
Code List
If NO, mark one reason
CL Item
Liver chemistry stopping criteria (1)
CL Item
Adverse Event (2)
CL Item
Severe or repeated occurrences of hypoglycemia (3)
CL Item
Pancreatitis or skin and systematic allergic reactions (4)
CL Item
QT interval withdrawal criteria (5)
CL Item
Consent withdrawn (6)
CL Item
Lost to Follow-Up (7)
CL Item
Protocol violation (8)
CL Item
Noncompliance with study visit schedule (9)
CL Item
Termination of study by sponsor (10)
CL Item
Nausea requiring the use of antiemetics (12)
CL Item
Other (specify in comments) (13)
Date of Discontinuation
Item
Date of Discontinuation
date
Comments
Item
Comments
text
If Liver chemistry stopping criteria, specify Adverse Event Number
Item
If Liver chemistry stopping criteria, specify Adverse Event Number
integer
If Adverse Event, specify Adverse Event Number
Item
If Adverse Event, specify Adverse Event Number
integer
If Severe or repeated occurrences of hypoglycemia, specify Adverse Event Number
Item
If Severe or repeated occurrences of hypoglycemia, specify Adverse Event Number
integer
If Pancreatitis or skin and systematic allergic reactions, specify Adverse Event Number
Item
If Pancreatitis or skin and systematic allergic reactions, specify Adverse Event Number
integer
If QT interval withdrawal criteria, specify Adverse Event Number
Item
If QT interval withdrawal criteria, specify Adverse Event Number
integer
If Nausea requiring the use of antiemetics, specify Adverse Event Number
Item
If Nausea requiring the use of antiemetics, specify Adverse Event Number
integer
Was the blind broken for this subjects during the study?
Item
Was the blind broken for this subjects during the study?
boolean
If Yes, date of unblinding
Item
If Yes, date of unblinding
date
Time of unblinding
Item
Time of unblinding
time