ID
32944
Description
Study ID: 107085 Clinical Study ID: GLP107085 Study Title: A Randomized, Double-blind, Parallel, Nested Crossover Study to Investigate the Effect of Albiglutide on Cardiac Repolarization (corrected QT Interval) Compared With Placebo in Healthy Male and Female Subjects: A Thorough ECG Study Employing Placebo, Albiglutide, and a Positive Control (Moxifloxacin) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT01406262 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: albiglutide Trade Name: Tanzeum,Eperzan Study Indication: Diabetes Mellitus, Type 2
Keywords
Versions (1)
- 11/21/18 11/21/18 -
Copyright Holder
GSK group of companies
Uploaded on
November 21, 2018
DOI
To request one please log in.
License
Creative Commons BY-NC 3.0
Model comments :
You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.
Itemgroup comments for :
Item comments for :
In order to download data models you must be logged in. Please log in or register for free.
The Effect of Albiglutide on Cardiac Repolarisation Compared with Placebo 107085
Pregnancy Notification Form
- StudyEvent: ODM
Description
Demography
Description
Subject ID Number
Data type
integer
Description
Race
Data type
text
Description
Age
Data type
integer
Measurement units
- years
Description
Date of Birth
Data type
date
Description
Weight (kilogram)
Data type
float
Measurement units
- kg
Description
Weight (pounds)
Data type
float
Measurement units
- pounds
Description
Height (centimeters)
Data type
float
Measurement units
- cm
Description
Height (inches)
Data type
float
Measurement units
- inches
Description
Was the mother using a method of contraception?
Data type
boolean
Description
If Yes, specify
Data type
text
Description
select one
Data type
text
Description
e.g., ultrasound, amniocentesis, chronic villi sampling, including dates of test and procedures
Data type
text
Description
Known allergies
Data type
boolean
Description
If Yes, specify
Data type
text
Description
Alcohol intake
Data type
boolean
Description
If Yes, specify
Data type
text
Description
Other significant prior or co-existent medical conditions or history
Data type
boolean
Description
If Yes, specify
Data type
text
Description
Pregnancy Information
Description
Start date of last menstrual period
Data type
date
Description
Date of positive pregnancy test
Data type
date
Description
Date of last negative pregnancy test
Data type
date
Description
Was pregnancy terminated?
Data type
boolean
Description
If Yes, record the date
Data type
date
Description
If Yes, clarify if elective or spontaneous termination?
Data type
text
Description
Date of expected delivery
Data type
date
Description
If none, enter a zero
Data type
integer
Description
If none, enter a zero
Data type
integer
Description
Has subject experienced complications during this or previous pregnancies?
Data type
boolean
Description
If Yes, specify
Data type
text
Description
Important Note
Similar models
Pregnancy Notification Form
- StudyEvent: ODM