Administrative data
Visit Number
text
Date of Visit
date
Subject Number
integer
General Medical History / Physical Examination
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
Cutaneous
Diagnosis
Eyes
Ears-Nose-Throat
Cardiovascular
Respiratory
Gastrointestinal
Muskuloskeletal
Neurological
Genitourinary
Haematology
Allergies
Endocrine
Other, specify
Concomitant Medications
Please report medication(s) as specified in the protocol and fill in the Medication section