ID

33122

Description

Study ID: 106837 Clinical Study ID: HZA106837 Study Title: A Long-Term, Randomized, Double-Blind, Parallel Group Study of Fluticasone Furoate/GW642444 Inhalation Powder Once-Daily and Fluticasone Furoate Inhalation Powder Once-Daily in Subjects with Asthma Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT01086384 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: fluticasone furoate/vilanterol Trade Name: Relvar Study Indication: Asthma

Keywords

Versions (2)
  1. 10/30/18 10/30/18 -
  2. 11/28/18 11/28/18 -
Copyright Holder

GSK group of companies

Uploaded on

November 28, 2018

DOI

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License

Creative Commons BY-NC 3.0
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A Parallel Group Study of Fluticasone Furoate/Vilanterol in Subjects with Asthma - 106837

English

Screen Failure Form

1 forms  
  1. StudyEvent: ODM
    1. Screen Failure Form
Screen Failure Data
Description

Screen Failure Data

Alias
UMLS CUI-1
C1710476
Was this subject a screen failure?
Description

Was this subject a screen failure?

Data type

boolean

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0681850
Screen Failure Date
Description

Screen Failure Date

Data type

date

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0011008
If YES, please select reason
Description

If YES, please select reason

Data type

integer

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0392360
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Similar models

Screen Failure Form

1 forms
  1. StudyEvent: ODM
    1. Screen Failure Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Screen Failure Data
C1710476 (UMLS CUI-1)
Was this subject a screen failure?
Item
Was this subject a screen failure?
boolean
C1710476 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
Screen Failure Date
Item
Screen Failure Date
date
C1710476 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
If YES, please select reason
integer
C1710476 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
If YES, please select reason
Code List
If YES, please select reason
CL Item
Did not meet inclusion/exclusion criteria (1)
CL Item
Adverse Event (unspecified) (2)
CL Item
Study closed/terminated  (3)
CL Item
Investigator discretion, specify_____ (4)
CL Item
withdrew consent, specify______ (5)
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