ID

33385

Descripción

Study ID: 107806 Clinical Study ID: RA3107806 Study Title: An open label study to determine the safety, tolerability, excretion balance and pharmacokinetics of Losmapimod, administered as a single dose of an oral solution to healthy adult male subjects Patient Level Data: Clinicaltrials.gov Identifier: NCT00599612 https://clinicaltrials.gov/ct2/show/NCT00599612 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: losmapimod Trade Name: losmapimod Study Indication: Pulmonary Disease, Chronic Obstructive The study consists of a screening, study visit and follow-up. The protocol identifier for all: RA3107806 This document contains Study conclusion, Investigator Comment Log, Investigator's signature. It has to be filled in for the end of study.

Link

https://clinicaltrials.gov/ct2/show/NCT00599612

Palabras clave

Versiones (2)
  1. 7/12/18 7/12/18 -
  2. 11/12/18 11/12/18 - Sarah Riepenhausen
Titular de derechos de autor

GlaxoSmithKline

Subido en

7 de diciembre de 2018

DOI

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Licencia

Creative Commons BY-NC 3.0
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Safety, tolerability, excretion balance and pharmacokinetics of Losmapimod in healthy males, NCT00599612

Inglés

Study conclusion, Investigator Comment Log, Investigator's signature

1 formularios  
Administrative data
Descripción

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Descripción

Subject Number

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Study conclusion
Descripción

Study conclusion

Alias
UMLS CUI-1
C1707478
UMLS CUI-2
C0008972
Date of subject completion or withdrawal
Descripción

day month year

Tipo de datos

date

Alias
UMLS CUI [1]
C1549507
UMLS CUI [2,1]
C0011008
UMLS CUI [2,2]
C0422727
Was the subject withdrawn from the study?
Descripción

Subject's withdraw

Tipo de datos

text

Alias
UMLS CUI [1]
C2349954
If subject was withdraw form study, tick one primary reason for withdrawal
Descripción

If you tick 1: Record details on the Non-Serious Adverse Events or Serious Adverse Event pages as appropriate. To 6 and 7: Only tick if none of the other primary reasons are appropriate

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C0566251
If you tick "Investigator discretion", please specify
Descripción

Investigator discretion, specification

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0008961
UMLS CUI [1,2]
C0022423
UMLS CUI [2,1]
C2349954
UMLS CUI [2,2]
C0566251
If you tick "Withdrew consent ", please specify
Descripción

Withdrew consent , specification

Tipo de datos

text

Alias
UMLS CUI [1]
C1707492
UMLS CUI [2,1]
C2349954
UMLS CUI [2,2]
C0566251
Investigator Comment Log
Descripción

Investigator Comment Log

Alias
UMLS CUI-1
C0008961
UMLS CUI-2
C0947611
CRF page number if applicable
Descripción

CRF page number

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1704732
UMLS CUI [1,2]
C1516308
Comment
Descripción

Comment

Tipo de datos

text

Alias
UMLS CUI [1]
C0947611
Investigator's signature
Descripción

Investigator's signature

Alias
UMLS CUI-1
C2346576
I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below.
Descripción

Confirmation complete data in CRF

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0750484
UMLS CUI [1,2]
C3899518
Investigator's signature
Descripción

Investigator's signature

Tipo de datos

text

Alias
UMLS CUI [1]
C2346576
Investigator's name (print)
Descripción

Investigator's name (print)

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Date of signature
Descripción

day month year

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Study conclusion, Investigator Comment Log, Investigator's signature

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Item Group
Study conclusion
C1707478 (UMLS CUI-1)
C0008972 (UMLS CUI-2)
Date of subject completion or withdrawal
Item
Date of subject completion or withdrawal
date
C1549507 (UMLS CUI [1])
C0011008 (UMLS CUI [2,1])
C0422727 (UMLS CUI [2,2])
Item
Was the subject withdrawn from the study?
text
C2349954 (UMLS CUI [1])
Subject's withdraw
Code List
Was the subject withdrawn from the study?
CL Item
Yes (Y)
CL Item
No (N)
Item
If subject was withdraw form study, tick one primary reason for withdrawal
integer
C2349954 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
Withdraw, reason
Code List
If subject was withdraw form study, tick one primary reason for withdrawal
CL Item
Adverse event  (1)
CL Item
Protocol deviation (2)
CL Item
Subject reached protocol defined stopping criteria (3)
CL Item
Study closed/terminated (4)
CL Item
Lost to follow-up (5)
CL Item
Investigator discretion  (6)
CL Item
Withdrew consent (7)
Investigator discretion, specification
Item
If you tick "Investigator discretion", please specify
text
C0008961 (UMLS CUI [1,1])
C0022423 (UMLS CUI [1,2])
C2349954 (UMLS CUI [2,1])
C0566251 (UMLS CUI [2,2])
Withdrew consent , specification
Item
If you tick "Withdrew consent ", please specify
text
C1707492 (UMLS CUI [1])
C2349954 (UMLS CUI [2,1])
C0566251 (UMLS CUI [2,2])
Item Group
Investigator Comment Log
C0008961 (UMLS CUI-1)
C0947611 (UMLS CUI-2)
CRF page number
Item
CRF page number if applicable
integer
C1704732 (UMLS CUI [1,1])
C1516308 (UMLS CUI [1,2])
Comment
Item
Comment
text
C0947611 (UMLS CUI [1])
Item Group
Investigator's signature
C2346576 (UMLS CUI-1)
Confirmation complete data in CRF
Item
I confirm that I have reviewed the data in this Case Report Form for this subject. All information entered by myself or my colleagues is, to the best of my knowledge, complete and accurate, as of the date below.
boolean
C0750484 (UMLS CUI [1,1])
C3899518 (UMLS CUI [1,2])
Investigator's signature
Item
Investigator's signature
text
C2346576 (UMLS CUI [1])
Investigator's name (print)
Item
Investigator's name (print)
text
C2826892 (UMLS CUI [1])
Date of signature
Item
Date of signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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