Study conclusion
day month year Refer to protocol section(s) to evaluate subject completion or withdrawal from the study. If subject completed the study 'Date of subject completion (or withdrawal)' must match the last scheduled study visit date. If the subject withdrew from the study 'Date of subject completion or withdrawal' is the date at which the investigator agreed, or determined, that the subject's participation in the study was over. Typically, this will be the date of the subject's last visit to the investigator but an alternative date of withdrawal may be used in the circumstances described below. In the event that the contact between subject and investigator is conducted remotely during the planned study period (as defined in the protocol, i.e., by phone, by mail or electronic e-mail) and the subject is deemed to have withdrawn or been withdrawn, the date of withdrawal is considered to be the date on which the investigatoris made aware of the withdrawal or makes the decision to withdraw the subject. In the event that the subject is lost to follow-up, the date of withdrawal is considered to be the last point at which the investigator had contact with the subject during the study period (as defined in the protocol). Note: An 'actual contact' is defined as an interaction between the subject and the investigator or investigator's designee, where the investigatorldesignee has the opportunity to query the subject about the subject's status. This would include clinic visits, telephone contacts or electronic e-mail.
date
Subject's withdraw
text
You must only tick ONE Primary reason for withdrawal If the subject is withdrawn from the study, only tick 'Investigator discretion' or 'Withdrew consent' if the reason for withdrawaldoes not fit into any of the other primary reason categories. Adverse event: Use this primary reason only if the subject discontinues medication and is withdrawn from the study due to an adverse event. If the subject was withdrawn due to an adverse event, confirm that details recorded correspond with details on the appropriate (Non-)Serious Adverse Event page. Protocol deviation Study closed/terminated: Use this primary reason only if the site is closed or the study is terminated by the sponsor. Lost to follow-up: In the event that the subject is lost to follow-up, the date of withdrawal is considered to be the last point at which the investigator had contact with the subject. Investigator discretion: Use this primary reason only if the subject discontinues from tile study at the investigator's discretion and none of the other reasons apply. Withdrew consent: Use this primary reason only if the subject discontinues from the study because consent has been withdrawn and none of the other reasons apply (e.g., subject found the travel time to the clinic too long and does not want to continue in the study). Only use 'specify' to provide detailed information which is not covered by predefined sub-reasons provided. Note: An 'actual contact' is defined as an interaction between the subject and the investigator or investigator's designee, where the investigatorldesignee has the opportunity to query the subject about the subject's status. This would include clinic visits, telephone contacts or electronic e-mail.
integer
Investigator discretion, specification
text
Pregnancy Information
Investigator Comment Log
Investigator's signature
Confirmation complete data in CRF
boolean
Investigator's signature
text
Investigator's name (print)
text
day month year
date