ID

33708

Beschreibung

Study ID: 107032 Clinical Study ID: GLP107032 Study Title: An open-label study to evaluate the pharmacokinetics of an oral contraceptive containing Norethindrone and Ethinyl Estradiol when co-administered with GSK716155 in healthy adult female subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT01077505 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

Stichworte

Versionen (3)
  1. 12.12.18 12.12.18 -
  2. 20.12.18 20.12.18 -
  3. 20.12.18 20.12.18 -
Rechteinhaber

GSK group of companies

Hochgeladen am

20. Dezember 2018

DOI

Für eine Beantragung loggen Sie sich ein.

Lizenz

Creative Commons BY-NC 3.0
Modell Kommentare :

Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.

Zurück zu Modell Kommentaren
Itemgroup Kommentare für :

Item Kommentare für :

  • Neueste
  • Älteste
  • Beliebt
  • Neueste
    • Neueste
    • Älteste
    • Beliebt

Keine Kommentare

Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.

Pharmacokinetics of an oral contraceptive co-administered with Albiglutide in women - 107032

Englisch

Visit 20: Prior and Concomitant Medications + Gen-consent

1 Formulare  
Administrative data
Beschreibung

Administrative data

Site
Beschreibung

Site

Datentyp

text

Subject
Beschreibung

Subject

Datentyp

text

Visit Name
Beschreibung

Visit Name

Datentyp

text

Status
Beschreibung

Status

Datentyp

text

Doc №
Beschreibung

Doc №

Datentyp

integer

Is Page Blank?
Beschreibung

blank page?

Datentyp

boolean

Prior and Concomitant Medications/Non-Drug Therapies
Beschreibung

Prior and Concomitant Medications/Non-Drug Therapies

Concomitant Medication
Beschreibung

Concomitant Medication

Datentyp

boolean

Non-Drug Therapy
Beschreibung

including procedures and surgeries

Datentyp

boolean

Drug Name
Beschreibung

Trade name preferred

Datentyp

text

Unit Dose
Beschreibung

Unit Dose

Datentyp

text

Unit
Beschreibung

Unit

Datentyp

text

Frequency
Beschreibung

Frequency

Datentyp

text

Route
Beschreibung

Route

Datentyp

text

Indication
Beschreibung

If AE/SAE enter Event Term

Datentyp

text

AE/SAE Event Number
Beschreibung

AE/SAE Event Number

Datentyp

integer

Start date
Beschreibung

Start date

Datentyp

date

Stop date
Beschreibung

Stop date

Datentyp

date

Ongoing?
Beschreibung

Ongoing?

Datentyp

boolean

Taken prior to study?
Beschreibung

Taken prior to study?

Datentyp

boolean

PGx-Pharmacogenetic Research Consent
Beschreibung

PGx-Pharmacogenetic Research Consent

Has the informed consent been obtained for PGx-Pharmacogenetic Research?
Beschreibung

Has the informed consent been obtained for PGx-Pharmacogenetic Research?

Datentyp

boolean

Date informed consent obtained
Beschreibung

Date informed consent obtained

Datentyp

date

If no consent obtained, check the reason
Beschreibung

If no consent obtained, check the reason

Datentyp

text

If other, specify
Beschreibung

If other, specify

Datentyp

text

Blood Sample
Beschreibung

Blood Sample

Has a blood sample been collected for PGx research?
Beschreibung

Has a blood sample been collected for PGx research?

Datentyp

boolean

Record the date sample taken
Beschreibung

Record the date sample taken

Datentyp

date

If no, check the reason
Beschreibung

If no, check the reason

Datentyp

text

If Other, specify
Beschreibung

If Other, specify

Datentyp

text

PGx-Pharmacogenetic Research Consent Withdrawal
Beschreibung

PGx-Pharmacogenetic Research Consent Withdrawal

Has subject withdrawn consent for PGx-Pharmacogenetic research?
Beschreibung

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Datentyp

boolean

Has a request been made for sample destruction?
Beschreibung

Has a request been made for sample destruction?

Datentyp

boolean

If Yes, enter the reason
Beschreibung

If Yes, enter the reason

Datentyp

text

If Other, specify
Beschreibung

If Other, specify

Datentyp

text

Zum Seitenanfang zurückkehren

Ähnliche Modelle

Visit 20: Prior and Concomitant Medications + Gen-consent

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Site
Item
Site
text
Subject
Item
Subject
text
Item
Visit Name
text
Visit Name
Code List
Visit Name
CL Item
Adverse Events (1)
Status
Item
Status
text
Doc №
Item
Doc №
integer
blank page?
Item
Is Page Blank?
boolean
Item Group
Prior and Concomitant Medications/Non-Drug Therapies
Concomitant Medication
Item
Concomitant Medication
boolean
Non-Drug Therapy
Item
Non-Drug Therapy
boolean
Drug Name
Item
Drug Name
text
Unit Dose
Item
Unit Dose
text
Unit
Item
Unit
text
Frequency
Item
Frequency
text
Route
Item
Route
text
Indication
Item
Indication
text
AE/SAE Event Number
Item
AE/SAE Event Number
integer
Start date
Item
Start date
date
Stop date
Item
Stop date
date
Ongoing?
Item
Ongoing?
boolean
Taken prior to study?
Item
Taken prior to study?
boolean
Has the informed consent been obtained for PGx-Pharmacogenetic Research?
Item
Has the informed consent been obtained for PGx-Pharmacogenetic Research?
boolean
Date informed consent obtained
Item
Date informed consent obtained
date
Item
If no consent obtained, check the reason
text
If no consent obtained, check the reason
Code List
If no consent obtained, check the reason
CL Item
Subject declined (1)
CL Item
Subject not asked by investigator (2)
CL Item
Other (3)
If other, specify
Item
If other, specify
text
Item Group
Blood Sample
Has a blood sample been collected for PGx research?
Item
Has a blood sample been collected for PGx research?
boolean
Record the date sample taken
Item
Record the date sample taken
date
Item
If no, check the reason
text
If no, check the reason
Code List
If no, check the reason
CL Item
Subject declined (1)
CL Item
Subject not asked by investigator (2)
CL Item
Other (3)
If Other, specify
Item
If Other, specify
text
Item Group
PGx-Pharmacogenetic Research Consent Withdrawal
Has subject withdrawn consent for PGx-Pharmacogenetic research?
Item
Has subject withdrawn consent for PGx-Pharmacogenetic research?
boolean
Has a request been made for sample destruction?
Item
Has a request been made for sample destruction?
boolean
Item
If Yes, enter the reason
text
If Yes, enter the reason
Code List
If Yes, enter the reason
CL Item
Subject requested (1)
CL Item
Other (2)
If Other, specify
Item
If Other, specify
text
Zum Seitenanfang zurückkehren 

Kontakt

Benutzen Sie dieses Formular für Rückmeldungen, Fragen und Verbesserungsvorschläge.

Mit * gekennzeichnete Felder sind notwendig.

Hilfe

Benötigen Sie Hilfe bei der Suche? Um mehr Details zu erfahren und die Suche effektiver nutzen zu können schauen Sie sich doch das entsprechende Video auf unserer Tutorial Seite an.

Zum Video