Subject Number
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
Subject ID
Item
Subject ID
integer
C2348585 (UMLS CUI [1])
Age at BSL visit for QoL addition (derived)
Item
Age at BSL visit for QoL addition (derived)
integer
C0001779 (UMLS CUI [1])
Container Number
Item
Container Number
integer
C0180098 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Date of Assessment
Item
Date of Assessment
date
C2985720 (UMLS CUI [1])
Item
Status
integer
C0449438 (UMLS CUI [1])
CL Item
Re- dispensed (2)
Weight
Item
Weight
integer
C0043100 (UMLS CUI [1])
Date of First Study Treatment
Item
Date of First Study Treatment
date
C3173309 (UMLS CUI [1])
Item
Please indicate if the first dose was a morning (AM) or evening (PM) dose
integer
C3174092 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Code List
Please indicate if the first dose was a morning (AM) or evening (PM) dose
Date of Last Study Treatment
Item
Date of Last Study Treatment (If date of last study treatment is not certain, enter the last known date of treatment)
date
C1531784 (UMLS CUI [1])
Item
Please indicate if the last dose was a morning (AM) or evening (PM) dose
integer
C0178602 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Code List
Please indicate if the last dose was a morning (AM) or evening (PM) dose
Has the subject missed any study product applications as specified in the protocol?
Item
Between the Date of First Study Treatment and the Date of Last Study Treatment, has the subject missed any study product applications as specified in the protocol?
boolean
C1709043 (UMLS CUI [1])
Date of Missed Treatment
Item
Date of Missed Treatment
date
C1709043 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Check if AM treatment missed
integer
C1709043 (UMLS CUI [1,1])
C4331833 (UMLS CUI [1,2])
Code List
Check if AM treatment missed
CL Item
AM treatment missed (1)
Item
Check if PM treatment missed
integer
C1709043 (UMLS CUI [1,1])
C1509133 (UMLS CUI [1,2])
Code List
Check if PM treatment missed
CL Item
PM treatment missed (1)
Item
If consent to photographs was not given, please check box:
integer
C0021430 (UMLS CUI [1,1])
C0441468 (UMLS CUI [1,2])
Code List
If consent to photographs was not given, please check box:
CL Item
Consent to photographs was not given (1)
Item
Visit
integer
C0545082 (UMLS CUI [1])
CL Item
Day 15 / Early Withdrawal (4)
Date of Photograph
Item
Date of Photograph
date
C0441468 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Or check if Photograph Not Done
integer
C0441468 (UMLS CUI [1,1])
C1272696 (UMLS CUI [1,2])
Code List
Or check if Photograph Not Done
CL Item
Photograph not done (1)