ID

35513

Description

Study ID: 101468/194 Clinical Study ID: 101468/194 Study Title: A 12 Week, Double-Blind, Placebo-Controlled, Parallel Group Study to Assess the Efficacy and Safety of Ropinirole in Patients Suffering from Restless Legs Syndrome (RLS). Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 3 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: requip Study Indication: Restless Legs Syndrome

Keywords

Versions (1)
  1. 3/6/19 3/6/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

March 6, 2019

DOI

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License

Creative Commons BY-NC 3.0
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Ropinirole in Patients with Restless Legs Syndrome (Study ID: 101468/194)

English

Form D

1 forms  
  1. StudyEvent: ODM
    1. Form D
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Centre Number
Description

Study Coordinating Center, Identification number

Data type

integer

Alias
UMLS CUI [1,1]
C2825181
UMLS CUI [1,2]
C1300638
Patient Number
Description

Clinical Trial Subject Unique Identifier

Data type

integer

Alias
UMLS CUI [1]
C2348585
Patient Initials
Description

Person Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Form D
Description

Form D

Alias
UMLS CUI-1
C0011065
Certified Cause of Death
Description

Cause of Death

Data type

text

Alias
UMLS CUI [1]
C0007465
Date of Death
Description

Date of Death

Data type

date

Alias
UMLS CUI [1]
C1148348
Was a post-mortem carried out?
Description

Autopsy

Data type

boolean

Alias
UMLS CUI [1]
C0004398
If ‘Yes’ please summarise findings (include diagnosis)
Description

Autopsy, Findings, Diagnosis

Data type

text

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C0243095
UMLS CUI [1,3]
C0011900
Reporting Physician’s Signature
Description

Signature of responsible attending physician on file

Data type

text

Alias
UMLS CUI [1]
C0807938
Date
Description

Signature of responsible attending physician on file, Date in time

Data type

date

Alias
UMLS CUI [1,1]
C0807938
UMLS CUI [1,2]
C0011008
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Similar models

Form D

1 forms
  1. StudyEvent: ODM
    1. Form D
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Study Coordinating Center, Identification number
Item
Centre Number
integer
C2825181 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
Clinical Trial Subject Unique Identifier
Item
Patient Number
integer
C2348585 (UMLS CUI [1])
Person Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Item Group
Form D
C0011065 (UMLS CUI-1)
Cause of Death
Item
Certified Cause of Death
text
C0007465 (UMLS CUI [1])
Date of Death
Item
Date of Death
date
C1148348 (UMLS CUI [1])
Autopsy
Item
Was a post-mortem carried out?
boolean
C0004398 (UMLS CUI [1])
Autopsy, Findings, Diagnosis
Item
If ‘Yes’ please summarise findings (include diagnosis)
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
C0011900 (UMLS CUI [1,3])
Signature of responsible attending physician on file
Item
Reporting Physician’s Signature
text
C0807938 (UMLS CUI [1])
Signature of responsible attending physician on file, Date in time
Item
Date
date
C0807938 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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