ID

35641

Beschreibung

Study ID: 111611 Clinical Study ID: 111611 Study Title: A randomised, double-blind, placebo-controlled study to assess the effect of oral, single dose SB-705498 in a validated intranasal capsaicin challenge model in healthy volunteers. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00731250 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: SB-705498, Placebo, Caspaicin Trade Name: N/A Study Indication: Rhinitis

Stichworte

Versionen (1)
  1. 13.03.19 13.03.19 -
Rechteinhaber

GSK group of companies

Hochgeladen am

13. März 2019

DOI

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The effect of intranasal capsaicin challenge model in healthy volunteers - 111611

Englisch

Pharmacogenetics

1 Formulare  
  1. StudyEvent: ODM
    1. Pharmacogenetics
Administrative data
Beschreibung

Administrative data

Date of Visit
Beschreibung

Visit Date

Datentyp

date

Subject Number
Beschreibung

Subject Number

Datentyp

integer

Pharmacogenetic (PGx) Research Consent
Beschreibung

Pharmacogenetic (PGx) Research Consent

Has informed consent been obtained for PGx-Pharmacogenetic research?
Beschreibung

Pharmacogenetic Research Consent

Datentyp

boolean

Date and Time of Informed Consent
Beschreibung

Date and Time of Informed Consent

Datentyp

datetime

Has a blood sample been collected for PGx-pharmacogenetic (DNA) research?
Beschreibung

blood sample

Datentyp

boolean

Record the date sample taken
Beschreibung

Date Sample Taken

Datentyp

date

In case of no consent, record the reason
Beschreibung

reason for lack of consent

Datentyp

text

If other, please specify
Beschreibung

Specify Other

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Has subject withdrawn consent for PGx-Pharmacogenetic research?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Has subject withdrawn consent for PGx-Pharmacogenetic research?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

Investigator's Signature
Beschreibung

Investigator's Signature

By my dated signature below I verify that this case report form accurately displays the results of the examinations, tests, evaluations and treatment noted within.
Beschreibung

Investogator's Confirmation

Datentyp

date

Investigator's signature
Beschreibung

Investigator's signature

Datentyp

text

Investigator's name (Print)
Beschreibung

Investigator's name (Print)

Datentyp

text

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Ähnliche Modelle

Pharmacogenetics

1 Formulare
  1. StudyEvent: ODM
    1. Pharmacogenetics
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Administrative data
Visit Date
Item
Date of Visit
date
Subject Number
Item
Subject Number
integer
Item Group
Pharmacogenetic (PGx) Research Consent
Pharmacogenetic Research Consent
Item
Has informed consent been obtained for PGx-Pharmacogenetic research?
boolean
Date and Time of Informed Consent
Item
Date and Time of Informed Consent
datetime
blood sample
Item
Has a blood sample been collected for PGx-pharmacogenetic (DNA) research?
boolean
Date Sample Taken
Item
Record the date sample taken
date
Item
In case of no consent, record the reason
text
reason for lack of consent
Code List
In case of no consent, record the reason
CL Item
Subject declined (1)
CL Item
Subject not asked by Investigator (2)
CL Item
Other (3)
Specify Other
Item
If other, please 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
Item Group
Investigator's Signature
Investogator's Confirmation
Item
By my dated signature below I verify that this case report form accurately displays the results of the examinations, tests, evaluations and treatment noted within.
date
Investigator's signature
Item
Investigator's signature
text
Investigator's name (Print)
Item
Investigator's name (Print)
text
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