ID

35641

Descripción

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

Palabras clave

Versiones (1)
  1. 13/3/19 13/3/19 -
Titular de derechos de autor

GSK group of companies

Subido en

13 de marzo de 2019

DOI

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Licencia

Creative Commons BY-NC 3.0
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The effect of intranasal capsaicin challenge model in healthy volunteers - 111611

Inglés

Pharmacogenetics

1 formularios  
  1. StudyEvent: ODM
    1. Pharmacogenetics
Administrative data
Descripción

Administrative data

Date of Visit
Descripción

Visit Date

Tipo de datos

date

Subject Number
Descripción

Subject Number

Tipo de datos

integer

Pharmacogenetic (PGx) Research Consent
Descripción

Pharmacogenetic (PGx) Research Consent

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

Pharmacogenetic Research Consent

Tipo de datos

boolean

Date and Time of Informed Consent
Descripción

Date and Time of Informed Consent

Tipo de datos

datetime

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

blood sample

Tipo de datos

boolean

Record the date sample taken
Descripción

Date Sample Taken

Tipo de datos

date

In case of no consent, record the reason
Descripción

reason for lack of consent

Tipo de datos

text

If other, please specify
Descripción

Specify Other

Tipo de datos

text

PGx-Pharmacogenetic Research Consent Withdrawal
Descripción

PGx-Pharmacogenetic Research Consent Withdrawal

Has subject withdrawn consent for PGx-Pharmacogenetic research?
Descripción

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Tipo de datos

boolean

Has a request been made for sample destruction?
Descripción

Has a request been made for sample destruction?

Tipo de datos

boolean

If Yes, enter the reason
Descripción

If Yes, enter the reason

Tipo de datos

text

If Other, specify
Descripción

If Other, specify

Tipo de datos

text

Investigator's Signature
Descripción

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.
Descripción

Investogator's Confirmation

Tipo de datos

date

Investigator's signature
Descripción

Investigator's signature

Tipo de datos

text

Investigator's name (Print)
Descripción

Investigator's name (Print)

Tipo de datos

text

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Similar models

Pharmacogenetics

1 formularios
  1. StudyEvent: ODM
    1. Pharmacogenetics
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
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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