ID

35641

Beschrijving

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

Trefwoorden

Versies (1)
  1. 13-03-19 13-03-19 -
Houder van rechten

GSK group of companies

Geüploaded op

13 maart 2019

DOI

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Licentie

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

Engels

Pharmacogenetics

1 Formulieren  
  1. StudyEvent: ODM
    1. Pharmacogenetics
Administrative data
Beschrijving

Administrative data

Date of Visit
Beschrijving

Visit Date

Datatype

date

Subject Number
Beschrijving

Subject Number

Datatype

integer

Pharmacogenetic (PGx) Research Consent
Beschrijving

Pharmacogenetic (PGx) Research Consent

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

Pharmacogenetic Research Consent

Datatype

boolean

Date and Time of Informed Consent
Beschrijving

Date and Time of Informed Consent

Datatype

datetime

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

blood sample

Datatype

boolean

Record the date sample taken
Beschrijving

Date Sample Taken

Datatype

date

In case of no consent, record the reason
Beschrijving

reason for lack of consent

Datatype

text

If other, please specify
Beschrijving

Specify Other

Datatype

text

PGx-Pharmacogenetic Research Consent Withdrawal
Beschrijving

PGx-Pharmacogenetic Research Consent Withdrawal

Has subject withdrawn consent for PGx-Pharmacogenetic research?
Beschrijving

Has subject withdrawn consent for PGx-Pharmacogenetic research?

Datatype

boolean

Has a request been made for sample destruction?
Beschrijving

Has a request been made for sample destruction?

Datatype

boolean

If Yes, enter the reason
Beschrijving

If Yes, enter the reason

Datatype

text

If Other, specify
Beschrijving

If Other, specify

Datatype

text

Investigator's Signature
Beschrijving

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.
Beschrijving

Investogator's Confirmation

Datatype

date

Investigator's signature
Beschrijving

Investigator's signature

Datatype

text

Investigator's name (Print)
Beschrijving

Investigator's name (Print)

Datatype

text

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Similar models

Pharmacogenetics

1 Formulieren
  1. StudyEvent: ODM
    1. Pharmacogenetics
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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