ID

36004

Description

Study ID: 101468/198 Clinical Study ID: 101468/198 Study Title:An open, randomised, crossover, healthy volunteer study to compare the PK and tolerability of ropinirole as 3 different new formulations with the standard marketed formulation and to study the effects of a high fat meal on a new formulation Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 1 Study Recruitment Status: Completed Generic Name: ropinirole Trade Name: Modutab,ZIPEREVE,ZEPREVE,REPREVE,ADARTREL,REQUIP,Zygara; Zygara,ZIPEREVE,ZEPREVE,Requip Depot,REQUIP,REPREVE,Modutab,ADARTREL Study Indication : Restless Legs Syndrome The Study consists of a Screening, 5 Sessions each with 2 days and a Follow-up. This document contains the Demographic Details and demography for females form. It has to be filled in for screening.

Mots-clés

Versions (1)
  1. 09/04/2019 09/04/2019 -
Détendeur de droits

GlaxoSmithKline

Téléchargé le

9 avril 2019

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0
Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Retour au modèle Commentaires
Groupe Item commentaires pour :

Item commentaires pour :

  • Plus récent
  • Plus ancien
  • Favori
  • Plus récent
    • Plus récent
    • Plus ancien
    • Favori

Aucun commentaire

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

Comparison of pharmacokinetic and tolerability of ropinirole in healthy adults, 101468/198

Anglais

Demographic Details, demography for females

1 Formulaires  
Administrative data
Description

Administrative data

Alias
UMLS CUI-1
C1320722
Subject No.
Description

Subject No.

Type de données

text

Alias
UMLS CUI [1]
C2348585
Panel ID
Description

Panel ID

Type de données

text

Alias
UMLS CUI [1]
C3846158
Visit Date
Description

day month year

Type de données

date

Alias
UMLS CUI [1]
C1320303
Demographic Details
Description

Demographic Details

Alias
UMLS CUI-1
C0011298
Date of birth
Description

Date of birth

Type de données

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

Sex

Type de données

text

Alias
UMLS CUI [1]
C0079399
Height
Description

Body Height

Type de données

integer

Unités de mesure
  • cm
Alias
UMLS CUI [1]
C0005890
cm
Weight
Description

Body Weight

Type de données

float

Unités de mesure
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Body mass index
Description

Body mass index

Type de données

float

Unités de mesure
  • kg/m^2
Alias
UMLS CUI [1]
C1305855
kg/m^2
Clinical Staff Signature
Description

Clinical Staff Signature

Type de données

text

Alias
UMLS CUI [1,1]
C0025106
UMLS CUI [1,2]
C1519316
Date of signature
Description

day month year

Type de données

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Racial group
Description

Racial group

Alias
UMLS CUI-1
C0034510
American Hispanic
Description

American Hispanic race

Type de données

boolean

Alias
UMLS CUI [1]
C0019576
Arabic/North African
Description

Arabic/North African race

Type de données

boolean

Alias
UMLS CUI [1]
C0238604
Black race
Description

Black race

Type de données

boolean

Alias
UMLS CUI [1]
C0005680
East and South East Asia
Description

East and South East Asian race

Type de données

boolean

Alias
UMLS CUI [1]
C0003983
Japanese
Description

Japanese race

Type de données

boolean

Alias
UMLS CUI [1]
C1556094
South Asia
Description

South Asian race

Type de données

boolean

Alias
UMLS CUI [1]
C1519427
White/Caucasian
Description

White/Caucasian race

Type de données

boolean

Alias
UMLS CUI [1]
C0043157
Other
Description

Other race

Type de données

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0034510
If other race, please specify
Description

Other race, specification

Type de données

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0034510
UMLS CUI [1,3]
C2348235
Childbearing potential
Description

Childbearing potential

Alias
UMLS CUI-1
C3831118
Childbearing potential
Description

Tick one. If you tick Potentially able to conceive children: is she practising a clinically accepted method of contraception such as surgical sterilisation, LU .D., diaphragm in conjunction with spermicidal foam and condom on the male partner, or systemic

Type de données

integer

Alias
UMLS CUI [1]
C3831118
Pregnancy Test
Description

Pregnancy Test

Alias
UMLS CUI-1
C0032976
Was a pregnancy test carried out?
Description

Pregnancy test

Type de données

text

Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C1272682
If no pregnancy test, please specify reason
Description

No pregnancy test, reason

Type de données

text

Alias
UMLS CUI [1,1]
C0566251
UMLS CUI [1,2]
C3841220
UMLS CUI [1,3]
C0032976
If pregnancy test was performed, please note date of test
Description

day month year

Type de données

date

Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0011008
If pregnancy test was performed, please note time of test
Description

00:00-23:59

Type de données

time

Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0040223
Pregnancy Test result
Description

If 'Positive', DO NOT include the subject in the study.

Type de données

text

Alias
UMLS CUI [1]
C0427777
Pregnancy test type
Description

Please tick box for test type

Type de données

integer

Alias
UMLS CUI [1,1]
C0032976
UMLS CUI [1,2]
C0332307
If other pregnancy test type, please specify
Description

Other pregnancy test type

Type de données

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0032976
UMLS CUI [1,3]
C0332307
Retour au début de la page

Similar models

Demographic Details, demography for females

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject No.
Item
Subject No.
text
C2348585 (UMLS CUI [1])
Panel ID
Item
Panel ID
text
C3846158 (UMLS CUI [1])
Visit Date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Item Group
Demographic Details
C0011298 (UMLS CUI-1)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Sex
text
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (M)
CL Item
Female (F)
Body Height
Item
Height
integer
C0005890 (UMLS CUI [1])
Body Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Body mass index
Item
Body mass index
float
C1305855 (UMLS CUI [1])
Clinical Staff Signature
Item
Clinical Staff Signature
text
C0025106 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
Date of signature
Item
Date of signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Racial group
C0034510 (UMLS CUI-1)
American Hispanic race
Item
American Hispanic
boolean
C0019576 (UMLS CUI [1])
Arabic/North African race
Item
Arabic/North African
boolean
C0238604 (UMLS CUI [1])
Black race
Item
Black race
boolean
C0005680 (UMLS CUI [1])
East and South East Asian race
Item
East and South East Asia
boolean
C0003983 (UMLS CUI [1])
Japanese race
Item
Japanese
boolean
C1556094 (UMLS CUI [1])
South Asian race
Item
South Asia
boolean
C1519427 (UMLS CUI [1])
White/Caucasian race
Item
White/Caucasian
boolean
C0043157 (UMLS CUI [1])
Other race
Item
Other
text
C0205394 (UMLS CUI [1,1])
C0034510 (UMLS CUI [1,2])
Other race, specification
Item
If other race, please specify
text
C0205394 (UMLS CUI [1,1])
C0034510 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item Group
Childbearing potential
C3831118 (UMLS CUI-1)
Item
Childbearing potential
integer
C3831118 (UMLS CUI [1])
Childbearing potential
Code List
Childbearing potential
CL Item
Premenarcheal (1)
CL Item
Sterile ( of childbearing age) (2)
CL Item
Postmenopausal (3)
CL Item
Potentially able to conceive children (4)
CL Item
contraception (i.e., Norplant) (5)
Item Group
Pregnancy Test
C0032976 (UMLS CUI-1)
Item
Was a pregnancy test carried out?
text
C0032976 (UMLS CUI [1,1])
C1272682 (UMLS CUI [1,2])
Pregnancy test
Code List
Was a pregnancy test carried out?
CL Item
Yes (Y)
CL Item
No (N)
No pregnancy test, reason
Item
If no pregnancy test, please specify reason
text
C0566251 (UMLS CUI [1,1])
C3841220 (UMLS CUI [1,2])
C0032976 (UMLS CUI [1,3])
Date of pregnancy test
Item
If pregnancy test was performed, please note date of test
date
C0032976 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time of pregnancy test
Item
If pregnancy test was performed, please note time of test
time
C0032976 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item
Pregnancy Test result
text
C0427777 (UMLS CUI [1])
Pregnancy Test result
Code List
Pregnancy Test result
CL Item
Positive (P)
CL Item
Negative (N)
Item
Pregnancy test type
integer
C0032976 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
Pregnancy test, test type
Code List
Pregnancy test type
CL Item
Dipstick urine HCG (1)
CL Item
SerurnHCG (2)
CL Item
Other (3)
Other pregnancy test type
Item
If other pregnancy test type, please specify
text
C0205394 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
C0332307 (UMLS CUI [1,3])
Retour au début de la page 

Contact

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Aide

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial