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Form D

1 Formulär  
  1. StudyEvent: ODM
    1. Form D
Administrative data
Beskrivning

Administrative data

Alias
UMLS CUI-1
C1320722
Subject Number
Beskrivning

Subject Number

Datatyp

text

Alias
UMLS CUI [1]
C2348585
Panel ID
Beskrivning

Panel ID

Datatyp

text

Alias
UMLS CUI [1]
C3846158
GSK Receipt Date
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1]
C0011008
Form D
Beskrivning

Form D

Alias
UMLS CUI-1
C0011065
Certified Cause of Death
Beskrivning

Cause of Death

Datatyp

text

Alias
UMLS CUI [1]
C0007465
Date of Death
Beskrivning

day month year Complete Adverse Event From.

Datatyp

date

Alias
UMLS CUI [1]
C1148348
Was an autopsy done?
Beskrivning

Autopsy

Datatyp

text

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C0884358
If an autopsy was done, please summarize findings (include diagnosis)
Beskrivning

Autopsy findings

Datatyp

text

Alias
UMLS CUI [1,1]
C0004398
UMLS CUI [1,2]
C0243095
UMLS CUI [2,1]
C0004398
UMLS CUI [2,2]
C0011900
Investigator's Signature
Beskrivning

Investigator's Signature

Datatyp

text

Alias
UMLS CUI [1]
C2346576
Date of signature
Beskrivning

day month year

Datatyp

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
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Similar models

Form D

1 Formulär
  1. StudyEvent: ODM
    1. Form D
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Subject Number
Item
Subject Number
text
C2348585 (UMLS CUI [1])
Panel ID
Item
Panel ID
text
C3846158 (UMLS CUI [1])
Date
Item
GSK Receipt Date
date
C0011008 (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])
Item
Was an autopsy done?
text
C0004398 (UMLS CUI [1,1])
C0884358 (UMLS CUI [1,2])
Autopsy
Code List
Was an autopsy done?
CL Item
No (N)
CL Item
Yes (Y)
Autopsy findings
Item
If an autopsy was done, please summarize findings (include diagnosis)
text
C0004398 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
C0004398 (UMLS CUI [2,1])
C0011900 (UMLS CUI [2,2])
Investigator's Signature
Item
Investigator's Signature
text
C2346576 (UMLS CUI [1])
Date of signature
Item
Date of signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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