ID

36905

Descrizione

Study ID: 109731 Clinical Study ID: 109731 Study Title: An adaptive PET study in healthy volunteers using 11C GSK931145 to establish the relationship of Glycine Transporter1 occupancy by GSK1018921 to plasma concentrations over time Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00945503 Sponsor: GlaxoSmithKline Phase: Phase 1 Study Recruitment Status: Completed Generic Name: GSK1018921 Study Indication: Schizophrenia

Keywords

  1. 20/06/19 20/06/19 -
Titolare del copyright

GlaxoSmithKline

Caricato su

20 giugno 2019

DOI

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Licenza

Creative Commons BY-NC 3.0

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The relationship of Glycine Transporter1 occupancy by GSK1018921 to plasma concentrations over time NCT00945503

Concomitant Medications; Non-Serious Adverse Events; Serious Adverse Events

Administrative
Descrizione

Administrative

Alias
UMLS CUI-1
C1320722
Subject Identifier
Descrizione

Subject Identifier

Tipo di dati

text

Alias
UMLS CUI [1]
C2348585
Centre Number
Descrizione

Centre Number

Tipo di dati

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Randomisation Number
Descrizione

Randomisation Number

Tipo di dati

integer

Alias
UMLS CUI [1,1]
C0034656
UMLS CUI [1,2]
C0237753
Concomitant Medications
Descrizione

Concomitant Medications

Alias
UMLS CUI-1
C2347852
Were any concomitant medications taken by the subject during the study?
Descrizione

Were any concomitant medications taken by the subject during the study?

Tipo di dati

boolean

Alias
UMLS CUI [1]
C2347852
Concomitant Medications
Descrizione

Concomitant Medications

Alias
UMLS CUI-1
C2347852
Drug Name
Descrizione

Trade Name preferred

Tipo di dati

text

Alias
UMLS CUI [1]
C0013227
Concomitant Medication Unit Dose
Descrizione

Concomitant Medication Unit Dose

Tipo di dati

float

Alias
UMLS CUI [1,1]
C0869039
UMLS CUI [1,2]
C2347852
Concomitant Medication Units
Descrizione

Concomitant Medication Units

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C2347852
Concomitant Medications Frequency
Descrizione

Concomitant Medications Frequency

Tipo di dati

text

Alias
UMLS CUI [1,1]
C3476109
UMLS CUI [1,2]
C2347852
Concomitant Medication Route
Descrizione

Concomitant Medication Route

Tipo di dati

text

Alias
UMLS CUI [1]
C2826730
Reason for Medication
Descrizione

Reason for Medication

Tipo di dati

text

Alias
UMLS CUI [1]
C2826696
Concomitant Medication Start Date
Descrizione

Concomitant Medication Start Date

Tipo di dati

date

Alias
UMLS CUI [1]
C2826734
Concomitant Medication Start Time
Descrizione

Concomitant Medication Start Time

Tipo di dati

time

Alias
UMLS CUI [1,1]
C1301880
UMLS CUI [1,2]
C2347852
Concomitant Medication taken prior to study?
Descrizione

Concomitant Medication taken prior to study?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C2603343
UMLS CUI [1,3]
C1883727
UMLS CUI [1,4]
C0332152
Concomitant Medication Stop Date
Descrizione

Concomitant Medication Stop Date

Tipo di dati

date

Alias
UMLS CUI [1]
C2826744
Concomitant Medication Stop Time
Descrizione

Concomitant Medication Stop Time

Tipo di dati

time

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C1522314
Ongoing Medication?
Descrizione

Ongoing Medication?

Tipo di dati

boolean

Alias
UMLS CUI [1]
C2826666
Non-Serious Adverse Events
Descrizione

Non-Serious Adverse Events

Alias
UMLS CUI-1
C1518404
Did the subject experience any non-serious adverse events during the study?
Descrizione

If Yes, record details below.

Tipo di dati

boolean

Alias
UMLS CUI [1]
C1518404
Non-Serious Adverse Events
Descrizione

Non-Serious Adverse Events

Alias
UMLS CUI-1
C1518404
Event
Descrizione

Diagnosis Only (if known) Otherwise Sign/Symptom

Tipo di dati

text

Alias
UMLS CUI [1]
C1518404
Non-Serious Adverse Event Start Date
Descrizione

Non-Serious Adverse Event Start Date

Tipo di dati

date

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0808070
Non-Serious Adverse Event Start Time
Descrizione

Non-Serious Adverse Event Start Time

Tipo di dati

time

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C1301880
Non-Serious Adverse Event Outcome
Descrizione

Non-Serious Adverse Event Outcome

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C1705586
Non-Serious Adverse Event End Date
Descrizione

Non-Serious Adverse Event End Date

Tipo di dati

date

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0806020
Non-Serious Adverse Event End Time
Descrizione

Non-Serious Adverse Event End Time

Tipo di dati

time

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C1522314
Non-Serious Adverse Event Frequency
Descrizione

Non-Serious Adverse Event Frequency

Tipo di dati

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0439603
Non-Serious Adverse Event Maximum Intensity
Descrizione

Non-Serious Adverse Event Maximum Intensity

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0518690
UMLS CUI [1,3]
C0806909
Action Taken with investigational Product(s) as a Result of the Non-Serious AE
Descrizione

Action Taken with investigational Product(s) as a Result of the Non-Serious AE

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1704758
UMLS CUI [1,2]
C1518404
Did the subject withdraw from study as a result of this AE?
Descrizione

Did the subject withdraw from study as a result of this AE?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C1710677
UMLS CUI [1,2]
C1518404
ls there a reasonable possibility that the AE may have been caused by the investigational product?
Descrizione

ls there a reasonable possibility that the AE may have been caused by the investigational product?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
Serious Adverse Event
Descrizione

Serious Adverse Event

Alias
UMLS CUI-1
C1519255
Did the subject experience a serious adverse event during the study?
Descrizione

If Yes, record details below.

Tipo di dati

boolean

Alias
UMLS CUI [1]
C1519255
Serious Adverse Event - Section 1
Descrizione

Serious Adverse Event - Section 1

Alias
UMLS CUI-1
C1519255
Event
Descrizione

Diagnosis Only (if known) Otherwise Sign/Symptom

Tipo di dati

text

Alias
UMLS CUI [1]
C1519255
Serious Adverse Event Start Date
Descrizione

Serious Adverse Event Start Date

Tipo di dati

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0808070
Serious Adverse Event Start Time
Descrizione

Serious Adverse Event Start Time

Tipo di dati

time

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1301880
Serious Adverse Event Outcome
Descrizione

Serious Adverse Event Outcome

Tipo di dati

integer

Alias
UMLS CUI [1,1]
C1705586
UMLS CUI [1,2]
C1519255
Serious Adverse Event End Date
Descrizione

If fatal, record date of death.

Tipo di dati

date

Alias
UMLS CUI [1]
C1519255
Serious Adverse Event Maximum Intensity
Descrizione

Serious Adverse Event Maximum Intensity

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0518690
UMLS CUI [1,3]
C0806909
Action Taken with lnvestigational Product(s) as a Result of the SAE
Descrizione

Action Taken with lnvestigational Product(s) as a Result of the SAE

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1704758
UMLS CUI [1,2]
C1519255
Did the subject withdraw from study as a result of this SAE?
Descrizione

Did the subject withdraw from study as a result of this SAE?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C2349954
UMLS CUI [1,2]
C1519255
ls there a reasonable possibility the SAE may have been caused by the investigational product?
Descrizione

ls there a reasonable possibility the SAE may have been caused by the investigational product?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
Serious Adverse Event - Section 2 Seriousness
Descrizione

Serious Adverse Event - Section 2 Seriousness

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C1710056
Serious Adverse Event Seriousness
Descrizione

Serious Adverse Event Seriousness

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1710056
UMLS CUI [1,2]
C1519255
If other Sersiousness of SAE, specify.
Descrizione

If other Sersiousness of SAE, specify.

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1710056
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2348235
Serious Adverse Event - Section 3 Demography Data
Descrizione

Serious Adverse Event - Section 3 Demography Data

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C0011298
Date of birth
Descrizione

Date of birth

Tipo di dati

date

Alias
UMLS CUI [1]
C0421451
Sex
Descrizione

Sex

Tipo di dati

text

Alias
UMLS CUI [1]
C0079399
Weight
Descrizione

Weight

Tipo di dati

float

Unità di misura
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Serious Adverse Event - Section 4
Descrizione

Serious Adverse Event - Section 4

Alias
UMLS CUI-1
C1519255
If investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further lnvestigational Product(s) were Administered?
Descrizione

If investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further lnvestigational Product(s) were Administered?

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0034897
Serious Adverse Event - Section 5
Descrizione

Serious Adverse Event - Section 5

Alias
UMLS CUI-1
C1519255
Possible Causes of SAE Other Than investigational Product(s)
Descrizione

Check all that apply:

Tipo di dati

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0085978
UMLS CUI [2,1]
C0304229
UMLS CUI [2,2]
C0205394
Medical conditions(s) specification
Descrizione

Medical conditions(s) specification

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C2348235
Concomitant medication(s) specification
Descrizione

Concomitant medication(s) specification

Tipo di dati

text

Alias
UMLS CUI [1,1]
C2347852
UMLS CUI [1,2]
C2348235
Specification of other reason
Descrizione

Specification of other reason

Tipo di dati

text

Alias
UMLS CUI [1,1]
C3840932
UMLS CUI [1,2]
C2348235
Serious Adverse Event - Section 6 Medical Conditions
Descrizione

Serious Adverse Event - Section 6 Medical Conditions

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C0012634
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
Descrizione

Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C2347946
UMLS CUI [2,1]
C0020517
UMLS CUI [2,2]
C2347946
UMLS CUI [3,1]
C0543467
UMLS CUI [3,2]
C2347946
UMLS CUI [4,1]
C1519255
UMLS CUI [4,2]
C0681841
Medical Condition Date of Onset
Descrizione

Medical Condition Date of Onset

Tipo di dati

date

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C0574845
Condition Present at Time of the SAE?
Descrizione

Condition Present at Time of the SAE?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C0012634
UMLS CUI [1,2]
C1519255
If not present at time of the SAE, Date of Last Occurrence
Descrizione

If not present at time of the SAE, Date of Last Occurrence

Tipo di dati

date

Alias
UMLS CUI [1,1]
C2745955
UMLS CUI [1,2]
C0012634
UMLS CUI [1,3]
C0011008
Serious Adverse Event - Section 7
Descrizione

Serious Adverse Event - Section 7

Alias
UMLS CUI-1
C1519255
Other RELEVANT Risk Factors (provide any family or social history (e.g., smoking, alcohol, diet, drug abuse, occupational hazard) relevant to the SAE
Descrizione

Other RELEVANT Risk Factors

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2347946
UMLS CUI [2,1]
C3714536
UMLS CUI [2,2]
C0241889
UMLS CUI [3]
C0543414
UMLS CUI [4]
C0001948
UMLS CUI [5]
C0012155
UMLS CUI [6]
C0013146
UMLS CUI [7]
C0337074
Serious Adverse Event - Section 8 Relevant Concomitant Medication
Descrizione

Serious Adverse Event - Section 8 Relevant Concomitant Medication

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C2347852
UMLS CUI-3
C2347946
Serious Adverse Event - Concomitant Medication Drug Name
Descrizione

Trade Name preferred

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1519255
UMLS CUI [1,3]
C2347852
Serious Adverse Event - Concomitant Medication Dose
Descrizione

Serious Adverse Event - Concomitant Medication Dose

Tipo di dati

float

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2347852
UMLS CUI [1,3]
C3174092
Serious Adverse Event - Concomitant Medication Unit
Descrizione

Serious Adverse Event - Concomitant Medication Unit

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2347852
UMLS CUI [1,3]
C1519795
Serious Adverse Event - Concomitant Medication Frequency
Descrizione

Serious Adverse Event - Concomitant Medication Frequency

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2347852
UMLS CUI [1,3]
C3476109
Serious Adverse Event - Concomitant Medication Route
Descrizione

Serious Adverse Event - Concomitant Medication Route

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826730
Serious Adverse Event - Concomitant Medication Taken prior to study?
Descrizione

Serious Adverse Event - Concomitant Medication Taken prior to study?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2347852
UMLS CUI [1,3]
C2603343
UMLS CUI [1,4]
C1883727
UMLS CUI [1,5]
C0332152
Serious Adverse Event - Concomitant Medication Start Date
Descrizione

Serious Adverse Event - Concomitant Medication Start Date

Tipo di dati

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826734
Serious Adverse Event - Concomitant Medication Stop Date
Descrizione

Serious Adverse Event - Concomitant Medication Stop Date

Tipo di dati

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826744
Serious Adverse Event - Concomitant Medication Ongoing?
Descrizione

Serious Adverse Event - Concomitant Medication Ongoing?

Tipo di dati

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826666
Serious Adverse Event - Reason for Concomitant Medication
Descrizione

Serious Adverse Event Reason - for Concomitant Medication

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826696
Serious Adverse Event - Section 9
Descrizione

Serious Adverse Event - Section 9

Alias
UMLS CUI-1
C1519255
Details of investigational Product(s)
Descrizione

Details of investigational Product(s)

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C1522508
Was treatment blind broken at investigational site?
Descrizione

Was treatment blind broken at investigational site?

Alias
UMLS CUI-1
C3897431
Was treatment blind broken at investigational site?
Descrizione

Was treatment blind broken at investigational site?

Tipo di dati

integer

Alias
UMLS CUI [1]
C3897431
Serious Adverse Event - Section 10
Descrizione

Serious Adverse Event - Section 10

Alias
UMLS CUI-1
C1519255
Details of RELEVANT Assessments
Descrizione

Provide details of any other tests/procedures which were carried out to diagnose or confirm the SAE e.g., laboratory data with units and normal range

Tipo di dati

text

Alias
UMLS CUI [1,1]
C1261322
UMLS CUI [1,2]
C1522508
UMLS CUI [1,3]
C1519255
Serious Adverse Event - Section 11
Descrizione

Serious Adverse Event - Section 11

Alias
UMLS CUI-1
C1519255
Narrative Remarks
Descrizione

Provide a brief narrative description of the SAE and details of treatment given

Tipo di dati

text

Alias
UMLS CUI [1,1]
C0947611
UMLS CUI [1,2]
C1519255
Serious Adverse Event - lnvestigator's signature
Descrizione

Serious Adverse Event - lnvestigator's signature

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C2346576
lnvestigator's signature
Descrizione

Confirming that the data on the SAE pages are accurate and complete

Tipo di dati

text

Alias
UMLS CUI [1]
C2346576
lnvestigator's name (print)
Descrizione

lnvestigator's name (print)

Tipo di dati

text

Alias
UMLS CUI [1]
C2826892
Signature Date
Descrizione

Signature Date

Tipo di dati

date

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

Similar models

Concomitant Medications; Non-Serious Adverse Events; Serious Adverse Events

Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Centre Number
Item
Centre Number
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Randomisation Number
Item
Randomisation Number
integer
C0034656 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Item Group
Concomitant Medications
C2347852 (UMLS CUI-1)
Were any concomitant medications taken by the subject during the study?
Item
Were any concomitant medications taken by the subject during the study?
boolean
C2347852 (UMLS CUI [1])
Item Group
Concomitant Medications
C2347852 (UMLS CUI-1)
Drug Name
Item
Drug Name
text
C0013227 (UMLS CUI [1])
Concomitant Medication Unit Dose
Item
Concomitant Medication Unit Dose
float
C0869039 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Item
Concomitant Medication Units
text
C1519795 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Code List
Concomitant Medication Units
CL Item
Tablet (TAB)
CL Item
Microlitre (MCL)
CL Item
Millilitre (ML)
CL Item
Litre (L)
CL Item
Microgram (MCG)
CL Item
Milligram (MG)
CL Item
Gram (G)
Item
Concomitant Medications Frequency
text
C3476109 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Code List
Concomitant Medications Frequency
CL Item
1 x Daily (OD/QD)
CL Item
2 x Daily (BID)
CL Item
3 x Daily (TID)
CL Item
4 x Daily (QID)
CL Item
As required (PRN)
Item
Concomitant Medication Route
text
C2826730 (UMLS CUI [1])
Code List
Concomitant Medication Route
CL Item
Intramuscular (IM)
CL Item
Inhalation (IH)
CL Item
Intravenous (IV)
CL Item
Nasal (NS)
CL Item
Topical (TP)
CL Item
Oral (PO)
CL Item
Vaginal (VG)
Reason for Medication
Item
Reason for Medication
text
C2826696 (UMLS CUI [1])
Concomitant Medication Start Date
Item
Concomitant Medication Start Date
date
C2826734 (UMLS CUI [1])
Concomitant Medication Start Time
Item
Concomitant Medication Start Time
time
C1301880 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Concomitant Medication taken prior to study?
Item
Concomitant Medication taken prior to study?
boolean
C2347852 (UMLS CUI [1,1])
C2603343 (UMLS CUI [1,2])
C1883727 (UMLS CUI [1,3])
C0332152 (UMLS CUI [1,4])
Concomitant Medication Stop Date
Item
Concomitant Medication Stop Date
date
C2826744 (UMLS CUI [1])
Concomitant Medication Stop Time
Item
Concomitant Medication Stop Time
time
C2347852 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])
Ongoing Medication?
Item
Ongoing Medication?
boolean
C2826666 (UMLS CUI [1])
Item Group
Non-Serious Adverse Events
C1518404 (UMLS CUI-1)
Did the subject experience any non-serious adverse events during the study?
Item
Did the subject experience any non-serious adverse events during the study?
boolean
C1518404 (UMLS CUI [1])
Item Group
Non-Serious Adverse Events
C1518404 (UMLS CUI-1)
Event
Item
Event
text
C1518404 (UMLS CUI [1])
Non-Serious Adverse Event Start Date
Item
Non-Serious Adverse Event Start Date
date
C1518404 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Non-Serious Adverse Event Start Time
Item
Non-Serious Adverse Event Start Time
time
C1518404 (UMLS CUI [1,1])
C1301880 (UMLS CUI [1,2])
Item
Non-Serious Adverse Event Outcome
text
C1518404 (UMLS CUI [1,1])
C1705586 (UMLS CUI [1,2])
Code List
Non-Serious Adverse Event Outcome
CL Item
Recovered/Resolved (1)
CL Item
Recovering/Resolving (2)
CL Item
Not recovered/Not resolved (3)
CL Item
Recovered/Resolved with sequelae (4)
Non-Serious Adverse Event End Date
Item
Non-Serious Adverse Event End Date
date
C1518404 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Non-Serious Adverse Event End Time
Item
Non-Serious Adverse Event End Time
time
C1518404 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])
Item
Non-Serious Adverse Event Frequency
integer
C1518404 (UMLS CUI [1,1])
C0439603 (UMLS CUI [1,2])
Code List
Non-Serious Adverse Event Frequency
CL Item
Single episode (1)
CL Item
lntermittent (2)
Item
Non-Serious Adverse Event Maximum Intensity
text
C1519255 (UMLS CUI [1,1])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
Code List
Non-Serious Adverse Event Maximum Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
CL Item
Not applicable (X)
Item
Action Taken with investigational Product(s) as a Result of the Non-Serious AE
text
C1704758 (UMLS CUI [1,1])
C1518404 (UMLS CUI [1,2])
Code List
Action Taken with investigational Product(s) as a Result of the Non-Serious AE
CL Item
Investigational product(s) withdrawn (1)
CL Item
Dose reduced (2)
CL Item
Dose increased (3)
CL Item
Dose not changed (4)
CL Item
Dose interrupted (5)
CL Item
Not applicable (X)
Did the subject withdraw from study as a result of this AE?
Item
Did the subject withdraw from study as a result of this AE?
boolean
C1710677 (UMLS CUI [1,1])
C1518404 (UMLS CUI [1,2])
ls there a reasonable possibility that the AE may have been caused by the investigational product?
Item
ls there a reasonable possibility that the AE may have been caused by the investigational product?
boolean
C1518404 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Item Group
Serious Adverse Event
C1519255 (UMLS CUI-1)
Did the subject experience a serious adverse event during the study?
Item
Did the subject experience a serious adverse event during the study?
boolean
C1519255 (UMLS CUI [1])
Item Group
Serious Adverse Event - Section 1
C1519255 (UMLS CUI-1)
Event
Item
Event
text
C1519255 (UMLS CUI [1])
Serious Adverse Event Start Date
Item
Serious Adverse Event Start Date
date
C1519255 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Serious Adverse Event Start Time
Item
Serious Adverse Event Start Time
time
C1519255 (UMLS CUI [1,1])
C1301880 (UMLS CUI [1,2])
Item
Serious Adverse Event Outcome
integer
C1705586 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Code List
Serious Adverse Event Outcome
CL Item
Recovered/Resolved (1)
CL Item
Recovering/Resolving (2)
CL Item
Not recovered/Not resolved (3)
CL Item
Recovered/Resolved with sequelae (4)
CL Item
Fatal (5)
Serious Adverse Event End Date
Item
Serious Adverse Event End Date
date
C1519255 (UMLS CUI [1])
Item
Serious Adverse Event Maximum Intensity
text
C1519255 (UMLS CUI [1,1])
C0518690 (UMLS CUI [1,2])
C0806909 (UMLS CUI [1,3])
Code List
Serious Adverse Event Maximum Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
CL Item
Not applicable (X)
Item
Action Taken with lnvestigational Product(s) as a Result of the SAE
text
C1704758 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Code List
Action Taken with lnvestigational Product(s) as a Result of the SAE
CL Item
lnvestigational product(s) withdrawn (1)
CL Item
Dose reduced (2)
CL Item
Dose increased (3)
CL Item
Dose not changed (4)
CL Item
Dose interrupted (5)
CL Item
Not applicable (X)
Did the subject withdraw from study as a result of this SAE?
Item
Did the subject withdraw from study as a result of this SAE?
boolean
C2349954 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
ls there a reasonable possibility the SAE may have been caused by the investigational product?
Item
ls there a reasonable possibility the SAE may have been caused by the investigational product?
boolean
C1519255 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Item Group
Serious Adverse Event - Section 2 Seriousness
C1519255 (UMLS CUI-1)
C1710056 (UMLS CUI-2)
Item
Serious Adverse Event Seriousness
text
C1710056 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Code List
Serious Adverse Event Seriousness
CL Item
Results in death (A)
CL Item
ls life-threatening (B)
CL Item
Requires hospitalisation or prolongation of existing hospitalisation (C)
CL Item
Results in disability/incapacity (D)
CL Item
Congenital anomaly/birth defect (E)
CL Item
Other, specify (see definition of SAE) (F)
If other Sersiousness of SAE, specify.
Item
If other Sersiousness of SAE, specify.
text
C1710056 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Serious Adverse Event - Section 3 Demography Data
C1519255 (UMLS CUI-1)
C0011298 (UMLS CUI-2)
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Item
Sex
text
C0079399 (UMLS CUI [1])
Code List
Sex
CL Item
Male (M)
CL Item
Female (F)
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Item Group
Serious Adverse Event - Section 4
C1519255 (UMLS CUI-1)
Item
If investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further lnvestigational Product(s) were Administered?
text
C1519255 (UMLS CUI [1,1])
C0034897 (UMLS CUI [1,2])
Code List
If investigational Product(s) was Stopped, Did the Reported Event(s) Recur After Further lnvestigational Product(s) were Administered?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown at this time (3)
CL Item
Not applicable (4)
Item Group
Serious Adverse Event - Section 5
C1519255 (UMLS CUI-1)
Item
Possible Causes of SAE Other Than investigational Product(s)
integer
C1519255 (UMLS CUI [1,1])
C0085978 (UMLS CUI [1,2])
C0304229 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Code List
Possible Causes of SAE Other Than investigational Product(s)
CL Item
Disease under study (1)
CL Item
Medical condition(s) specify (2)
CL Item
Lack of efficacy (3)
CL Item
Withdrawal of investigational product(s) (4)
CL Item
Concomitant medication(s) specify (5)
CL Item
Activity related to study participation (e.g., procedures) (6)
CL Item
Other, specify (7)
Medical conditions(s) specification
Item
Medical conditions(s) specification
text
C0012634 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Concomitant medication(s) specification
Item
Concomitant medication(s) specification
text
C2347852 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Specification of other reason
Item
Specification of other reason
text
C3840932 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item Group
Serious Adverse Event - Section 6 Medical Conditions
C1519255 (UMLS CUI-1)
C0012634 (UMLS CUI-2)
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
Item
Specify any RELEVANT past or current medical disorders, allergies, surgeries, etc. that can help explain the SAE
text
C0012634 (UMLS CUI [1,1])
C2347946 (UMLS CUI [1,2])
C0020517 (UMLS CUI [2,1])
C2347946 (UMLS CUI [2,2])
C0543467 (UMLS CUI [3,1])
C2347946 (UMLS CUI [3,2])
C1519255 (UMLS CUI [4,1])
C0681841 (UMLS CUI [4,2])
Medical Condition Date of Onset
Item
Medical Condition Date of Onset
date
C0012634 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Condition Present at Time of the SAE?
Item
Condition Present at Time of the SAE?
boolean
C0012634 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
If not present at time of the SAE, Date of Last Occurrence
Item
If not present at time of the SAE, Date of Last Occurrence
date
C2745955 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Serious Adverse Event - Section 7
C1519255 (UMLS CUI-1)
Other RELEVANT Risk Factors
Item
Other RELEVANT Risk Factors (provide any family or social history (e.g., smoking, alcohol, diet, drug abuse, occupational hazard) relevant to the SAE
text
C0035648 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2347946 (UMLS CUI [1,4])
C3714536 (UMLS CUI [2,1])
C0241889 (UMLS CUI [2,2])
C0543414 (UMLS CUI [3])
C0001948 (UMLS CUI [4])
C0012155 (UMLS CUI [5])
C0013146 (UMLS CUI [6])
C0337074 (UMLS CUI [7])
Item Group
Serious Adverse Event - Section 8 Relevant Concomitant Medication
C1519255 (UMLS CUI-1)
C2347852 (UMLS CUI-2)
C2347946 (UMLS CUI-3)
Serious Adverse Event - Concomitant Medication Drug Name
Item
Serious Adverse Event - Concomitant Medication Drug Name
text
C0013227 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
C2347852 (UMLS CUI [1,3])
Serious Adverse Event - Concomitant Medication Dose
Item
Serious Adverse Event - Concomitant Medication Dose
float
C1519255 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
C3174092 (UMLS CUI [1,3])
Serious Adverse Event - Concomitant Medication Unit
Item
Serious Adverse Event - Concomitant Medication Unit
text
C1519255 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
C1519795 (UMLS CUI [1,3])
Serious Adverse Event - Concomitant Medication Frequency
Item
Serious Adverse Event - Concomitant Medication Frequency
text
C1519255 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
C3476109 (UMLS CUI [1,3])
Serious Adverse Event - Concomitant Medication Route
Item
Serious Adverse Event - Concomitant Medication Route
text
C1519255 (UMLS CUI [1,1])
C2826730 (UMLS CUI [1,2])
Serious Adverse Event - Concomitant Medication Taken prior to study?
Item
Serious Adverse Event - Concomitant Medication Taken prior to study?
boolean
C1519255 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
C2603343 (UMLS CUI [1,3])
C1883727 (UMLS CUI [1,4])
C0332152 (UMLS CUI [1,5])
Serious Adverse Event - Concomitant Medication Start Date
Item
Serious Adverse Event - Concomitant Medication Start Date
date
C1519255 (UMLS CUI [1,1])
C2826734 (UMLS CUI [1,2])
Serious Adverse Event - Concomitant Medication Stop Date
Item
Serious Adverse Event - Concomitant Medication Stop Date
date
C1519255 (UMLS CUI [1,1])
C2826744 (UMLS CUI [1,2])
Serious Adverse Event - Concomitant Medication Ongoing?
Item
Serious Adverse Event - Concomitant Medication Ongoing?
boolean
C1519255 (UMLS CUI [1,1])
C2826666 (UMLS CUI [1,2])
Serious Adverse Event Reason - for Concomitant Medication
Item
Serious Adverse Event - Reason for Concomitant Medication
text
C1519255 (UMLS CUI [1,1])
C2826696 (UMLS CUI [1,2])
Item Group
Serious Adverse Event - Section 9
C1519255 (UMLS CUI-1)
Details of investigational Product(s)
Item
Details of investigational Product(s)
text
C0304229 (UMLS CUI [1,1])
C1522508 (UMLS CUI [1,2])
Item Group
Was treatment blind broken at investigational site?
C3897431 (UMLS CUI-1)
Item
Was treatment blind broken at investigational site?
integer
C3897431 (UMLS CUI [1])
Code List
Was treatment blind broken at investigational site?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not applicable (3)
Item Group
Serious Adverse Event - Section 10
C1519255 (UMLS CUI-1)
Details of RELEVANT Assessments
Item
Details of RELEVANT Assessments
text
C1261322 (UMLS CUI [1,1])
C1522508 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
Item Group
Serious Adverse Event - Section 11
C1519255 (UMLS CUI-1)
Narrative Remarks
Item
Narrative Remarks
text
C0947611 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Item Group
Serious Adverse Event - lnvestigator's signature
C1519255 (UMLS CUI-1)
C2346576 (UMLS CUI-2)
lnvestigator's signature
Item
lnvestigator's signature
text
C2346576 (UMLS CUI [1])
lnvestigator's name (print)
Item
lnvestigator's name (print)
text
C2826892 (UMLS CUI [1])
Signature Date
Item
Signature Date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])

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