ID

37756

Description

Study ID: 104864/517 Clinical Study ID: 104864/517 Study Title: A Phase I Study of Oral Topotecan as a Radiosensitizing Agent in Patients With Rectal Cancer Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00158886 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: Topotecan + Radiation therapy Trade Name: N/A Study Indication: Rectal Cancer, Carcinoma, Renal Cell

Keywords

Versions (1)
  1. 8/22/19 8/22/19 -
Copyright Holder

GlaxoSmithKline

Uploaded on

August 22, 2019

DOI

To request one please log in.

License

Creative Commons BY-NC 3.0
Model comments :

You can comment on the data model here. Via the speech bubbles at the itemgroups and items you can add comments to those specificially.

Back to model comments
Itemgroup comments for :

Item comments for :

In order to download data models you must be logged in. Please log in or register for free.

Oral Topotecan as Radiosensitizing Agent in Patients with Rectal Cancer; NCT00158886

English

CRF Tracking/Review Forms

1 forms  
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Center number
Description

Study Coordinating Center, Identification number

Data type

integer

Alias
UMLS CUI [1,1]
C2825181
UMLS CUI [1,2]
C1300638
Patient Number
Description

Patient number

Data type

integer

Alias
UMLS CUI [1]
C1830427
Patient Initials
Description

Person Initials

Data type

text

Alias
UMLS CUI [1]
C2986440
Investigator
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
CRF Tracking/Review Form
Description

CRF Tracking/Review Form

Alias
UMLS CUI-1
C3889409
Screening failure (archive only)
Description

Clinical Trial Regulatory Tracking Document, Trial Screening, Failed

Data type

boolean

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1710477
UMLS CUI [1,3]
C0231175
Module
Description

Clinical Trial Regulatory Tracking Document, Module

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1709061
Module Description
Description

Clinical Trial Regulatory Tracking Document, Module, Description

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1709061
UMLS CUI [1,3]
C0678257
Page Range
Description

Clinical Trial Regulatory Tracking Document, Page, Range

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1704732
UMLS CUI [1,3]
C1514721
Modules
Description

Clinical Trial Regulatory Tracking Document, Module, Send

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1709061
UMLS CUI [1,3]
C1519246
Missing pages (if applicable)
Description

Clinical Trial Regulatory Tracking Document, Page, Missing

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C1704732
UMLS CUI [1,3]
C1705492
Site Monitor's comments (e.g. protocol violations or deviations)
Description

Clinical Trial Regulatory Tracking Document, Comment

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C0947611
Site Monitor's signature
Description

Clinical Trial Regulatory Tracking Document, Investigator Signature

Data type

text

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C2346576
Date Submitted
Description

Clinical Trial Regulatory Tracking Document, Investigator Signature, Date in time

Data type

date

Alias
UMLS CUI [1,1]
C3889409
UMLS CUI [1,2]
C2346576
UMLS CUI [1,3]
C0011008
Back to the top of the page

Similar models

CRF Tracking/Review Forms

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study Coordinating Center, Identification number
Item
Center number
integer
C2825181 (UMLS CUI [1,1])
C1300638 (UMLS CUI [1,2])
Patient number
Item
Patient Number
integer
C1830427 (UMLS CUI [1])
Person Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Investigator Name
Item
Investigator
text
C2826892 (UMLS CUI [1])
Item Group
CRF Tracking/Review Form
C3889409 (UMLS CUI-1)
Clinical Trial Regulatory Tracking Document, Trial Screening, Failed
Item
Screening failure (archive only)
boolean
C3889409 (UMLS CUI [1,1])
C1710477 (UMLS CUI [1,2])
C0231175 (UMLS CUI [1,3])
Item
Module
text
C3889409 (UMLS CUI [1,1])
C1709061 (UMLS CUI [1,2])
Clinical Trial Regulatory Tracking Document, Module
Code List
Module
CL Item
MOD1 (1)
CL Item
SAE1 (2)
CL Item
SAE2 (3)
CL Item
SAE3 (4)
CL Item
SAE4 (5)
CL Item
SAE5 (6)
CL Item
FORMD (7)
CL Item
PSFM1 (8)
CL Item
PSFM2 (9)
CL Item
PSFM3 (10)
CL Item
PSFM4 (11)
CL Item
PSFM5 (12)
CL Item
PSFM6 (13)
CL Item
PSFM7 (14)
CL Item
PSFM8 (15)
CL Item
PSFU1 (16)
CL Item
PSFU2 (17)
Item
Module Description
text
C3889409 (UMLS CUI [1,1])
C1709061 (UMLS CUI [1,2])
C0678257 (UMLS CUI [1,3])
Clinical Trial Regulatory Tracking Document, Module
Code List
Module Description
CL Item
Screening/Course 1 (1)
CL Item
Serious Adverse Experiences (2)
CL Item
Serious Adverse Experiences (3)
CL Item
Serious Adverse Experiences (4)
CL Item
Serious Adverse Experiences (5)
CL Item
Serious Adverse Experiences (6)
CL Item
Form D (7)
CL Item
Post-Study Minimal FU M3 (8)
CL Item
Post-Study Minimal FU M6 (9)
CL Item
Post-Study Minimal FU M9 (10)
CL Item
Post-Study Minimal FU M12 (11)
CL Item
Post-Study Minimal FU M15 (12)
CL Item
Post-Study Minimal FU M18 (13)
CL Item
Post-Study Minimal FU M21 (14)
CL Item
Post-Study Minimal FU M324 (15)
CL Item
Post-Study Minimal FU M___ (16)
CL Item
Post-Study Minimal FU M___ (17)
Item
Page Range
text
C3889409 (UMLS CUI [1,1])
C1704732 (UMLS CUI [1,2])
C1514721 (UMLS CUI [1,3])
Clinical Trial Regulatory Tracking Document, Module
Code List
Page Range
CL Item
1-25 (1)
CL Item
26-27 (2)
CL Item
28-29 (3)
CL Item
30-31 (4)
CL Item
32-33 (5)
CL Item
34-35 (6)
CL Item
36 (7)
CL Item
1 page (8)
CL Item
1 page (9)
CL Item
1 page (10)
CL Item
1 page (11)
CL Item
1 page (12)
CL Item
1 page (13)
CL Item
1 page (14)
CL Item
1 page (15)
CL Item
1 page (16)
CL Item
1 page (17)
Item
Modules
text
C3889409 (UMLS CUI [1,1])
C1709061 (UMLS CUI [1,2])
C1519246 (UMLS CUI [1,3])
Clinical Trial Regulatory Tracking Document, Module, Send
Code List
Modules
CL Item
Sent to DM (1)
CL Item
Unused (2)
Clinical Trial Regulatory Tracking Document, Page, Missing
Item
Missing pages (if applicable)
text
C3889409 (UMLS CUI [1,1])
C1704732 (UMLS CUI [1,2])
C1705492 (UMLS CUI [1,3])
Clinical Trial Regulatory Tracking Document, Comment
Item
Site Monitor's comments (e.g. protocol violations or deviations)
text
C3889409 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Clinical Trial Regulatory Tracking Document, Investigator Signature
Item
Site Monitor's signature
text
C3889409 (UMLS CUI [1,1])
C2346576 (UMLS CUI [1,2])
Clinical Trial Regulatory Tracking Document, Investigator Signature, Date in time
Item
Date Submitted
date
C3889409 (UMLS CUI [1,1])
C2346576 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Back to the top of the page 

Contact

Please use this form for feedback, questions and suggestions for improvements.

Fields marked with * are required.

Help

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