ID

37972

Descripción

Study ID: 104864/627 Clinical Study ID: 104864/627 Study Title: An Open-label, Multicenter, Non-Comparative Phase II Study of the Combination of Intravenous Topotecan and Gemcitabine Administered Once Weekly for Three Weeks Every 28 Days as Second-line Treatment in Patients With Recurrent Platinum Sensitive Ovarian Cancer Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00061308 Sponsor: GlaxoSmithKline Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Topotecan, Gemcitabine Study Indication: Peritoneal Cancer, Ovarian Cancer, Neoplasms, Ovarian, Fallopian Tube Cancer

Palabras clave

Versiones (1)
  1. 3/9/19 3/9/19 -
Titular de derechos de autor

GlaxoSmithKline

Subido en

3 de septiembre de 2019

DOI

Para solicitar uno, por favor iniciar sesión.

Licencia

Creative Commons BY-NC 3.0
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Intravenous Topotecan and Gemcitabine as Second-line Treatment in Patients With Ovarian Cancer NCT00061308

Inglés

Adverse Events; Serious Adverse Event; Prior and Concomitant Medications

1 formularios  
Administrative
Descripción

Administrative

Alias
UMLS CUI-1
C1320722
Center Number
Descripción

Center Number

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Patient Number
Descripción

Patient Number

Tipo de datos

text

Alias
UMLS CUI [1]
C1709561
Patient ID
Descripción

Patient ID

Tipo de datos

text

Alias
UMLS CUI [1]
C2348585
Are there any non-serious adverse events to report?
Descripción

Are there any non-serious adverse events to report?

Alias
UMLS CUI-1
C1518404
Are there any non-serious adverse events to report?
Descripción

If yes, record any adverse events (using standard medical terminology) observed or elicited by the following direct question to patient: Do you feel different in any way since starting the treatment or since the last visit? Provide the diagnosis, not symptoms, where possible. Record only one adverse event per column.

Tipo de datos

boolean

Alias
UMLS CUI [1]
C1518404
Non-Serious adverse Events
Descripción

Non-Serious adverse Events

Alias
UMLS CUI-1
C1518404
Non-Serious adverse Event
Descripción

Non-Serious adverse Event

Tipo de datos

text

Alias
UMLS CUI [1]
C1518404
Non-Serious adverse Event Onset Date
Descripción

Non-Serious adverse Event Onset Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2985916
UMLS CUI [1,2]
C1518404
Non-Serious adverse Event End Date
Descripción

Non-Serious adverse Event End Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0806020
Non-serious adverse Event Outcome
Descripción

(If died, STOP; go to SAE section and follow instructions)

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C1705586
Non-Serious adverse Event Experience Course
Descripción

Non-Serious adverse Event Experience Course

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0750729
Non-Serious adverse Event Common Toxicity Grade
Descripción

Non-Serious adverse Event Common Toxicity Grade

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C2826262
Non-Serious adverse Event - Action Taken with Respect to investigational Drug
Descripción

Non-Serious adverse Event - Action Taken with Respect to investigational Drug

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C2826626
Non-Serious adverse Event - Relationship to Investigational Drug
Descripción

Non-Serious adverse Event - Relationship to Investigational Drug

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
Non-Serious adverse Event - Corrective Therapy
Descripción

If yes, record details in Concomitant Medication section

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1518404
UMLS CUI [1,2]
C0087111
Was patient withdrawn due to this specific AE?
Descripción

Was patient withdrawn due to this specific AE?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C1518404
Serious Adverse Event #1
Descripción

Serious Adverse Event #1

Alias
UMLS CUI-1
C1519255
Serious Adverse Event
Descripción

Serious Adverse Event

Tipo de datos

text

Alias
UMLS CUI [1]
C1519255
Person Reporting SAE:
Descripción

Person Reporting SAE:

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0008961
UMLS CUI [1,2]
C1519255
Serious Adverse Event Onset Date
Descripción

Serious Adverse Event Onset Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2985916
UMLS CUI [1,2]
C1519255
Serious Adverse Event Onset Time
Descripción

Serious Adverse Event Onset Time

Tipo de datos

time

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0449244
Serious Adverse Event End Date
Descripción

Serious Adverse Event End Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0806020
Serious Adverse Event End Time
Descripción

Serious Adverse Event End Time

Tipo de datos

time

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C1522314
Specify reason(s) for considering this an SAE.
Descripción

Mark all that apply

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0392360
If other reason(s) for considering this an SAE, specify
Descripción

If other reason(s) for considering this an SAE, specify

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0392360
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C2348235
Serious Adverse Event Outcome
Descripción

Serious Adverse Event Outcome

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1705586
UMLS CUI [1,2]
C1519255
Serious Adverse Event - Experience Course
Descripción

Serious Adverse Event - Experience Course

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0750729
Serious Adverse Event - Common Toxicity Grade
Descripción

Serious Adverse Event - Common Toxicity Grade

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826262
Serious Adverse Event - Action Taken with Respect to Investigational Drug
Descripción

Serious Adverse Event - Action Taken with Respect to Investigational Drug

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2826626
Did the SAE abate?
Descripción

Did the SAE abate?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C3853704
If study medication was interrupted, stopped, or dose reduced, was study Medication reintroduced (or dose decresed)?
Descripción

If study medication was interrupted, stopped, or dose reduced, was study Medication reintroduced (or dose decresed)?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C1707811
If study Medication was reintroduced, did SAE recur?
Descripción

If study Medication was reintroduced, did SAE recur?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0304229
UMLS CUI [1,2]
C1707811
UMLS CUI [2,1]
C1519255
UMLS CUI [2,2]
C0034897
Serious Adverse Event - Relationship to Investigatinoal Drug
Descripción

Serious Adverse Event - Relationship to Investigatinoal Drug

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0439849
UMLS CUI [1,3]
C0304229
If Relationship to Investigational Product is "Unrelated" or "Probably Unrelated", the SAE is propably associated with...
Descripción

Mark one

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0439849
UMLS CUI [1,3]
C0304229
UMLS CUI [2]
C0445356
UMLS CUI [3]
C0332281
If SAE is associated with Protocol design or procedures, specify
Descripción

If SAE is associated with Protocol design or procedures, specify

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0184661
UMLS CUI [1,3]
C0332281
UMLS CUI [1,4]
C2348235
If SAE ist associated with another condition, specify
Descripción

If SAE ist associated with another condition, specify

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0348080
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C0332281
UMLS CUI [1,5]
C2348235
If SAE is associated with another Drug, specify
Descripción

If SAE is associated with another Drug, specify

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0013227
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C0332281
UMLS CUI [1,5]
C2348235
Serious Adverse Event - Corrective Therapy
Descripción

If yes, record details in Concomitant Medication section

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0087111
Was patient withdrawn due to this specific SAE?
Descripción

Was patient withdrawn due to this specific SAE?

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C1519255
Serious Adverse Event - Remarks
Descripción

Please provide a brief narrative description of he SAE, attaching extra pages e.g., hospital discharge summary if necessary.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C0947611
Serious Adverse Event #1 - Relevant Laboratory Data
Descripción

Serious Adverse Event #1 - Relevant Laboratory Data

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C0587081
Laboratory Test
Descripción

Laboratory Test

Tipo de datos

text

Alias
UMLS CUI [1]
C0022885
Laboratory Test Date
Descripción

Laboratory Test Date

Tipo de datos

date

Alias
UMLS CUI [1]
C2826641
Laboratory Test Value
Descripción

Laboratory Test Value

Tipo de datos

text

Alias
UMLS CUI [1]
C0587081
Laboratory Test Units
Descripción

Laboratory Test Units

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0587081
Laboratory Test Normal Range
Descripción

Laboratory Test Normal Range

Tipo de datos

text

Alias
UMLS CUI [1]
C1096215
Serious Adverse Event #1 - Signature
Descripción

Serious Adverse Event #1 - Signature

Alias
UMLS CUI-1
C1519255
UMLS CUI-2
C2346576
Serious Adverse Event - Investigator's Signature
Descripción

Confirming above data are accurate and complete.^

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1519255
UMLS CUI [1,2]
C2346576
Investigator's Name
Descripción

Investigator's Name

Tipo de datos

text

Alias
UMLS CUI [1]
C2826892
Investigator's Siganture Date Signed
Descripción

Investigator's Siganture Date Signed

Tipo de datos

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Medical Monitor‘s Signature
Descripción

Medical Monitor‘s Signature

Tipo de datos

text

Alias
UMLS CUI [1,1]
C1708968
UMLS CUI [1,2]
C1519316
Medical Monitor's Name
Descripción

Medical Monitor's Name

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0027365
UMLS CUI [1,2]
C1708968
Medical Monitors Signature Date Signed
Descripción

Medical Monitors Signature Date Signed

Tipo de datos

date

Alias
UMLS CUI [1,1]
C1708968
UMLS CUI [1,2]
C1519316
UMLS CUI [1,3]
C0011008
Prior and Concomitant Medications
Descripción

Prior and Concomitant Medications

Alias
UMLS CUI-1
C2826257
UMLS CUI-2
C2347852
Were any Medications taken by the patient up to 14 days prior to first administration of study medication and/or during the study?
Descripción

If "Yes", provide information below.

Tipo de datos

boolean

Alias
UMLS CUI [1,1]
C2826257
UMLS CUI [1,2]
C2347852
Prior and Concomitant Medications
Descripción

Prior and Concomitant Medications

Alias
UMLS CUI-1
C2826257
UMLS CUI-2
C2347852
Line Number
Descripción

Line Number

Tipo de datos

integer

Alias
UMLS CUI [1]
C0449788
Medication Generic Name
Descripción

If a combmation drug, use Trade name.

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0592502
Medication Dose
Descripción

Medication Dose

Tipo de datos

text

Alias
UMLS CUI [1]
C3174092
Medication Units
Descripción

Medication Units

Tipo de datos

text

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C1519795
Medication Route
Descripción

Medication Route

Tipo de datos

text

Alias
UMLS CUI [1]
C0013153
Medication Frequency
Descripción

Medication Frequency

Tipo de datos

text

Alias
UMLS CUI [1]
C3476109
Medication Indication
Descripción

Medication Indication

Tipo de datos

text

Alias
UMLS CUI [1]
C2826696
UMLS CUI [2,1]
C3146298
UMLS CUI [2,2]
C0013227
Medication prior to study medication
Descripción

Medication prior to study medication

Tipo de datos

integer

Alias
UMLS CUI [1]
C2826257
UMLS CUI [2]
C0304229
Concomitant Medication
Descripción

Concomitant Medication

Tipo de datos

integer

Alias
UMLS CUI [1]
C2347852
Medication Start Date
Descripción

Medication Start Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0808070
Medication End Date
Descripción

Medication End Date

Tipo de datos

date

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0806020
OR Ongoing at end of study
Descripción

OR Ongoing at end of study

Tipo de datos

integer

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0549178
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Adverse Events; Serious Adverse Event; Prior and Concomitant Medications

1 formularios
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Center Number
Item
Center Number
text
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C1709561 (UMLS CUI [1])
Patient ID
Item
Patient ID
text
C2348585 (UMLS CUI [1])
Item Group
Are there any non-serious adverse events to report?
C1518404 (UMLS CUI-1)
Are there any non-serious adverse events to report?
Item
Are there any non-serious adverse events to report?
boolean
C1518404 (UMLS CUI [1])
Item Group
Non-Serious adverse Events
C1518404 (UMLS CUI-1)
Non-Serious adverse Event
Item
Non-Serious adverse Event
text
C1518404 (UMLS CUI [1])
Non-Serious adverse Event Onset Date
Item
Non-Serious adverse Event Onset Date
date
C2985916 (UMLS CUI [1,1])
C1518404 (UMLS CUI [1,2])
Non-Serious adverse Event End Date
Item
Non-Serious adverse Event End Date
date
C1518404 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
Non-serious adverse Event Outcome
integer
C1518404 (UMLS CUI [1,1])
C1705586 (UMLS CUI [1,2])
Non-serious adverse Event Outcome
Code List
Non-serious adverse Event Outcome
CL Item
Resolved (1)
CL Item
Ongoing (at end of study) (2)
CL Item
Deíed --> see SAE section (3)
Item
Non-Serious adverse Event Experience Course
integer
C1518404 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
Non-Serious adverse Event Experience Course
Code List
Non-Serious adverse Event Experience Course
CL Item
Intermittent (1)
CL Item
Constant (2)
Non-Serious adverse Event Common Toxicity Grade
Item
Non-Serious adverse Event Common Toxicity Grade
integer
C1518404 (UMLS CUI [1,1])
C2826262 (UMLS CUI [1,2])
Item
Non-Serious adverse Event - Action Taken with Respect to investigational Drug
integer
C1518404 (UMLS CUI [1,1])
C2826626 (UMLS CUI [1,2])
Non-Serious adverse Event - Action Taken with Respect to investigational Drug
Code List
Non-Serious adverse Event - Action Taken with Respect to investigational Drug
CL Item
None  (1)
CL Item
Dose reduced  (2)
CL Item
Drug interrupted/restarted  (3)
CL Item
Drug stopped  (4)
CL Item
Dose delayed  (5)
CL Item
Dose delayed and reduced (6)
Item
Non-Serious adverse Event - Relationship to Investigational Drug
integer
C1518404 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Non-Serious adverse Event - Relationship to Investigational Drug
Code List
Non-Serious adverse Event - Relationship to Investigational Drug
CL Item
Unretated  (1)
CL Item
Probably Unrelated  (2)
CL Item
Possibly Related  (3)
CL Item
Reslated (4)
Non-Serious adverse Event - Corrective Therapy
Item
Non-Serious adverse Event - Corrective Therapy
boolean
C1518404 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Was patient withdrawn due to this specific AE?
Item
Was patient withdrawn due to this specific AE?
boolean
C0422727 (UMLS CUI [1,1])
C1518404 (UMLS CUI [1,2])
Item Group
Serious Adverse Event #1
C1519255 (UMLS CUI-1)
Serious Adverse Event
Item
Serious Adverse Event
text
C1519255 (UMLS CUI [1])
Person Reporting SAE:
Item
Person Reporting SAE:
text
C0008961 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Serious Adverse Event Onset Date
Item
Serious Adverse Event Onset Date
date
C2985916 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Serious Adverse Event Onset Time
Item
Serious Adverse Event Onset Time
time
C1519255 (UMLS CUI [1,1])
C0449244 (UMLS CUI [1,2])
Serious Adverse Event End Date
Item
Serious Adverse Event End Date
date
C1519255 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Serious Adverse Event End Time
Item
Serious Adverse Event End Time
time
C1519255 (UMLS CUI [1,1])
C1522314 (UMLS CUI [1,2])
Item
Specify reason(s) for considering this an SAE.
integer
C1519255 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
Specify reason(s) for considering this an SAE.
Code List
Specify reason(s) for considering this an SAE.
CL Item
Results in death  (1)
CL Item
Life threatening  (2)
CL Item
Results in hospitalization or prolongation of existing hospitalization  (3)
CL Item
Results in disability / incapacity  (4)
CL Item
Congenital abnormality / birth defect  (5)
CL Item
Other (see definition), specify: (6)
If other reason(s) for considering this an SAE, specify
Item
If other reason(s) for considering this an SAE, specify
text
C1519255 (UMLS CUI [1,1])
C0392360 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item
Serious Adverse Event Outcome
integer
C1705586 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Serious Adverse Event Outcome
Code List
Serious Adverse Event Outcome
CL Item
Resolved (1)
CL Item
Ongoing (2)
CL Item
Died (Complete Patient Form D) (3)
Item
Serious Adverse Event - Experience Course
integer
C1519255 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
Serious Adverse Event - Experience Course
Code List
Serious Adverse Event - Experience Course
CL Item
Intermittent (1)
CL Item
Consatant (2)
Serious Adverse Event - Common Toxicity Grade
Item
Serious Adverse Event - Common Toxicity Grade
integer
C1519255 (UMLS CUI [1,1])
C2826262 (UMLS CUI [1,2])
Item
Serious Adverse Event - Action Taken with Respect to Investigational Drug
integer
C1519255 (UMLS CUI [1,1])
C2826626 (UMLS CUI [1,2])
Serious Adverse Event - Action Taken with Respect to Investigational Drug
Code List
Serious Adverse Event - Action Taken with Respect to Investigational Drug
CL Item
None  (1)
CL Item
Dose reduced (2)
CL Item
Drug interrupted/restarted  (3)
CL Item
Drug stopped  (4)
CL Item
Dose delayed  (5)
CL Item
Dose delayed and reduced (6)
Did the SAE abate?
Item
Did the SAE abate?
boolean
C1519255 (UMLS CUI [1,1])
C3853704 (UMLS CUI [1,2])
If study medication was interrupted, stopped, or dose reduced, was study Medication reintroduced (or dose decresed)?
Item
If study medication was interrupted, stopped, or dose reduced, was study Medication reintroduced (or dose decresed)?
boolean
C0304229 (UMLS CUI [1,1])
C1707811 (UMLS CUI [1,2])
If study Medication was reintroduced, did SAE recur?
Item
If study Medication was reintroduced, did SAE recur?
boolean
C0304229 (UMLS CUI [1,1])
C1707811 (UMLS CUI [1,2])
C1519255 (UMLS CUI [2,1])
C0034897 (UMLS CUI [2,2])
Item
Serious Adverse Event - Relationship to Investigatinoal Drug
integer
C1519255 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
Serious Adverse Event - Relationship to Investigatinoal Drug
Code List
Serious Adverse Event - Relationship to Investigatinoal Drug
CL Item
Unrelated (1)
CL Item
Propably Unrelated (2)
CL Item
Possibly Related (3)
CL Item
Related (4)
Item
If Relationship to Investigational Product is "Unrelated" or "Probably Unrelated", the SAE is propably associated with...
integer
C1519255 (UMLS CUI [1,1])
C0439849 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
C0445356 (UMLS CUI [2])
C0332281 (UMLS CUI [3])
The SAE is propably associated with...
Code List
If Relationship to Investigational Product is "Unrelated" or "Probably Unrelated", the SAE is propably associated with...
CL Item
Protocol design of procedures (but not to study drug), specify (1)
CL Item
Another condition (e.g., condition under study, intercurrent illness), specify (2)
CL Item
Another Drug, specify (3)
If SAE is associated with Protocol design or procedures, specify
Item
If SAE is associated with Protocol design or procedures, specify
text
C1519255 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C0332281 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
If SAE ist associated with another condition, specify
Item
If SAE ist associated with another condition, specify
text
C1519255 (UMLS CUI [1,1])
C0348080 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0332281 (UMLS CUI [1,4])
C2348235 (UMLS CUI [1,5])
If SAE is associated with another Drug, specify
Item
If SAE is associated with another Drug, specify
text
C1519255 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0332281 (UMLS CUI [1,4])
C2348235 (UMLS CUI [1,5])
Serious Adverse Event - Corrective Therapy
Item
Serious Adverse Event - Corrective Therapy
boolean
C1519255 (UMLS CUI [1,1])
C0087111 (UMLS CUI [1,2])
Was patient withdrawn due to this specific SAE?
Item
Was patient withdrawn due to this specific SAE?
boolean
C0422727 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Serious Adverse Event - Remarks
Item
Serious Adverse Event - Remarks
text
C1519255 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Item Group
Serious Adverse Event #1 - Relevant Laboratory Data
C1519255 (UMLS CUI-1)
C0587081 (UMLS CUI-2)
Laboratory Test
Item
Laboratory Test
text
C0022885 (UMLS CUI [1])
Laboratory Test Date
Item
Laboratory Test Date
date
C2826641 (UMLS CUI [1])
Laboratory Test Value
Item
Laboratory Test Value
text
C0587081 (UMLS CUI [1])
Laboratory Test Units
Item
Laboratory Test Units
text
C1519795 (UMLS CUI [1,1])
C0587081 (UMLS CUI [1,2])
Laboratory Test Normal Range
Item
Laboratory Test Normal Range
text
C1096215 (UMLS CUI [1])
Item Group
Serious Adverse Event #1 - Signature
C1519255 (UMLS CUI-1)
C2346576 (UMLS CUI-2)
Serious Adverse Event - Investigator's Signature
Item
Serious Adverse Event - Investigator's Signature
text
C1519255 (UMLS CUI [1,1])
C2346576 (UMLS CUI [1,2])
Investigator's Name
Item
Investigator's Name
text
C2826892 (UMLS CUI [1])
Investigator's Siganture Date Signed
Item
Investigator's Siganture Date Signed
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Medical Monitor‘s Signature
Item
Medical Monitor‘s Signature
text
C1708968 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
Medical Monitor's Name
Item
Medical Monitor's Name
text
C0027365 (UMLS CUI [1,1])
C1708968 (UMLS CUI [1,2])
Medical Monitors Signature Date Signed
Item
Medical Monitors Signature Date Signed
date
C1708968 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Prior and Concomitant Medications
C2826257 (UMLS CUI-1)
C2347852 (UMLS CUI-2)
Were any Medications taken by the patient up to 14 days prior to first administration of study medication and/or during the study?
Item
Were any Medications taken by the patient up to 14 days prior to first administration of study medication and/or during the study?
boolean
C2826257 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
Item Group
Prior and Concomitant Medications
C2826257 (UMLS CUI-1)
C2347852 (UMLS CUI-2)
Line Number
Item
Line Number
integer
C0449788 (UMLS CUI [1])
Medication Generic Name
Item
Medication Generic Name
text
C0013227 (UMLS CUI [1,1])
C0592502 (UMLS CUI [1,2])
Medication Dose
Item
Medication Dose
text
C3174092 (UMLS CUI [1])
Medication Units
Item
Medication Units
text
C0013227 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Medication Route
Item
Medication Route
text
C0013153 (UMLS CUI [1])
Medication Frequency
Item
Medication Frequency
text
C3476109 (UMLS CUI [1])
Medication Indication
Item
Medication Indication
text
C2826696 (UMLS CUI [1])
C3146298 (UMLS CUI [2,1])
C0013227 (UMLS CUI [2,2])
Item
Medication prior to study medication
integer
C2826257 (UMLS CUI [1])
C0304229 (UMLS CUI [2])
Medication prior to study medication
Code List
Medication prior to study medication
CL Item
Yes (1)
Item
Concomitant Medication
integer
C2347852 (UMLS CUI [1])
Concomitant Medication
Code List
Concomitant Medication
CL Item
Yes (1)
Medication Start Date
Item
Medication Start Date
date
C0013227 (UMLS CUI [1,1])
C0808070 (UMLS CUI [1,2])
Medication End Date
Item
Medication End Date
date
C0013227 (UMLS CUI [1,1])
C0806020 (UMLS CUI [1,2])
Item
OR Ongoing at end of study
integer
C0013227 (UMLS CUI [1,1])
C0549178 (UMLS CUI [1,2])
OR Ongoing at end of study
Code List
OR Ongoing at end of study
CL Item
Yes (1)
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