ID

38164

Beschrijving

Study ID: 105-123 Clinical Study ID: 105-123 Study Title: Lamotrigine as add-on therapy in patients with clinical diagnosis of a Lennox-Gastaut syndrome (severe generalised epilepsy of childhood onset.) A multicentre, double-blind, placebo controlled parallel group study Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Sponsor: GlaxoSmithKline Phase: Phase 3 Study Recruitment Status: Completed Generic Name: Lamotrigine Study Indication: Seizures

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Versies (1)
  1. 23-09-19 23-09-19 -
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GlaxoSmithKline

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23 september 2019

DOI

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Creative Commons BY-NC 3.0
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Lamotrigine as add-on therapy in patients with a clinical diagnosis of a Lennox-Gastaut syndrome (105-123)

Engels

Study Termination Record

1 Formulieren  
Administrative
Beschrijving

Administrative

Alias
UMLS CUI-1
C1320722
Patient's initials
Beschrijving

Patient's initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Patient's trial number
Beschrijving

Patient's trial number

Datatype

text

Alias
UMLS CUI [1]
C2348585
Centre number
Beschrijving

Centre number

Datatype

text

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Date the patient took last full dose of study medication
Beschrijving

Date the patient took last full dose of study medication

Datatype

date

Alias
UMLS CUI [1]
C1762893
Date of last assessment
Beschrijving

Date of last assessment

Datatype

date

Alias
UMLS CUI [1,1]
C2985720
UMLS CUI [1,2]
C1517741
Study Termination
Beschrijving

Study Termination

Alias
UMLS CUI-1
C0008972
UMLS CUI-2
C0013135
Did the patient complete 16 weeks of the study?
Beschrijving

Did the patient complete 16 weeks of the study?

Datatype

boolean

Alias
UMLS CUI [1]
C2348577
Did the patient discontinued prematurely?
Beschrijving

Did the patient discontinued prematurely?

Datatype

boolean

Alias
UMLS CUI [1]
C2718058
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
Beschrijving

If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?

Datatype

boolean

Alias
UMLS CUI [1]
C2348577
UMLS CUI [2,1]
C0064636
UMLS CUI [2,2]
C0549178
UMLS CUI [3,1]
C0064636
UMLS CUI [3,2]
C0439659
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
Beschrijving

If the patient completed 16 weeks did he/ she taper off study medication from week 16?

Datatype

boolean

Alias
UMLS CUI [1]
C2348577
UMLS CUI [2,1]
C0441640
UMLS CUI [2,2]
C0304229
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
Beschrijving

If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?

Datatype

boolean

Alias
UMLS CUI [1]
C2718058
UMLS CUI [2]
C0877248
UMLS CUI [3,1]
C0013230
UMLS CUI [3,2]
C0439849
Did the patient die during the study?
Beschrijving

Did the patient die during the study?

Datatype

boolean

Alias
UMLS CUI [1,1]
C0011065
UMLS CUI [1,2]
C0347984
UMLS CUI [1,3]
C0008976
If patient died, enter date of Death
Beschrijving

If patient died, enter date of Death

Datatype

date

Alias
UMLS CUI [1]
C1148348
Cause of Death
Beschrijving

Cause of Death

Datatype

text

Alias
UMLS CUI [1]
C0007465
Other reasons for premature discontinuation
Beschrijving

Please chek on only.

Datatype

integer

Alias
UMLS CUI [1,1]
C2718058
UMLS CUI [1,2]
C3840932
Investigator's Statement
Beschrijving

Investigator's Statement

Alias
UMLS CUI-1
C0008961
UMLS CUI-2
C1710187
Principal Investigator's signature
Beschrijving

I confirm that I have carefully examined all entries on the Case Report Forms for this patient. All Information entered by myself or my colleagues is, to the best of my knowledge, correct as of the date below.

Datatype

text

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C1521895
Prinicpal Investigator's Name
Beschrijving

Prinicpal Investigator's Name

Datatype

text

Alias
UMLS CUI [1]
C2826892
Date of Signature
Beschrijving

Date of Signature

Datatype

date

Alias
UMLS CUI [1,1]
C2346576
UMLS CUI [1,2]
C0011008
Terug naar het begin van de pagina

Similar models

Study Termination Record

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Patient's initials
Item
Patient's initials
text
C2986440 (UMLS CUI [1])
Patient's trial number
Item
Patient's trial number
text
C2348585 (UMLS CUI [1])
Centre number
Item
Centre number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Date the patient took last full dose of study medication
Item
Date the patient took last full dose of study medication
date
C1762893 (UMLS CUI [1])
Date of last assessment
Item
Date of last assessment
date
C2985720 (UMLS CUI [1,1])
C1517741 (UMLS CUI [1,2])
Item Group
Study Termination
C0008972 (UMLS CUI-1)
C0013135 (UMLS CUI-2)
Did the patient complete 16 weeks of the study?
Item
Did the patient complete 16 weeks of the study?
boolean
C2348577 (UMLS CUI [1])
Did the patient discontinued prematurely?
Item
Did the patient discontinued prematurely?
boolean
C2718058 (UMLS CUI [1])
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
Item
If the patient completed 16 weeks did he/she continue/ start lamotrigine treatment?
boolean
C2348577 (UMLS CUI [1])
C0064636 (UMLS CUI [2,1])
C0549178 (UMLS CUI [2,2])
C0064636 (UMLS CUI [3,1])
C0439659 (UMLS CUI [3,2])
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
Item
If the patient completed 16 weeks did he/ she taper off study medication from week 16?
boolean
C2348577 (UMLS CUI [1])
C0441640 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
Item
If the patient discontinued prematurely, was the discontinuation due to an adverse experience regardless of association with the test agent?
boolean
C2718058 (UMLS CUI [1])
C0877248 (UMLS CUI [2])
C0013230 (UMLS CUI [3,1])
C0439849 (UMLS CUI [3,2])
Did the patient die during the study?
Item
Did the patient die during the study?
boolean
C0011065 (UMLS CUI [1,1])
C0347984 (UMLS CUI [1,2])
C0008976 (UMLS CUI [1,3])
If patient died, enter date of Death
Item
If patient died, enter date of Death
date
C1148348 (UMLS CUI [1])
Cause of Death
Item
Cause of Death
text
C0007465 (UMLS CUI [1])
Item
Other reasons for premature discontinuation
integer
C2718058 (UMLS CUI [1,1])
C3840932 (UMLS CUI [1,2])
Other reasons for premature discontinuation
Code List
Other reasons for premature discontinuation
CL Item
Patient failed to return (1)
CL Item
Parent/ guardian withdrew consent (2)
CL Item
Protocol violation (3)
CL Item
General condition deteriorated (4)
CL Item
Clinically significant deterioration of seizure control (5)
Item Group
Investigator's Statement
C0008961 (UMLS CUI-1)
C1710187 (UMLS CUI-2)
Principal Investigator's signature
Item
Principal Investigator's signature
text
C1519316 (UMLS CUI [1,1])
C1521895 (UMLS CUI [1,2])
Prinicpal Investigator's Name
Item
Prinicpal Investigator's Name
text
C2826892 (UMLS CUI [1])
Date of Signature
Item
Date of Signature
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Terug naar het begin van de pagina 

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