Inglês

End of Treatment

1 Formulários  
  1. StudyEvent: ODM
    1. End of Treatment
Administrative data
Descrição

Administrative data

Alias
UMLS CUI-1
C1320722
Country No.
Descrição

Country No.

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0454664
UMLS CUI [1,2]
C0600091
Centre No.
Descrição

Centre No.

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C1301943
UMLS CUI [1,2]
C0600091
Subject No.
Descrição

Clinical Trial Subject Unique Identifier

Tipo de dados

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Descrição

Subject Initials

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
End of Treatment
Descrição

End of Treatment

Alias
UMLS CUI-1
C0087111
UMLS CUI-2
C0444930
Date of last administration
Descrição

Date of last administration

Tipo de dados

date

Alias
UMLS CUI [1,1]
C1762893
UMLS CUI [1,2]
C1533734
Main reason for stopping treatment
Descrição

Select lack of efficacy in case of suspicion of DVT and/or PE, even if not confirmed, and complete appropriate forms. For Adverse Events, complete AE/SAE forms as well as Bleeding or Death Forms, if appropriate. Specify other main reason in next item.

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C1542147
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0087111
UMLS CUI [1,4]
C0444930
Specify other main reason for stopping treatment
Descrição

if applicable

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1521902
UMLS CUI [1,2]
C1542147
UMLS CUI [1,3]
C3840932
UMLS CUI [1,4]
C0087111
UMLS CUI [1,5]
C0444930
Investigator's Signature
Descrição

Investigator's Signature

Alias
UMLS CUI-1
C2346576
Investigator's Signature
Descrição

"I, the undersigned, certify that I have carefully examined all entries on the CRF for this subject.To the best of my knowledge, all information is correct."

Tipo de dados

text

Alias
UMLS CUI [1]
C2346576
Investigator's signature date
Descrição

Investigator's signature date

Tipo de dados

date

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

End of Treatment

1 Formulários
  1. StudyEvent: ODM
    1. End of Treatment
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Administrative data
C1320722 (UMLS CUI-1)
Country No.
Item
Country No.
integer
C0454664 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Centre No.
Item
Centre No.
integer
C1301943 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Clinical Trial Subject Unique Identifier
Item
Subject No.
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
Item Group
End of Treatment
C0087111 (UMLS CUI-1)
C0444930 (UMLS CUI-2)
Date of last administration
Item
Date of last administration
date
C1762893 (UMLS CUI [1,1])
C1533734 (UMLS CUI [1,2])
Item
Main reason for stopping treatment
integer
C1542147 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0087111 (UMLS CUI [1,3])
C0444930 (UMLS CUI [1,4])
Main reason for stopping treatment
Code List
Main reason for stopping treatment
CL Item
Completed study treatment period (1)
CL Item
Lack of efficacy (2)
CL Item
Adverse event (3)
CL Item
Poor compliance to protocol (4)
CL Item
Subject's request (5)
CL Item
Subject lost to follow-up (6)
CL Item
Other reason (7)
Specify other main reason for stopping treatment
Item
Specify other main reason for stopping treatment
text
C1521902 (UMLS CUI [1,1])
C1542147 (UMLS CUI [1,2])
C3840932 (UMLS CUI [1,3])
C0087111 (UMLS CUI [1,4])
C0444930 (UMLS CUI [1,5])
Item Group
Investigator's Signature
C2346576 (UMLS CUI-1)
Investigator's Signature
Item
Investigator's Signature
text
C2346576 (UMLS CUI [1])
Investigator's signature date
Item
Investigator's signature date
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
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