ID
40996
Beschreibung
Study ID: 103447 Clinical Study ID: NKV103447 Study Title:A study to evaluate the effect of casoptiant on cardiac conduction as assessed by 12-lead electrocardiogram as compared to placebo and moxifloxacin Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Sponsor: GlaxoSmithKline Phase: Phase 1 Study Recruitment Status: Completed Generic Name: casopitant Trade Name: Rezonic,Zunrisa; Zunrisa,Rezonic Study Indication: Nausea and Vomiting, Chemotherapy-Induced
Stichworte
Versionen (1)
- 09.06.20 09.06.20 -
Rechteinhaber
GlaxoSmithKline
Hochgeladen am
9. Juni 2020
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 4.0
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Effect of casoptiant on cardiac conduction as compared to placebo and moxifloxacin 103447
Pregnancy Notification Form (Subject's Partner)
- StudyEvent: ODM
Beschreibung
Pregnancy Notification Form - Mother's relevant medical/ family history
Alias
- UMLS CUI-1
- C0032961
- UMLS CUI-2
- C0026591
- UMLS CUI-3
- C0262926
- UMLS CUI-4
- C0241889
Beschreibung
Mother’s date of birth
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0421451
- UMLS CUI [1,2]
- C0026591
Beschreibung
Date of last menstrual period
Datentyp
date
Alias
- UMLS CUI [1]
- C0425932
Beschreibung
Estimated date of delivery
Datentyp
date
Alias
- UMLS CUI [1]
- C1287845
Beschreibung
Was the mother using a method of contraception?
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0026591
- UMLS CUI [1,2]
- C0700589
Beschreibung
If the mother was using a method of contraception, specify
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0026591
- UMLS CUI [1,2]
- C0700589
- UMLS CUI [1,3]
- C2348235
Beschreibung
Check one
Datentyp
integer
Alias
- UMLS CUI [1]
- C2598844
Beschreibung
Relevant laboratory tests and procedures (e.g., ultrasound, amniocentesis and chorionic villi sampling, including dates of tests and procedures).
Datentyp
text
Alias
- UMLS CUI [1]
- C0022885
- UMLS CUI [2]
- C1456803
- UMLS CUI [3]
- C0002627
- UMLS CUI [4]
- C0008509
- UMLS CUI [5]
- C0011008
Beschreibung
Number of previous pregnancies - Pre-term
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C1547235
Beschreibung
Number of previous pregnancies - Full-term
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C3814420
Beschreibung
Number of previous pregnancies - Normal births
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C3665337
Beschreibung
Number of previous pregnancies - Stillbirths
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C0595939
Beschreibung
Number of previous pregnancies - Children with birth defects
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C0000768
Beschreibung
Number of previous pregnancies - Spontaneous abortion
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C0000786
Beschreibung
Number of previous pregnancies - Elective abortion
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C0269439
Beschreibung
Number of previous pregnancies - Other
Datentyp
integer
Alias
- UMLS CUI [1,1]
- C0422807
- UMLS CUI [1,2]
- C0205394
Beschreibung
Record details of children born with defects
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1522508
- UMLS CUI [1,2]
- C0000768
Beschreibung
Are there any additional factors that may have an impact on the outcome of this pregnancy?
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0032972
- UMLS CUI [1,2]
- C1521761
Beschreibung
If there are any additional factors that may have an impact on the outcome of this pregnancy, specify.
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0032972
- UMLS CUI [1,2]
- C1521761
- UMLS CUI [1,3]
- C2348235
Beschreibung
Pregnancy Notification Form - Father's relevant medical/ family history
Alias
- UMLS CUI-1
- C0032961
- UMLS CUI-2
- C0015671
- UMLS CUI-3
- C0262926
- UMLS CUI-4
- C0241889
Beschreibung
(Include habitual exposures such as alcohol/substance abuse, chronic illnesses, familial birth defects/genetic chromosomal disorders and medication use)
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0032961
- UMLS CUI [1,2]
- C0015671
- UMLS CUI [1,3]
- C0262926
- UMLS CUI [1,4]
- C0241889
Beschreibung
Pregnancy Notification Form - Drug Exposures
Alias
- UMLS CUI-1
- C0032961
- UMLS CUI-2
- C0743284
Beschreibung
Trade Name preferred
Datentyp
text
Alias
- UMLS CUI [1]
- C0013227
Beschreibung
Route of Administration or Formulation
Datentyp
text
Alias
- UMLS CUI [1]
- C0013153
- UMLS CUI [2]
- C1705957
Beschreibung
Total Daily Dose
Datentyp
float
Alias
- UMLS CUI [1,1]
- C2348070
- UMLS CUI [1,2]
- C0439810
Beschreibung
Medication Units
Datentyp
text
Alias
- UMLS CUI [1]
- C1519795
Beschreibung
Medication started pre-study
Datentyp
boolean
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0808070
- UMLS CUI [2,1]
- C0332152
- UMLS CUI [2,2]
- C2347804
Beschreibung
Medication start date
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0808070
Beschreibung
Medication stop date
Datentyp
date
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C0806020
Beschreibung
Ongoing medication
Datentyp
boolean
Alias
- UMLS CUI [1]
- C2826666
Beschreibung
Reason for medication
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0392360
- UMLS CUI [1,2]
- C0013227
Beschreibung
Was the subject withdrawn from the study as a result of this pregnancy?
Datentyp
boolean
Alias
- UMLS CUI [1]
- C0422727
Beschreibung
Reporting Investigator Information
Alias
- UMLS CUI-1
- C0008961
- UMLS CUI-2
- C1533716
Beschreibung
Name
Datentyp
text
Alias
- UMLS CUI [1]
- C2826892
Beschreibung
Title
Datentyp
text
Alias
- UMLS CUI [1]
- C3888414
Beschreibung
Speciality
Datentyp
text
Alias
- UMLS CUI [1]
- C0037778
Beschreibung
Address
Datentyp
text
Alias
- UMLS CUI [1]
- C1442065
Beschreibung
City or State/Province
Datentyp
text
Alias
- UMLS CUI [1,1]
- C0008848
- UMLS CUI [1,2]
- C1547742
Beschreibung
Country
Datentyp
text
Alias
- UMLS CUI [1]
- C0454664
Beschreibung
Post or Zip Code
Datentyp
text
Alias
- UMLS CUI [1,1]
- C1514254
- UMLS CUI [1,2]
- C0600091
Beschreibung
Telephone No
Datentyp
integer
Alias
- UMLS CUI [1]
- C1515258
Beschreibung
Fax No
Datentyp
integer
Alias
- UMLS CUI [1]
- C1549619
Beschreibung
(confirming that the data on these pages are accurate and complete)
Datentyp
text
Alias
- UMLS CUI [1]
- C2346576
Beschreibung
Investigator’s signature Date
Datentyp
date
Alias
- UMLS CUI [1,1]
- C2346576
- UMLS CUI [1,2]
- C0011008
Beschreibung
Investigator’s name
Datentyp
text
Alias
- UMLS CUI [1]
- C2826892
Ähnliche Modelle
Pregnancy Notification Form (Subject's Partner)
- StudyEvent: ODM
C0019994 (UMLS CUI [1,2])
C0237753 (UMLS CUI [1,2])
C0026591 (UMLS CUI-2)
C0262926 (UMLS CUI-3)
C0241889 (UMLS CUI-4)
C0026591 (UMLS CUI [1,2])
C0700589 (UMLS CUI [1,2])
C0700589 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C1456803 (UMLS CUI [2])
C0002627 (UMLS CUI [3])
C0008509 (UMLS CUI [4])
C0011008 (UMLS CUI [5])
C1547235 (UMLS CUI [1,2])
C3814420 (UMLS CUI [1,2])
C3665337 (UMLS CUI [1,2])
C0595939 (UMLS CUI [1,2])
C0000768 (UMLS CUI [1,2])
C0000786 (UMLS CUI [1,2])
C0269439 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,2])
C0000768 (UMLS CUI [1,2])
C1521761 (UMLS CUI [1,2])
C1521761 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
C0015671 (UMLS CUI-2)
C0262926 (UMLS CUI-3)
C0241889 (UMLS CUI-4)
C0015671 (UMLS CUI [1,2])
C0262926 (UMLS CUI [1,3])
C0241889 (UMLS CUI [1,4])
C0743284 (UMLS CUI-2)
C1705957 (UMLS CUI [2])
C0439810 (UMLS CUI [1,2])
C0808070 (UMLS CUI [1,2])
C0332152 (UMLS CUI [2,1])
C2347804 (UMLS CUI [2,2])
C0808070 (UMLS CUI [1,2])
C0806020 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,2])
C1533716 (UMLS CUI-2)
C1547742 (UMLS CUI [1,2])
C0600091 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])