ID
41053
Description
This form documents the serious adverse events which may have occurred during the study. To filled in continuously. If you wish to record a new SAE please determine if the new SAE is clinically or temporally related to an SAE previously entered on this form. If yes, record it in the same instance of the form. If not clinically or temporally related, create a new instance of the SAE form. Do not record pre and post randomization events on the same form. Study ID: 103629 Clinical Study ID: TRX103629 Study Title: An open-label, randomized, 3-period crossover study to evaluate sumatriptan and naproxen pharmacokinetics for a combination tablet product containing sumatriptan/naproxen sodium followed by IMITREX™ (sumatriptan succinate) Injection 4mg administered using the IMITREX STATdose System and a sumatriptan/naproxen sodium tablet followed by IMITREX (sumatriptan succinate) Injection 6mg administered using the STATdose system compared with an IMITREX tablet 100mg followed by an IMITREX tablet 100mg Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00875784 Clinicaltrials.gov link: https://clinicaltrials.gov/ct2/show/NCT00875784 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: phase 1 Study Recruitment Status: Completed Generic Name: sumatriptan Trade Name: Imitrex ,Imiject ,Imigran; Imitrex,Imiject,Imigran Study Indication: Migraine Disorders
Link
https://clinicaltrials.gov/ct2/show/NCT00875784
Keywords
Versions (1)
- 6/17/20 6/17/20 -
Copyright Holder
GlaxoSmithKline
Uploaded on
June 17, 2020
DOI
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License
Creative Commons BY-NC 4.0
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Sumatriptan pharmacokinetics for TREXIMA/IMITREX ID 103629
Serious Adverse Events
- StudyEvent: ODM
Description
TYPE OF REPORT
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0585733
Description
RANDOMISATION
Alias
- UMLS CUI-1
- C0034656
Description
4. SERIOUS ADVERSE EVENT
Alias
- UMLS CUI-1
- C1519255
Description
SAE Diagnosis | SAE Sign/Symptom
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0011900
- UMLS CUI [2,1]
- C1519255
- UMLS CUI [2,2]
- C0037088
Description
Serious Adverse Event Start Date/Time
Data type
datetime
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C2826806
Description
Outcome of Serious Adverse Event
Data type
text
Alias
- UMLS CUI [1,1]
- C1705586
- UMLS CUI [1,2]
- C1519255
Description
This is the date the SAE Recovered/Resolved, or if the outcome was fatal, record the date the subject died. If the event Recovered/Resolved with sequelae, enter the date the subject’s medical condition resolved or stabilised. Leave blank if the SAE is ’Not recovered/Not resolved’ or ’Recovering/Resolving’.
Data type
datetime
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C2826793
Description
Maximum Intensity of Serious Adverse Event
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0518690
- UMLS CUI [1,3]
- C0806909
Description
Actions taken with Study Treatment, SAE
Data type
text
Alias
- UMLS CUI [1,1]
- C1704758
- UMLS CUI [1,2]
- C1519255
Description
Patient withdrawn from trial because of SAE
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0422727
- UMLS CUI [1,2]
- C1519255
Description
Relationship of Experimental Drug to Investigational Product(s)
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0304229
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C1519255
Description
SAE Caused by Activiteies related to Study participation
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0085978
- UMLS CUI [1,3]
- C0441655
- UMLS CUI [1,4]
- C2348568
Description
5. Seriousness?
Alias
- UMLS CUI-1
- C1710056
Description
SAE results in death
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1705232
- UMLS CUI [1,2]
- C1519255
Description
SAE is life-threatening
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1517874
- UMLS CUI [1,2]
- C1519255
Description
SAE requires hospitalisation
Data type
boolean
Alias
- UMLS CUI [1,1]
- C2826664
- UMLS CUI [1,2]
- C1519255
Description
SAE results in disability/incapacity
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0231170
Description
SAE: Congenital anomaly/birth defect
Data type
boolean
Alias
- UMLS CUI [1,1]
- C0000768
- UMLS CUI [1,2]
- C1519255
Description
SAE, other
Data type
boolean
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C1880177
Description
6. RELEVANT CONCOMITANT/TREATMENT MEDICATIONS
Alias
- UMLS CUI-1
- C2347852
- UMLS CUI-2
- C0304229
Description
(Trade Name preferred)
Data type
text
Alias
- UMLS CUI [1,1]
- C0013227
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C0013227
- UMLS CUI [2,2]
- C0304229
Description
Dose of concomitant medication or investigational agent
Data type
float
Alias
- UMLS CUI [1,1]
- C3174092
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C3174092
- UMLS CUI [2,2]
- C0304229
Description
Unit of concomitant medication or investigational agent
Data type
text
Alias
- UMLS CUI [1,1]
- C1519795
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C1519795
- UMLS CUI [2,2]
- C0304229
Description
Frequency of concomitant medication or investigational agent
Data type
text
Alias
- UMLS CUI [1,1]
- C3476109
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C3476109
- UMLS CUI [2,2]
- C0304229
Description
Route of concomitant medication or investigational agent admission
Data type
text
Alias
- UMLS CUI [1,1]
- C0013153
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C0013153
- UMLS CUI [2,2]
- C0304229
Description
Start Date of concomitant medication or investigational agent
Data type
date
Alias
- UMLS CUI [1,1]
- C0808070
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C0808070
- UMLS CUI [2,2]
- C0304229
Description
Ongoing concomitant medication or investigational agent
Data type
text
Alias
- UMLS CUI [1]
- C2826666
- UMLS CUI [2,1]
- C0304229
- UMLS CUI [2,2]
- C0549178
Description
Only if Concomitant Medication/Treatment is not ongoing.
Data type
date
Alias
- UMLS CUI [1,1]
- C0806020
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C0806020
- UMLS CUI [2,2]
- C0304229
Description
Indication of concomitant medication or investigational agent
Data type
text
Alias
- UMLS CUI [1,1]
- C3146298
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C3146298
- UMLS CUI [2,2]
- C0304229
Description
Drug Type of concomitant medication or investigational agent
Data type
text
Alias
- UMLS CUI [1,1]
- C0457591
- UMLS CUI [1,2]
- C2347852
- UMLS CUI [2,1]
- C0457591
- UMLS CUI [2,2]
- C0304229
Description
RELEVANT MEDICAL CONDITIONS/RISK FACTORS
Alias
- UMLS CUI-1
- C0262926
Description
Relevant Medical Conditions
Data type
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0262926
- UMLS CUI [1,3]
- C1519255
Description
Date of onset
Data type
date
Alias
- UMLS CUI [1]
- C0574845
Description
Disease Continuing
Data type
text
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C0549178
Description
Only to be filled in if the Condition is not continuing
Data type
date
Alias
- UMLS CUI [1,1]
- C0012634
- UMLS CUI [1,2]
- C1517741
- UMLS CUI [1,3]
- C2745955
- UMLS CUI [1,4]
- C0011008
- UMLS CUI [2,1]
- C0035648
- UMLS CUI [2,2]
- C1517741
- UMLS CUI [2,3]
- C2745955
- UMLS CUI [2,4]
- C0011008
Description
Relevance of Other Medical History/Risk Factors
Data type
text
Alias
- UMLS CUI [1,1]
- C2347946
- UMLS CUI [1,2]
- C0205394
- UMLS CUI [1,3]
- C0262926
- UMLS CUI [2,1]
- C2347946
- UMLS CUI [2,2]
- C0205394
- UMLS CUI [2,3]
- C0035648
Description
9. RELEVANT DIAGNOSTIC RESULTS
Alias
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0430022
Description
Diagnostic Procedure Name
Data type
text
Alias
- UMLS CUI [1,1]
- C0430022
- UMLS CUI [1,2]
- C2826273
Description
Test Date
Data type
text
Alias
- UMLS CUI [1]
- C2826247
Description
Test Result
Data type
text
Alias
- UMLS CUI [1]
- C0456984
Description
Test Units
Data type
text
Alias
- UMLS CUI [1,1]
- C1519795
- UMLS CUI [1,2]
- C0430022
Description
Normal Low Range
Data type
text
Alias
- UMLS CUI [1]
- C1272773
Description
Normal High Range
Data type
text
Alias
- UMLS CUI [1]
- C1299400
Description
Other Diagnostic procedure Result
Data type
text
Alias
- UMLS CUI [1,1]
- C0430022
- UMLS CUI [1,2]
- C0456984
- UMLS CUI [1,3]
- C0205394
Description
INVESTIGATIONAL PRODUCTS
Alias
- UMLS CUI-1
- C1828479
- UMLS CUI-2
- C0013230
Description
Recurrence of the reported SAE following new administration | administration of investigational agent interrupted earlier
Data type
text
Alias
- UMLS CUI [1,1]
- C1519255
- UMLS CUI [1,2]
- C0034897
- UMLS CUI [1,3]
- C0231290
- UMLS CUI [1,4]
- C0304229
- UMLS CUI [1,5]
- C1533734
- UMLS CUI [2,1]
- C0231290
- UMLS CUI [2,2]
- C0304229
- UMLS CUI [2,3]
- C1512900
Description
GENERAL NARRATIVE COMMENTS
Alias
- UMLS CUI-1
- C0947611
Similar models
Serious Adverse Events
- StudyEvent: ODM
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C0205265 (UMLS CUI [1,3])
C1704685 (UMLS CUI [1,2])
C0231290 (UMLS CUI [1,2])
C0304229 (UMLS CUI [1,3])
C1704686 (UMLS CUI [1,4])
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C1519255 (UMLS CUI [1,2])
C0085978 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C0085978 (UMLS CUI [1,2])
C0441655 (UMLS CUI [1,3])
C2348568 (UMLS CUI [1,4])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,2])
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C1880177 (UMLS CUI [1,2])
C0304229 (UMLS CUI-2)
C2347852 (UMLS CUI [1,2])
C0013227 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C3174092 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
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C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C3476109 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C0013153 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C0808070 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C0304229 (UMLS CUI [2,1])
C0549178 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C0806020 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C3146298 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C2347852 (UMLS CUI [1,2])
C0457591 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C0262926 (UMLS CUI [1,2])
C1519255 (UMLS CUI [1,3])
C1517741 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C0035648 (UMLS CUI [2,1])
C1517741 (UMLS CUI [2,2])
C2745955 (UMLS CUI [2,3])
C0011008 (UMLS CUI [2,4])
C0205394 (UMLS CUI [1,2])
C0262926 (UMLS CUI [1,3])
C2347946 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0035648 (UMLS CUI [2,3])
C0430022 (UMLS CUI-2)
C2826273 (UMLS CUI [1,2])
C0430022 (UMLS CUI [1,2])
C0456984 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C0013230 (UMLS CUI-2)
C0034897 (UMLS CUI [1,2])
C0231290 (UMLS CUI [1,3])
C0304229 (UMLS CUI [1,4])
C1533734 (UMLS CUI [1,5])
C0231290 (UMLS CUI [2,1])
C0304229 (UMLS CUI [2,2])
C1512900 (UMLS CUI [2,3])
C1519255 (UMLS CUI [1,2])