Biochemistry
(For visit 2 only: Has a blood sample for biochemistry been taken at screening visit 1?) If yes, please complete the items below.
boolean
Please complete only if date of collection of blood specimen is different from visit date. (For visit 2 only: Please complete only if date of collection of blood specimen is different from date of screening visit 1.)
date
Please fill in results for ALT measurement or indicate if not done in the following item.
integer
Please indicate if ALT has not been tested for.
boolean
Please enter ONE code (e.g. 1 or 2). If [2] Preexisting/concomitant medical condition or [5] Other, please specify in the following item.
integer
If [2] Preexisting/concomitant medical condition or [5] Other has been selected in prior item, please specify.
text
Please fill in results for creatinine measurement or indicate if not done in the following item.
integer
Please indicate if creatinine has not been tested for.
boolean
Please enter ONE code (e.g. 1 or 2). If [2] Preexisting/concomitant medical condition or [5] Other, please specify in the following item.
integer
If [2] Preexisting/concomitant medical condition or [5] Other has been selected in prior item, please specify.
text
Haematology
(For visit 2 only: Has a blood sample for haematology been taken at screening visit 1?) If yes, please complete the items below.
boolean
Please complete only if date of collection of blood specimen is different from visit date. (For visit 2 only: Please complete only if date of collection of blood specimen is different from date of screening visit 1.)
date
Please indicate if haemoglobin has not been tested for.
boolean
Please fill in results if haemoglobin has been tested for.
float
Please enter ONE code (e.g. 1 or 2). If [2] Preexisting/concomitant medical condition or [5] Other, please specify in the following item.
integer
If [2] Preexisting/concomitant medical condition or [5] Other has been selected in prior item, please specify.
text
Please indicate if WBC has not been tested for.
boolean
Please fill in results if WBC has been tested for.
float
Please enter ONE code (e.g. 1 or 2). If [2] Preexisting/concomitant medical condition or [5] Other, please specify in the following item.
integer
If [2] Preexisting/concomitant medical condition or [5] Other has been selected in prior item, please specify.
text
Please indicate if creatinine has not been tested for.
boolean
Please fill in results if creatinine has been tested for.
float
Please enter ONE code (e.g. 1 or 2). If [2] Preexisting/concomitant medical condition or [5] Other, please specify in the following item.
integer
If [2] Preexisting/concomitant medical condition or [5] Other has been selected in prior item, please specify.
text
Serology
(For visit 2 only: Has a blood sample for serology been taken at screening visit 1?) If yes, please complete the item below.
boolean
Please complete only if date of collection of blood specimen is different from visit date. (For visit 2 only: Please complete only if date of collection of blood specimen is different from date of screening visit 1.)
date
CMI Sample
(For visit 2 only: Has a blood sample for cellular immunity been taken at screening visit 1?) If yes, please complete the item below.
boolean
Please complete only if date of collection of blood specimen is different from visit date. (For visit 2 only: Please complete only if date of collection of blood specimen is different from date of screening visit 1.)
date