Biochemistry
(For visit 2 only: Has a blood sample for biochemistry been taken at screening visit 1?) If yes, please complete the items below. This item group does not need to be filled in for visit 5.
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
Alanine aminotransferase measurement abnormal reason to 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
Creatinine measurement abnormal reason to specify
text
Please fill in results for bilirubin measurement or indicate if not done in the following item.
float
Please indicate if bilirubin 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
Bilirubin measurement abnormal reason to 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. This item group does not need to be filled in for visit 5.
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 haemoglobin measurement or indicate if not done in the following item.
integer
Please indicate if haemoglobin 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
Haemoglobin measurement abnormal reason to specify
text
Please fill in results for WBC measurement or indicate if not done in the following item.
float
Please indicate if WBC 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
White blood cell count procedure abnormal reason to specify
text
Please fill in results for blood platelets measurement or indicate if not done in the following item.
integer
Please indicate if blood platelets have 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
Blood platelets abnormal reason to 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. This item group does not need to be filled in for visit 3.
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 | B-Cell Memory
(For visit 2 only: Has a blood sample been taken for CMI / B-Cell Memory testing at Screening - Visit 1?) If yes, please complete the item below. This item group does not need to be filled in for visit 3.
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