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Visit 10 (Week 72): Vital Signs/Physical Examination BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

1 Formulare  
Subject Identification
Beschreibung

Subject Identification

Number of Facility
Beschreibung

Site number

Datentyp

integer

Alias
UMLS CUI [1]
C2826711
Subject number
Beschreibung

Subject number

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials
Beschreibung

Subject Initials

Datentyp

text

Alias
UMLS CUI [1]
C2986440
Vital Signs
Beschreibung

Vital Signs

Date of examination
Beschreibung

Date of examination

Datentyp

date

Alias
UMLS CUI [1]
C2826643
Blood Pressure
Beschreibung

Blood Pressure

Datentyp

text

Alias
UMLS CUI [1]
C0005823
Pulse
Beschreibung

Pulse

Datentyp

integer

Maßeinheiten
  • bpm
Alias
UMLS CUI [1]
C0232117
bpm
Temperature
Beschreibung

Temperature

Datentyp

float

Maßeinheiten
  • °C
Alias
UMLS CUI [1]
C0005903
°C
Weight
Beschreibung

Weight

Datentyp

float

Maßeinheiten
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Physical examination
Beschreibung

Physical examination

Body System
Beschreibung

Body System

Datentyp

integer

Alias
UMLS CUI [1]
C0460002
Examination Status
Beschreibung

Examination Status

Datentyp

integer

Alias
UMLS CUI [1]
C3267137
Abnormal examination findings
Beschreibung

physical examination findings

Datentyp

text

Alias
UMLS CUI [1]
C2826636
EDSS Evaluation
Beschreibung

EDSS Evaluation

Date of Evaluation
Beschreibung

EDSS Date

Datentyp

date

Alias
UMLS CUI [1,1]
C0451246
UMLS CUI [1,2]
C0011008
Functional System Scores
Beschreibung

Functional System Scores

Visual
Beschreibung

Visual System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0042789
UMLS CUI [1,2]
C0451246
Brinstem
Beschreibung

Brainstem System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0451246
UMLS CUI [1,2]
C0006121
Pyramidal
Beschreibung

Pyramidal System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0228060
UMLS CUI [1,2]
C0451246
Cerebellar
Beschreibung

Cerebellar System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0007765
UMLS CUI [1,2]
C0451246
Sensory
Beschreibung

Sensory System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0682648
UMLS CUI [1,2]
C0451246
Bowel or Bladder
Beschreibung

Bowel or Bladder System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0451246
UMLS CUI [1,2]
C2707247
Cerebral
Beschreibung

Cerebral System EDSS

Datentyp

text

Alias
UMLS CUI [1,1]
C0006104
UMLS CUI [1,2]
C0451246
Additional and Results
Beschreibung

Additional and Results

Actual Distance Walked
Beschreibung

type the number that indicates the furthest distance the subject is able to walk without aid or rest

Datentyp

text

Alias
UMLS CUI [1]
C0429886
Actual Distance Walked
Beschreibung

type the number that indicates the furthest distance the subject is able to walk without aid or rest

Datentyp

integer

Alias
UMLS CUI [1]
C0429886
EDSS Score
Beschreibung

EDSS score

Datentyp

float

Alias
UMLS CUI [1]
C0451246
Name of Neurologist
Beschreibung

Name of Neurologist

Datentyp

text

Alias
UMLS CUI [1,1]
C0237426
UMLS CUI [1,2]
C0027365
Visual Function Test
Beschreibung

Visual Function Test

Date of Evaluation
Beschreibung

Visual Function test, date

Datentyp

date

Alias
UMLS CUI [1,1]
C0234621
UMLS CUI [1,2]
C0392366
UMLS CUI [1,3]
C0011008
Contrast Sensitivity Evaluation Binocular
Beschreibung

Contrast Sensitivity Evaluation Binocular

100% Chart, Total # Correct
Beschreibung

Contrast Sensitivity Evaluation Binocular: 100% Chart, Total # Correct

Datentyp

float

Alias
UMLS CUI [1,1]
C0009928
UMLS CUI [1,2]
C0042794
2,5% Chart, Total # Correct
Beschreibung

Contrast Sensitivity Evaluation Binocular: 2,5% Chart, Total # Correct

Datentyp

float

Alias
UMLS CUI [1,1]
C0009928
UMLS CUI [1,2]
C0042794
1,25% Chart, Total # Correct
Beschreibung

Contrast Sensitivity Evaluation Binocular: 1,25% Chart, Total # Correct

Datentyp

float

Alias
UMLS CUI [1,1]
C0009928
UMLS CUI [1,2]
C0042794
Snellen visual acuity equivalent
Beschreibung

Contrast Sensitivity Evaluation Binocular: Snellen visual acuity equivalent

Datentyp

text

Alias
UMLS CUI [1,1]
C0009928
UMLS CUI [1,2]
C0042794
Study Drug Accountability
Beschreibung

Study Drug Accountability

date of first dose
Beschreibung

first dose date

Datentyp

date

Alias
UMLS CUI [1]
C3173309
Number of capsules not taken since previous visit to this visit
Beschreibung

number of capsules not taken

Datentyp

integer

Alias
UMLS CUI [1,1]
C1705492
UMLS CUI [1,2]
C0178602
Was there a protocol-defined dose reduction/interruption since the previous visit?
Beschreibung

If no, please specify on the appropriate adverse events form

Datentyp

boolean

Alias
UMLS CUI [1]
C1707814
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Ähnliche Modelle

Visit 10 (Week 72): Vital Signs/Physical Examination BG00012 Monotherapy Safety and Efficacy Extension Study in Multiple Sclerosis (MS) (ENDORSE) NCT00835770

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Subject Identification
Site number
Item
Number of Facility
integer
C2826711 (UMLS CUI [1])
Subject number
Item
Subject number
integer
C2348585 (UMLS CUI [1])
Subject Initials
Item
Subject Initials
text
C2986440 (UMLS CUI [1])
Item Group
Vital Signs
Date of examination
Item
Date of examination
date
C2826643 (UMLS CUI [1])
Blood Pressure
Item
Blood Pressure
text
C0005823 (UMLS CUI [1])
Pulse
Item
Pulse
integer
C0232117 (UMLS CUI [1])
Temperature
Item
Temperature
float
C0005903 (UMLS CUI [1])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Item Group
Physical examination
Item
Body System
integer
C0460002 (UMLS CUI [1])
Body System
Code List
Body System
CL Item
Skin (1)
C1123023 (UMLS CUI-1)
(Comment:en)
CL Item
HEENT  (2)
C1512338 (UMLS CUI-1)
(Comment:en)
CL Item
Lymph nodes (3)
C0024204 (UMLS CUI-1)
(Comment:en)
CL Item
Neck and Thyroid  (4)
C0027530 (UMLS CUI-1)
C0040132 (UMLS CUI-2)
(Comment:en)
CL Item
Breasts (5)
C0006141 (UMLS CUI-1)
(Comment:en)
CL Item
Chest/Lungs (6)
C0817096 (UMLS CUI-1)
C0024109 (UMLS CUI-2)
(Comment:en)
CL Item
Heart  (7)
C0018787 (UMLS CUI-1)
(Comment:en)
CL Item
Vascular (8)
C1801960 (UMLS CUI-1)
(Comment:en)
CL Item
Abdomen (9)
C0000726 (UMLS CUI-1)
(Comment:en)
CL Item
Rectal  (10)
C0205052 (UMLS CUI-1)
(Comment:en)
CL Item
Neurological  (11)
CL Item
Extremities/Joints (12)
Item
Examination Status
integer
C3267137 (UMLS CUI [1])
Examination Status
Code List
Examination Status
CL Item
Not done (1)
C1272696 (UMLS CUI-1)
(Comment:en)
CL Item
Normal (2)
C0205307 (UMLS CUI-1)
(Comment:en)
CL Item
Abnormal (please specify) (3)
C0205161 (UMLS CUI-1)
(Comment:en)
physical examination findings
Item
Abnormal examination findings
text
C2826636 (UMLS CUI [1])
Item Group
EDSS Evaluation
EDSS Date
Item
Date of Evaluation
date
C0451246 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Functional System Scores
Visual System EDSS
Item
Visual
text
C0042789 (UMLS CUI [1,1])
C0451246 (UMLS CUI [1,2])
Brainstem System EDSS
Item
Brinstem
text
C0451246 (UMLS CUI [1,1])
C0006121 (UMLS CUI [1,2])
Pyramidal System EDSS
Item
Pyramidal
text
C0228060 (UMLS CUI [1,1])
C0451246 (UMLS CUI [1,2])
Cerebellar System EDSS
Item
Cerebellar
text
C0007765 (UMLS CUI [1,1])
C0451246 (UMLS CUI [1,2])
Sensory System EDSS
Item
Sensory
text
C0682648 (UMLS CUI [1,1])
C0451246 (UMLS CUI [1,2])
Bowel or Bladder System EDSS
Item
Bowel or Bladder
text
C0451246 (UMLS CUI [1,1])
C2707247 (UMLS CUI [1,2])
Cerebral System EDSS
Item
Cerebral
text
C0006104 (UMLS CUI [1,1])
C0451246 (UMLS CUI [1,2])
Item Group
Additional and Results
Item
Actual Distance Walked
text
C0429886 (UMLS CUI [1])
walking distance
Code List
Actual Distance Walked
CL Item
<100 metres (<100 metres)
CL Item
>100 metres and <200 metres (>100 metres and <200 metres)
CL Item
>200 metres and <300 metres (>200 metres and <300 metres)
CL Item
>300 metres and <500 metres (>300 metres and <500 metres)
CL Item
>500 metres (>500 metres)
Item
Actual Distance Walked
integer
C0429886 (UMLS CUI [1])
walking distance
Code List
Actual Distance Walked
CL Item
<100 metres (1)
CL Item
>100 metres and <200 metres (2)
CL Item
>200 metres and <300 metres (3)
CL Item
>300 metres and <500 metres (4)
CL Item
>500 metres (5)
EDSS score
Item
EDSS Score
float
C0451246 (UMLS CUI [1])
Name of Neurologist
Item
Name of Neurologist
text
C0237426 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
Item Group
Visual Function Test
Visual Function test, date
Item
Date of Evaluation
date
C0234621 (UMLS CUI [1,1])
C0392366 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item Group
Contrast Sensitivity Evaluation Binocular
Contrast Sensitivity Evaluation Binocular: 100% Chart, Total # Correct
Item
100% Chart, Total # Correct
float
C0009928 (UMLS CUI [1,1])
C0042794 (UMLS CUI [1,2])
Contrast Sensitivity Evaluation Binocular: 2,5% Chart, Total # Correct
Item
2,5% Chart, Total # Correct
float
C0009928 (UMLS CUI [1,1])
C0042794 (UMLS CUI [1,2])
Contrast Sensitivity Evaluation Binocular: 1,25% Chart, Total # Correct
Item
1,25% Chart, Total # Correct
float
C0009928 (UMLS CUI [1,1])
C0042794 (UMLS CUI [1,2])
Contrast Sensitivity Evaluation Binocular: Snellen visual acuity equivalent
Item
Snellen visual acuity equivalent
text
C0009928 (UMLS CUI [1,1])
C0042794 (UMLS CUI [1,2])
Item Group
Study Drug Accountability
first dose date
Item
date of first dose
date
C3173309 (UMLS CUI [1])
number of capsules not taken
Item
Number of capsules not taken since previous visit to this visit
integer
C1705492 (UMLS CUI [1,1])
C0178602 (UMLS CUI [1,2])
protocol-defined dose reduction/interruption
Item
Was there a protocol-defined dose reduction/interruption since the previous visit?
boolean
C1707814 (UMLS CUI [1])
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