trial completed
Item
Has the patient completed the trial regulary
boolean
C0509584 (UMLS CUI[1,1])
fill out
Item
please fill out the following:
text
C1521902 (UMLS CUI [1,1])
early termination
Item
Date of early termination
date
C0011008 (UMLS CUI [1,1])
C2718058 (UMLS CUI [1,2])
Item
Reason for premature end of study:
integer
C0566251 (UMLS CUI [1,1])
C2361259 (UMLS CUI [1,2])
Code List
Reason for premature end of study:
CL Item
Withdrawal of informed consent (1)
C0021430 (UMLS CUI [1,1])
C2349954 (UMLS CUI [1,2])
CL Item
Lost to follow up (2)
C1302313 (UMLS CUI [1,1])
CL Item
Death (3)
C1306577 (UMLS CUI [1,1])
CL Item
Other, please specify: (4)
C1521902 (UMLS CUI [1,1])
specify
Item
please specify
text
C1521902 (UMLS CUI [1,1])
Date death
Item
Date of death
date
C1148348 (UMLS CUI [1,1])
Cause death
Item
Cause of death
string
C0007465 (UMLS CUI [1,1])
Protocol Violations
Item
Were there any protocol violations?
integer
C1709750 (UMLS CUI [1,1])
specify
Item
please specify
string
C1521902 (UMLS CUI [1,1])
SAE
Item
Were there any new serious adverse events since last visit
integer
C0205314 (UMLS CUI [1,1])
C1519255 (UMLS CUI [1,2])
Investigator's Statement
Item
With this electronic signature, I acknowledge that THIS REPORTED eFORM for this patient has been reviewed by me and agree that the data are true and accurate.
date
C2346576 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])