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Effect of GSK958108 on ejaculatory latency time (ELT); NCT00861484 - Logs/Repeats

- 2021-09-27 - 1 Formulär, 12 Item-grupper, 130 Dataelement, 1 Språk
Item-grupper: Date of visit, Assessment Date, Adverse Event; Concomitant Agent; Evaluation, Repeat, Liver, Adverse Event, Non-serious Adverse Event, Serious Adverse Event, Concomitant Agent, Laboratory Procedures, Urinalysis, Vital signs, 12 lead ECG, 12 lead ECG, Abnormality, Repeat, Pharmacokinetic aspect, Blood, Repeat
Study ID: 111155 Clinical Study ID: 111155 Study Title: A double blind, parallel group, placebo controlled study to evaluate the effect of a single oral dose of GSK958108 on ejaculatory latency time (ELT) in male patients suffering from premature ejaculation. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00861484 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: GSK958108 , Placebo Trade Name: N/A Study Indication: Premature Ejaculation

Initial Evaluation Form Prostate Cancer RTOG 1115 I1 NCT01546987

- 2015-07-30 - 1 Formulär, 17 Item-grupper, 157 Dataelement, 1 Språk
Item-grupper: Header Module, Patient Information, OTHER PATIENT DISEASE TYPE, Prostate: Prior Treatment, Prostate: Initial Diagnosis, STUDY ENTRY PSA MEASUREMENTS, PSA, Disease, Chemistry Panel, Liver Panel, Fasting Lipid Panel, CBC with Differential, Hemoglobin A1C (%), Serum Testosterone, Patient Evaluations, Survival, Concomitant Medications
Prostate Cancer Pre-Study RTOG NCT01546987 RTOG 1115 I1: Phase III RT + Standard ADT vs RT + Enhanced ADT + TAK-700 Initial Evaluation Form Hormone Therapy, Radiation Therapy, and Steroid 17alpha-monooxygenase TAK-700 in Treating Patients With High-Risk Prostate Cancer Prostate Cancer NCT01546987 Pre-Study Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AEA3B793-58EB-AE06-E040-BB89AD431781

Study hospital, Medical Faculty Münster- Clinical Examination findings - Clinical Examination findings

- 2016-07-21 - 1 Formulär, 25 Item-grupper, 138 Dataelement, 2 Språk
Item-grupper: Demographics, General Health assessment, Skin assessment, Head assessment, Assessment of Lymph nodes, Eyes, Ears, Nose, Oral cavity, Neck, Thorax, Lungs, Heart, Abdominal Examination, Liver, Spleen, Fibrous capsule of kidney, Rectal examination, Genitalia, Extremities, Vascular status, Neurologic status, Central nervous system, Peripheral nervous system, Diagnosis
Medical history form, Study hospital, Medical Faculty Münster derived from Medical history form by Dr. Schusdziarra

ACNS1123 Eligibility - FP.0000

- 2015-06-02 - 1 Formulär, 11 Item-grupper, 42 Dataelement, 1 Språk
Item-grupper: STRATIFICATION, TUMOR LOCATION Elig - Block 1, TUMOR LOCATION Elig - Block 2, INCLUSION CRITERIA - NGGCT STRATUM 1, INCLUSION CRITERIA - Germinoma STRATUM 2, ORGAN FUNCTION REQUIREMENT - Bone Marrow Function, ORGAN FUNCTION REQUIREMENT - Renal Function, ORGAN FUNCTION REQUIREMENT - Liver Function, CENTRAL NERVOUS SYSTEM FUNCTION, EXCLUSION CRITERIA, REGULATORY
ACNS1123 Eligibility Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=

Response - Non-Hodgkins Lymphoma - Follow-Up Disease Assessment Form - 2270621v3.0 - Non-Hodgkins Lymphoma - Follow-Up Disease Assessment Form

- 2015-01-09 - 1 Formulär, 10 Item-grupper, 88 Dataelement, 1 Språk
Item-grupper: CRF Header, Lymphoma: Form Administration, Lymphoma: Dominant Node Response, Lymphoma: Nondominant Lesion Response, Lymphoma: Measurable Hepatic/Splenic Nodule Response, Lymphoma: Non-Measurable Lesion Response, Lymphoma: New Lesions, Lymphoma: Bone Marrow, Liver and Spleen Response Assessment, Non-Hodgkin's Lymphoma: Biochemical and B Symptoms, Non-Hodgkin's Lymphoma: Response Assessment
Non-Hodgkin's Lymphoma - Follow-Up Disease Assessment Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D5EC0BF1-C6F3-750B-E034-0003BA12F5E7

NINDS CDE Fasting information and Laboratory tests Amyotrophic Lateral Sclerosis - Fasting information and Laboratory tests

- 2016-04-04 - 1 Formulär, 15 Item-grupper, 568 Dataelement, 1 Språk
Item-grupper: Fasting Information, Laboratory Tests Information, Complete Blood Count Laboratory Tests, Chemistry Laboratory Tests, Electrolyte Laboratory Tests, Blood Gasses, Liver Function Laboratory Tests, Lipid Laboratory Tests, Autoimmune Laboratory Tests, Clotting Laboratory Tests, Endocrine Laboratory Tests, Cerebrospinal Fluid (CSF) Laboratory Tests, Pregnancy Tests, Urinalysis Tests, Urine Chemistry Tests
NINDS Common Data Elements (Fasting information and Laboratory tests Amyotrophic Lateral Sclerosis) Used from the National Institute of Neurological Disorders and Stroke Common Data Elements (https://www.commondataelements.ninds.nih.gov/) References: Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-9.

GSK1034702 after Repeat Doses in Healthy Subjects; NCT00950586 - Logs and Repeats

- 2021-09-20 - 1 Formulär, 16 Item-grupper, 156 Dataelement, 1 Språk
Item-grupper: Date of visit, Assessment Date, Adverse Event; Concomitant Agent; Evaluation, Repeat, Liver, Adverse Event, Non-serious Adverse Event, Serious Adverse Event, Concomitant Agent, Laboratory Procedures, Vital signs, Pharmacokinetic aspect, Blood, Repeat, Pulmonary function tests, Repeat, Holter Electrocardiography, Repeat, Holter Electrocardiography, Abnormality, Repeat, Telemetry, Repeat, Telemetry, Abnormality, Repeat, 12 lead ECG, Abnormality, Repeat, 12 lead ECG
Study ID: 110792 Clinical Study ID: 110792 Study Title: A placebo-controlled, single-blind, randomised study to investigate the safety, tolerability, pharmacokinetics and drug interaction of GSK1034702 after repeat doses in healthy subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00950586 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 1 Study Recruitment Status: Completed Generic Name: Dextromethorphan, Placebo Trade Name: N/A Study Indication: Cognitive Disorders

Hematopoietic Stem Cell Transplantation - Post-HSCT Data (100 Days) 2100 Revision 2

- 2021-09-20 - 1 Formulär, 24 Item-grupper, 397 Dataelement, 1 Språk
Item-grupper: Registry Use Only, Identification Data, HSCT Type, Vital Status, Hematopoietic Reconstitution, Granulopoiesis / Neutrophil Recovery, Megakaryopoiesis / Platelet Recovery, Hematology findings, Immune Reconstitution, Chimerism analysis post transplantation, Chimerism Studies - Single Donor, Chimerism Studies - Multiple Donors, Engraftment Syndrome, Acute GVHD, Chronic GVHD, Infection, Pulmonary Function, Liver, Other Organ Impairment, New malignancy, Functional Status, Subsequent HSCT, Donor Cellular Infusion, Author Information
2100 Revision 2 - 100 Days Post-HSCT Data Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=9FB3D5BF-EA64-EEEB-E040-BB89AD4331BD

Safety, tolerability and pharmacokinetics of single, ascending and twice-daily repeat doses of intranasal SB-705498 NCT00907933 - Logs/ Repeats - Logs and Repeats; Non- Serious Adverse Events; Serious Adverse Events; Concomitant Medication; Electronically Transferred Lab Data; Vital Signs

- 2019-10-28 - 1 Formulär, 15 Item-grupper, 122 Dataelement, 1 Språk
Item-grupper: Logs and Repeats, Logs and Repeats - Adverse event/ Concomitant Medication/ Repeat Assessment Check Questions, Liver event, Non-serious Adverse Event (AE), Serious Adverse Events (SAE), Serious Adverse Event - Concomitant Medication, Serious Adverse Event - Medical Conditions/ Risk Factors, Serious Adverse Events - Relevant diagnostic results, Serious Adverse Events - Investigational Products, Serious Adverse Events - General narrative comments, Serious Adverse Events - Non clinical, Concomitant Medication, Electronically Transferred Lab Data, Electronically Transferred Steroid Hormone Lab Data, Vital signs
Study ID: 111610 Clinical Study ID: 111610 Study Title: A randomised, double-blind, placebo-controlled study in healthy volunteers to examine the safety, tolerability and pharmacokinetics of a) single, ascending and b) twice-daily repeat doses of intranasal SB-705498. Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00907933 Sponsor: GlaxoSmithKline Phase: Phase 1 Study Recruitment Status: Completed Generic Name: SB705498, Placebo Study Indication: Rhinitis

GLOBAL HEALING CENTER - General Health Questionnaire

- 2017-02-01 - 1 Formulär, 16 Item-grupper, 178 Dataelement, 1 Språk
Item-grupper: Overall wellbeing, Do You Have Chronic Inflammation in Your Body?, Poor Nutrition and Lifestyle, Do You Have Abnormal Blood Sugar Levels? Are You Pre-Diabetic or At Risk?, Do You Have Impaired Cellular/Mitochondrial Function?, Exposure to Toxins: Is Your Detoxification Capacity Impaired?, Is Your Home and/or Work Environment Toxic?, Impaired Immune System: What is the Quality of Your Immune System Function?, Is Your Liver Impaired by Your Emotions?, Are Your Kidney and Urinary Systems Functioning Properly?, Do You Have Parasites, Viruses, Fungi, or other Microbes Inside Your Body?, Hormonal Imbalance: Are Your Adrenal Glands Functioning Properly?, Is Your Thyroid Imbalanced?, Are Your Sex Hormones Reduced in Production or Quality?, FOR WOMEN - Is Your Body Out of Balance?, FOR MEN - Is Your Body Out of Balance?
GLOBAL HEALING CENTER - LIVE HEALTHY|General Health Questionnaire Note — This General Health Questionnaire is not intended to diagnose, treat, cure or prevent any disease. No statements herein have been evaluated by the FDA nor is any endorsement thereof implied or given. We advise use of this Questionnaire simply as a starting point for consideration of any negative health symptoms you may be experiencing and potential preventative measures or as a resource for further discussion with your healthcare provider. http://www.globalhealingcenter.com/general-health-questionnaire.html

Clinical activity of recMAGE-A3 + AS15 in patients with metastatic cutaneous melanoma NCT00942162 - IMD Report - Idiopathic Thrombocytopenic Purpura; Pernicious Anaemia; Vasculitis (Report Final and Annex Report 2 Final)

- 2020-11-03 - 1 Formulär, 25 Item-grupper, 91 Dataelement, 1 Språk
Item-grupper: Administrative, Idiopathic Thrombocytopenic Purpura, Idiopathic Thrombocytopenic Purpura - Signs and Symptoms, Idiopathic Thrombocytopenic Purpura - Other signs and symptoms, Idiopathic Thrombocytopenic Purpura - Other signs and symptoms , Idiopathic Thrombocytopenic Purpura - Diagnostic Test Results, Idiopathic Thrombocytopenic Purpura - Other Diagnostic Test Results , Idiopathic Thrombocytopenic Purpura - Other Diagnostic Test Results , Idiopathic Thrombocytopenic Purpura - Other diagnostic Procedure, Pernicious Anaemia, Pernicious Anaemia - Signs and symptoms, Pernicious Anaemia - Other Signs and symptoms, Pernicious Anaemia - Other Signs and symptoms , Pernicious Anaemia - Diagnostic Test Results, Pernicious Anaemia - Other Diagnostic Test Results , Pernicious Anaemia - Other Diagnostic Test Results , Pernicious Anaemia - Other diagnostic Procedure , Vasculitis, Vasculitis - Signs and symptoms, Vasculitis - Other Signs and symptoms , Vasculitis - Other Signs and symptoms , Vasculitis - Diagnostic Test Results , Vasculitis - Other Diagnostic Test Results , Vasculitis - Other Diagnostic Test Results (i.e. Serological viral hepatic tests, Serological liver enzymes), Vasculitis - Other diagnostic Procedure
Study ID: 111476 Clinical Study ID: 111476 Study Title: An open, single-arm trial to assess the clinical activity of recMAGE-A3 + AS15 in patients with unresectable MAGE-A3-positive metastatic cutaneous melanoma Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00942162 Sponsor: GlaxoSmithKline Phase: Phase 2 Study Recruitment Status: Completed Generic Name: Antigen-Specific Cancer Immunotherapeutic Study Indication: Melanoma

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