Completion of clinical trial
Item
This clinical trail has been completed according to protocol
boolean
C2732579 (UMLS CUI [1])
Item
If the trial has not been completed according to protocol please specify the reason why
text
C2732579 (UMLS CUI [1])
Code List
If the trial has not been completed according to protocol please specify the reason why
CL Item
adverse effect during dose titration (1)
CL Item
adverse/serious adverse event (2)
CL Item
withdrawal of informed consent (3)
CL Item
comorbidities (4)
CL Item
protocol violation (i.e lack of compliance) (5)
CL Item
private considerations of patient (7)
CL Item
lost to follow up (9)
Completion of clinical trial
Item
Please specify any other reason that caused discontinuation
text
C2732579 (UMLS CUI [1])
Completion of clinical trial
Item
If the patient was lost to follow up, please specify date the patient was last seen
date
C2732579 (UMLS CUI [1])
Item
Participation discontinued by
text
C0457454 (UMLS CUI [1])
Code List
Participation discontinued by
Patient diary
Item
Patient diary part 1-5 has been retrieved from the patient.
boolean
C0018700 (UMLS CUI [1])
Further comments
Item
Further comments
text
C1830770 (UMLS CUI [1])
Confirmation
Item
Confirmatin of investigator: The treatment of this patient during this investigation was under my supervision and according to study protocol. All data and statements in this CRF are complete and correct
boolean
C0750484 (UMLS CUI [1])
Date
Item
Date of completion of this form
date
C0011008 (UMLS CUI [1])
Signature of investigator
Item
Signature of investigator
text
C0807938 (UMLS CUI [1])