ID

41345

Description

Study ID: 105043/013 Clinical Study ID: 105043/013 Study Title: An Open-Label Study of Argatroban Injection to Evaluate the Safety and Effectiveness in Pediatric Patients Requiring Anticoagulant Alternatives to Heparin (Protocol SKF105043/013) Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00039858 Sponsor: GlaxoSmithKline Collaborators: Encysive Pharmaceuticals Phase: Phase 4 Study Recruitment Status: Completed Generic Name: Argatroban Trade Name: N/A Study Indication: Thrombosis This Study evaluates the safety and the efficacy of i.v. Argatroban treatment in paediatric patients which require anticoagulants but aren't suitable for Heparin treatment. The study consists of screening visit (pre-treatment examination), treatment period of maximum 14 days after reaching therapeutical dose, post-treatment visit (once the treatment is stopped or after 14 days) and a follow-up visit which follows 30 days (+/- 14 days) after clinical resolution of underlying condition or after the end of the 14-day study period. Treatment can be continued after the 14-day study period if needed but such treatment isn't part of this Study. See https://clinicaltrials.gov/ct2/show/NCT00039858 This Form has to be filled in at the screening visit after the Investigator decides whether Patient should be enrolled into the Study. Please fax GSK immediately after a patient is enrolled or failed the screen. Use the fax form provided. (fax form not included in CRF)

Link

https://clinicaltrials.gov/ct2/show/NCT00039858

Keywords

  1. 8/31/20 8/31/20 -
  2. 9/2/20 9/2/20 -
Copyright Holder

GlaxoSmithKline

Uploaded on

September 2, 2020

DOI

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License

Creative Commons BY-NC 4.0

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Safety and Efficacy of Argatroban in Pediatric Patients, NCT00039858

Patient Enrollment / Screen Failure

Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Description

Study centre number

Data type

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Description

patient ID

Data type

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Description

visit date

Data type

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Description

Investigator Name

Data type

text

Alias
UMLS CUI [1]
C2826892
Patient Enrollment / Screen Failure
Description

Patient Enrollment / Screen Failure

Alias
UMLS CUI-1
C4041024
UMLS CUI-2
C1710476
Has the patient been enrolled into the study for Argatroban administration?
Description

*If No, check reason for patient not being enrolled into study:

Data type

text

Alias
UMLS CUI [1,1]
C2348568
UMLS CUI [1,2]
C1516879
UMLS CUI [1,3]
C0048470
Patient did not meet one or more of the inclusion/exclusion criteria
Description

Eligibility Criteria not met

Data type

boolean

Alias
UMLS CUI [1,1]
C1516637
UMLS CUI [1,2]
C0231175
Patient’s age stratification group is full
Description

Age stratification group full

Data type

boolean

Alias
UMLS CUI [1,1]
C0441833
UMLS CUI [1,2]
C1514983
UMLS CUI [1,3]
C0001779
UMLS CUI [1,4]
C0443225
Patient and/or guardian withdrew consent
Description

Consent withdrawal

Data type

boolean

Alias
UMLS CUI [1]
C1707492
Other
Description

Other reason of screen failure

Data type

boolean

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0205394
Other, specify:
Description

Other reason of screen failure - specification

Data type

text

Alias
UMLS CUI [1,1]
C1710476
UMLS CUI [1,2]
C0566251
UMLS CUI [1,3]
C0205394
UMLS CUI [1,4]
C1521902

Similar models

Patient Enrollment / Screen Failure

Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Item Group
Patient Enrollment / Screen Failure
C4041024 (UMLS CUI-1)
C1710476 (UMLS CUI-2)
Item
Has the patient been enrolled into the study for Argatroban administration?
text
C2348568 (UMLS CUI [1,1])
C1516879 (UMLS CUI [1,2])
C0048470 (UMLS CUI [1,3])
Code List
Has the patient been enrolled into the study for Argatroban administration?
CL Item
Yes (Yes)
CL Item
No* (No*)
Eligibility Criteria not met
Item
Patient did not meet one or more of the inclusion/exclusion criteria
boolean
C1516637 (UMLS CUI [1,1])
C0231175 (UMLS CUI [1,2])
Age stratification group full
Item
Patient’s age stratification group is full
boolean
C0441833 (UMLS CUI [1,1])
C1514983 (UMLS CUI [1,2])
C0001779 (UMLS CUI [1,3])
C0443225 (UMLS CUI [1,4])
Consent withdrawal
Item
Patient and/or guardian withdrew consent
boolean
C1707492 (UMLS CUI [1])
Other reason of screen failure
Item
Other
boolean
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Other reason of screen failure - specification
Item
Other, specify:
text
C1710476 (UMLS CUI [1,1])
C0566251 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C1521902 (UMLS CUI [1,4])

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