ID

44401

Descrição

https://www.gsk-clinicalstudyregister.com/study/102886/003?search=study&study_ids=102886#csr Study ID : 102886/003 Clinical Study ID : 102886/003 Study Title :Safety, tolerance and preliminary pharmacokinetics of single ascending intravenous doses of halofantrine [SK&F 102886] in healthy male volunteers. Clinicaltrials.gov Identifier : Sponsor : GlaxoSmithKline Collaborators :N/A Phase :N/A Study Recruitment Status :Completed Generic Name :halofantrine Trade Name :Halfan Study Indication Malaria

Link

https://www.gsk-clinicalstudyregister.com/study/102886/003?search=study&study_ids=102886#csr

Palavras-chave

  1. 05/06/2018 05/06/2018 - Halim Ugurlu
  2. 20/09/2021 20/09/2021 -
Titular dos direitos

GlaxoSmithKline (GSK)

Transferido a

20 de setembro de 2021

DOI

Para um pedido faça login.

Licença

Creative Commons BY-NC 3.0

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Safety, tolerance and preliminary pharmacokinetics of single ascending intravenous doses of halofantrine [SK&F 102886] in healthy male volunteers.

Administration, demographics, inclusion criteria, exclusion criteria, infusion details, ecg, alcohol/drug screening, baseline/advers events

Administration
Descrição

Administration

Alias
UMLS CUI-1
C1320722
Vol. No.
Descrição

Vol. No.

Tipo de dados

text

Alias
UMLS CUI [1]
C2348585
Panel ID.
Descrição

Panel ID.

Tipo de dados

text

Alias
UMLS CUI [1]
C3846158
Study Period
Descrição

Study Period

Tipo de dados

text

Alias
UMLS CUI [1]
C2347804
Date and Time
Descrição

Date and Time

Tipo de dados

datetime

Alias
UMLS CUI [1]
C1264639
Demographic Details
Descrição

Demographic Details

Alias
UMLS CUI-1
C0011298
UMLS CUI-2
C1522508
Date of Birth
Descrição

Date of Birth

Tipo de dados

date

Alias
UMLS CUI [1]
C0421451
Race
Descrição

Race

Tipo de dados

integer

Alias
UMLS CUI [1]
C0034510
Height
Descrição

Height

Tipo de dados

float

Unidades de medida
  • metres
Alias
UMLS CUI [1]
C0005890
metres
Weight
Descrição

Weight

Tipo de dados

float

Unidades de medida
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Volunteer Inclusion Criteria
Descrição

Volunteer Inclusion Criteria

Alias
UMLS CUI-1
C1512693
Is the volunteer aged between 21 and 39 years?
Descrição

Age

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0001779
Has the volunteer passed a compherensive pre-study medical examination during the week prior to the start of each study section, including: -medical history -clinical examination -electrocardiography (12 leads) -blood pressure -weight and height determination -pulmonary function test -haematological, clinical chemistry examinations, urinalysis and drug screening?
Descrição

compherensive pre-study medical examination

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0031809
Recorder's initials
Descrição

Recorder's initials

Tipo de dados

text

Alias
UMLS CUI [1]
C2986440
date
Descrição

date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Study director
Descrição

Study director

Tipo de dados

text

Alias
UMLS CUI [1]
C0025081
date
Descrição

date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Volunteer Exclusion Criteria
Descrição

Volunteer Exclusion Criteria

Alias
UMLS CUI-1
C0680251
Does the volunteer have pathological findings in any of the investigations stated in the Inclusion Criteria?
Descrição

pathological findings

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0205469
UMLS CUI [1,2]
C0243095
Is the volunteer currently receiving, or taken within the previous 7 days prior to dosing, any other medicine (prescribed or over-the-counter drugs) ?
Descrição

receiving medicine

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C2826257
UMLS CUI [1,2]
C2347852
Has the volunteer received a research drug within the last 8 weeks (i.e, a compound which has not been granted a product licence) ?
Descrição

received a research drug

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0013230
UMLS CUI [1,2]
C1514756
Is the volunteer known to practice alcohol abuse and/or have taken drugs of abuse (e.g. as shown by a positive finding in the drug screen) ?
Descrição

alcohol abuse and/or have taken drugs of abuse

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0085762
UMLS CUI [2]
C0038586
Has the volunteer weight/height ratio deviations of more than 25% from the average (the average may be calculated by expressing the height above 100 m as a figure expressed in kg (Broca Formula) )
Descrição

weight/height ratio deviations

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0005890
UMLS CUI [1,2]
C0005910
Does the volunteer have a known or suspected allergic status?
Descrição

allergic status

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0018759
UMLS CUI [1,2]
C0155877
UMLS CUI [1,3]
C1527304
Does the volunteer have a history of psychiatric disorders, epilepsy or seizures?
Descrição

history of psychiatric disorders, epilepsy or seizures

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0004936
UMLS CUI [1,3]
C0036572
UMLS CUI [1,4]
C0014544
Has the volunteer taken anti-malarial frugs within the last 12 months?
Descrição

anti-malarial frugs within the last 12 months

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0003374
Infusion Details
Descrição

Infusion Details

Alias
UMLS CUI-1
C0574032
UMLS CUI-2
C1522508
Date of infusion
Descrição

Date of infusion

Tipo de dados

date

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0011008
Time commenced
Descrição

Time commenced

Tipo de dados

time

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0451613
Time completed
Descrição

Time completed

Tipo de dados

time

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0205197
UMLS CUI [1,3]
C1522314
Duration of infusion
Descrição

Duration of infusion

Tipo de dados

integer

Unidades de medida
  • mins
Alias
UMLS CUI [1,1]
C0444921
UMLS CUI [1,2]
C0574032
mins
Volunteer weight on Day-1
Descrição

Volunteer weight on Day-1

Tipo de dados

float

Unidades de medida
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Volume of infusion
Descrição

Volume of infusion

Tipo de dados

integer

Unidades de medida
  • mls
Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0449468
mls
Dose checked and administred by
Descrição

Dose checked and administred by

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0178602
UMLS CUI [1,2]
C0574032
ECG-Arrhythmia
Descrição

ECG-Arrhythmia

Alias
UMLS CUI-1
C1623258
UMLS CUI-2
C0003811
Time Relative to start of infusion
Descrição

Time Relative to start of infusion

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0439659
UMLS CUI [1,3]
C0040223
Actual Time
Descrição

Actual Time

Tipo de dados

time

Alias
UMLS CUI [1]
C0040223
Couplets (per time inverval)
Descrição

Couplets (per time inverval)

Tipo de dados

text

Alias
UMLS CUI [1]
C0429001
Bigeminus (per time interval)
Descrição

Bigeminus

Tipo de dados

text

Alias
UMLS CUI [1]
C0262662
EVPB (per time interval)
Descrição

EVPB (per time interval)

Tipo de dados

text

Alias
UMLS CUI [1]
C0151636
VPB (per time interval)
Descrição

VPB

Tipo de dados

text

Alias
UMLS CUI [1]
C0865677
initials
Descrição

initials

Tipo de dados

text

Alias
UMLS CUI [1]
C2986440
Electrocardiography
Descrição

Electrocardiography

Alias
UMLS CUI-1
C1623258
Were there any ECG recordings carried out?
Descrição

ECG recordings carried out

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1623258
Electrocardiography
Descrição

Electrocardiography

Alias
UMLS CUI-1
C1623258
Time relative to start of infusion
Descrição

Time relative to start of infusion

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0574032
UMLS CUI [1,2]
C0439659
UMLS CUI [1,3]
C0040223
Date and time taken
Descrição

Date and time taken

Tipo de dados

datetime

Alias
UMLS CUI [1]
C0011008
Is the ECG normal
Descrição

ECG normal

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0522054
Any changes
Descrição

Any changes

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0855329
Comments
Descrição

Comments

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Initials
Descrição

Initials

Tipo de dados

text

Alias
UMLS CUI [1]
C2986440
date
Descrição

date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Alcohol Screening (Blow test)
Descrição

Alcohol Screening (Blow test)

Alias
UMLS CUI-1
C0202306
Study time relevant to dose
Descrição

Study time relevant to dose

Tipo de dados

integer

Alias
UMLS CUI [1]
C0439564
Date and time sample taken
Descrição

Date and time sample taken

Tipo de dados

datetime

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0040223
UMLS CUI [1,3]
C0200345
Was there any alcohol detected?
Descrição

any alcohol detected

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0202306
initials
Descrição

initials

Tipo de dados

text

Alias
UMLS CUI [1]
C2986440
Drug Screening (Urine)
Descrição

Drug Screening (Urine)

Alias
UMLS CUI-1
C0202274
Day/hr relative to dose
Descrição

Day/hr relative to dose

Tipo de dados

integer

Alias
UMLS CUI [1]
C0439564
Date and time sample taken
Descrição

Date and time sample taken

Tipo de dados

datetime

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0040223
UMLS CUI [1,3]
C0200345
Were there any Drugs detected?
Descrição

Drugs detected

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C1511790
UMLS CUI [1,2]
C1254351
Type of drug/compound found
Descrição

Type of drug/compound found

Tipo de dados

text

Alias
UMLS CUI [1]
C0457591
Contra indicated?
Descrição

Contra indicated?

Tipo de dados

boolean

Alias
UMLS CUI [1]
C1301624
Initials Lab
Descrição

Initials Lab

Tipo de dados

text

Alias
UMLS CUI [1]
C0022877
Initials Physician
Descrição

Initials Physician

Tipo de dados

text

Alias
UMLS CUI [1,1]
C2986440
UMLS CUI [1,2]
C2826892
Comments
Descrição

Comments

Tipo de dados

text

Alias
UMLS CUI [1]
C0947611
Baseline Events
Descrição

Baseline Events

Alias
UMLS CUI-1
C1442488
UMLS CUI-2
C0877248
Have you felt different in any way over the last few days?
Descrição

Record baseline event observed or elicited by the following direct question to the subject:

Tipo de dados

boolean

Alias
UMLS CUI [1]
C0559546
Baseline Events
Descrição

Baseline Events

Alias
UMLS CUI-1
C1442488
UMLS CUI-2
C0877248
ADECS Code
Descrição

ADECS Code

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0805701
UMLS CUI [1,2]
C0600091
Event Observed (describe)
Descrição

Event Observed (describe)

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0947611
Onset date and time
Descrição

Onset date and time

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2826806
End date and time
Descrição

End date and time

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2826793
Event duration
Descrição

hours and minutes

Tipo de dados

text

Alias
UMLS CUI [1]
C0449238
Intensity
Descrição

Intensity

Tipo de dados

integer

Alias
UMLS CUI [1]
C1710066
Event Course
Descrição

Event Course

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0750729
Outcome of Event
Descrição

Outcome of Event

Tipo de dados

integer

Alias
UMLS CUI [1]
C1705586
Recorder's signature
Descrição

Recorder's signature

Tipo de dados

text

Alias
UMLS CUI [1,1]
C1519316
UMLS CUI [1,2]
C0035173
Date
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Study Director's Signature
Descrição

Study Director's Signature

Tipo de dados

text

Alias
UMLS CUI [1]
C2346576
Date
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Adverse Event
Descrição

Adverse Event

Alias
UMLS CUI-1
C0877248
Do you feel different in any way since starting the new treatment or since the last visit?
Descrição

Record any adverse event observed or elicited by the following direct question to the patient:

Tipo de dados

boolean

Alias
UMLS CUI [1,1]
C0559546
UMLS CUI [1,2]
C0877248
Adverse Events
Descrição

Adverse Events

Alias
UMLS CUI-1
C0877248
ADECS Code
Descrição

ADECS Code

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0805701
UMLS CUI [1,2]
C0600091
Event observed (describe)
Descrição

Event observed (describe)

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0947611
Onset date and time
Descrição

Onset date and time

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2985916
Intensity
Descrição

Intensity

Tipo de dados

integer

Alias
UMLS CUI [1]
C1710066
Outcome
Descrição

Outcome

Tipo de dados

integer

Alias
UMLS CUI [1]
C1705586
Event course
Descrição

Event course

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0750729
End date and time
Descrição

End date and time

Tipo de dados

datetime

Alias
UMLS CUI [1]
C2826793
Event (or severity) duration
Descrição

hours and minutes

Tipo de dados

text

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0449238
Relation to investigational drug
Descrição

Relation to investigational drug

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0877248
UMLS CUI [1,2]
C0013230
UMLS CUI [1,3]
C0439849
Present before or at baseline assessment?
Descrição

Present before or at baseline assessment

Tipo de dados

integer

Alias
UMLS CUI [1,1]
C0011900
UMLS CUI [1,2]
C1444637
Action taken (on study drug dosage)
Descrição

*Please inform study monitor

Tipo de dados

integer

Alias
UMLS CUI [1]
C2826626
Outcome of event (select more than one if necessary)
Descrição

*Please inform study monitor **Treatment given to alleviate any adverse event must be entered on Concominant Medication form.

Tipo de dados

integer

Alias
UMLS CUI [1]
C1705586
Recorder's initials
Descrição

Recorder's initials

Tipo de dados

text

Alias
UMLS CUI [1]
C2986440
Date
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008
Study Director
Descrição

Study Director

Tipo de dados

text

Alias
UMLS CUI [1]
C0025081
Date
Descrição

Date

Tipo de dados

date

Alias
UMLS CUI [1]
C0011008

Similar models

Administration, demographics, inclusion criteria, exclusion criteria, infusion details, ecg, alcohol/drug screening, baseline/advers events

Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
Item Group
Administration
C1320722 (UMLS CUI-1)
Vol. No.
Item
Vol. No.
text
C2348585 (UMLS CUI [1])
Panel ID.
Item
Panel ID.
text
C3846158 (UMLS CUI [1])
Study Period
Item
Study Period
text
C2347804 (UMLS CUI [1])
Date and Time
Item
Date and Time
datetime
C1264639 (UMLS CUI [1])
Item Group
Demographic Details
C0011298 (UMLS CUI-1)
C1522508 (UMLS CUI-2)
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Race
integer
C0034510 (UMLS CUI [1])
Code List
Race
CL Item
Caucasian/European (1)
CL Item
Asian (2)
CL Item
Black (3)
CL Item
Oriental (4)
CL Item
Other, please specify (5)
Height
Item
Height
float
C0005890 (UMLS CUI [1])
Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Item Group
Volunteer Inclusion Criteria
C1512693 (UMLS CUI-1)
Age
Item
Is the volunteer aged between 21 and 39 years?
boolean
C0001779 (UMLS CUI [1])
compherensive pre-study medical examination
Item
Has the volunteer passed a compherensive pre-study medical examination during the week prior to the start of each study section, including: -medical history -clinical examination -electrocardiography (12 leads) -blood pressure -weight and height determination -pulmonary function test -haematological, clinical chemistry examinations, urinalysis and drug screening?
boolean
C0262926 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Recorder's initials
Item
Recorder's initials
text
C2986440 (UMLS CUI [1])
date
Item
date
date
C0011008 (UMLS CUI [1])
Study director
Item
Study director
text
C0025081 (UMLS CUI [1])
date
Item
date
date
C0011008 (UMLS CUI [1])
Item Group
Volunteer Exclusion Criteria
C0680251 (UMLS CUI-1)
pathological findings
Item
Does the volunteer have pathological findings in any of the investigations stated in the Inclusion Criteria?
boolean
C0205469 (UMLS CUI [1,1])
C0243095 (UMLS CUI [1,2])
receiving medicine
Item
Is the volunteer currently receiving, or taken within the previous 7 days prior to dosing, any other medicine (prescribed or over-the-counter drugs) ?
boolean
C2826257 (UMLS CUI [1,1])
C2347852 (UMLS CUI [1,2])
received a research drug
Item
Has the volunteer received a research drug within the last 8 weeks (i.e, a compound which has not been granted a product licence) ?
boolean
C0013230 (UMLS CUI [1,1])
C1514756 (UMLS CUI [1,2])
alcohol abuse and/or have taken drugs of abuse
Item
Is the volunteer known to practice alcohol abuse and/or have taken drugs of abuse (e.g. as shown by a positive finding in the drug screen) ?
boolean
C0085762 (UMLS CUI [1])
C0038586 (UMLS CUI [2])
weight/height ratio deviations
Item
Has the volunteer weight/height ratio deviations of more than 25% from the average (the average may be calculated by expressing the height above 100 m as a figure expressed in kg (Broca Formula) )
boolean
C0005890 (UMLS CUI [1,1])
C0005910 (UMLS CUI [1,2])
allergic status
Item
Does the volunteer have a known or suspected allergic status?
boolean
C0018759 (UMLS CUI [1,1])
C0155877 (UMLS CUI [1,2])
C1527304 (UMLS CUI [1,3])
history of psychiatric disorders, epilepsy or seizures
Item
Does the volunteer have a history of psychiatric disorders, epilepsy or seizures?
boolean
C0262926 (UMLS CUI [1,1])
C0004936 (UMLS CUI [1,2])
C0036572 (UMLS CUI [1,3])
C0014544 (UMLS CUI [1,4])
anti-malarial frugs within the last 12 months
Item
Has the volunteer taken anti-malarial frugs within the last 12 months?
boolean
C0003374 (UMLS CUI [1])
Item Group
Infusion Details
C0574032 (UMLS CUI-1)
C1522508 (UMLS CUI-2)
Date of infusion
Item
Date of infusion
date
C0574032 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Time commenced
Item
Time commenced
time
C0011008 (UMLS CUI [1,1])
C0451613 (UMLS CUI [1,2])
Time completed
Item
Time completed
time
C0574032 (UMLS CUI [1,1])
C0205197 (UMLS CUI [1,2])
C1522314 (UMLS CUI [1,3])
Duration of infusion
Item
Duration of infusion
integer
C0444921 (UMLS CUI [1,1])
C0574032 (UMLS CUI [1,2])
Volunteer weight on Day-1
Item
Volunteer weight on Day-1
float
C0005910 (UMLS CUI [1])
Volume of infusion
Item
Volume of infusion
integer
C0574032 (UMLS CUI [1,1])
C0449468 (UMLS CUI [1,2])
Dose checked and administred by
Item
Dose checked and administred by
text
C0178602 (UMLS CUI [1,1])
C0574032 (UMLS CUI [1,2])
Item Group
ECG-Arrhythmia
C1623258 (UMLS CUI-1)
C0003811 (UMLS CUI-2)
Item
Time Relative to start of infusion
integer
C0574032 (UMLS CUI [1,1])
C0439659 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Code List
Time Relative to start of infusion
CL Item
-0.5 to 0 hours (1)
CL Item
0 to +0.5 hours (2)
CL Item
+0.5 to +1.5 hours (3)
CL Item
+1.5 to 2.5 hours (4)
CL Item
+2.5 to +3.5 hours (5)
CL Item
+3.5 to +4.5 hours (6)
CL Item
+4.5 to +5.5 hours (7)
CL Item
+5.5 to +6.5 hours (8)
CL Item
+6.5 to +7.5 hours (9)
CL Item
+7.5 to +8.5 hours (10)
Actual Time
Item
Actual Time
time
C0040223 (UMLS CUI [1])
Couplets (per time inverval)
Item
Couplets (per time inverval)
text
C0429001 (UMLS CUI [1])
Bigeminus
Item
Bigeminus (per time interval)
text
C0262662 (UMLS CUI [1])
EVPB (per time interval)
Item
EVPB (per time interval)
text
C0151636 (UMLS CUI [1])
VPB
Item
VPB (per time interval)
text
C0865677 (UMLS CUI [1])
initials
Item
initials
text
C2986440 (UMLS CUI [1])
Item Group
Electrocardiography
C1623258 (UMLS CUI-1)
ECG recordings carried out
Item
Were there any ECG recordings carried out?
boolean
C1623258 (UMLS CUI [1])
Item Group
Electrocardiography
C1623258 (UMLS CUI-1)
Item
Time relative to start of infusion
integer
C0574032 (UMLS CUI [1,1])
C0439659 (UMLS CUI [1,2])
C0040223 (UMLS CUI [1,3])
Code List
Time relative to start of infusion
CL Item
-15 mins (1)
CL Item
+35 mins (2)
CL Item
+0.5 to +1.5 hours (3)
CL Item
+1 hour (4)
CL Item
+2.5 hours (5)
CL Item
+4.5 hours (6)
CL Item
+7.5 hours (7)
CL Item
+10.5 hours (8)
CL Item
+25.5 hours (9)
CL Item
+49.25 hours (10)
Date and time taken
Item
Date and time taken
datetime
C0011008 (UMLS CUI [1])
ECG normal
Item
Is the ECG normal
boolean
C0522054 (UMLS CUI [1])
Any changes
Item
Any changes
boolean
C0855329 (UMLS CUI [1])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Initials
Item
Initials
text
C2986440 (UMLS CUI [1])
date
Item
date
date
C0011008 (UMLS CUI [1])
Item Group
Alcohol Screening (Blow test)
C0202306 (UMLS CUI-1)
Item
Study time relevant to dose
integer
C0439564 (UMLS CUI [1])
Code List
Study time relevant to dose
CL Item
Day -1 (1)
CL Item
Day 1 (2)
CL Item
Day +1 (3)
CL Item
Day +2 (4)
CL Item
Day +3 (5)
CL Item
Day +6 (6)
CL Item
Day +9 (7)
CL Item
Day +14 (8)
Date and time sample taken
Item
datetime
C0011008 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
C0200345 (UMLS CUI [1,3])
any alcohol detected
Item
Was there any alcohol detected?
boolean
C0202306 (UMLS CUI [1])
initials
Item
initials
text
C2986440 (UMLS CUI [1])
Item Group
Drug Screening (Urine)
C0202274 (UMLS CUI-1)
Item
Day/hr relative to dose
integer
C0439564 (UMLS CUI [1])
Code List
Day/hr relative to dose
CL Item
Day -1 (1)
CL Item
Day 1 (2)
Date and time sample taken
Item
Date and time sample taken
datetime
C0011008 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
C0200345 (UMLS CUI [1,3])
Drugs detected
Item
Were there any Drugs detected?
boolean
C1511790 (UMLS CUI [1,1])
C1254351 (UMLS CUI [1,2])
Type of drug/compound found
Item
Type of drug/compound found
text
C0457591 (UMLS CUI [1])
Contra indicated?
Item
Contra indicated?
boolean
C1301624 (UMLS CUI [1])
Initials Lab
Item
Initials Lab
text
C0022877 (UMLS CUI [1])
Initials Physician
Item
Initials Physician
text
C2986440 (UMLS CUI [1,1])
C2826892 (UMLS CUI [1,2])
Comments
Item
Comments
text
C0947611 (UMLS CUI [1])
Item Group
Baseline Events
C1442488 (UMLS CUI-1)
C0877248 (UMLS CUI-2)
Felt different in any way over tha last few days
Item
Have you felt different in any way over the last few days?
boolean
C0559546 (UMLS CUI [1])
Item Group
Baseline Events
C1442488 (UMLS CUI-1)
C0877248 (UMLS CUI-2)
ADECS Code
Item
ADECS Code
text
C0805701 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Event Observed (describe)
Item
Event Observed (describe)
text
C0877248 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Onset date and time
Item
Onset date and time
datetime
C2826806 (UMLS CUI [1])
End date and time
Item
End date and time
datetime
C2826793 (UMLS CUI [1])
Event duration
Item
Event duration
text
C0449238 (UMLS CUI [1])
Item
Intensity
integer
C1710066 (UMLS CUI [1])
Code List
Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Event Course
integer
C0877248 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
Code List
Event Course
CL Item
Once (1)
CL Item
Consant (2)
CL Item
Intermittent (3)
Item
Outcome of Event
integer
C1705586 (UMLS CUI [1])
Code List
Outcome of Event
CL Item
Event continuing (1)
CL Item
Event resolved (2)
Recorder's signature
Item
Recorder's signature
text
C1519316 (UMLS CUI [1,1])
C0035173 (UMLS CUI [1,2])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Study Director's Signature
Item
Study Director's Signature
text
C2346576 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Item Group
Adverse Event
C0877248 (UMLS CUI-1)
adverse event observed or elicited
Item
Do you feel different in any way since starting the new treatment or since the last visit?
boolean
C0559546 (UMLS CUI [1,1])
C0877248 (UMLS CUI [1,2])
Item Group
Adverse Events
C0877248 (UMLS CUI-1)
ADECS Code
Item
ADECS Code
text
C0805701 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Event observed (describe)
Item
Event observed (describe)
text
C0877248 (UMLS CUI [1,1])
C0947611 (UMLS CUI [1,2])
Onset date and time
Item
Onset date and time
datetime
C2985916 (UMLS CUI [1])
Item
Intensity
integer
C1710066 (UMLS CUI [1])
Code List
Intensity
CL Item
Mild (1)
CL Item
Moderate (2)
CL Item
Severe (3)
Item
Outcome
integer
C1705586 (UMLS CUI [1])
Code List
Outcome
CL Item
Event continuing (1)
CL Item
event resolved (2)
Item
Event course
integer
C0877248 (UMLS CUI [1,1])
C0750729 (UMLS CUI [1,2])
Code List
Event course
CL Item
Once (1)
CL Item
Constant (2)
CL Item
Intermittent (3)
End date and time
Item
End date and time
datetime
C2826793 (UMLS CUI [1])
Event (or severity) duration
Item
Event (or severity) duration
text
C0877248 (UMLS CUI [1,1])
C0449238 (UMLS CUI [1,2])
Item
Relation to investigational drug
integer
C0877248 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
C0439849 (UMLS CUI [1,3])
Code List
Relation to investigational drug
CL Item
Unrelated (1)
CL Item
Possibly related (2)
CL Item
Related (3)
Item
Present before or at baseline assessment?
integer
C0011900 (UMLS CUI [1,1])
C1444637 (UMLS CUI [1,2])
Code List
Present before or at baseline assessment?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Action taken (on study drug dosage)
integer
C2826626 (UMLS CUI [1])
Code List
Action taken (on study drug dosage)
CL Item
None (1)
CL Item
Dose interrupted (2)
CL Item
Dose changed (3)
CL Item
Drug withdrawn* (4)
Item
Outcome of event (select more than one if necessary)
integer
C1705586 (UMLS CUI [1])
Code List
Outcome of event (select more than one if necessary)
CL Item
Corrective therapy given** (1)
CL Item
Life threatening* (2)
CL Item
Significantly disabling* (3)
CL Item
Pat. hosp./Hosp. prolonged* (4)
CL Item
Patient died* (5)
Recorder's initials
Item
Recorder's initials
text
C2986440 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Study Director
Item
Study Director
text
C0025081 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])

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