| # | Question | Response |
|---|---|---|
|
1
|
Type of Consent
field_001
|
|
|
2
|
Date of Consent Withdrawal
field_002
|
| # | Question | Response |
|---|---|---|
|
1
|
Is the subject a screen fa
field_001
|
|
|
2
|
Primary Screen Failure Rea
field_002
|
|
|
3
|
If Primary Screen Failure
field_003
|
|
|
4
|
field_004
|
| # | Question | Response |
|---|---|---|
|
1
|
Date Consent Form Signed
enrlment.ICDT_RAW
|
|
|
2
|
Consent Version Number
enrlment.ICVERS
|
|
|
3
|
Protocol Version
enrlment.PRTVERS
|
|
|
4
|
Date of Enrollment
enrlment.ENRLDT_RAW
|
|
|
5
|
Date of Randomization
enrlment.RANDDT_RAW
|
|
|
6
|
Randomization number
enrlment.RANDNO
|
| # | Question | Response |
|---|---|---|
|
1
|
Did the subject complete t
field_001
|
|
|
2
|
Did the subject complete t
field_002
|
|
|
3
|
Date of completion/discont
eos.EOSTDT_RAW
|
|
|
4
|
Primary reason for ending
eos.EOTERM
|
| # | Question | Response |
|---|---|---|
|
1
|
Did the subject complete t
field_001
|
|
|
2
|
Date of completion/discont
eos.EOSTDT_RAW
|
|
|
3
|
Primary reason for ending
eos.EOTERM
|
|
|
4
|
If other, specify
field_004
|