The Protocol Deviations (DV) is an events domain that contains protocol violations and deviations during the course of the study.
This example DV CRF has 2 sections: Section 1 collects whether the subject had any protocol deviations, and the second section creates a row/record for every deviation each subject experienced.
Section 1
Order
Question Text
Prompt
Case Report Form Completion Instructions
Type
Collection Variable
Tabulation Target
Mapping Instructions
Controlled Terminology CodeList Name
Permissible Values
Pre-Populated Value
1
Were there any protocol deviations?
Any Deviations
Enter Yes if a protocol deviation occurred and No if none occurred. Ensure that any adverse event which triggers a protocol deviation (e.g., concomitant medication use, newly discovered medical history) is noted on the respective CRF.
Text
DVYN
Not Submitted
(NY)
No;Yes;
Section 2
Order
Question Text
Prompt
Case Report Form Completion Instructions
Type
Collection Variable
Tabulation Target
Mapping Instructions
Controlled Terminology CodeList Name
Permissible Values
Pre-Populated Value
2
What is the protocol deviation identifier?
DV Number
If collected on the CRF, applicant may insert instructions to ensure each record has a unique identifier.
Text
DVSPID
DVSPID
3
What was the protocol deviation?
Protocol Deviation
Record protocol deviations identified and/or select the appropriate code from the list of protocol deviation terms.
Text
DVDECOD
DVDECOD
INFORMED CONSENT NOT OBTAINED; INCLUSION CRITERIA NOT MET; STUDY PRODUCT ASSIGNMENT DEVIATION; STUDY PRODUCT ADMINSTRATION DEVIATION; EXCLUDED CONCOMITANT MEDICATION; OTHER
4
What was the protocol deviation term?
Specify Protocol Deviation
Record the protocol deviation
Text
DVTERM
DVTERM
5
What was the protocol deviation start date?
Start Date
Record the start date for the protocol deviation using this format (DD-MON-YYYY). This should be the start or occurrence of the protocol deviation, not the date it was discovered or reported.
Date
DVSTDTC
DVSTDTC
6
What was the protocol deviation end date?
End Date
Record the end date of the protocol deviation using this format (DD-MON-YYYY). This should be the date the protocol deviation stopped, not the date it was discovered or reported.
Date
DVENDTC
DVENDTC
This is the SDTM data that was collected on a DV CRF. The DVDECOD column is for controlled terminology; the DVTERM captures free text.
Rows 1, 3:
Show examples of a study product assignment and study product administration protocol deviations.
Row 2:
Shows an example of a deviation due to the subject taking a prohibited concomitant medication.
Row 4:
Shows an example of a medication that should not be taken during the study.
dv.xpt
xx.xpt
Row
STUDYID
DOMAIN
USUBJID
DVSEQ
DVTERM
DVDECOD
EPOCH
DVSTDTC
1
ABC123
DV
123101
1
IVRS PROCESS DEVIATION - NO DOSE CALL PERFORMED.
STUDY PRODUCT ASSIGNMENT DEVIATION
STUDY PRODUCT EXPOSURE
2003-09-21
2
ABC123
DV
123103
1
BUPROPION ADMINISTERED DURING STUDY PRODUCT EXPSOURE