This is an example CRF used to collect information on prior use of smoking cessation products. The specific type of non-pharmaceutical smoking cessation product was not of interest. The reason why a product was discontinued and any use in the last 14 days was of interest. .
Indicate if the subject took any smoking cessation products If Yes, include the appropriate details where indicated on the CRF. | Were any smoking cessation products taken? CMYN Not Submitted | <NY codelist> | |
---|---|---|---|
Check all the Smoking Cessation Products previously used. Cessation product used. For each product previously complete the following i | What was the Smoking Cessation medication? CMTRT(n) CMTRT | ||
CMTRTOT CMTRT | _________________ |
For each product previously taken record the appropriate details below.
Indicate the type of smoking cessation products previously used. For each product type previously used complete a new line. | What was the Smoking Cessation medication? CMTRT | ||
---|---|---|---|
Indicate the Other type of smoking cessation products previously used. | CMTRTOT CMTRT | _________________ | |
Indicate if the smoking cessation product was discontinued due to a Adverse Event | Was the smoking cessation products discontinued due to a adverse event ? CMCRSDIS If Yes then CMRSDISC = "ADVERSE EVENT" | <NY codelist> | |
Was the product used in the last 14 days? CMENDTC |
Thsi is the SDTM date for the date collected above.
Dataset Wrapper Debug Message
Please add a row column to your dataset.
Overview
Content Tools