6.1
Geef aan of de patiënt de volledige studie heeft doorlopen zoals gespecificeerd in het protocol, of de studie vroegtijdig heeft beëindigd:
6.2
Indien vroegtijdig beëindigd, geef aan welke reden hiervoor **het meest van toepassing** is:
Only shown if field 6.1 is equal to 2
6.3
Specificeer Adverse Event (AE):
Only shown if field 6.2 is equal to 2
6.4
Datum overlijden
Only shown if field 6.2 is equal to 3
6.5
Primaire doodsoorzaak:
Only shown if field 6.2 is equal to 3
6.6
Datum laatste contact met deze patiënt in deze studie:
Only shown if field 6.2 is equal to 4
6.7
Datum intrekken Informed Consent:
Only shown if field 6.2 is equal to 5
6.8
Reden intrekken Informed Consent
Only shown if field 6.2 is equal to 5
6.9
Datum besluit:
Only shown if field 6.2 is equal to 6
6.10
Reden besluit
Only shown if field 6.2 is equal to 6
6.11
Andere reden
Only shown if field 6.2 is equal to 8
7.1
I declare that all entries in the electronic case report forms (CRFs), including corrections, were made by a trial staff member identified on the ‘sites signature and delegation Log‘ and that the collected data in the electronic case report forms corresponds to a truthful, careful and complete transcription of the source data, which were generated during the study.
EOS_complete
EOS_reason
YesNo