Prior Crohn's Disease Medication: Biologics


This CRF collects information about individual biologic medications previously used to treat Crohn's disease.


This is a repeating CRF that is completed once for each biologic medication previously used to treat Crohn's disease.


"Prior Crohn's Disease Medication Class- Biologics [CD_CMBIO]" Form Preview
Prior Crohn's Disease Medication Class- Biologics
Prior Crohn's Disease Medication Class- Biologics 1
* What is the category for the medication?
* For what indication was the medication taken?
* What is the subcategory for the medication?
* What was the medication identifier?
* What was the name of the biologic drug taken for Crohn's disease?
What was the start date of this biologic?
 01 Jan 2000
What was the end date of this biologic?
 01 Jan 2000
How many months did the subject take this biologic?
* What was the maximum dose amount of this biologic?
* What was the unit of the maximum dose amount of this biologic?
* What was the frequency of the maximum dose amount of this biologic?
* What was the final dose amount of this biologic?
* What was the final dose amount unit of this biologic?
* What was the frequency of the final dose amount of this biologic?
* What was the route of administration of this biologic?
* What was the primary reason for discontinuation of this biologic?
If primary non-responder, what were the signs and symptoms leading to discontinuation of treatment?
If "Other", specify.
If secondary non-responder, what were the signs and symptoms leading to treatment discontinuation?
If "Other", specify.
Prior Crohn's Disease Medication Class- Biologics 2
* What was the category of the medical history?
* When did the medical history event start relative to the study reference period?
* What was the relationship to the non-study medication?
* If treatment was discontinued due to intolerance, what was the condition indicating intolerance?
Prior Crohn's Disease Medication Class- Biologics 3
* What was the subcategory of the medical history?
* What is the observation group identifier?
* If significant injection site reactions, what were the specific signs and symptoms causing treatment intolerance? Significant bruising  Erythema  Hemorrhage  
Prior Crohn's Disease Medication Class- Biologics 4
* What was the subcategory of the medical history?
* What is the observation group identifier?
* If significant acute administration reactions, what were the specific signs and symptoms causing treatment intolerance?
Prior Crohn's Disease Medication Class- Biologics 5
* What was the subcategory of the medical history?
* What is the observation group identifier?
* If significant delayed administration reactions, what were the signs and symptoms causing treatment intolerance?
If "Other symptom", specify.
* Mandatory field

Package(s)
CD CMBIO Package