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  • Rando 2239

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    Mohamed Nigm
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    Patient 2239 was randomly assigned to a treatment in a clinical trial for metastatic breast cancer. The patient was randomized on September 30, 2011 at 5:59:28 PM GMT+1 by Adeline Masse. The patient received treatment kit numbers 104515 and 449550 and had previously received no taxane therapy but did have visceral metastases and a positive hormone receptor status. The pharmacist verified that the kit numbers matched those prepared for the patient.

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    Rando-2239

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    Patient 2239 was randomly assigned to a treatment in a clinical trial for metastatic breast cancer. The patient was randomized on September 30, 2011 at 5:59:28 PM GMT+1 by Adeline Masse. The patient received treatment kit numbers 104515 and 449550 and had previously received no taxane therapy but did have visceral metastases and a positive hormone receptor status. The pharmacist verified that the kit numbers matched those prepared for the patient.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    7 views1 page

    Rando 2239

    Uploaded by

    Mohamed Nigm
    Patient 2239 was randomly assigned to a treatment in a clinical trial for metastatic breast cancer. The patient was randomized on September 30, 2011 at 5:59:28 PM GMT+1 by Adeline Masse. The patient received treatment kit numbers 104515 and 449550 and had previously received no taxane therapy but did have visceral metastases and a positive hormone receptor status. The pharmacist verified that the kit numbers matched those prepared for the patient.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    Patient Randomization Confirmation

    Patient No 2239
    Sponsor Information

    Site Information

    Name of Sponsor : ImClone Systems


    5504
    Incorporated
    Protocol Number : IMCL CP12-0606/TRIO-012 Alexandria University, New University Hospital ATTN: Sara Mohamed
    Alexandria Clinical Research centre (8th floor)
    Alexandria
    EGYPT

    Patient Details
    Patient No : 2239
    Patient DOB : 12 Nov 1949
    Date and Time of Randomization * : 30 Sep 2011 17:59:28 (GMT+1)
    Randomization By : Adeline Masse (41499)
    Treatment kit numbers : 104515 449550
    Prior taxane therapy : No
    Visceral metastasis : Yes
    Hormone receptor status : Positive

    I hereby certify that the kit numbers printed above have been checked and match the kits
    prepared for the patient.
    Pharmacist name ...............................................................................................................................
    Date .................................................................. Signature ................................................................
    Name ...................................................................................................................................................
    Date
    ..................................................................
    Signature ................................................................
    * All dates
    and times are GMT +1
    IMPORTANT : Please ensure that you communicate this information ONLY to authorised individuals, and keep a paper copy for reference in the
    patients files. If you require assistance please contact the helpdesk at the following number:
    US Helpdesk

    European Helpdesk

    1-866-SOS-IDDI

    +32-16-270-969I

    Issued By : IDDI Benelux


    Issued On : 30 Sep 2011 18:03:38 (GMT+1)

    Page Number : 1

    Tel : +32.10.61.44.44
    Fax : +32.10.61.88.88
    Email : helpdesk@iddi.com

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