Escolar Documentos
Profissional Documentos
Cultura Documentos
Sponsor:
Protocol:
Account:
Transmittal Number:
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 2 / DAY 21 / PRE DOSE
23-DEC-2015
13:26:05
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: V5
Heart Rate (bpm) :
Mean
81
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
744
N/A
N/A
PR Interval (ms) :
163
N/A
N/A
93
N/A
N/A
387
N/A
N/A
424
N/A
N/A
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
A Nagamani
10-JUL-2016 22:00 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947854
COLLECTED: 23-DEC-2015
13:26:05
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 3 / DAY 15 / 1.5 POST DOSE
08-OCT-2015
12:24:42
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
24-JAN-1948
5009001
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
68
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
880
N/A
N/A
PR Interval (ms) :
138
N/A
N/A
83
N/A
N/A
375
N/A
N/A
393
N/A
N/A
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:47 ET
Findings
Conduction:
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947866
COLLECTED: 08-OCT-2015
12:24:42
Page 2 of 2
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 3 / DAY 15 / PRE DOSE
08-OCT-2015
10:36:48
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
24-JAN-1948
5009001
Collected By:
Tracing Quality:
Lead Analyzed: V4
PR Interval (ms) :
Mean
129
Comparator
Mean
N/A
Change
N/A
Lead Analyzed: V6
Heart Rate (bpm) :
Mean
66
Comparator
Mean
N/A
Change
N/A
909
N/A
N/A
95
N/A
N/A
QT Interval (ms) :
395
N/A
N/A
405
N/A
N/A
RR Interval (ms) :
QRS Interval (ms) :
Evaluation
Interpretation:
Abnormal
Evaluation Comments:
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:47 ET
Findings
Conduction:
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947867
COLLECTED: 08-OCT-2015
10:36:48
Page 2 of 2
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 2 / DAY 8 / PRE DOSE
03-SEP-2015
09:17:16
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
24-JAN-1948
5009001
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
60
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
995
N/A
N/A
PR Interval (ms) :
142
N/A
N/A
77
N/A
N/A
390
N/A
N/A
391
N/A
N/A
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:47 ET
Findings
Conduction:
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947863
COLLECTED: 03-SEP-2015
09:17:16
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 1 / DAY 15 / 1.5 POST DOSE
20-AUG-2015
11:48:15
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
24-JAN-1948
5009001
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
60
Comparator
(3 of 3)
Mean
61
Change
-1
RR Interval (ms) :
1002
985
17
PR Interval (ms) :
137
131
79
84
-5
QT Interval (ms) :
396
406
-10
396
408
-12
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:47 ET
Findings
Conduction:
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947860
COLLECTED: 20-AUG-2015
11:48:15
Page 2 of 2
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
UNSCHEDULED PREDOSE
23-MAR-2016
14:51:56
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
94
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
641
N/A
N/A
PR Interval (ms) :
197
N/A
N/A
83
N/A
N/A
361
N/A
N/A
418
N/A
N/A
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:43 ET
Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: / /
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947833
COLLECTED: 23-MAR-2016
14:51:56
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 2 / DAY 1 / LEE011 4 POST
DOSE
02-FEB-2016
14:17:48
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Comparator
Mean
N/A
Change
N/A
813
N/A
N/A
159
N/A
N/A
83
N/A
N/A
QT Interval (ms) :
443
N/A
N/A
475
N/A
N/A
Lead Analyzed: II
Heart Rate (bpm) :
Mean
74
RR Interval (ms) :
PR Interval (ms) :
QRS Interval (ms) :
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:44 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947845
COLLECTED: 02-FEB-2016
14:17:48
Page 2 of 2
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
UNSCHEDULED 1.5 POSTDOSE
04-JAN-2016
16:45:56
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
69
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
875
N/A
N/A
PR Interval (ms) :
205
N/A
N/A
86
N/A
N/A
432
N/A
N/A
452
N/A
N/A
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:43 ET
Findings
Conduction:
Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: RUNIN CYCLE 3 / DAY 15 / 1.5 POST DOSE
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947836
COLLECTED: 04-JAN-2016
16:45:56
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 21 / LEE011 4 POST
DOSE
27-JAN-2016
14:32:50
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
73
RR Interval (ms) :
PR Interval (ms) :
Comparator
(3 of 3)
Mean
66
Change
7
817
913
-96
164
177
-13
75
82
-7
QT Interval (ms) :
422
432
-10
451
445
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:44 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947848
COLLECTED: 27-JAN-2016
14:32:50
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 2 / DAY 15 / 1.5 POST DOSE
16-FEB-2016
12:18:28
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
76
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
789
N/A
N/A
PR Interval (ms) :
162
N/A
N/A
74
N/A
N/A
435
N/A
N/A
471
N/A
N/A
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:44 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947841
COLLECTED: 16-FEB-2016
12:18:28
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 1 / DAY 15 / 1.5 POST DOSE
23-NOV-2015
13:01:20
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
78
Comparator
(3 of 3)
Mean
81
Change
-3
RR Interval (ms) :
768
735
33
PR Interval (ms) :
205
182
23
79
91
-12
379
368
11
413
407
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
A Nagamani
07-JUL-2016 23:43 ET
Findings
Conduction:
Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: RUNIN CYCLE 1 / DAY 15 / PRE DOSE
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947838
COLLECTED: 23-NOV-2015
13:01:20
Page 2 of 2
Subject Information
Date of Birth:
7 Digit Subject Number:
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
UNSCHEDULED PREDOSE
02-FEB-2016
08:51:14
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
65
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
929
N/A
N/A
PR Interval (ms) :
174
N/A
N/A
74
N/A
N/A
414
N/A
N/A
424
N/A
N/A
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: PART 2 CYCLE 2 / DAY 1 / PRE DOSE
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947843
COLLECTED: 02-FEB-2016
08:51:14
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 8 / PRE DOSE
13-JAN-2016
12:16:52
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
68
Comparator
(3 of 3)
Mean
66
Change
2
RR Interval (ms) :
881
913
-32
PR Interval (ms) :
171
177
-6
75
82
-7
QT Interval (ms) :
413
432
-19
431
445
-14
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947849
COLLECTED: 13-JAN-2016
12:16:52
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / 1.5 POST DOSE
08-JAN-2016
12:22:11
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
65
Comparator
(3 of 3)
Mean
66
Change
-1
RR Interval (ms) :
921
913
PR Interval (ms) :
180
177
81
82
-1
QT Interval (ms) :
419
432
-13
431
445
-14
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947853
COLLECTED: 08-JAN-2016
12:22:11
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 8 / 1.5 POST DOSE
13-APR-2016
11:50:10
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
92
Comparator
(3 of 3)
Mean
81
Change
11
RR Interval (ms) :
653
738
-85
PR Interval (ms) :
193
183
10
76
97
-21
364
369
-5
419
409
10
Evaluation
Interpretation:
Abnormal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:20 ET
Findings
Ectopy:
T Waves:
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947830
COLLECTED: 13-APR-2016
11:50:10
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 2 / DAY 8 / 1.5 POST DOSE
11-DEC-2015
12:41:44
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
56
Comparator
Mean
N/A
Change
N/A
RR Interval (ms) :
1067
N/A
N/A
PR Interval (ms) :
183
N/A
N/A
81
N/A
N/A
438
N/A
N/A
429
N/A
N/A
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947856
COLLECTED: 11-DEC-2015
12:41:44
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 8 / PRE DOSE
13-APR-2016
10:12:03
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
80
Comparator
(3 of 3)
Mean
81
Change
-1
RR Interval (ms) :
746
738
PR Interval (ms) :
195
183
12
79
97
-18
364
369
-5
401
409
-8
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:20 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947831
COLLECTED: 13-APR-2016
10:12:03
Page 2 of 2
Subject Information
Date of Birth:
5009
7 Digit Subject Number:
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 21 / LEE011_1.5 POST
DOSE
27-JAN-2016
11:48:52
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
70
RR Interval (ms) :
PR Interval (ms) :
Comparator
(3 of 3)
Mean
66
Change
4
862
913
-51
163
177
-14
81
82
-1
QT Interval (ms) :
419
432
-13
440
445
-5
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947846
COLLECTED: 27-JAN-2016
11:48:52
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / LEE011 4 POST
DOSE
08-JAN-2016
15:43:13
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
13-MAR-1958
5009002
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
68
RR Interval (ms) :
PR Interval (ms) :
Comparator
(3 of 3)
Mean
66
Change
2
882
913
-31
168
177
-9
74
82
-8
QT Interval (ms) :
417
432
-15
434
445
-11
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:19 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947852
COLLECTED: 08-JAN-2016
15:43:13
Page 2 of 2
Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / LEE011 4 POST
DOSE
06-APR-2016
17:15:36
Site ID:
Investigator Name:
Address:
Visit:
Collection Date:
Collection Time:
Date of Birth:
7 Digit Subject Number:
05-OCT-1939
5009003
Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :
Mean
82
RR Interval (ms) :
PR Interval (ms) :
Comparator
(3 of 3)
Mean
81
Change
1
728
738
-10
185
183
93
97
-4
QT Interval (ms) :
389
369
20
433
409
24
Evaluation
Interpretation:
Normal
Evaluation By:
Evaluation Date/Time:
Muhammad Iqbal
07-JUL-2016 17:20 ET
Date: ____________________________
Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ
PROTOCOL:
SITE:
5009
ERT
ACCOUNT: 746874
TRANSMITTAL: 12947832
COLLECTED: 06-APR-2016
17:15:36
Page 2 of 2