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Study Identifier: R01-123456-CCSO

Item field name/value: PULSE = 59

Study Subject: CAM105 Study Event: Initial


Treatment

Study Event Date: 2011-08- CRF: Physical Exam


01 12:00:00.0 Status: Complete

Type: Failed Validation Resolution Status: New


Check

Number of notes: 2 Discrepancy Note ID: 7

Days Open: 2431 Days Since Updated: 2431

Discrepancy note id: 8

Subject name: CAM105 CRF name: Physical Exam

Description: Pulse was taken twice Discrepancy note type: Failed


and was 59 BPM Validation Check

Event name: Initial Treatment Parent note ID: 7

Resolution status: New Detailed notes: [Pulse rate ouf of


expected range of 60-100(must be
an integer)]

Entity name: PULSE Entity value: 59

Date updated: 05-Jul-2011 Study ID: 3


Study Identifier: R01-123456-CCSO pg.2

Item field name/value: IFC_PDF

Study Subject: CAM105 Study Event: Registration


Visit

Study Event Date: 2011-07- CRF: Verification of


06 12:00:00.0 Informed Consent
Status: Complete

Type: Query Resolution Status: New

Number of notes: 2 Discrepancy Note ID: 9

Days Open: 2431 Days Since Updated: 2431

Discrepancy note id: 10

Subject name: CAM105 CRF name: Verification of Informed


Consent

Description: Please attach signed Discrepancy note type: Query


informed consent

Event name: Registration Visit Parent note ID: 9

Resolution status: New Detailed notes: This subject has a


signed paper form on record.
Please attach

Entity name: IFC_PDF Entity value:

Date updated: 05-Jul-2011 Study ID: 3

Item field name/value: SYSTOLIC = 200


Study Identifier: R01-123456-CCSO pg.3

Item field name/value: SYSTOLIC = 200

Study Subject: SUB001 Study Event: Registration


Visit

Study Event Date: 2018-03- CRF: Physical Exam


05 00:00:00.0 Status: Complete

Type: Failed Validation Resolution Status: New


Check

Number of notes: 2 Discrepancy Note ID: 167

Days Open: 0 Days Since Updated:

Discrepancy note id: 168

Subject name: SUB001 CRF name: Physical Exam

Description: Actual condition Discrepancy note type: Failed


Validation Check

Event name: Registration Visit Parent note ID: 167

Resolution status: New Detailed notes: [Out of expected


range.Systolic expected range of
110-140.]

Entity name: SYSTOLIC Entity value: 200

Date updated: 01-Mar-2018 Study ID: 4

Item field name/value: DIASTOLIC = 110


Study Identifier: R01-123456-CCSO pg.4

Item field name/value: DIASTOLIC = 110

Study Subject: SUB001 Study Event: Registration


Visit

Study Event Date: 2018-03- CRF: Physical Exam


05 00:00:00.0 Status: Complete

Type: Failed Validation Resolution Status: New


Check

Number of notes: 2 Discrepancy Note ID: 169

Days Open: 0 Days Since Updated:

Discrepancy note id: 170

Subject name: SUB001 CRF name: Physical Exam

Description: Actual condition Discrepancy note type: Failed


Validation Check

Event name: Registration Visit Parent note ID: 169

Resolution status: New Detailed notes: [Out of expected


range. Diastolic expected range of
70-90.]

Entity name: DIASTOLIC Entity value: 110

Date updated: 01-Mar-2018 Study ID: 4

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