Was Yes No molecular genotyping for P. vivax performed (Y/N) NA PFPERF NOT SUBMITTED MSP 1 Microsatellites Other surface proteins Reason not PFGENRI PFEGNTYP Study day Not done Date of sample Marker gene done PFDAT PFDTC Bp Domain Bp Marker name Bp PFDY PFSTAT name PFREASND PFTEST= PFGENSR PFORRES PFGENRI PFORRES Amplicon size PFGENRI F1 MS16 PFORRES PFORRES PFORRES Visit1 |__|__|-|__|__|__|-|__|__|__|__| F3 MSP4 Pv3.27 (Pre-dose) PFORRES PFORRES PFORRES MSP5 Pv1.501 PFORRES PFORRES F1 MSP3a MS16 Day of PFORRES PFORRES PFORRES |__|__|-|__|__|__|-|__|__|__|__| recurrence/ F3 MSP4 Pv3.27 PFORRES PFORRES PFORRES relapse MSP5 Pv1.501 PFORRES PFORRES APPENDIX C Was PK sampling performed? PHARMACOKINETIC (PK) SAMPLING Yes No NA PC PCYN NOT SUBMITTED Collection date Collection time Sample type Sample condition Not done Reason not done Lab identifier PCREFID PCDAT PCDTC PCDTC PCTPT PCSPEC PCSPCCND PCSTAT PCREASND Capillary plasma S01 PREDOSE |__|__|-|__|__|__|-|__|__|__|__| |__|__|:|__|__| Venous plasma
Was molecular genotyping for P. vivax performed (Y/N) PFPERF NOT SUBMITTED Yes No NA Study day PFDY Date of sample PFDAT PFDTC MSP 1 PFGENRI Other surface proteins Microsatellites PFEGNTYP Not done PFSTAT Reason not done PFREASND Domain PFGENSR Bp PFTEST= Amplicon size Marker gene name PFGENRI Bp PFORRES Marker name PFGENRI Bp PFORRES Visit1 (Pre-dose) |__|__|-|__|__|__|-|__|__|__|__| F1 PFORRES PFORRES MS16 PFORRES F3 PFORRES MSP4 PFORRES Pv3.27 PFORRES MSP5 PFORRES Pv1.501 PFORRES Day of recurrence/ relapse |__|__|-|__|__|__|-|__|__|__|__| F1 PFORRES MSP3a PFORRES MS16 PFORRES F3 PFORRES MSP4 PFORRES Pv3.27 PFORRES MSP5 PFORRES Pv1.501 PFORRES APPENDIX C PHARMACOKINETIC (PK) SAMPLING PC Was PK sampling performed? PCYN NOT SUBMITTED Yes No NA Collection date PCDAT PCDTC Collection time PCDTC PCTPT Lab identifier PCREFID Sample type PCSPEC Sample condition PCSPCCND Not done PCSTAT Reason not done PCREASND |__|__|-|__|__|__|-|__|__|__|__| |__|__|:|__|__| PREDOSE S01 Capillary plasma Venous plasma
wwarn-malaria-case-record-form-crf-v1-january-2017.docx