NUS Institutional Review Board (IRB)
Final Report
(For Closure of an IRB-Approved Research)
NUS-IRB Ref Code :
Approval Number : NUS
Title of Research Protocol :
1. Principal Investigator : ________________________________________________________________
2. Co-Investigators : ___________________________________________________________________
3. Start Date: _________________________________________________________________________
4. Completion Date (including data analysis): ___________________________________________________
5. Summary of Results (in 100 words or less): __________________________________________________
__________________________________________________________________________________
6. Publications or Thesis (please give citation(s) and attach a copy of publications, manuscripts or thesis resulting from this
protocol):____________________________________________________________________________
7. Difficulties encountered, if any (Please provide details): _________________________________________
Report on Human Subject Recruitment
8. Target Number of Subjects approved :___________________________________________________
9. Actual Number of Subjects recruited : ___________________________________________________
(i)
Number of subjects screened : _____________________________________________________
(ii)
Number of subjects still involved in the research : _______________________________________
(iii) Number of subjects who withdrawn/discontinued research : ______________________________
(iv) Number of subjects who completed research: _________________________________________
Report on Serious Adverse Events / Unanticipated Events (SAE/UE) (if applicable)
10. Total No. of SAE/UEs notified to IRB : ___________________________________________________
11. No. of SAE/UEs from Singapore: _____________ No. of SAE/UEs not from Singapore: _________
12. No. of NUH/NUS subjects involved: ___________ No. of local subjects involved: _______________
13. Nature of SAE/UEs: ________________________________________________________________
By signing below, the Principal Investigator assures the information contained on this form is true and accurate.
Principal Investigator's signature :
Date :
Phone :
Email :
Fax :
Please mail the completed form to: The NUS-IRB Secretariat, Clinical Research Centre (Blk MD 11), 10
Medical Drive, #03-02, Singapore 117597.
IRB-FORM-005
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Version No: 5
Date of revision: 27/08/2015