NUS Institutional Review Board (IRB)

Continuing Review of IRB-Approved Research

NUS-IRB Ref Code:

Title of Research Protocol:

  1. Principal Investigator :
  2. Co-Investigators :
  3. Is this project funded?

No Yes If yes, provide name(s) of current funding agency and grant number(s): ______

(and a copy of the notice of grant approval, if not previously submitted.)

  1. Status of the research: (Please tick all relevant boxes.)

Data Analysis Only.

Research on Hold.Reasons:______

Researchhas not Begun. Reasons:______

Recruiting Subjects. Version No. Date of Consent Form :______(Please include a copy of the consent form currently used,if the consent form has been amended since previous submission.)

Following up on Subjects.

Completed/Discontinued.Should the IRB inactivate the continuing review of this research? Yes. No.

(Please fill in the Final Report form for completed or discontinued research)

Tissues or Cell cultures research. (Please include a copy of the approval for release of researchsamples from Tissue Repositories, Banks, etc., or proof of purchase, if not previously submitted.)

  1. Start Date(If not started, please give estimated date):
  2. Completion Date (If ongoing, please give estimated date):

Please provide a summary of any amendments or modifications to the research, interim findings, any relevant multi-center trial reports, information about additional risk,and relevant recent literature since the last review.

Report on Human Participants(if applicable)
  1. Target Number of Subjects approved:
  2. Actual Number of Subjectsrecruited:

(i)Number of subjectsscreened:

(ii)Number of subjects still involved in the research:

(iii)Number of subjects who discontinued research:

(iv)Number of subjects who completed research:

  1. Describe any unanticipated problems, subject withdrawals, or complaints about the research in the conduct of the research:(if none, put “NIL”)
Report of Serious Adverse Events (SAE)(if applicable)

(Please provide a summary of adverse events and any unanticipated problems involving risks to subjects or others and any withdrawal of subjects from the research or complaints about the research since the last IRB review.)

  1. Total No. of SAEs notified to IRB :
  1. No. of SAEs from Singapore: No. of SAEs not from Singapore:
  1. No. of NUS/NUH subjects involved : No. of local subjects involved:
  1. Nature of SAEs :

By signing below, the Principal Investigator assures the information contained on this form is true and accurate.
Principal Investigator's signature : / Date :
Phone : / Fax : / Email :

Please email the completed form to .

IRB-FORM-009Page 1 of 2 Version No: 4

Date of revision: 19/05/2017