| Form Name | Visit 1 | Visit 2 | Visit 4 | Visit 5 | Visit 8 | Visit 9 | Visit 10 | Visit 11 | Visit 12 | Visit 13 | Visit 14 |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Biopsy Results | |||||||||||
| Blinding Integrity | |||||||||||
| Concomitant Medication | |||||||||||
| ECG Interpretation | |||||||||||
| Follow-up Visit | |||||||||||
| Hematology Laboratory Results | |||||||||||
| Informed Consent | |||||||||||
| Infusion Record | |||||||||||
| MRI/CT Scan Results | |||||||||||
| Past Surgical History | |||||||||||
| Serious Adverse Event | |||||||||||
| Study Completion | |||||||||||
| Surgical Procedure | |||||||||||
| Urinalysis |