Clostridium Difficile Study

Do you currently have a C. diff infection?

You may be interested in a research study for adults who suffer from recurrent C. diff infections.

Participants will receive the study medication at no cost while enrolled in the study. Additionally, study-related costs such as visits, lab tests and procedures are at no cost. Participants may also be eligible for compensation for travel and time, depending on location.

This study is investigating the effectiveness and safety of a study medicine in adults with active C. diff.

Clinical trial participants should:

Be over the age of 18
Have a current C. diff infection
Be taking vancomycin to treat their infection

What happens if I sign up to pre-qualify?

We will match you to a clinical research study centre that is seeking patients with C. diff or notify you if one becomes available. Someone from the study team will contact you to explain more about the study before you make your decision to participate and see if you are eligible. This does not guarantee eligibility for the study, but the centre can perform additional reviews and tests to determine eligibility.

Register to Pre-qualify

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Do you consent to the collection and processing of your personal data, including information about your race and ethnicity (as applicable), and your health information, including symptoms, diagnoses, medications, and treatments and our sharing of this information for the purpose of recruitment into clinical research studies, determining your eligibility for studies, and provision of other services you requested? You may withdraw your consent at any time by contacting us at info@autocruitment.com. Please note that your revocation will not impact any records or health data already collected, disclosed, or processed based on your consent. *

Yes

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First Name *

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Last Name *

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Phone Number *

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Email *

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Date of Birth MM/DD/YYYY *

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Zip Code *

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Have you been diagnosed by a doctor with a Clostridium difficile (C. diff) infection? *

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What treatments or medications are you taking to treat your current C. diff infection? *
Select all that apply...

Vancomycin (Vancocin®/ Firvanq®)

Fidaxomicin (Dificid®)

Bezlotoxumab (Zinplava®)

Fecal transplant

None of the above

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Do you have an active diarrheal illness from ulcerative colitis or Crohn’s disease? *

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Have you been diagnosed (by a doctor) with any other medical conditions? *
(For Example: HIV, Hepatitis B, Hepatitis C, Tuberculosis).
Please list here or write 'none'.
Please only include conditions which have been diagnosed by a doctor.

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Are you taking any medications or treatments for other health conditions?
(For Example: alprazolam (Xanax ®), amlodipine (Norvasc ®), dexamethasone (DexPak ®), diazepam (Valium ®), digoxin (Lanoxin ®), diltiazem (Cardizem ®, Cartia XT ®), felodipine (Plendil ®), fluvastatin (Lescol ®), glipizide (Glucotrol ®), glyburide (Diabeta ®, Glynase ®), grapefruit juice, loperamide (Imodium ®), losartan (Cozaar ®), midazolam (Versed ®), omeprazole (Prilosec ®), phenytoin (Dilantin ®), prednisone (Deltasone ®), rosuvastatin (Crestor ®), sildenafil (Viagra ®), simvastatin (Zocor ®), tadalafil (Cialis ®), vardenafil (Levitra ®), verapamil (Calan ®, Verelan ®), warfarin (Coumadin ®)).
Please list them below or type ‘none’.

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If female, are you currently pregnant, breastfeeding, or planning to become pregnant in the next 6 months? *

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Which racial or ethnic group(s) do you identify with? *
Please select all that apply.

American Indian or Alaskan Native

Asian

Black or African American

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Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Mediterranean (Greek/Italian/Portuguese/Spanish/etc)

Another race or ethnicity

I prefer not to answer

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What is the best day/time to reach you via telephone (we know you are busy)? *

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The information you are providing here will be processed in accordance with our Privacy Policy, which describes our data privacy practices, including how we share your information with our Research Partners and use your information to send you details about potential clinical trial opportunities. When you submit this information, you consent to AutoCruitment’s use of your data as described in our Privacy Policy. By providing your phone number and clicking “Submit” below, you consent to receive messages, including SMS/MMS text messages, sent by or on behalf of AutoCruitment, with information about research studies for which you may be eligible. By clicking Submit, you also agree to our SMS Terms. If you have any questions regarding the handling of the information you have provided to AutoCruitment, or if you would like to make any changes or withdraw your consent, please contact us at info@autocruitment.com.

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