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ECG Analysis Report with Mean Comparator Change

Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707563

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 9 / DAY 15 / PRE DOSE
04-FEB-2016
11:12:09

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

24-JAN-1948
5009001

Interval Duration Measurements


Warren, Dominic
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
59

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

1016

N/A

N/A

PR Interval (ms) :

137

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

75

N/A

N/A

396

N/A

N/A

394

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

Svetlana Nikitina
15-JUN-2016 14:07 ET

Date: ____________________________

Generated on: 15-JUN-2016 14:12:35


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 01/24/1948


7 DIGIT SUBJECT NUMBER: 5009001
P1C9 / 15 / P

58 bpm
1020 ms
131 ms
86 ms
400 ms
396 ms
397 ms
398 ms
79/-16/50

TRANSMITTAL: 12707563
COLLECTED: 04-FEB-2016

11:12:09

SINUS BRADYCARDIA
NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 15-JUN-2016 14:12:35

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707332

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 2 / DAY 8 / PRE DOSE
08-DEC-2015
10:04:43

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

05-OCT-1939
5009003

Interval Duration Measurements


Warren, Dominic
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
80

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

750

N/A

N/A

PR Interval (ms) :

196

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

94

N/A

N/A

375

N/A

N/A

413

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

Svetlana Nikitina
15-JUN-2016 14:07 ET

Date: ____________________________

Generated on: 15-JUN-2016 14:12:34


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 10/05/1939


7 DIGIT SUBJECT NUMBER: 5009003
RC2 / 8 / P

79 bpm
751 ms
186 ms
104 ms
385 ms
444 ms
423 ms
420 ms
79/37/64

TRANSMITTAL: 12707332
COLLECTED: 08-DEC-2015

10:04:43

SINUS RHYTHM
RSR (QR) IN V1/V2 CONSISTENT WITH RIGHT VENTRICULAR CONDUCTION DELAY
MODERATE ST DEPRESSION
ABNORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 15-JUN-2016 14:12:34

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707358

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 2 / DAY 21 / PRE DOSE
22-DEC-2015
09:31:10

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

05-OCT-1939
5009003

Interval Duration Measurements


Warren, Dominic
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
79

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

762

N/A

N/A

PR Interval (ms) :

202

N/A

N/A

89

N/A

N/A

391

N/A

N/A

428

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

Evaluation
Interpretation:

Abnormal

Evaluation By:
Evaluation Date/Time:

Svetlana Nikitina
15-JUN-2016 14:07 ET

Findings
Conduction:

First Degree AV Block

For Site Use Only.


Investigator Signature: __________________________________________________

Date: ____________________________

Generated on: 15-JUN-2016 14:12:23


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 10/05/1939


7 DIGIT SUBJECT NUMBER: 5009003
RC2 / 21 / P

75 bpm
797 ms
200 ms
94 ms
393 ms
440 ms
423 ms
422 ms
50/45/61

TRANSMITTAL: 12707358
COLLECTED: 22-DEC-2015

09:31:10

SINUS RHYTHM WITH OCCASIONAL SUPRAVENTRICULAR PREMATURE COMPLEXES


NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 15-JUN-2016 14:12:23

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707390

Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 7 / DAY 15 / 1.5 POST DOSE
22-DEC-2015
10:46:09

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

Date of Birth:
7 Digit Subject Number:

24-JAN-1948
5009001

Interval Duration Measurements


Warren, Dominic
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
64

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

944

N/A

N/A

PR Interval (ms) :

135

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

78

N/A

N/A

383

N/A

N/A

391

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

Svetlana Nikitina
15-JUN-2016 14:06 ET

Date: ____________________________

Generated on: 15-JUN-2016 14:12:09


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 01/24/1948


7 DIGIT SUBJECT NUMBER: 5009001
P1C7 / 15 / PD

61 bpm
971 ms
126 ms
88 ms
391 ms
396 ms
394 ms
395 ms
77/-23/50

TRANSMITTAL: 12707390
COLLECTED: 22-DEC-2015

10:46:09

SINUS RHYTHM
MODERATE LEFT AXIS DEVIATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 15-JUN-2016 14:12:09

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707259

Subject Information
5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 2 / DAY 21 / 1.5 POST DOSE
17-SEP-2015
11:02:05

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

Date of Birth:
7 Digit Subject Number:

24-JAN-1948
5009001

Interval Duration Measurements


Padden, William
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
59

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

1019

N/A

N/A

PR Interval (ms) :

139

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

79

N/A

N/A

413

N/A

N/A

410

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

Svetlana Nikitina
15-JUN-2016 14:06 ET

Date: ____________________________

Generated on: 15-JUN-2016 14:11:49


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 01/24/1948


7 DIGIT SUBJECT NUMBER: 5009001
P1C2 / 21 / PD

58 bpm
1026 ms
135 ms
90 ms
401 ms
395 ms
397 ms
398 ms
75/-30/49

TRANSMITTAL: 12707259
COLLECTED: 17-SEP-2015

11:02:05

SINUS BRADYCARDIA
MODERATE LEFT AXIS DEVIATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 15-JUN-2016 14:11:49

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707273

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 1 / DAY 1 / PRE DOSE B
12-NOV-2015
11:40:01

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

13-MAR-1958
5009002

Interval Duration Measurements


Cross, Katherine
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
64

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

937

N/A

N/A

PR Interval (ms) :

166

N/A

N/A

94

N/A

N/A

425

N/A

N/A

434

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

Muhammad Iqbal
08-JUN-2016 05:36 ET

Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: R1C1 / 1 / B

For Site Use Only.


Investigator Signature: __________________________________________________

Date: ____________________________

Generated on: 08-JUN-2016 05:42:21


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 03/13/1958


7 DIGIT SUBJECT NUMBER: 5009002
R1C1 / 1 / B

61 bpm
973 ms
172 ms
85 ms
424 ms
429 ms
427 ms
427 ms
78/45/28

TRANSMITTAL: 12707273
COLLECTED: 12-NOV-2015

11:40:01

SINUS RHYTHM
NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 08-JUN-2016 05:42:21

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707278

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
RUNIN CYCLE 1 / DAY 1 / PRE DOSE C
12-NOV-2015
11:45:01

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

13-MAR-1958
5009002

Interval Duration Measurements


Cross, Katherine
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
64

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

934

N/A

N/A

PR Interval (ms) :

169

N/A

N/A

88

N/A

N/A

421

N/A

N/A

430

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

Muhammad Iqbal
08-JUN-2016 05:36 ET

Remarks: >> The following demography or visit name was modified from the original source ECG.
>> Please review the modified data listed above and notify ERT of any required changes
>> using the data correction instructions in your study guide.
Visit: R1C1 / 1 / C

For Site Use Only.


Investigator Signature: __________________________________________________

Date: ____________________________

Generated on: 08-JUN-2016 05:41:48


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 03/13/1958


7 DIGIT SUBJECT NUMBER: 5009002
R1C1 / 1 / C

63 bpm
941 ms
172 ms
85 ms
429 ms
442 ms
437 ms
437 ms
42/46/27

TRANSMITTAL: 12707278
COLLECTED: 12-NOV-2015

11:45:01

SINUS RHYTHM
NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 08-JUN-2016 05:41:48

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707431

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / PRE DOSE B
08-JAN-2016
10:01:32

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

13-MAR-1958
5009002

Interval Duration Measurements


Fishman, Jonathan
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
66

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

913

N/A

N/A

PR Interval (ms) :

174

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

87

N/A

N/A

439

N/A

N/A

453

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

Muhammad Iqbal
08-JUN-2016 04:05 ET

Date: ____________________________

Generated on: 08-JUN-2016 04:10:34


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 03/13/1958


7 DIGIT SUBJECT NUMBER: 5009002
P2C1 / 1 / B

67 bpm
891 ms
177 ms
85 ms
431 ms
456 ms
447 ms
446 ms
48/29/20

TRANSMITTAL: 12707431
COLLECTED: 08-JAN-2016

10:01:32

SINUS RHYTHM
NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 08-JUN-2016 04:10:34

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707691

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / PRE DOSE C
06-APR-2016
11:16:05

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

05-OCT-1939
5009003

Interval Duration Measurements


Philips, Neil
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
82

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

734

N/A

N/A

PR Interval (ms) :

185

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

96

N/A

N/A

376

N/A

N/A

417

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 21:50 ET

Date: ____________________________

Generated on: 07-JUN-2016 21:56:21


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 10/05/1939


7 DIGIT SUBJECT NUMBER: 5009003
P2C1 / 1 / C

81 bpm
738 ms
186 ms
104 ms
365 ms
424 ms
403 ms
402 ms
60/42/50

TRANSMITTAL: 12707691
COLLECTED: 06-APR-2016

11:16:05

SINUS RHYTHM
RSR (QR) IN V1/V2 CONSISTENT WITH RIGHT VENTRICULAR CONDUCTION DELAY
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 21:56:21

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707665

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / PRE DOSE B
06-APR-2016
11:10:52

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

05-OCT-1939
5009003

Interval Duration Measurements


Philips, Neil
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
79

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

759

N/A

N/A

PR Interval (ms) :

186

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

93

N/A

N/A

366

N/A

N/A

402

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 21:50 ET

Date: ____________________________

Generated on: 07-JUN-2016 21:56:08


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 10/05/1939


7 DIGIT SUBJECT NUMBER: 5009003
P2C1 / 1 / B

80 bpm
746 ms
191 ms
95 ms
361 ms
417 ms
398 ms
397 ms
58/44/50

TRANSMITTAL: 12707665
COLLECTED: 06-APR-2016

11:10:52

SINUS RHYTHM
NONSPECIFIC ST ELEVATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 21:56:08

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707622

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / PRE DOSE A
06-APR-2016
11:04:51

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

05-OCT-1939
5009003

Interval Duration Measurements


Philips, Neil
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
83

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

722

N/A

N/A

PR Interval (ms) :

178

N/A

N/A

QRS Interval (ms) :

102

N/A

N/A

QT Interval (ms) :

366

N/A

N/A

408

N/A

N/A

QTc Fridericia's (ms) :

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 21:50 ET

Date: ____________________________

Generated on: 07-JUN-2016 21:55:56


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 10/05/1939


7 DIGIT SUBJECT NUMBER: 5009003
P2C1 / 1 / A

84 bpm
714 ms
192 ms
99 ms
365 ms
431 ms
408 ms
405 ms
72/39/51

TRANSMITTAL: 12707622
COLLECTED: 06-APR-2016

11:04:51

SINUS RHYTHM WITH OCCASIONAL SUPRAVENTRICULAR PREMATURE COMPLEXES


RSR (QR) IN V1/V2 CONSISTENT WITH RIGHT VENTRICULAR CONDUCTION DELAY
NONSPECIFIC ST ELEVATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 21:55:56

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707252

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 1 / DAY 1 / PRE DOSE A
07-AUG-2015
08:18:01

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

24-JAN-1948
5009001

Interval Duration Measurements


Fishman, Jonathan
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
61

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

992

N/A

N/A

PR Interval (ms) :

127

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

83

N/A

N/A

401

N/A

N/A

402

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 21:15 ET

Date: ____________________________

Generated on: 07-JUN-2016 21:20:56


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 01/24/1948


7 DIGIT SUBJECT NUMBER: 5009001
P1C1 / 1 / A

60 bpm
988 ms
121 ms
89 ms
399 ms
401 ms
400 ms
400 ms
75/-25/55

TRANSMITTAL: 12707252
COLLECTED: 07-AUG-2015

08:18:01

SINUS RHYTHM
MODERATE LEFT AXIS DEVIATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 21:20:56

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707254

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 1 CYCLE 1 / DAY 1 / PRE DOSE B
07-AUG-2015
08:23:00

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

24-JAN-1948
5009001

Interval Duration Measurements


Fishman, Jonathan
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
62

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

967

N/A

N/A

PR Interval (ms) :

129

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

87

N/A

N/A

405

N/A

N/A

410

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 21:15 ET

Date: ____________________________

Generated on: 07-JUN-2016 21:20:45


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 01/24/1948


7 DIGIT SUBJECT NUMBER: 5009001
P1C1 / 1 / B

62 bpm
955 ms
122 ms
88 ms
396 ms
405 ms
402 ms
402 ms
72/-26/52

TRANSMITTAL: 12707254
COLLECTED: 07-AUG-2015

08:23:00

SINUS RHYTHM
MODERATE LEFT AXIS DEVIATION
BORDERLINE ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 21:20:45

ERT

Page 2 of 2

ECG Analysis Report with Mean Comparator Change


Sponsor:
Protocol:
Account:
Transmittal Number:

Array BioPharma Inc.


CLGX818X2109
746874
12707420

Subject Information
Date of Birth:
7 Digit Subject Number:

5009
Chmielowski, Bartosz
924 Westwood Blvd.
Suite 200
Los Angeles CA 90024
United States of America
PART 2 CYCLE 1 / DAY 1 / PRE DOSE A
08-JAN-2016
09:56:59

Site ID:
Investigator Name:
Address:

Visit:
Collection Date:
Collection Time:

13-MAR-1958
5009002

Interval Duration Measurements


Fleming, Laura
Good Tracing

Collected By:
Tracing Quality:
Lead Analyzed: II
Heart Rate (bpm) :

Mean
63

Comparator
Mean
N/A

Change
N/A

RR Interval (ms) :

947

N/A

N/A

PR Interval (ms) :

176

N/A

N/A

QRS Interval (ms) :


QT Interval (ms) :
QTc Fridericia's (ms) :

86

N/A

N/A

427

N/A

N/A

435

N/A

N/A

Evaluation
Interpretation:

Normal

Evaluation By:
Evaluation Date/Time:

For Site Use Only.


Investigator Signature: __________________________________________________

B Ashalatha
07-JUN-2016 20:18 ET

Date: ____________________________

Generated on: 07-JUN-2016 20:23:46


1818 Market Street
Philadelphia, PA 19103
United States of America

Page 1 of 2
Peterborough Business Park
Lynch Wood
Peterborough, Cambridgeshire PE2 6FZ

PROTOCOL:
SITE:

Array BioPharma Inc. - CLGX818X2109


5009
INVESTIGATOR: Chmielowski, Bartosz

DATE OF BIRTH: 03/13/1958


7 DIGIT SUBJECT NUMBER: 5009002
P2C1 / 1 / A

63 bpm
952 ms
178 ms
82 ms
424 ms
434 ms
431 ms
430 ms
43/47/30

TRANSMITTAL: 12707420
COLLECTED: 08-JAN-2016

09:56:59

SINUS RHYTHM
NORMAL ECG

CAUTION:

WAVEFORM QUALITY AND SCALING MAY BE AFFECTED BY THE RECEIVING FAX MACHINE

VISIT:

HR_GL:
RR_GL:
PR_GL:
QRS_GL:
QT_GL:
QTcB_GL:
QTcF_GL:
QTcL_GL:
P-R-T axes:

ACCOUNT: 746874

Generated on: 07-JUN-2016 20:23:46

ERT

Page 2 of 2

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