DCRI COMMERCIAL RELATIONSHIPS TRACKING FORM COI Reporting is based on the previous year and anticipated relationships for the coming year. Please report current and anticipated information for the calendar year (January through December) 2018. For audit purposes, please keep conflict of interest/financial records for three years after the conclusion of the award. How to Use This Form: 1) Save the document on your drive. 2) Enter the Year (e.g. 2018), your Name, Title and Address in the appropriate fields. 3) Make sure you save your version on your drive. 4) Then Click on File, click Protect Document, in the drop-down menu click Restrict Editing. In the column to the right at the bottom click unprotect. 5) Click on the appropriate checkboxes. 6) Save your updated version on your drive 7) Send an email to DCRI Communications (DCRIExternalWebsite@dm.duke.edu) with your COI attached for posting on our DCRI website. Editing the Document (Necessary only when you have to add companies not on the form): 1) Scroll down to the last page to the blank rows and enter the company name(s) on the company field(s). 2) Enter new information. 3) Click on the appropriate checkboxes on your new listing and save. 4) Make sure you save your version on your drive. Column Explanations: (1) Funding is provided for my effort in research grants or contracts for multi-center projects in which I serve as either the Chairman, Co-Chairman, Executive or Steering Committee member or I am involved as a DCRI faculty leader for specific aspects in a project. A check in this column denotes that I am involved in such a research contract. Payments for the work performed for these contracts are made to the. A portion of my salary as a faculty member, representative of % effort on the project, is supported by these funds. research grant company supports the expenses associated with projects in the DUHS that are under my direction. (3) I provide educational activities or deliver occasional lectures that generate revenue company. All revenues from these activities are paid to the. None of it is taken for personal income. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (4) I receive personal income outside of my salary for consulting or other services (Including CME) company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (5) I receive personal income outside of my salary for consulting or other non-cme services company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. personally receive royalties in excess of $5,000 per year company. (7) I, or an immediate member of my family, have equity (with shareholder voting privileges) in this company of either > $5,000 or > 1%. ***If you have no conflict to report please check the box at the end of the list. page 1 of 12
DCRI COMMERCIAL RELATIONSHIPS TRACKING FORM Year: 2017 Name: Vance Fowler Title: Professor Address: Room 183, 315 Trent Drive Division of Infectious Diseases Medical Center Durham, NC 27710 Please complete the applicable rows in the following table. Monetary amounts are on an annual basis. : (1) A this this Lectures for this > CME) for this Generates > > <$5 K >$5K/1% Abbott Laboratories Abbott Vascular Business (formerly Abbott Vascular Devices) AbbVie Abiomed Acceleron Pharma Inc Acerta Pharma ACIST Medical Systems, Inc AegisCN LLC Aires Akili Interactive Labs 2 of 12
: (1) A this this Lectures for this CME) for this Generates > > > Akros Alexion Amgen, Inc Amylin, Inc. ARCA biopharma Armis Biopharma Astellas Scientific and Medical Affairs Inc AstraZeneca Baseline Study LLC Basilea Pharmaceutica International Ltd Bayer AG Biosensors International Group Ltd Boehringer Ingleheim Boston Scientific Corporation 3 of 12
: (1) A this this Lectures for this CME) for this Generates > > > Bristol Myers Squibb Cempra, Inc. ContraFect Corporation CPC Clinical CryoLife Inc CSL Limited DAIICHI SANKYO COMPANY, LIMITED Datavant Inc David H Murdock Inst for Business and Culture Clinical Institute Durata Therapeutics Eiger BioPharmaceutical s Inc 4 of 12
: (1) A this this Lectures for this CME) for this Generates > > > Einstein HC Network Philadelphia Elesvier Eli Lilly & Eureka Therapeutics Evalve, Inc. Ferring Filament BioSolutions Galectin Therapeutic Genentech General Electric Genetic Alliance Genzyme Corporation German AFNET Gilead GlaxoSmithKline plc 5 of 12
Grifols : (1) A this this Lectures for this CME) for this Generates > > > HeartFlow Intarcia Therapeutics, Inc. Intra-Cellular Therapies Inc Ironwood Janssen Pharmaceutica Products, L.P. Janssen and Development Janssen Scientific Affairs, LLC Japanese Org for Med Device Devlpt Johnson and Johnson Pharmaceutical and Development Kem Pharm Inc Ligand 6 of 12
Luitpold, Inc. : (1) A this this Lectures for this CME) for this Generates > > > Lundbeck Mallinckrodt Marinus Inc Medtronic AVE Medtronic PLC Medtronic Vascular, Inc (formerly Medtronic AVE) Merck & Co, Inc. Mercy Health System Murdock MyoKardia Inc Novartis Pharmaceutical Olympus Corporation 7 of 12
Oncternal Therapeutics OrbusNeich : (1) A this this Lectures for this CME) for this Generates > > > Otsuka America Pharmaceutical, Inc PATH PENTA Medical Pfizer Purdue Pharma Reflexion Health Regeneron, Inc ReNeuron Triangle Institute ResMed Corp Roche Diagnostics Roche Diagnostics Corp Roche Group Roche Labs Sanofi Genzyme 8 of 12
Sanofi-Aventis Sanofi-Synthelabo : (1) A this this Lectures for this CME) for this Generates > > > Society of Thoracic Surgeons Summit Svelte Medical Systems Inc. Swedish Orphan Biovitrum AB Tacere Therapeutics Taiwanj Ltd Takeda Pharmaceutical North America Inc TESARO Inc TEVA Industries Theravance Biopharma Thrombosis Institute 9 of 12
Ultragenyx United Health Network : (1) A this this Lectures for this CME) for this Generates > > > Abbott Laboratories of Arkansas Karius Cidara UpToDate Allergan Polyphor Haymarket Media Infectious Diseases Society of America River West Meeting Wolters Kluwer Health NIH Health Advances Wiley Publishing Becker Pharmaceutical consulting 10 of 12
: (1) A this this Lectures for this CME) for this Generates > > > Back Bay Life Arivan Professional & Scientific Associates Global HMC No Conflicts to report Column Explanations: (1) Funding is provided for my effort in research grants or contracts for multi-center projects in which I serve as either the Chairman, Co-Chairman, Executive or Steering Committee member or I am involved as a DCRI faculty leader for specific aspects in a project. A check in this column denotes that I am involved in such a research contract. Payments for the work performed for these contracts are made to the. A portion of my salary as a faculty member, representative of % effort on the project, is supported by these funds. research grant company supports the expenses associated with projects in the DUHS that are under my direction. (3) I provide educational activities or deliver occasional lectures that generate revenue company. All revenues from these activities are paid to the. None of it is taken for personal income. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. (4) I receive personal income outside of my salary for consulting or other services (Including CME) company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. 11 of 12
(5) I receive personal income outside of my salary for consulting or other non-cme services company. The three columns represent annual payments of more than $5,000, between $5,000 and $25,000, and in excess of $25,000 per year company. personally receive royalties in excess of $5,000 per year company. (7) I, or an immediate member of my family, have equity (with shareholder voting privileges) in this company of either > $5,000 or > 1%. 12 of 12