Data Sharing Request Form

Please list the legal address to be incorporated within the data sharing agreement.

Please enter "N/A" if no other researchers are participating.

Refer to the trial record(s) listed in www.clinicaltrials.gov and/or www.clinicaltrialregister.eu.

Please include the study titles and numbers, as they are listed within www.clinicaltrials.gov and/or www.clinicaltrialregister.eu.

Briefly describe the intended use of the data and pertinent background information supporting this use.

Briefly describe the proposed approach and intended outcomes of the research.

Briefly describe the quantitative measurements required by and supporting the research objectives.

(if requesting a dataset, specify data attributes/chracteristics/variables/images requested)

Provide details of any planned presentations and/or publications including the intended conference(s) or target journal(s) and timing. If there are no plans to publish, please explain.

Please provide a brief summary of relevant scientific/statistical experience and expertise of the research team in support of the proposed research.

Are there existing CDA/NDAs in place between Blueprint Medicines and any of the proposed researchers and/or institutions?

Are you aware of any real or perceived conflicts of interest related to this research?