ID

10093

Descripción

E2603 Concomitant Medication Form Form No. 2169 Carboplatin and Paclitaxel With or Without Sorafenib in Treating Patients With Unresectable Stage III or Stage IV Melanoma NCT00110019 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E7D649ED-D8C9-54BD-E034-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E7D649ED-D8C9-54BD-E034-0003BA3F9857

Palabras clave

Versiones (7)
  1. 19/9/12 19/9/12 -
  2. 26/11/14 26/11/14 - Martin Dugas
  3. 26/11/14 26/11/14 - Martin Dugas
  4. 8/1/15 8/1/15 - Martin Dugas
  5. 9/1/15 9/1/15 - Martin Dugas
  6. 9/1/15 9/1/15 - Martin Dugas
  7. 26/3/15 26/3/15 - Martin Dugas
Subido en

26 de marzo de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Melanoma Concomitant Medication NCT00110019

Alemán Inglés

Concomitant Medication Melanoma NCT00110019 E2603 No. 2169

1 formularios  
  1. StudyEvent: E2603 Concomitant Medication Form Form No. 2169
    1. Concomitant Medication Melanoma NCT00110019 E2603 No. 2169
Header
Descripción

Header

Alias
UMLS CUI-1
C1320722
Protocol Number ECOG
Descripción

Protocol Number ECOG

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
Patient ID ECOG
Descripción

Patient ID ECOG

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C1512162
NCI Thesaurus Property
C25364
NCI Thesaurus Property-2
C25491
Generic drug form
Descripción

Generic drug form

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C3242750
NCI Thesaurus Property
C19464
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus ObjectClass-2
C25452
Registration Number
Descripción

Registration Number

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C1514821
NCI Thesaurus ObjectClass
C25646
UMLS CUI-2
C0237753
NCI Thesaurus Property
C16154
NCI Thesaurus ValueDomain-2
C16154
Patient Initials
Descripción

Patient Initials

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Study Number Participating Group
Descripción

Study Number Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C3274381
NCI Thesaurus ObjectClass
C25320
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Institution Name
Descripción

Institution Name

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25454
UMLS CUI-1
C1301943
NCI Thesaurus ObjectClass-2
C21541
NCI Thesaurus Property
C25364
NCI Thesaurus ValueDomain
C25191
NCI Thesaurus ValueDomain-2
C21541
Trial subject ID Participating Group
Descripción

Trial subject ID Participating Group

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25337
UMLS CUI-1
C2348585
NCI Thesaurus ObjectClass
C16960
UMLS CUI-2
C2347449
NCI Thesaurus Property
C25608
NCI Thesaurus Property-2
C25364
Data amended
Descripción

Data amended

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Data amended date
Descripción

Data amended date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
UMLS CUI-2
C0011008
NCI Thesaurus Property
C25416
NCI Thesaurus ValueDomain-2
C25367
Reporting Period Start Date
Descripción

Reporting Period Start Date

Tipo de datos

date

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25616
UMLS CUI-1
C2361257
NCI Thesaurus Property-2
C25651
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25431
Reporting Period End Date
Descripción

Reporting Period End Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2361259
NCI Thesaurus Property
C25616
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property-2
C25651
Research Comments
Descripción

Research Comments

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0947611
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
Investigator Signature
Descripción

Investigator Signature

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
UMLS CUI-1
C2346576
Investigator Signature Date
Descripción

Investigator Signature Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
UMLS CUI-2
C0011008
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C17089
Concomitant Medication
Descripción

Concomitant Medication

Alias
UMLS CUI-1
C2347852
Cycle number
Descripción

Cycle number

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2045829
NCI Thesaurus Property
C25214
NCI Thesaurus Property-2
C25616
NCI Thesaurus ObjectClass
C15368
Concomitant Medication used
Descripción

Concomitant Medication used

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ObjectClass-2
C25730
NCI Thesaurus Property
C25382
UMLS CUI-1
C2347852
Chemotherapy cycle
Descripción

Chemotherapy cycle

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C15368
NCI Thesaurus Property
C25214
UMLS CUI-1
C1302181
NCI Thesaurus Property-2
C25616
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ValueDomain-2
C25472
NCI Thesaurus ValueDomain-3
C25275
Agent
Descripción

Agent

Tipo de datos

text

Alias
NCI Thesaurus Property
C25364
UMLS CUI-1
C1521826
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C1708
NCI Thesaurus ValueDomain-2
C42614
Medication Dose
Descripción

Medication Dose

Tipo de datos

float

Alias
NCI Thesaurus ValueDomain
C25488
UMLS CUI-1
C3174092
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain-2
C1708
NCI Thesaurus Property
C25382
Units
Descripción

Units (*)

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25730
NCI Thesaurus Property-2
C25409
NCI Thesaurus ValueDomain
C25709
UMLS CUI-1
C1519795
Unit, other
Descripción

Unit, other

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C25491
NCI Thesaurus ObjectClass-2
C459
NCI Thesaurus Property
C25365
UMLS CUI-1
C1519795
Medication frequency
Descripción

Medication frequency

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ValueDomain
C25515
NCI Thesaurus Property
C25382
UMLS CUI-1
C3476109
Medication frequency
Descripción

Medication frequency

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS CUI-1
C3476109
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus ObjectClass-2
C25409
NCI Thesaurus Property
C25275
Drug Administration Route
Descripción

Drug Administration Route

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25284
NCI Thesaurus ObjectClass
C459
NCI Thesaurus ObjectClass-2
C25409
NCI Thesaurus Property
C25169
UMLS CUI-1
C0013153
Medication Administration Route, Specify
Descripción

Medication Administration Route, Specify

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25685
NCI Thesaurus ObjectClass
C459
NCI Thesaurus ObjectClass-2
C25409
NCI Thesaurus Property
C25169
UMLS CUI-1
C0013153
Concomitant Medication Start Date
Descripción

Concomitant Medication Start Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ValueDomain-2
C25431
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
UMLS CUI-1
C2826734
Medication continued
Descripción

Medication continued

Tipo de datos

boolean

Alias
NCI Thesaurus ValueDomain
C38147
NCI Thesaurus ObjectClass
C459
NCI Thesaurus Property
C25409
NCI Metathesaurus Property
C0750536
UMLS CUI-1
C0013227
UMLS CUI-2
C0549178
Concomitant Medication End Date
Descripción

Concomitant Medication End Date

Tipo de datos

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
UMLS CUI-1
C2826744
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Concomitant Medication Melanoma NCT00110019 E2603 No. 2169

1 formularios
  1. StudyEvent: E2603 Concomitant Medication Form Form No. 2169
    1. Concomitant Medication Melanoma NCT00110019 E2603 No. 2169
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
C1320722 (UMLS CUI-1)
Protocol Number ECOG
Item
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Patient ID ECOG
Item
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
Generic drug form
Item
text
C25191 (NCI Thesaurus ValueDomain)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
Registration Number
Item
text
C25337 (NCI Thesaurus ValueDomain)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
Patient Initials
Item
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Study Number Participating Group
Item
text
C25337 (NCI Thesaurus ValueDomain)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Institution Name
Item
text
C25454 (NCI Thesaurus ObjectClass)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
Trial subject ID Participating Group
Item
text
C25337 (NCI Thesaurus ValueDomain)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
Data amended
Item
text
C25704 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Data amended date
Item
date
C25164 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
Reporting Period Start Date
Item
date
C15368 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C2361257 (UMLS CUI-1)
C25651 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
Reporting Period End Date
Item
date
C25164 (NCI Thesaurus ValueDomain)
C2361259 (UMLS CUI-1)
C25616 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25651 (NCI Thesaurus Property-2)
Research Comments
Item
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
Investigator Signature
Item
text
C25704 (NCI Thesaurus ValueDomain)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
Investigator Signature Date
Item
date
C25164 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)
Item Group
C2347852 (UMLS CUI-1)
Item
text
C25284 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
CL.1
Code List
Cycle number
CL Item
 (Baseline)
C25213 (NCI Thesaurus)
C1442488 (UMLS 2011AA)
C25213 (NCI Thesaurus-3)
C1442488 (UMLS 2011AA-4)
CL Item
 (Cycle 1)
CL Item
 (Cycle 2)
CL Item
 (Cycle 3)
CL Item
 (Cycle 4)
CL Item
 (Cycle 5)
CL Item
 (Cycle 6)
CL Item
 (Cycle 7)
CL Item
 (Cycle 8)
CL Item
 (Cycle 9)
CL Item
 (Cycle 10)
CL Item
 (> Cycle 10)
Concomitant Medication used
Item
boolean
C38147 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C2347852 (UMLS CUI-1)
Chemotherapy cycle
Item
text
C15368 (NCI Thesaurus ObjectClass)
C25214 (NCI Thesaurus Property)
C1302181 (UMLS CUI-1)
C25616 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C25472 (NCI Thesaurus ValueDomain-2)
C25275 (NCI Thesaurus ValueDomain-3)
Agent
Item
text
C25364 (NCI Thesaurus Property)
C1521826 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain)
C42614 (NCI Thesaurus ValueDomain-2)
Medication Dose
Item
float
C25488 (NCI Thesaurus ValueDomain)
C3174092 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C1708 (NCI Thesaurus ValueDomain-2)
C25382 (NCI Thesaurus Property)
Item
Units
text
C1708 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus Property)
C25409 (NCI Thesaurus Property-2)
C25709 (NCI Thesaurus ValueDomain)
C1519795 (UMLS CUI-1)
CL.3
Code List
Units
CL Item
Kapsel (capsules)
C0006935 (UMLS CUI-1)
CL Item
Gramm (gram)
C48155 (NCI Thesaurus)
C0439208 (UMLS CUI-1)
CL Item
Tropfen (drops)
C69442 (NCI Thesaurus)
C2347093 (UMLS CUI-1)
CL Item
Zoll (inch)
C48500 (NCI Thesaurus)
C0439204 (UMLS CUI-1)
CL Item
Kilogramm (kilogram)
C28252 (NCI Thesaurus)
C0439209 (UMLS CUI-1)
CL Item
Liter (liter)
C0475211 (UMLS CUI-1)
CL Item
Mikrogramm (microgram)
C0439211 (UMLS CUI-1)
CL Item
Milliäquivalent (milliequivalent)
C0439152 (UMLS CUI-1)
CL Item
Milligramm (milligram)
C28253 (NCI Thesaurus)
C0439210 (UMLS CUI-1)
CL Item
Milliliter (milliliter)
C28254 (NCI Thesaurus)
C0439242 (UMLS CUI-1)
CL Item
Unze (ounce)
C48519 (NCI Thesaurus)
C0439218 (UMLS CUI-1)
CL Item
Tabletten (tablets)
C0039225 (UMLS CUI-1)
CL Item
Esslöffel (tablespoon)
C1532188 (UMLS CUI-1)
CL Item
Teelöffel (teaspoon)
C1704619 (UMLS CUI-1)
CL Item
Einheit (unit)
C44278 (NCI Thesaurus)
C0439148 (UMLS CUI-1)
CL Item
Sonstig (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
Unit, other
Item
text
C25685 (NCI Thesaurus ValueDomain)
C25491 (NCI Thesaurus ObjectClass)
C459 (NCI Thesaurus ObjectClass-2)
C25365 (NCI Thesaurus Property)
C1519795 (UMLS CUI-1)
Item
text
C1708 (NCI Thesaurus ObjectClass)
C25515 (NCI Thesaurus ValueDomain)
C25382 (NCI Thesaurus Property)
C3476109 (UMLS CUI-1)
CL.4
Code List
Medication frequency
CL Item
 (immediately)
C0205548 (UMLS CUI-1)
CL Item
 (as needed)
C1879745 (UMLS CUI-1)
CL Item
 (every day)
C0332173 (UMLS CUI-1)
CL Item
 (every other day)
C0558287 (UMLS CUI-1)
CL Item
 (twice a day)
C0585361 (UMLS CUI-1)
CL Item
 (three times a day)
C0556984 (UMLS CUI-1)
CL Item
 (four times a day)
C0585291 (UMLS CUI-1)
CL Item
 (twice a week)
C0556985 (UMLS CUI-1)
CL Item
 (three times a week)
C0556987 (UMLS CUI-1)
CL Item
 (before meals)
C1550738 (UMLS CUI-1)
CL Item
 (after meals)
C0376674 (UMLS CUI-1)
CL Item
 (at bedtime or hour of sleep)
C0521112 (UMLS CUI-1)
CL Item
 (every 4 hours)
C0585324 (UMLS CUI-1)
CL Item
 (every 6 hours)
C0585325 (UMLS CUI-1)
CL Item
 (every 8 hours)
C0585326 (UMLS CUI-1)
CL Item
 (every 12 hours)
C0585327 (UMLS CUI-1)
CL Item
 (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
Medication frequency
Item
text
C25685 (NCI Thesaurus ValueDomain)
C3476109 (UMLS CUI-1)
C1708 (NCI Thesaurus ObjectClass)
C25409 (NCI Thesaurus ObjectClass-2)
C25275 (NCI Thesaurus Property)
Item
text
C25284 (NCI Thesaurus ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C25409 (NCI Thesaurus ObjectClass-2)
C25169 (NCI Thesaurus Property)
C0013153 (UMLS CUI-1)
CL.5
Code List
Drug Administration Route
CL Item
 (PO)
C25311 (NCI Thesaurus)
C25311 (NCI Thesaurus-3)
C0442027 (UMLS CUI-1)
CL Item
 (SC)
C13353 (NCI Thesaurus)
C13353 (NCI Thesaurus-3)
C0443315 (UMLS CUI-1)
CL Item
 (IM)
C27974 (NCI Thesaurus)
C27974 (NCI Thesaurus-3)
C0442117 (UMLS CUI-1)
CL Item
 (IV)
X-MO-6794 (MGED)
X-MO-6794 (MGED-2)
C0348016 (UMLS CUI-1)
CL Item
 (rectal)
C25224 (NCI Thesaurus)
C0205052 (UMLS CUI-1)
CL Item
 (topical)
C13344 (NCI Thesaurus)
C13344 (NCI Thesaurus-3)
C0332237 (UMLS CUI-1)
CL Item
 (nasal)
C27958 (NCI Thesaurus)
C0028429 (UMLS CUI-1)
CL Item
 (inhaled)
C0001559 (UMLS CUI-1)
CL Item
 (transdermal)
C28017 (NCI Thesaurus)
C0694643 (UMLS CUI-1)
CL Item
 (sublingual)
C89785 (NCI Thesaurus)
C0001565 (UMLS CUI-1)
CL Item
 (intradermal)
C28213 (NCI Thesaurus)
C0150647 (UMLS CUI-1)
CL Item
 (other)
C17649 (NCI Thesaurus)
C0205394 (UMLS CUI-1)
Medication Administration Route, Specify
Item
text
C25685 (NCI Thesaurus ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C25409 (NCI Thesaurus ObjectClass-2)
C25169 (NCI Thesaurus Property)
C0013153 (UMLS CUI-1)
Concomitant Medication Start Date
Item
date
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2826734 (UMLS CUI-1)
Medication continued
Item
boolean
C38147 (NCI Thesaurus ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C25409 (NCI Thesaurus Property)
C0750536 (NCI Metathesaurus Property)
C0013227 (UMLS CUI-1)
C0549178 (UMLS CUI-2)
Concomitant Medication End Date
Item
date
C25164 (NCI Thesaurus ValueDomain)
C1708 (NCI Thesaurus ObjectClass)
C25275 (NCI Thesaurus Property)
C2826744 (UMLS CUI-1)
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