ID

10093

Description

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

Lien

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

Mots-clés

Versions (7)
  1. 19/09/2012 19/09/2012 -
  2. 26/11/2014 26/11/2014 - Martin Dugas
  3. 26/11/2014 26/11/2014 - Martin Dugas
  4. 08/01/2015 08/01/2015 - Martin Dugas
  5. 09/01/2015 09/01/2015 - Martin Dugas
  6. 09/01/2015 09/01/2015 - Martin Dugas
  7. 26/03/2015 26/03/2015 - Martin Dugas
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26 mars 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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Melanoma Concomitant Medication NCT00110019

Allemand Anglais

Concomitant Medication Melanoma NCT00110019 E2603 No. 2169

1 Formulaires  
  1. StudyEvent: E2603 Concomitant Medication Form Form No. 2169
    1. Concomitant Medication Melanoma NCT00110019 E2603 No. 2169
Header
Description

Header

Alias
UMLS CUI-1
C1320722
Protocol Number ECOG
Description

Protocol Number ECOG

Type de données

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
Description

Patient ID ECOG

Type de données

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
Description

Generic drug form

Type de données

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
Description

Registration Number

Type de données

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
Description

Patient Initials

Type de données

text

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

Study Number Participating Group

Type de données

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
Description

Institution Name

Type de données

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
Description

Trial subject ID Participating Group

Type de données

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
Description

Data amended

Type de données

text

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

Data amended date

Type de données

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
Description

Reporting Period Start Date

Type de données

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
Description

Reporting Period End Date

Type de données

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
Description

Research Comments

Type de données

text

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

Investigator Signature

Type de données

text

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

Investigator Signature Date

Type de données

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
Description

Concomitant Medication

Alias
UMLS CUI-1
C2347852
Cycle number
Description

Cycle number

Type de données

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
Description

Concomitant Medication used

Type de données

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
Description

Chemotherapy cycle

Type de données

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
Description

Agent

Type de données

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
Description

Medication Dose

Type de données

float

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

Units (*)

Type de données

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
Description

Unit, other

Type de données

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
Description

Medication frequency

Type de données

text

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

Medication frequency

Type de données

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
Description

Drug Administration Route

Type de données

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
Description

Medication Administration Route, Specify

Type de données

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
Description

Concomitant Medication Start Date

Type de données

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
Description

Medication continued

Type de données

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
Description

Concomitant Medication End Date

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C1708
NCI Thesaurus Property
C25275
UMLS CUI-1
C2826744
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Similar models

Concomitant Medication Melanoma NCT00110019 E2603 No. 2169

1 Formulaires
  1. StudyEvent: E2603 Concomitant Medication Form Form No. 2169
    1. Concomitant Medication Melanoma NCT00110019 E2603 No. 2169
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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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