Unnamed1
ProtocolECOGIdentifierNumber
text
PatientECOGIdentifierNumber
CollectedDataFormName
RegistrationStepNumber
Unnamed2
PatientInitialsName
ProtocolParticipatingIdentifierNumber
CombinedInstitutionName
PatientParticipatingIdentifierNumber
Unnamed4
DataAmendedText
DataAmendedDate
date
On Treatment Reporting Period
TreatmentEvaluationPeriodType
Off Treatment
PersonOff-TreatmentTimePeriodType
Unnamed5
TreatmentReportingPeriodBeginDate
TreatmentReportingPeriodEndDate
Unnamed6
ConcomitantMedicationCorticosteroidTherapeuticProcedureRelationshipAdverseEventAdministeredInd-2
CommonTerminologyCriteriaforAdverseEventsVersion4.0LowLevelTermName
ConcomitantMedicationCorticosteroidTherapeuticProcedureRelationshipAdverseEventAdministeredName
AgentAdministeredDose
double
AgentConcomitantAdministrationUOM
ECOGMedicationUOMSpecify
AgentAdministeredFrequency
AgentAdministeredFrequencySpecify
Drug Administration Route
MedicationAdministrationRouteSpecify
AgentBeginDate
Medication continued
AgentEndDate
Other Treatment-related Adverse Event
ConcomitantMedicationImmunosuppressantTherapeuticProcedureRelationshipAdverseEventAdministeredInd-2
ConcomitantMedicationImmunosuppressantTherapeuticProcedureRelationshipAdverseEventAdministeredName
ConcomitantMedicationImmunosuppressantTherapeuticProcedureRelationshipAdverseEventAdministeredSpecify
CommonToxicityCriteriaAdverseEventOtherEndocrineSystemSpecify
ConcomitantMedicationHormoneReplacementTherapyTherapeuticProcedureRelationshipAdverseEventAdministeredTherapyInd-2
ConcomitantMedicationHormoneReplacementTherapyTherapeuticProcedureRelationshipAdverseEventAdministeredName
ConcomitantMedicationHormoneReplacementTherapyTherapeuticProcedureRelationshipAdverseEventAdministeredSpecify
Comments
ResearchCommentsText
InvestigatorSignatureText
InvestigatorSignatureDate