ID

10095

Beskrivning

E2905 Hematology Form Lenalidomide With or Without Epoetin Alfa in Treating Patients With Myelodysplastic Syndrome and Anemia NCT00843882 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11427DB4-3795-240D-E044-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=11427DB4-3795-240D-E044-0003BA3F9857

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-08 2015-01-08 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
  4. 2015-01-09 2015-01-09 - Martin Dugas
  5. 2015-03-27 2015-03-27 - Martin Dugas
Uppladdad den

27 mars 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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MDS Hematology Form NCT00843882

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files

Header
Beskrivning

Header

Alias
UMLS CUI-1
C1320722
ECOG Protocol Number
Beskrivning

Protocol Number ECOG

Datatyp

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
ECOG Patient ID
Beskrivning

Patient ID ECOG

Datatyp

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
DCI Name
Beskrivning

Generic drug form

Datatyp

text

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

Registration Number

Datatyp

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 (Last, First)
Beskrivning

Patient Initials

Datatyp

text

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

Study Number Participating Group

Datatyp

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
Participating Group Patient ID
Beskrivning

Trial subject ID Participating Group

Datatyp

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
Institution/Affiliate
Beskrivning

Institution Name

Datatyp

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
Are data amended
Beskrivning

Data amended

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C38148
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Investigator Signature
Beskrivning

Investigator Signature

Datatyp

text

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

Investigator Signature Date

Datatyp

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
ON/Off TREATMENT
Beskrivning

ON/Off TREATMENT

On Treatment Report Period (Step 2 - Choose one x)
Beskrivning

Cycle number

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C2045829
NCI Thesaurus Property
C25214
NCI Thesaurus Property-2
C25616
NCI Thesaurus ObjectClass
C15368
Specify Cycle
Beskrivning

Chemotherapy cycle

Datatyp

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
Off Treatment Report Period (since registration - Choose one x)
Beskrivning

PersonOff-TreatmentTimePeriodType

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C25190
NCI Thesaurus Property
C25616
NCI Thesaurus Property-2
C25601
NCI Thesaurus Property-3
C25207
NCI Thesaurus ValueDomain
C25284
UMLS CUI-1
C0027361
UMLS CUI-2
C1948053
UMLS CUI-3
C1518544
UMLS CUI-4
C0040223
UMLS CUI-5
C0332307
Pre-registration Hematology/chemistry
Beskrivning

Pre-registration Hematology/chemistry

Date Hematology (Blood) Sample Obtained
Beskrivning

HematologySpecimenCollectedDate

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C16673
NCI Thesaurus ObjectClass-2
C19157
NCI Thesaurus Property
C25452
UMLS CUI-1
C1317250
Test not done (Please mark "X" in Box only if test not done)
Beskrivning

Test not done (Please mark "X" in Box only if test not done)

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus Property
C25594
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0022885
UMLS CUI-2
C0445106
Peripheral Granulocytes Count LLN
Beskrivning

LaboratoryProcedureGranulocyteResultLowerLimitofNormalCount

Datatyp

float

Måttenheter
  • /mm^3
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12530
NCI Thesaurus ValueDomain
C25463
NCI Thesaurus ValueDomain-2
C25555
UMLS CUI-1
C0857490
UMLS CUI-2
C1518030
/mm^3
Peripheral Granulocytes Count
Beskrivning

Peripheral Granulocytes Count (AGC/ANC/mm^3 - Do not report % granulocytes: report absolute count without decimal.)

Datatyp

float

Måttenheter
  • /mm^3
Alias
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12530
NCI Thesaurus ValueDomain
C25463
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0857490
/mm^3
Peripheral platelet count, LLN (/mm^3x1000)
Beskrivning

Platelets LLN

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0005821
NCI Thesaurus Property
C20200
UMLS CUI-2
C1518030
NCI Thesaurus Property-2
C12520
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25555
Peripheral Platelet Count
Beskrivning

Peripheral Platelet Count

Datatyp

float

Måttenheter
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12520
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
UMLS CUI-1
C0005821
1000/uL
Peripheral Blasts
Beskrivning

LaboratoryProcedureBlastCellOutcomePercentageValue

Datatyp

float

Måttenheter
  • %
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12918
NCI Thesaurus ValueDomain
C25613
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI-1
C0523113
%
Peripheral WBC count, LLN
Beskrivning

LaboratoryProcedureLeukocyteResultLowerLimitofNormalValue

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C12529
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25555
UMLS CUI-1
C0023508
UMLS CUI-2
C1518030
Peripheral WBC Count
Beskrivning

Leukocytes (WBC)

Datatyp

float

Måttenheter
  • 1000/uL
Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0023508
NCI Thesaurus Property
C12529
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C38024
1000/uL
Creatinine ULN
Beskrivning

LaboratoryProcedureCreatinineResultUpperLimitNormalValue

Datatyp

float

Alias
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C399
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
UMLS CUI-1
C0201976
UMLS CUI-2
C1519815
Creatinine
Beskrivning

Creatinine, Serum

Datatyp

float

Måttenheter
  • mg/dL
Alias
NCI Thesaurus Property
C20200
UMLS CUI-1
C0201976
NCI Thesaurus Property-2
C399
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
mg/dL
Hemoglobin (Hgb), LLN
Beskrivning

Hemoglobin (Hgb), LLN

Datatyp

float

Måttenheter
  • g/dL
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C16676
NCI Thesaurus Property-2
C20200
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C38024
NCI Thesaurus ValueDomain-3
C25555
UMLS CUI-1
C0019046
UMLS CUI-2
C1518030
g/dL
Hemoglobin (Hgbg/dl)
Beskrivning

Hemoglobin

Datatyp

float

Måttenheter
  • g/dL
Alias
NCI Thesaurus Property
C16676
UMLS CUI-1
C0019046
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
g/dL
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
Beskrivning

CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C49704
NCI Thesaurus Property
C25358
UMLS CUI-1
C1706735
AE Expedited report filed? (Check box if yes)
Beskrivning

AdverseDrugExperienceReportText

Datatyp

boolean

Alias
NCI Thesaurus ValueDomain
C25704
NCI Thesaurus ObjectClass
C25375
NCI Metathesaurus ObjectClass
C0085425
NCI Thesaurus Property
C25175
UMLS CUI-1
C2348483
CTC Adverse Event Term
Beskrivning

AdverseEventCommonTerminologyforAdverseEventsVersion4TermName

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C41331
NCI Thesaurus Property
C49704
NCI Thesaurus Property-2
C45559
NCI Thesaurus ValueDomain
C45255
NCI Thesaurus ValueDomain-2
C49704
NCI Thesaurus ValueDomain-3
C42614
NCI Thesaurus ValueDomain-4
C45559
NCI Thesaurus ValueDomain-5
C25714
UMLS CUI-1
C1516728
UMLS CUI-2
C2826934
CTC Adverse Event Grade
Beskrivning

AdverseEventSeverityGrade CTC Adverse Event Grade (Note: Always provide CTC adverse event attribution code if an adverse event occurred. Also provide CTC AE v4 grade only if extenuating circumstances per the CTC AE v4 grading criteria would trigger a higher grade AE than the lab value would indicate.)

Datatyp

text

Alias
NCI Thesaurus ObjectClass
C41331
NCI Thesaurus Property
C48309
NCI Thesaurus Property-2
C49705
NCI Thesaurus Property-3
C25676
NCI Thesaurus ValueDomain
C41331
NCI Thesaurus ValueDomain-2
C48309
NCI Thesaurus ValueDomain-3
C25676
UMLS CUI-1
C2985911

Similar models

INSTRUCTIONS: Complete this form and submit original to the ECOG Coordinating Center within one week of registration. Keep a copy for your files

Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Header
C1320722 (UMLS CUI-1)
Protocol Number ECOG
Item
ECOG Protocol Number
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
ECOG Patient ID
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
DCI Name
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
Registration Step
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
Patient Initials (Last, First)
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
Study Number Participating Group
Item
Participating Group Protocol Number
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)
Trial subject ID Participating Group
Item
Participating Group Patient ID
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)
Institution Name
Item
Institution/Affiliate
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)
Data amended
Item
Are data amended
boolean
C38148 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Investigator Signature
Item
Investigator Signature
text
C25704 (NCI Thesaurus ValueDomain)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
Investigator Signature Date
Item
Investigator Signature Date
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
ON/Off TREATMENT
Item
On Treatment Report Period (Step 2 - Choose one x)
text
C25284 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
Code List
On Treatment Report Period (Step 2 - Choose one x)
CL Item
Cycle 1 Step 2 (Cycle 1 Step 2)
CL Item
Cycle 2 Step 2 (Cycle 2 Step 2)
CL Item
Cycle 3 Step 2 (Cycle 3 Step 2)
CL Item
Cycle 4 Step 2 (Cycle 4 Step 2)
CL Item
Cycle 5 Step 2 (Cycle 5 Step 2)
CL Item
Cycle 6 Step 2 (Cycle 6 Step 2)
CL Item
Cycle 7 Step 2 (Cycle 7 Step 2)
CL Item
Cycle 8 Step 2 (Cycle 8 Step 2)
CL Item
Cycle 9 Step 2 (Cycle 9 Step 2)
CL Item
Cycle 10 Step 2 (Cycle 10 Step 2)
CL Item
Cycle 11 Step 2 (Cycle 11 Step 2)
CL Item
Cycle 12 Step 2 (Cycle 12 Step 2)
CL Item
Cycle 13-step 2 (Cycle 13-Step 2)
CL Item
>cycle 13-step 2 (>Cycle 13-Step 2)
Chemotherapy cycle
Item
Specify Cycle
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)
Item
Off Treatment Report Period (since registration - Choose one x)
text
C25190 (NCI Thesaurus ObjectClass)
C25616 (NCI Thesaurus Property)
C25601 (NCI Thesaurus Property-2)
C25207 (NCI Thesaurus Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0027361 (UMLS CUI-1)
C1948053 (UMLS CUI-2)
C1518544 (UMLS CUI-3)
C0040223 (UMLS CUI-4)
C0332307 (UMLS CUI-5)
Code List
Off Treatment Report Period (since registration - Choose one x)
CL Item
3 Months Post End Of Treatment (3 months post end of treatment)
CL Item
6 Months Post End Of Treatment (6 months post end of treatment)
Item Group
Pre-registration Hematology/chemistry
Sample collection date
Item
Date Hematology (Blood) Sample Obtained
date
C25164 (NCI Thesaurus ValueDomain)
C16673 (NCI Thesaurus ObjectClass)
C19157 (NCI Thesaurus ObjectClass-2)
C25452 (NCI Thesaurus Property)
C1317250 (UMLS CUI-1)
Laboratory Procedure Not Performed
Item
Test not done (Please mark "X" in Box only if test not done)
boolean
C25704 (NCI Thesaurus ValueDomain)
C25594 (NCI Thesaurus Property)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS CUI-1)
C0445106 (UMLS CUI-2)
Granulocytes LLN
Item
Peripheral Granulocytes Count LLN
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C12530 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0857490 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Granulocyte count
Item
Peripheral Granulocytes Count
float
C20200 (NCI Thesaurus Property)
C12530 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C0857490 (UMLS CUI-1)
Platelets LLN
Item
Peripheral platelet count, LLN (/mm^3x1000)
float
C25294 (NCI Thesaurus ObjectClass)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1518030 (UMLS CUI-2)
C12520 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
Platelets
Item
Peripheral Platelet Count
float
C20200 (NCI Thesaurus Property)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI-1)
Blasts
Item
Peripheral Blasts
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C12918 (NCI Thesaurus Property-2)
C25613 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0523113 (UMLS CUI-1)
WBC LLN
Item
Peripheral WBC count, LLN
float
C25294 (NCI Thesaurus ObjectClass)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25555 (NCI Thesaurus ValueDomain-2)
C0023508 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Leukocytes (WBC)
Item
Peripheral WBC Count
float
C25294 (NCI Thesaurus ObjectClass)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
Creatinine ULN
Item
Creatinine ULN
float
C20200 (NCI Thesaurus Property)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
C0201976 (UMLS CUI-1)
C1519815 (UMLS CUI-2)
Creatinine, Serum
Item
Creatinine
float
C20200 (NCI Thesaurus Property)
C0201976 (UMLS CUI-1)
C399 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Hemoglobin LLN
Item
Hemoglobin (Hgb), LLN
float
C25294 (NCI Thesaurus ObjectClass)
C16676 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C25555 (NCI Thesaurus ValueDomain-3)
C0019046 (UMLS CUI-1)
C1518030 (UMLS CUI-2)
Hemoglobin
Item
Hemoglobin (Hgbg/dl)
float
C16676 (NCI Thesaurus Property)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Item
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
text
C25664 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
Code List
CTC Adverse Event Attribution Code (Note: Use the standard CTC criteria, not the BMT-specific CTC criteria.)
CL Item
Definite (Definite)
CL209464 (NCI Metathesaurus)
C1704787 (UMLS CUI-1)
CL Item
Possible (Possible)
C0332149 (NCI Metathesaurus)
C0332149 (UMLS CUI-1)
CL Item
Probable (Probable)
C0332148 (NCI Metathesaurus)
C1709683 (UMLS CUI-1)
CL Item
Unlikely (Unlikely)
C0750558 (UMLS CUI-1)
CL Item
Unrelated (Unrelated)
C25328 (NCI Thesaurus)
C0445356 (UMLS CUI-1)
Expedited Report
Item
AE Expedited report filed? (Check box if yes)
boolean
C25704 (NCI Thesaurus ValueDomain)
C25375 (NCI Thesaurus ObjectClass)
C0085425 (NCI Metathesaurus ObjectClass)
C25175 (NCI Thesaurus Property)
C2348483 (UMLS CUI-1)
CTC Adverse Event Term
Item
CTC Adverse Event Term
text
C41331 (NCI Thesaurus ObjectClass)
C49704 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C45255 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ValueDomain-2)
C42614 (NCI Thesaurus ValueDomain-3)
C45559 (NCI Thesaurus ValueDomain-4)
C25714 (NCI Thesaurus ValueDomain-5)
C1516728 (UMLS CUI-1)
C2826934 (UMLS CUI-2)
Item
CTC Adverse Event Grade
text
C41331 (NCI Thesaurus ObjectClass)
C48309 (NCI Thesaurus Property)
C49705 (NCI Thesaurus Property-2)
C25676 (NCI Thesaurus Property-3)
C41331 (NCI Thesaurus ValueDomain)
C48309 (NCI Thesaurus ValueDomain-2)
C25676 (NCI Thesaurus ValueDomain-3)
C2985911 (UMLS CUI-1)
Code List
CTC Adverse Event Grade
CL Item
Absent Adverse Event (0)
C75533 (NCI Thesaurus)
C2699517 (UMLS 2011AA)
CL Item
Mild Adverse Event (1)
C84263 (NCI Thesaurus)
C1513302 (UMLS 2011AA)
CL Item
Moderate Adverse Event (2)
C84264 (NCI Thesaurus)
C1513374 (UMLS 2011AA)
CL Item
Severe Adverse Event (3)
C84265 (NCI Thesaurus)
C2919019 (UMLS 2011AA)
CL Item
Life Threatening Adverse Event (4)
C84266 (NCI Thesaurus)
C1517874 (UMLS 2011AA)
CL Item
Death Related To Adverse Event (5)
C48275 (NCI Thesaurus)
C1705232 (UMLS 2011AA)

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