ID

10096

Description

E1505 Hematology/Chemistry Form Chemotherapy With or Without Bevacizumab in Treating Patients With Stage IB, Stage II, or Stage IIIA Non-Small Lung Cancer That Was Removed By Surgery NCT00324805 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=26A1ECBB-6572-4421-E044-0003BA3F9857

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=26A1ECBB-6572-4421-E044-0003BA3F9857

Mots-clés

Versions (5)
  1. 19/09/2012 19/09/2012 -
  2. 08/01/2015 08/01/2015 - Martin Dugas
  3. 09/01/2015 09/01/2015 - Martin Dugas
  4. 09/01/2015 09/01/2015 - Martin Dugas
  5. 27/03/2015 27/03/2015 - Martin Dugas
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27 mars 2015

DOI

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Creative Commons BY-NC 3.0 Legacy
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Lung Cancer Hematology/Chemistry NCT00324805

Anglais

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

1 Formulaires  
Header
Description

Header

Alias
UMLS CUI-1
C1320722
ECOG Protocol Number
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
ECOG Patient ID
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
DCI Name
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 Step
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 (Last, First)
Description

Patient Initials

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
Participating Group Protocol Number
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
Participating Group Patient ID
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
Institution/Affiliate
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
Please mark an 'X' if data have been amended. (Please circle amended items in red)
Description

Data amended

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0680532
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus Property
C25416
Date data amended (MM/DD/YYYY)
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
Investigator Signature
Description

Investigator Signature

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2346576
NCI Thesaurus Property
C25678
NCI Thesaurus ObjectClass
C17089
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
ON/Off TREATMENT
Description

ON/Off TREATMENT

On Treatment Report Period (Arm B Only - Choose one x)
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
Off Treatment Report Period (since End of Treatment - Choose one x)
Description

PersonOff-TreatmentTimePeriodType

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus Property-2
C25601
UMLS 2011AA Property-2
C1518544
NCI Thesaurus Property-3
C25207
UMLS 2011AA Property-3
C0040223
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Pre-registration Hematology/chemistry
Description

Pre-registration Hematology/chemistry

Were hematology/chemistry results obtained this report period (cycle)?
Description

HematologyAssessedInd-3

Type de données

boolean

Alias
NCI Thesaurus ValueDomain
C38148
NCI Thesaurus Property
C25217
NCI Thesaurus ObjectClass
C16673
UMLS CUI-1
C0474523
Date Hematology (Blood) Sample Obtained
Description

HematologySpecimenCollectedDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
NCI Thesaurus ObjectClass
C16673
NCI Thesaurus ObjectClass-2
C19157
NCI Thesaurus Property
C25452
UMLS CUI-1
C1317250
Peripheral Granulocytes Count
Description

Peripheral Granulocytes Count (AGC/ANC - If abnormal lab value, CTC AE Attribution Code must be provided - Do not report % granulocytes/neutrophils; report absolute count without decimal.)

Type de données

float

Unités de mesure
  • 1000/uL
Alias
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C12530
NCI Thesaurus ValueDomain
C25463
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0857490
1000/uL
Peripheral Platelet Count
Description

Peripheral Platelet Count (/mm^3x1000 - If abnormal lab value, CTC AE Attribution Code must be provided)

Type de données

float

Unités de mesure
  • 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
Hemoglobin (g/dl or g/L - If abnormal lab value, CTC AE Attribution Code must be provided)
Description

Hemoglobin

Type de données

float

Alias
NCI Thesaurus Property
C16676
UMLS CUI-1
C0019046
NCI Thesaurus Property-2
C20200
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus ValueDomain
C25712
Units
Description

Units

Type de données

text

Alias
NCI Thesaurus ObjectClass
C20989
NCI Thesaurus Property
C37984
NCI Thesaurus ValueDomain
C25709
UMLS CUI-1
C1519795
CTC Adverse Event Term (v4)
Description

CommonTerminologyCriteriaforAdverseEventsVersion4.0LowLevelTermName

Type de données

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 AE Grade (Provide CTCAEv4 Grade only if extenuating circumstance per the CTCAEv4 grading criteria would trigger a higher grade Hypernatremia/ Hyponatremia than the Sodium lab value would indicate.)
Description

CTC AE Grade (Provide CTCAEv4 Grade only if extenuating circumstance per the CTCAEv4 grading criteria would trigger a higher grade Hypernatremia/ Hyponatremia than the Sodium lab value would indicate.)

Type de données

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
C2985921
Creatinine ULN (mg/dl or mmol/L)
Description

Creatinine, serum ULN

Type de données

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201976
NCI Thesaurus Property
C20200
UMLS CUI-2
C1519815
NCI Thesaurus Property-2
C399
NCI Thesaurus ValueDomain
C25712
NCI Thesaurus ValueDomain-2
C25706
Creatinine (mg/dl or mmol/L - If abnormal lab value, CTC AE Attribution Code must be provided)
Description

Creatinine, Serum

Type de données

float

Alias
NCI Thesaurus ObjectClass
C25294
UMLS CUI-1
C0201976
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C399
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
Sodium
Description

LaboratoryProcedureSodiumElectrolytesOutcomeUnspecifiedValue (NA mmol/L or mg/dl - If abnormal lab value, CTC AE Attribution Code must be provided)

Type de données

float

Unités de mesure
  • mmol/L
Alias
NCI Thesaurus ObjectClass
C25294
NCI Thesaurus Property
C20200
NCI Thesaurus Property-2
C830
NCI Thesaurus Property-3
C464
NCI Thesaurus ValueDomain
C38046
NCI Thesaurus ValueDomain-2
C25712
UMLS CUI-1
C0337443
mmol/L
Test not done (Please mark "X" in Box only if test not done)
Description

Laboratory Procedure Not Performed

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C0022885
NCI Thesaurus Property
C25594
UMLS CUI-2
C0445106
NCI Thesaurus Property-2
C38000
NCI Thesaurus ObjectClass
C25294
CTC AE Attribution Code (Leave attribution box blank if no adverse event.)
Description

CTC AE Attribution Code (Leave attribution box blank if no adverse event.)

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25664
NCI Thesaurus ObjectClass
C49704
NCI Thesaurus Property
C25358
UMLS CUI-1
C1706735
Action taken for this AE for Chemotherapy
Description

DoseChemotherapyAdverseEventModificationStatus

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25488
NCI Thesaurus Property
C15632
NCI Thesaurus Property-2
C41331
NCI Thesaurus Property-3
C25572
NCI Thesaurus ValueDomain
C25688
UMLS CUI-1
C0441472
Action taken for this AE for Bevacizumab
Description

DoseBevacizumabAdverseEventModificationStatus

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25488
NCI Thesaurus Property
C2039
NCI Thesaurus Property-2
C41331
NCI Thesaurus Property-3
C25572
NCI Thesaurus ValueDomain
C25688
UMLS CUI-1
C0178602
UMLS CUI-2
C0796392
UMLS CUI-3
C0877248
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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

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
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
Please mark an 'X' if data have been amended. (Please circle amended items in red)
text
C25704 (NCI Thesaurus ValueDomain)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
Data amended date
Item
Date data amended (MM/DD/YYYY)
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)
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 (Arm B Only - 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)
CL.2
Code List
On Treatment Report Period (Arm B Only - Choose one x)
CL Item
Cycle 5 (Cycle 5)
CL Item
Cycle 6 (Cycle 6)
CL Item
Cycle 7 (Cycle 7)
CL Item
Cycle 8 (cycle 8)
CL Item
Cycle 9 (Cycle 9)
CL Item
Cycle 10 (Cycle 10)
CL Item
Cycle 11 (Cycle 11)
CL Item
Cycle 12 (Cycle 12)
CL Item
Cycle 13 (Cycle 13)
CL Item
Cycle 14 (Cycle 14)
CL Item
Cycle 15 (Cycle 15)
CL Item
Cycle 16 (Cycle 16)
CL Item
Cycle 17 (Cycle 17)
Item
Off Treatment Report Period (since End of Treatment - Choose one x)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.3
Code List
Off Treatment Report Period (since End of Treatment - Choose one x)
CL Item
3 Months Post-treatment (3 Months Post-Treatment)
Item Group
Pre-registration Hematology/chemistry
Hematology lab
Item
Were hematology/chemistry results obtained this report period (cycle)?
boolean
C38148 (NCI Thesaurus ValueDomain)
C25217 (NCI Thesaurus Property)
C16673 (NCI Thesaurus ObjectClass)
C0474523 (UMLS CUI-1)
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)
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
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)
Hemoglobin
Item
Hemoglobin (g/dl or g/L - If abnormal lab value, CTC AE Attribution Code must be provided)
float
C16676 (NCI Thesaurus Property)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
Item
Units
text
C20989 (NCI Thesaurus ObjectClass)
C37984 (NCI Thesaurus Property)
C25709 (NCI Thesaurus ValueDomain)
C1519795 (UMLS CUI-1)
CL.9
Code List
Units
CL Item
Milligrams Per Liter (mg/L)
CL Item
Millimole Per Liter (mmol/L)
Item
CTC Adverse Event Term (v4)
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)
CL.10
Code List
CTC Adverse Event Term (v4)
CL Item
Hypernatremia (Hypernatremia)
E12293 (CTCAE)
CL Item
Hyponatremia (Hyponatremia)
E12339 (CTCAE)
Item
CTC AE Grade (Provide CTCAEv4 Grade only if extenuating circumstance per the CTCAEv4 grading criteria would trigger a higher grade Hypernatremia/ Hyponatremia than the Sodium lab value would indicate.)
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)
C2985921 (UMLS CUI-1)
CL.11
Code List
CTC AE Grade (Provide CTCAEv4 Grade only if extenuating circumstance per the CTCAEv4 grading criteria would trigger a higher grade Hypernatremia/ Hyponatremia than the Sodium lab value would indicate.)
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)
Creatinine, serum ULN
Item
Creatinine ULN (mg/dl or mmol/L)
float
C25294 (NCI Thesaurus ObjectClass)
C0201976 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C1519815 (UMLS CUI-2)
C399 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C25706 (NCI Thesaurus ValueDomain-2)
Creatinine, Serum
Item
Creatinine (mg/dl or mmol/L - If abnormal lab value, CTC AE Attribution Code must be provided)
float
C25294 (NCI Thesaurus ObjectClass)
C0201976 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C399 (NCI Thesaurus Property-2)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
Sodium
Item
Sodium
float
C25294 (NCI Thesaurus ObjectClass)
C20200 (NCI Thesaurus Property)
C830 (NCI Thesaurus Property-2)
C464 (NCI Thesaurus Property-3)
C38046 (NCI Thesaurus ValueDomain)
C25712 (NCI Thesaurus ValueDomain-2)
C0337443 (UMLS CUI-1)
Laboratory Procedure Not Performed
Item
Test not done (Please mark "X" in Box only if test not done)
text
C25704 (NCI Thesaurus ValueDomain)
C0022885 (UMLS CUI-1)
C25594 (NCI Thesaurus Property)
C0445106 (UMLS CUI-2)
C38000 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
Item
CTC AE Attribution Code (Leave attribution box blank if no adverse event.)
text
C25664 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
CL.12
Code List
CTC AE Attribution Code (Leave attribution box blank if no adverse event.)
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)
Item
Action taken for this AE for Chemotherapy
text
C25488 (NCI Thesaurus ObjectClass)
C15632 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C25572 (NCI Thesaurus Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0441472 (UMLS CUI-1)
CL.13
Code List
Action taken for this AE for Chemotherapy
CL Item
Dose Held (Dose held)
C0178602 (UMLS CUI-1)
C0549178 (UMLS CUI-2)
CL Item
Dose Delayed (Dose delayed)
C0178602 (UMLS CUI-1)
C0205421 (UMLS CUI-2)
CL Item
Dose Reduced (Dose reduced)
C49505 (NCI Thesaurus)
C49505 (NCI Thesaurus-3)
C1707814 (UMLS CUI-1)
CL Item
Dose Held and Reduced (Dose held and reduced)
C49505 (NCI Thesaurus)
C49505 (NCI Thesaurus-3)
C1553387 (UMLS CUI-1)
C1707814 (UMLS CUI-2)
CL Item
Drug Discontinued (Drug discontinued)
C0558681 (UMLS CUI-1)
Item
Action taken for this AE for Bevacizumab
text
C25488 (NCI Thesaurus ObjectClass)
C2039 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C25572 (NCI Thesaurus Property-3)
C25688 (NCI Thesaurus ValueDomain)
C0178602 (UMLS CUI-1)
C0796392 (UMLS CUI-2)
C0877248 (UMLS CUI-3)
CL.14
Code List
Action taken for this AE for Bevacizumab
CL Item
Dose Held (Dose held)
CL Item
Dose Delayed (Dose delayed)
CL Item
Drug Discontinued (Drug discontinued)
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