ID

10369

Description

ECOG 4599 Toxicity Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9046-8508-5FB4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16E9046-8508-5FB4-E034-080020C9C0E0

Keywords

Versions (2)
  1. 9/19/12 9/19/12 -
  2. 5/28/15 5/28/15 -
Uploaded on

May 28, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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ECOG 4599 Toxicity Form

English

No Instruction available.

1 forms  
  1. StudyEvent: ECOG 4599 Toxicity Form
    1. No Instruction available.
ECOG clinical trial administrative data
Description

ECOG clinical trial administrative data

Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

Adverse Event Report Begin Date
Description

AdverseEventReportBeginDate

Data type

text

Adverse Event Report End Date
Description

AdverseEventReportEndDate

Data type

text

Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

Treatment Relation
Description

TreatmentRelation

Data type

text

Treatment Relation
Description

TreatmentRelation

Data type

text

Treatment Relation
Description

TreatmentRelation

Data type

text

Treatment Relation
Description

TreatmentRelation

Data type

text

Comments1
Description

Comments1

Data type

text

Comments2
Description

Comments2

Data type

text

CTC Code
Description

CTCCode

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: ECOG 4599 Toxicity Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
ECOG clinical trial administrative data
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
AdverseEventReportBeginDate
Item
Adverse Event Report Begin Date
text
AdverseEventReportEndDate
Item
Adverse Event Report End Date
text
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
TreatmentRelation
Item
Treatment Relation
text
Comments1
Item
Comments1
text
Comments2
Item
Comments2
text
CTCCode
Item
CTC Code
text
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