Unnamed2
PatientInitialsName
text
ProtocolECOGIdentifierNumber
text
PatientECOGIdentifierNumber
text
ProtocolParticipatingIdentifierNumber
text
PatientParticipatingIdentifierNumber
text
CombinedInstitutionName
text
Unnamed3
DataAmendedText
text
DataAmendedDate
date
On Treatment
TreatmentEvaluationPeriodType
text
TreatmentEvaluationPeriodType
text
TreatmentEvaluationPeriodCycleSpecify
text
Off Treatment
PersonOff-TreatmentTimePeriodType
text
Unnamed2
AdverseEventCurrentAssessmentInd
text
CTCAdverseEventReportBeginDate
date
CTCAdverseEventReportEndDate
date
Blood/bone Marrow - Labs
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventGrade
double
CTCAdverseEventAttributionScale
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
Unnamed5
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventShortNameType
text
CTCAdverseEventSpecifiedTermType
text
CommonToxicityCriteriaAdverseEventGrade
double
CommonToxicityCriteriaAdverseEventGrade
double
CTCAdverseEventAttributionScale
text
CTCAdverseEventAttributionScale
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
Unnamed5
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventGrade
double
CTCAdverseEventAttributionScale
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
Other Adverse Events
CTCAdverseEventTermSpecify
text
CTCAdverseEventClassificationSpecify
text
CommonToxicityCriteriaAdverseEventGrade
double
CTCAdverseEventAttributionScale
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
Iii. Infections
CommonToxicityCriteriaAdverseEventShortNameType
text
CTCAdverseEventSpecifiedTermType
text
CommonToxicityCriteriaAdverseEventGrade
double
CTCAdverseEventAttributionScale
text
AdverseEventInvestigationalClinicalStudyTherapyAttributionind-2
text
Comments
InvestigatorSignatureText
text
InvestigatorSignatureDate
date