Description:

ADVL0212- Review Form (Dr. Chin) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2E959-BAAB-54D8-E034-0003BA12F5E7 NCT00053963

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2E959-BAAB-54D8-E034-0003BA12F5E7

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Versions (3) ▾
  1. 8/26/12
  2. 5/22/15
  3. 6/3/15
Uploaded on:

June 3, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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ADVL0212- Review Form (Dr. Chin) NCT00053963

No Instruction available.

  1. StudyEvent: ADVL0212- Review Form (Dr. Chin)
    1. No Instruction available.
ECG Assessment
Did patient experience any of the following: SVT, atrial fibrillation, or atrial flutter?
check all that apply
Did patient experience prolonged QTc compared to baseline?
check all that apply
Was there a T wave inversion in leads II, III, AVF (inferior leads) or V4, V5, and V6 (lateral leads)?
Was ST segment at the J-point greater than or equal to 2 mm below baseline in leads II, II AVF (inferior leads), V4, V5, V6 (lateral leads)?
Did patient experience ventricular arrhythmia?
Ccrr Module For Advl0212- Review Form (dr. Chin)