ID

10593

Descrizione

CALGB: 80101 Adverse Event Form NCT00052910 Chemotherapy and Radiation Therapy After Surgery in Treating Patients With Stomach or Esophageal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A35FEF5E-9EE9-11AA-E034-080020C9C0E0

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A35FEF5E-9EE9-11AA-E034-080020C9C0E0

Keywords

  1. 19/09/12 19/09/12 -
  2. 28/05/15 28/05/15 -
  3. 28/05/15 28/05/15 -
  4. 03/06/15 03/06/15 -
  5. 03/06/15 03/06/15 -
Caricato su

3 giugno 2015

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0 Legacy

Commenti del modello :

Puoi commentare il modello dati qui. Tramite i fumetti nei gruppi di articoli e articoli è possibile aggiungere commenti a quelli in modo specifico.

Commenti del gruppo di articoli per :

Commenti dell'articolo per :

Per scaricare i modelli di dati devi essere registrato. Per favore accesso o registrati GRATIS.

CALGB: 80101 Adverse Event Form NCT00052910

No Instruction available.

  1. StudyEvent: CALGB: 80101 Adverse Event Form
    1. No Instruction available.
CALGB clinical trial administrative data
Descrizione

CALGB clinical trial administrative data

CALGB Form
Descrizione

CALGBForm

Tipo di dati

text

CALGB Study No
Descrizione

CALGBProtocolNumber

Tipo di dati

text

CALGB Patient ID
Descrizione

CALGBPatientID

Tipo di dati

text

Reporting period start date
Descrizione

IntervalReportFromDate

Tipo di dati

date

Reporting period end date
Descrizione

IntervalReportToDate

Tipo di dati

date

Are data amended?
Descrizione

AmendedDataInd

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Patient's Name
Descrizione

Patient'sName

Tipo di dati

text

Participating Group
Descrizione

ParticipatingGroup

Tipo di dati

text

Alias
NCI Thesaurus ObjectClass
C17005
UMLS 2011AA ObjectClass
C1257890
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Patient Hospital No
Descrizione

PatientHospitalNumber

Tipo di dati

text

Participating Group Protocol No
Descrizione

ParticipatingGroupProtocolNo.

Tipo di dati

text

Institution/Affiliate
Descrizione

MainMemberInstitution/Affiliate

Tipo di dati

text

Participating Group Patient ID
Descrizione

ParticipatingGroupPatientID

Tipo di dati

text

Was an AER/ADRE filed with Central Office based on an event reported below?
Descrizione

WasanAER/ADRfiledwithCentralOfficebasedonaneventreportedbelow?

Tipo di dati

boolean

Expected Adverse Events
Descrizione

Expected Adverse Events

IMT Code
Descrizione

IMTCode

Tipo di dati

text

Name
Descrizione

CTCAdverseEventTerm

Tipo di dati

text

Grade
Descrizione

CTCAdverseEventGrade

Tipo di dati

text

Treatment Related
Descrizione

CTCAdverseEventAttributionCode

Tipo di dati

text

IMT Code (other)
Descrizione

IMTCode(other)

Tipo di dati

text

Name (other)
Descrizione

CTCAdverseEventTerm,Other

Tipo di dati

text

Completed By (First Name, Last Name)
Descrizione

CompletedBy

Tipo di dati

text

Date Form Completed
Descrizione

DateFormCompleted

Tipo di dati

text

Ccrr Module For Calgb: 80101 Adverse Event Form
Descrizione

Ccrr Module For Calgb: 80101 Adverse Event Form

Similar models

No Instruction available.

  1. StudyEvent: CALGB: 80101 Adverse Event Form
    1. No Instruction available.
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
CALGB clinical trial administrative data
CALGBForm
Item
CALGB Form
text
CALGBProtocolNumber
Item
CALGB Study No
text
CALGBPatientID
Item
CALGB Patient ID
text
IntervalReportFromDate
Item
Reporting period start date
date
IntervalReportToDate
Item
Reporting period end date
date
Item
Are data amended?
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
Code List
Are data amended?
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Patient'sName
Item
Patient's Name
text
ParticipatingGroup
Item
Participating Group
text
C17005 (NCI Thesaurus ObjectClass)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
PatientHospitalNumber
Item
Patient Hospital No
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
WasanAER/ADRfiledwithCentralOfficebasedonaneventreportedbelow?
Item
Was an AER/ADRE filed with Central Office based on an event reported below?
boolean
Item Group
Expected Adverse Events
Item
IMT Code
text
Code List
IMT Code
CL Item
10407 (10407)
CL Item
5765 (5765)
CL Item
20042 (20042)
CL Item
1423 (1423)
CL Item
17477 (17477)
CL Item
22047 (22047)
CL Item
127 (127)
CL Item
21197 (21197)
CL Item
1377 (1377)
CL Item
21162 (21162)
CL Item
2395 (2395)
CL Item
18172 (18172)
CL Item
17580 (17580)
CL Item
21521 (21521)
CL Item
11625 (11625)
Item
Name
text
Code List
Name
CL Item
WBC (WBC)
CL Item
ANC (ANC)
CL Item
Platelets (Platelets)
CL Item
Fatigue (Fatigue)
CL Item
Hand-foot skin reaction (Hand-foot skin reaction)
CL Item
Radiation dermatitis (Radiation dermatitis)
CL Item
Anorexia (Anorexia)
CL Item
Diarrhea (Diarrhea)
CL Item
Nausea (Nausea)
CL Item
Vomiting (Vomiting)
CL Item
Stomatitis/Mucositis (Stomatitis/Mucositis)
CL Item
Neuropathy-sensory (Neuropathy-sensory)
CL Item
Abdominal pain/cramping (Abdominal pain/cramping)
CL Item
Bilirubin (Bilirubin)
CL Item
Creatinine (Creatinine)
Item
Grade
text
Code List
Grade
CL Item
0 (0)
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
CL Item
-1 (-1)
Item
Treatment Related
text
Code List
Treatment Related
CL Item
Unrelated (Unrelated to treatment)
C25328 (NCI Thesaurus)
C0445356 (UMLS 2011AA)
CL Item
Unlikely (Unlikely to be related to treatment)
CL Item
Possibly (Possibly related to treatment)
CL Item
Probably (Probably related to treatment)
CL Item
Definitely (Definitely related to treatment)
IMTCode(other)
Item
IMT Code (other)
text
CTCAdverseEventTerm,Other
Item
Name (other)
text
CompletedBy
Item
Completed By (First Name, Last Name)
text
DateFormCompleted
Item
Date Form Completed
text
Item Group
Ccrr Module For Calgb: 80101 Adverse Event Form

Si prega di utilizzare questo modulo per feedback, domande e suggerimenti per miglioramenti.

I campi contrassegnati da * sono obbligatori.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial