Description:

PRL1013: Adverse Event Form NCT01268605 Postoperative Hypersensitivity Randomized Comparative Effectiveness Research Trial (POH RCERT) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A651C58C-D9BC-9A03-E040-BB89AD4309CC

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A651C58C-D9BC-9A03-E040-BB89AD4309CC

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 7/3/15
Uploaded on:

July 3, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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PRL1013: Adverse Event Form NCT01268605

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  1. StudyEvent: PRL1013: Adverse Event Form
    1. No Instruction available.
Header Module
Adverse event assessment
Severity of event
Relation of event to restoration on study tooth/teeth
Was this event expected or anticipated
Restoration replaced
Restoration replaced with temporary or sedative dressing
Pulpectomy and temporization
Endodontic therapy or referral
Extraction
New medication taken
Hospitalization
Other
Outcome of event
Was this considered a Serious Adverse Event
Death
Life-threatening
Disability/Incapacity
Congenital abnormality
Required intervention to prevent permanent impairment/damage
Hospitalization, initial or prolonged
Other
Comments

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