ID
11379
Beschrijving
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
Trefwoorden
Versies (3)
- 27-08-12 27-08-12 -
- 09-01-15 09-01-15 - Martin Dugas
- 03-07-15 03-07-15 -
Geüploaded op
3 juli 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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PRL1013: Adverse Event Form NCT01268605
No Instruction available.
- StudyEvent: PRL1013: Adverse Event Form
Beschrijving
Adverse event assessment
Beschrijving
AdverseEventTreatingDescriptionText
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25705
- UMLS 2011AA Property
- C1522326
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
Beschrijving
Adverse Event Onset Date
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985916
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25279
Beschrijving
AdverseEventSeverityType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
Beschrijving
AdverseEventDentalRestorationAttributionScale
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C60718
- UMLS 2011AA Property
- C0399059
- NCI Thesaurus Property-2
- C25358
- UMLS 2011AA Property-2
- C0596130
Beschrijving
AdverseEventExpectedInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25501
- UMLS 2011AA Property
- C1517001
Beschrijving
Resin-BasedCompositeTherapyReplacementPerformedInd-2
Datatype
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C53610
- UMLS 2011AA Property-2
- C0559956
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
Resin-BasedCompositeTherapySedativeFillingPerformedInd-2
Datatype
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C62295
- UMLS 2011AA Property-2
- C1947975
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
Resin-BasedCompositeTherapyPulpectomyPerformedInd-2
Datatype
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C52550
- UMLS 2011AA Property-2
- C1705872
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
EndodonticTreatmentPerformedIndicator
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C52575
- UMLS 2011AA ObjectClass
- C0700632
Beschrijving
ToothExtractionPerformedIndicator
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C12506
- UMLS 2011AA ObjectClass
- C0040426
- NCI Thesaurus ObjectClass-2
- C61575
- UMLS 2011AA ObjectClass-2
- C0185115
Beschrijving
NewAgentAdministeredInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschrijving
AdverseEventRequiredHospitalizationInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25652
- UMLS 2011AA Property
- C1514873
- NCI Thesaurus Property-2
- C25179
- UMLS 2011AA Property-2
- C0019993
Beschrijving
AdverseEventOtherResultInd-3
Datatype
boolean
Alias
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
Beschrijving
AdverseEventOtherResultSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
Beschrijving
AdverseEventDentalResultType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C41136
- UMLS 2011AA Property-2
- C0226984
Beschrijving
AdverseEventResolutionDate
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25655
- UMLS 2011AA Property
- C1514893
Beschrijving
SeriousAdverseEventReportInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25375
- UMLS 2011AA Property
- C0684224
- NCI Thesaurus ObjectClass-2
- C54035
- UMLS 2011AA ObjectClass-2
- C0205404
Beschrijving
SeriousAdverseEventDeathResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C28554
- UMLS 2011AA Property
- C0011065
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschrijving
SeriousAdverseEventLifeThreateningorDisablingResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C41337
- UMLS 2011AA Property-2
- C1517874
Beschrijving
SeriousAdverseEventDisabilityResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C21007
- UMLS 2011AA Property
- C0231170
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschrijving
SeriousAdverseEventCongenitalAbnormalityResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C2849
- UMLS 2011AA Property-2
- C0000768
Beschrijving
SeriousAdverseEventRequiredInterventionorProcedureResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property
- C25218
- UMLS 2011AA Property
- C1948041
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus Property-3
- C25652
- UMLS 2011AA Property-3
- C1514873
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschrijving
SeriousAdverseEventHospitalizationResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C25179
- UMLS 2011AA Property-2
- C0019993
Beschrijving
SeriousAdverseEventOtherResultInd-2
Datatype
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschrijving
SeriousAdverseEventOtherResultSpecify
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschrijving
Comments
Similar models
No Instruction available.
- StudyEvent: PRL1013: Adverse Event Form
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass-2)
C0205145 (UMLS 2011AA ObjectClass-2)
C52664 (NCI Thesaurus ObjectClass-3)
C1709628 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
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C0600091 (UMLS 2011AA Property)
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C0600091 (UMLS 2011AA ValueDomain)
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C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property-2)
C0545082 (UMLS 2011AA Property-2)
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C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
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C0877248 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus Property)
C1522326 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C2985916 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C1513302 (UMLS 2011AA)
C1513374 (UMLS 2011AA)
C1519275 (UMLS 2011AA)
C1517874 (UMLS 2011AA)
C1705232 (UMLS 2011AA)
C0349674 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C60718 (NCI Thesaurus Property)
C0399059 (UMLS 2011AA Property)
C25358 (NCI Thesaurus Property-2)
C0596130 (UMLS 2011AA Property-2)
C0445356 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25501 (NCI Thesaurus Property)
C1517001 (UMLS 2011AA Property)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C53610 (NCI Thesaurus Property-2)
C0559956 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C62295 (NCI Thesaurus Property-2)
C1947975 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52550 (NCI Thesaurus Property-2)
C1705872 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus ObjectClass)
C0700632 (UMLS 2011AA ObjectClass)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C61575 (NCI Thesaurus ObjectClass-2)
C0185115 (UMLS 2011AA ObjectClass-2)
C1512698 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25652 (NCI Thesaurus Property)
C1514873 (UMLS 2011AA Property)
C25179 (NCI Thesaurus Property-2)
C0019993 (UMLS 2011AA Property-2)
C0205394 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41136 (NCI Thesaurus Property-2)
C0226984 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25655 (NCI Thesaurus Property)
C1514893 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C54035 (NCI Thesaurus ObjectClass-2)
C0205404 (UMLS 2011AA ObjectClass-2)
C1512698 (UMLS 2011AA ValueDomain)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C41337 (NCI Thesaurus Property-2)
C1517874 (UMLS 2011AA Property-2)
C1512698 (UMLS 2011AA ValueDomain)
C21007 (NCI Thesaurus Property)
C0231170 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property-2)
C0000768 (UMLS 2011AA Property-2)
C1519255 (UMLS 2011AA ObjectClass)
C25218 (NCI Thesaurus Property)
C1948041 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25652 (NCI Thesaurus Property-3)
C1514873 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C25179 (NCI Thesaurus Property-2)
C0019993 (UMLS 2011AA Property-2)
C1512698 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)