ID

11431

Beskrivning

AE3 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF190472-F5B5-019C-E034-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF190472-F5B5-019C-E034-0003BA3F9857

Nyckelord

Versioner (3)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-07-03 2015-07-03 -
Uppladdad den

3 juli 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy
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AE3

Engelsk

No Instruction available.

1 Formulär  
Header module
Beskrivning

Header module

Date of Onset
Beskrivning

Adverse Event Onset Date

Datatyp

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS CUI-1
C2985916
NCI Thesaurus ValueDomain-2
C25367
NCI Thesaurus ObjectClass
C49704
NCI Thesaurus Property
C25279
Event description
Beskrivning

AdverseEventDescriptiveText

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
NCI Metathesaurus Property
C0678257
Segment
Beskrivning

Segment

Datatyp

text

Study Product/suspect Medication Data
Beskrivning

Study Product/suspect Medication Data

Study Product Name
Beskrivning

StudyProductName

Datatyp

text

Dose of Study Product(s) at SAE onset
Beskrivning

DoseofStudyProduct(s)atSAEonset

Datatyp

text

Route of Study Product(s) at SAE onset
Beskrivning

RouteofStudyProduct(s)atSAEonset

Datatyp

text

Schedule of Study Product(s) at SAE onset
Beskrivning

ScheduleofStudyProduct(s)atSAEonset

Datatyp

text

Concomitant Medications
Beskrivning

Concomitant Medications

Non-concomitant medications
Beskrivning

ConcomitantMedicationUseInd-3

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ObjectClass-2
C25730
UMLS 2011AA ObjectClass-2
C0521115
NCI Thesaurus Property
C25340
UMLS 2011AA Property
C0457083
Medications
Beskrivning

Concomitant Medication

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS CUI-1
C2347852
NCI Thesaurus ObjectClass
C459
NCI Thesaurus Property
C25639
NCI Thesaurus ObjectClass-2
C25730
Start Date
Beskrivning

ConcomitantMedicationStartDate

Datatyp

date

Alias
NCI Thesaurus Property
C25164
UMLS 2011AA Property
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25379
UMLS 2011AA ObjectClass
C0750729
NCI Metathesaurus Property
CL219258
Stop Date
Beskrivning

ConcomitantMedicationStopDate

Datatyp

date

Alias
NCI Thesaurus ObjectClass
C25164
UMLS 2011AA ObjectClass
C0011008
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Metathesaurus Property
C0723457
Dose, Route, Schedule
Beskrivning

ConcomitantMedicationAdministeredDose

Datatyp

float

Alias
NCI Thesaurus ObjectClass
C459
UMLS 2011AA ObjectClass
C0013227
NCI Thesaurus ValueDomain
C25488
UMLS 2011AA ValueDomain
C0178602
NCI Thesaurus ObjectClass-2
C25730
UMLS 2011AA ObjectClass-2
C0521115
NCI Thesaurus Property
C25382
UMLS 2011AA Property
C1521801
Comment
Beskrivning

AdverseEventAssessmentText

Datatyp

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ObjectClass
C41331
UMLS 2011AA ObjectClass
C0877248
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Similar models

No Instruction available.

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Header module
Adverse Event Onset Date
Item
Date of Onset
date
C25164 (NCI Thesaurus ValueDomain)
C2985916 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
AdverseEventDescriptiveText
Item
Event description
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C0678257 (NCI Metathesaurus Property)
Segment
Item
Segment
text
Item Group
Study Product/suspect Medication Data
StudyProductName
Item
Study Product Name
text
DoseofStudyProduct(s)atSAEonset
Item
Dose of Study Product(s) at SAE onset
text
RouteofStudyProduct(s)atSAEonset
Item
Route of Study Product(s) at SAE onset
text
ScheduleofStudyProduct(s)atSAEonset
Item
Schedule of Study Product(s) at SAE onset
text
Item Group
Concomitant Medications
ConcomitantMedicationUseInd-3
Item
Non-concomitant medications
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C0521115 (UMLS 2011AA ObjectClass-2)
C25340 (NCI Thesaurus Property)
C0457083 (UMLS 2011AA Property)
Concomitant Medication
Item
Medications
text
C25704 (NCI Thesaurus ValueDomain)
C2347852 (UMLS CUI-1)
C459 (NCI Thesaurus ObjectClass)
C25639 (NCI Thesaurus Property)
C25730 (NCI Thesaurus ObjectClass-2)
ConcomitantMedicationStartDate
Item
Start Date
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25379 (NCI Thesaurus ObjectClass)
C0750729 (UMLS 2011AA ObjectClass)
CL219258 (NCI Metathesaurus Property)
ConcomitantMedicationStopDate
Item
Stop Date
date
C25164 (NCI Thesaurus ObjectClass)
C0011008 (UMLS 2011AA ObjectClass)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C0723457 (NCI Metathesaurus Property)
ConcomitantMedicationAdministeredDose
Item
Dose, Route, Schedule
float
C459 (NCI Thesaurus ObjectClass)
C0013227 (UMLS 2011AA ObjectClass)
C25488 (NCI Thesaurus ValueDomain)
C0178602 (UMLS 2011AA ValueDomain)
C25730 (NCI Thesaurus ObjectClass-2)
C0521115 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
AdverseEventAssessmentText
Item
Comment
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
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