Description:

NCI Cooperative Group Colorectal Cancer - Toxicity Form - Subset of Patients NCT00079274 Comparison of Combination Chemotherapy Regimens With or Without Cetuximab in Treating Patients Who Have Undergone Surgery For Stage III Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DFBB64C6-A974-5B18-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DFBB64C6-A974-5B18-E034-0003BA12F5E7

Keywords:
Versions (4) ▾
  1. 8/27/12
  2. 1/9/15
  3. 1/9/15
  4. 7/5/15
Uploaded on:

July 5, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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NCI Coop Group Colorectal Ca Toxicity Form - Subset of Pts NCT00079274

All Grade 3+ adverse events, regardless of attribution, and including those reported via expedited reporting systems (e.g., AdEERS, MedWATCH) must be additionally recorded onto this form.

Header
Are data amended? (If data are amended, please circle in red when using paper form)
Treatment Reporting Interval
Reporting Period (Please indicate which cycles this CRF includes from time of registration:)
Adverse Event (First Cycle of Reporting Period)
Are all adverse event grades less than those required for reporting as listed below (If so, skip rest of form.)
CTC Adverse Event Term
CTC Adverse Event Term (NOTE: Permission given to maintain these 2 non-CTC valid values because approval given previously-DO NOT use for future protocols)
Adverse Event (Second Cycle of Reporting Period)
Are all adverse event grades less than those required for reporting as listed below (If so, skip rest of form.)
CTC Adverse Event Term
CTC Adverse Event Term (NOTE: Permission given to maintain these 2 non-CTC valid values because approval given previously-DO NOT use for future protocols)
Comments

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