Description:

NSABP PROTOCOL B-38ADVERSE EVENT FORM - Form AE NCT00093795 Combination Chemotherapy in Treating Women Who Have Undergone Surgery for Node-Positive Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DD8C2A7C-C75C-5AD7-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DD8C2A7C-C75C-5AD7-E034-0003BA12F5E7

Keywords:
Versions (5) ▾
  1. 8/26/12
  2. 1/9/15
  3. 1/9/15
  4. 7/8/15
  5. 7/8/15
Uploaded on:

July 8, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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NSABP PROTOCOL B-38ADVERSE EVENT FORM - Form AE NCT00093795

No Instruction available.

  1. StudyEvent: NSABP PROTOCOL B-38ADVERSE EVENT FORM - Form AE
    1. No Instruction available.
Header module
Are data amended?
Any grade 2, 3, 4, or 5 adverse event?
Was patient hospitalized for 24 hours or more?
Treatment Group (Did the patient receive Cytokine support?)
Filgrastim (Neupogen)
Pegfilgrastim (Neulasta)
Erythropoietin/Darbepoetin (Did the patient require:)
Red Blood Cell (RBC) Transfusion
Platelet Transfusion
Hematology Lab Values
Was a hematology sample obtained? (around Day 21 of this cycle for Group 1, or around Day 14 of this cycle for Group 2 or 3)
1000/uL
1000/uL
g/dL
Adverse Event Report Ind-2

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