Patient demographics
Patient Initials
text
Study Number Participating Group
text
Trial subject ID Participating Group
text
Institution Name
text
Data amendment
Data amended
text
Data amended date
date
Reporting Period
Cycle number
text
Off Treatment Reporting Period
PersonOff-TreatmentTimePeriodType
text
Adverse Events
AdverseEventCurrentAssessmentInd
text
Adverse Event Start Date
date
Adverse Event End Date
date
I. METABOLIC - LABS
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
CTC Adverse Event Attribution Category
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
II. NON-HEMATOLOGIC
III. NON-HEMATOLOGIC (GRADE 2-5)
CommonToxicityCriteriaAdverseEventShortNameType
text
CTC Adverse Event Term
text
IV. Other Adverse Events (GRADE 3-5)
V. INFECTIONS
Comments
Investigator Signature
text
Investigator Signature Date
date