Description:

E5202 Adverse Event Form (CTCAE v3.0) NCT00217737 Oxaliplatin, Leucovorin, and Fluorouracil With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF36966F-AF72-06D9-E034-0003BA3F9857

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF36966F-AF72-06D9-E034-0003BA3F9857

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

July 8, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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E5202 Adverse Event Form (CTCAE v3.0) NCT00217737

INSTRUCTIONS: Complete this form as indicated below and at the end of all protocol therapy. Submit original to the ECOG Coordinating Center. Keep a copy for your files.

ECOG clinical trial administrative data
Are data amended (If yes, please circle amended items in red.)
Patient demographics
On Treatment
On Treatment Report Period (Arm B Only)
Off Treatment
Off Treatment Report Period (since initial registration)
Adverse event assessment
Were adverse events assessed during this report period (cycle)
CTC Adverse Event Term
CTC Adverse Event Attribution Scale
III. INFECTIONS
Common Toxicity (Specify site for each event)
Other Adverse Events
Comments

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