Patient demographics
Protocol Number ECOG
text
Patient Initials
text
Patient ID ECOG
text
Study Number Participating Group
text
Institution Name
text
Trial subject ID Participating Group
text
Data amendment
Data amended
text
Data amended date
date
On Treatment
Off Treatment
PersonOff-TreatmentTimePeriodType
text
Adverse Event Current Assessment
AdverseEventCurrentAssessmentInd
text
Adverse Event Start Date
date
Adverse Event End Date
date
Blood/bone Marrow - Labs
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
CTC Adverse Event Attribution Category
text
NON-HEMATOLOGIC
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
CTC Adverse Event Attribution Category
text
II. INFECTIONS
CommonToxicityCriteriaAdverseEventShortNameType
text
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
CTC Adverse Event Attribution Category
text
Other Adverse Events
CTC Adverse Event Term
text
CTC Adverse Event Reported Term
text
CTC Adverse Event Grade
float
CTC Adverse Event Attribution Category
text
Comments
Research Comments
text
Investigator Signature
text
Investigator Signature Date
date