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Erreur:
ID
11804
Description
Eligibility HIV-1 HPV vaccination AMC-052 NCT00513526 Human Papillomavirus Vaccine Therapy in Treating Men With HIV-1 Infection Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3BAF52D2-F5E5-0D56-E044-0003BA3F9857
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Versions (5)
- 19/09/2012 19/09/2012 -
- 28/05/2015 28/05/2015 -
- 28/05/2015 28/05/2015 -
- 03/06/2015 03/06/2015 -
- 04/08/2015 04/08/2015 - Martin Dugas
Téléchargé le
4 août 2015
DOI
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Creative Commons BY-NC 3.0 Legacy
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Eligibility HIV-1 HPV vaccination AMC-052 NCT00513526
No Instruction available.
- StudyEvent: AMC-052 Eligibility Checklist Segment A
Similar models
No Instruction available.
- StudyEvent: AMC-052 Eligibility Checklist Segment A
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item
Inclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property-2)
C1512693 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25532 (NCI Thesaurus Property-2)
C1512693 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Date Of Informed Consent (Date of informed consent)
CL Item
Does The Participant Have Documentation Of Hiv-1 Infection By Any Licensed Elisa Test Kit And Confirmed By Western Blot At Any Time Prior To Study Entry (Does the participant have documentation of HIV-1 infection by any licensed ELISA test kit and confirmed by Western blot at any time prior to study entry)
CL Item
Does The Participant Have The Ability And Willingness To Give Informed Consent (Does the participant have the ability and willingness to give informed consent)
CL Item
Participant's Age (in Years) (Participant's age (in years))
Age
Item
Age
integer
C16960 (NCI Thesaurus ObjectClass)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI [1])
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C25150 (NCI Thesaurus Property)
C0001779 (UMLS CUI [1])
Informed Consent Date
Item
Informed Consent Date
date
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI [1])
C25367 (NCI Thesaurus ValueDomain-2)
C16468 (NCI Thesaurus ObjectClass)
C25679 (NCI Thesaurus Property)
C2985782 (UMLS CUI [1])
Item
Exclusion Criteria
text
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property-2)
C0680251 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C19707 (NCI Thesaurus ObjectClass-2)
C1515830 (UMLS 2011AA ObjectClass-2)
C16112 (NCI Thesaurus Property)
C1516637 (UMLS 2011AA Property)
C25370 (NCI Thesaurus Property-2)
C0680251 (UMLS 2011AA Property-2)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL Item
Does The Participant Have A History Of Anal Cytological Result With Hsil, Atypical Squamous Cells Suggestive Of Hsil, Or Suggestive Of Carcinoma (Does the participant have a history of anal cytological result with HSIL, atypical squamous cells suggestive of HSIL, or suggestive of carcinoma)
CL Item
Does The Participant Have A History Of Anal Or Perianal Carcinoma (Does the participant have a history of anal or perianal carcinoma)
CL Item
Does The Participant Have A History Of High Grade Ain (i.e. Ain 2 Or 3) Or High Grade Perianal Intraepithelial Neoplasia (Does the participant have a history of high grade AIN (i.e. AIN 2 or 3) or high grade perianal intraepithelial neoplasia)
CL Item
Does The Participant Have Active Drug Or Alcohol Use Or Dependence That, In The Opinion Of The Site Investigator, Would Interfere With Adherence To Study Requirements (Does the participant have active drug or alcohol use or dependence that, in the opinion of the site investigator, would interfere with adherence to study requirements)
CL Item
Does The Participant Have An Allergy To Yeast Or Any Other Components Of Gardasil (Does the participant have an allergy to yeast or any other components of Gardasil)
CL Item
Does The Participant Have Hemophilia (Does the participant have hemophilia)
CL Item
Has The Participant Ever Received Gardasil Or Any Other Hpv Vaccine (Has the participant ever received Gardasil or any other HPV vaccine)
CL Item
Has The Participant Undergone A Splenectomy (Has the participant undergone a splenectomy)