ID
11840
Beskrivning
E1105 Hypertension Status Form First-Line Chemotherapy and Trastuzumab With or Without Bevacizumab in Treating Patients With Metastatic Breast Cancer That Overexpresses HER-2/NEU Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3DA5CD22-EF9E-0E6A-E044-0003BA3F9857
Länk
Nyckelord
Versioner (6)
- 2012-08-26 2012-08-26 -
- 2014-08-08 2014-08-08 - Martin Dugas
- 2014-08-08 2014-08-08 - Martin Dugas
- 2014-12-16 2014-12-16 - Martin Dugas
- 2015-01-08 2015-01-08 - Martin Dugas
- 2015-08-07 2015-08-07 - Martin Dugas
Uppladdad den
7 augusti 2015
DOI
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Licens
Creative Commons BY-NC 3.0 Legacy
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Hypertension Status Form Breast Cancer E1105 NCT00520975
INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
- StudyEvent: E1105 Hypertension Status Form
Beskrivning
Reporting Period
Beskrivning
Cycle number
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Beskrivning
Systolic
Datatyp
integer
Måttenheter
- mmHg
Alias
- NCI Thesaurus ValueDomain
- C25209
- NCI Thesaurus Property
- C25214
- NCI Thesaurus ObjectClass
- C25298
- UMLS CUI [1]
- C0871470
Beskrivning
Diastolic
Datatyp
integer
Måttenheter
- mmHg
Alias
- NCI Thesaurus ValueDomain
- C25209
- NCI Thesaurus Property
- C25214
- NCI Thesaurus ObjectClass
- C25299
- UMLS CUI [1]
- C0428883
Beskrivning
LaboratoryProcedureNotPerformedText
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus Property
- C25594
- UMLS 2011AA Property
- C1518422
- NCI Thesaurus Property-2
- C38000
- UMLS 2011AA Property-2
- C0884358
- NCI Thesaurus ObjectClass
- C25294
- UMLS 2011AA ObjectClass
- C0022885
Beskrivning
Assessment Date
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985720
- NCI Thesaurus ObjectClass
- C25367
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus Property
- C38000
Beskrivning
ConcomitantAntihypertensiveAgentAdministeredType Anti-Hypertensive Drugs (Please mark an 'X' for each and every agent administered this cycle For Baseline, indicate agents administered in the last 21 days)
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C270
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25382
- UMLS CUI [1]
- C0003364
Beskrivning
ConcomitantAntihypertensiveAgentAdministeredSpecify
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C270
- NCI Thesaurus ObjectClass-2
- C25730
- NCI Thesaurus Property
- C25382
- UMLS CUI [1]
- C0003364
Beskrivning
Comments
Beskrivning
Investigator Signature
Datatyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Beskrivning
Investigator Signature Date
Datatyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- UMLS CUI-2
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
Similar models
INSTRUCTIONS: After patient is off treatment, complete this form for each required follow-up report period (see forms submission schedule).
- StudyEvent: E1105 Hypertension Status Form
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
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C0237753 (UMLS CUI-2)
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C2347449 (UMLS CUI-2)
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C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0680532 (UMLS CUI-1)
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C0011008 (UMLS CUI-2)
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C25367 (NCI Thesaurus ValueDomain-2)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C25214 (NCI Thesaurus Property)
C25298 (NCI Thesaurus ObjectClass)
C0871470 (UMLS CUI [1])
C25214 (NCI Thesaurus Property)
C25299 (NCI Thesaurus ObjectClass)
C0428883 (UMLS CUI [1])
C1527021 (UMLS 2011AA ValueDomain)
C25594 (NCI Thesaurus Property)
C1518422 (UMLS 2011AA Property)
C38000 (NCI Thesaurus Property-2)
C0884358 (UMLS 2011AA Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0022885 (UMLS 2011AA ObjectClass)
C2985720 (UMLS CUI-1)
C25367 (NCI Thesaurus ObjectClass)
C25367 (NCI Thesaurus ValueDomain-2)
C38000 (NCI Thesaurus Property)
C270 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0003364 (UMLS CUI [1])
C0332197 (UMLS CUI-2)
C0205394 (UMLS CUI-1)
C270 (NCI Thesaurus ObjectClass)
C25730 (NCI Thesaurus ObjectClass-2)
C25382 (NCI Thesaurus Property)
C0003364 (UMLS CUI [1])
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)