ID

10605

Description

E3200 Toxicity Form NCT00025337 Combination Chemotherapy With or Without Bevacizumab Compared With Bevacizumab Alone in Treating Patients With Advanced or Metastatic Colorectal Cancer That Has Been Previously Treated Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F9E6C-1B8C-6C02-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A16F9E6C-1B8C-6C02-E034-080020C9C0E0

Keywords

Versions (3)
  1. 8/27/12 8/27/12 -
  2. 5/23/15 5/23/15 -
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy
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E3200 Toxicity Form NCT00025337

English

No Instruction available.

1 forms  
  1. StudyEvent: E3200 Toxicity Form
    1. No Instruction available.
Toxicity Form
Description

Toxicity Form

Date of data transfer
Description

Dateofdatatransfer

Data type

text

Transfer Method
Description

TransferMethod

Data type

text

Specify other transfer method
Description

Specifyothertransfermethod

Data type

text

Patient Name
Description

PatientName

Data type

text

Particip. Group Protocol Number
Description

Particip.GroupProtocolNumber

Data type

double

Patient Study ID, Participating Group
Description

PatientStudyID,ParticipatingGroup

Data type

text

Institution Name
Description

InstitutionName

Data type

text

Affiliate Name
Description

AffiliateName

Data type

text

CTC Adverse Event Report Begin Date
Description

CTCAdverseEventReportBeginDate

Data type

date

CTC Adverse Event Report End Date
Description

CTCAdverseEventReportEndDate

Data type

date

Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Amended Data Ind
Description

AmendedDataInd

Data type

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Specify Adverse Event Term
Description

SpecifyAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Term
Description

CTCAdverseEventTerm

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

CTC Adverse Event Grade
Description

CTCAdverseEventGrade

Data type

text

Comments
Description

Comments

Data type

text

Comments2
Description

Comments2

Data type

text

CTC Code
Description

CTCCode

Data type

text

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Similar models

No Instruction available.

1 forms
  1. StudyEvent: E3200 Toxicity Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Toxicity Form
Dateofdatatransfer
Item
Date of data transfer
text
TransferMethod
Item
Transfer Method
text
Specifyothertransfermethod
Item
Specify other transfer method
text
PatientName
Item
Patient Name
text
Particip.GroupProtocolNumber
Item
Particip. Group Protocol Number
double
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
CTCAdverseEventReportBeginDate
Item
CTC Adverse Event Report Begin Date
date
CTCAdverseEventReportEndDate
Item
CTC Adverse Event Report End Date
date
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
AmendedDataInd
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
SpecifyAdverseEventTerm
Item
Specify Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventTerm
Item
CTC Adverse Event Term
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
CTCAdverseEventGrade
Item
CTC Adverse Event Grade
text
Comments
Item
Comments
text
Comments2
Item
Comments2
text
CTCCode
Item
CTC Code
text
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