ID
1297
Description
E2100 Treatment Form (E2100) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AC347692-7E8B-258D-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 8/27/12 8/27/12 -
- 5/23/15 5/23/15 -
Uploaded on
August 27, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer Treatment - E2100 Treatment Form (E2100) - 2068267v3.0
Form No. 1578
- StudyEvent: E2100 Treatment Form (E2100)
Description
Unnamed2
Description
Vital Status
Description
Patient'sVitalStatus
Data type
text
Description
DeathDate/LastContactDate
Data type
date
Description
Causeofdeath
Data type
text
Description
DeathReason,Specify
Data type
text
Description
Treatment Cycle Information
Description
CourseBeginDate
Data type
date
Description
CycleNumber
Data type
text
Description
Dose1(Paclitaxel)
Data type
double
Description
Dose2(Paclitaxel)
Data type
double
Description
Dose3(Paclitaxel)
Data type
double
Description
Dose1(Bevacizumab)
Data type
double
Description
Dose2(Bevacizumab)
Data type
double
Description
Werethereanydosemodificationsoradditions/omissionstoprotocoltreatmentthisreportperiod?
Data type
text
Description
Wasanynon-protocoltherapygivenduringprotocoltreatment(notpreviouslyreported)?
Data type
text
Description
Unnamed3
Description
Unnamed4
Description
ProtocolTreatmentAdministeredEndDate
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass
- C42651
- UMLS 2011AA ObjectClass
- C0442711
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Description
Reasontreatmentended
Data type
text
Description
specifyComplicatingDisease
Data type
text
Description
specifyOtherReasons(reasontreatmentended)
Data type
text
Description
Comments
Description
Ccrr Module For E2100 Treatment Form (e2100)
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