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1 Formulär  
  1. StudyEvent: CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL)
    1. No Instruction available.
Cetuximab Skin Toxicities
Beskrivning

Cetuximab Skin Toxicities

Mark with an X if there are none
Beskrivning

MarkwithanXiftherearenone

Datatyp

text

MedDRA
Beskrivning

MedDRA

Datatyp

text

Adverse event term
Beskrivning

Adverseeventterm

Datatyp

text

Other, specify
Beskrivning

Other,specify

Datatyp

text

Adverse event grade
Beskrivning

Adverseeventgrade

Datatyp

text

Cetuximab Dose Modification
Beskrivning

CetuximabDoseModification

Datatyp

text

Adverse event onset date
Beskrivning

Adverseeventonsetdate

Datatyp

text

Adverse event end date
Beskrivning

Adverseeventenddate

Datatyp

text

If ongoing mark with an X
Beskrivning

IfongoingmarkwithanX

Datatyp

text

Completed by
Beskrivning

Completedby

Datatyp

text

Date form originally completed
Beskrivning

Dateformoriginallycompleted

Datatyp

text

Ccrr Module For Calgb: 80203 Dermatology Specific Quality-of-life Questionnaire (dsql)
Beskrivning

Ccrr Module For Calgb: 80203 Dermatology Specific Quality-of-life Questionnaire (dsql)

Patient Initials
Beskrivning

PatientInitials

Datatyp

text

Patient Hospital No.
Beskrivning

PatientHospitalNo.

Datatyp

text

Institution/Affiliate
Beskrivning

Institution/Affiliate

Datatyp

text

Participating Group
Beskrivning

ParticipatingGroup

Datatyp

text

Participating Group Protocol No.
Beskrivning

ParticipatingGroupProtocolNo.

Datatyp

text

Participating Group Patient ID
Beskrivning

ParticipatingGroupPatientID

Datatyp

text

CALGB Study No.
Beskrivning

CALGBStudyNo.

Datatyp

text

CALGB Patient ID
Beskrivning

CALGBPatientID

Datatyp

text

From
Beskrivning

From

Datatyp

text

To
Beskrivning

To

Datatyp

text

Are data amended
Beskrivning

Aredataamended

Datatyp

text

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Similar models

No Instruction available.

1 Formulär
  1. StudyEvent: CALGB: 80203 DERMATOLOGY SPECIFIC QUALITY-OF-LIFE QUESTIONNAIRE (DSQL)
    1. No Instruction available.
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Cetuximab Skin Toxicities
MarkwithanXiftherearenone
Item
Mark with an X if there are none
text
MedDRA
Item
MedDRA
text
Item
Adverse event term
text
CL.1
Code List
Adverse event term
CL Item
Rash/desquamation (Rash/desquamation)
CL Item
Pruritus (Pruritus)
CL Item
Erithema multiforme (Erithema multiforme)
CL Item
Nail changes (Nail changes)
CL Item
Dry skin (Dry skin)
CL Item
Other, specify (Other, specify)
Other,specify
Item
Other, specify
text
Item
Adverse event grade
text
CL.2
Code List
Adverse event grade
CL Item
1 (1)
CL Item
2 (2)
CL Item
3 (3)
CL Item
4 (4)
CL Item
5 (5)
Item
Cetuximab Dose Modification
text
CL.3
Code List
Cetuximab Dose Modification
CL Item
Dose held (Dose held)
CL Item
Dose reduced (Dose reduced)
CL Item
Drug discontinued (Drug discontinued)
Adverseeventonsetdate
Item
Adverse event onset date
text
Adverseeventenddate
Item
Adverse event end date
text
IfongoingmarkwithanX
Item
If ongoing mark with an X
text
Completedby
Item
Completed by
text
Dateformoriginallycompleted
Item
Date form originally completed
text
Item Group
Ccrr Module For Calgb: 80203 Dermatology Specific Quality-of-life Questionnaire (dsql)
PatientInitials
Item
Patient Initials
text
PatientHospitalNo.
Item
Patient Hospital No.
text
Institution/Affiliate
Item
Institution/Affiliate
text
ParticipatingGroup
Item
Participating Group
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
CALGBStudyNo.
Item
CALGB Study No.
text
CALGBPatientID
Item
CALGB Patient ID
text
From
Item
From
text
To
Item
To
text
Item
Are data amended
text
CL.4
Code List
Are data amended
CL Item
Yes (Yes)
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