ID

1754

Descrição

AMC-052 History of AIDS Defining Disease Form (F03) 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=3953A5F2-81C4-5D54-E044-0003BA3F9857

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3953A5F2-81C4-5D54-E044-0003BA3F9857

Palavras-chave

Versões (2)
  1. 19/09/2012 19/09/2012 -
  2. 15/07/2017 15/07/2017 - Martin Dugas
Transferido a

19 de setembro de 2012

DOI

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Licença

Creative Commons BY-NC 3.0
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Infection NCT00513526 On-Study - AMC-052 History of AIDS Defining Disease Form (F03) - 2677022v1.0

Inglês

No Instruction available.

1 Formulários  
  1. StudyEvent: AMC-052 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Unnamed1
Descrição

Unnamed1

Date of Evaluation (mm/dd/yyyy)
Descrição

LesionAssessmentDate

Tipo de dados

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C3824
UMLS 2011AA ObjectClass
C0221198
NCI Thesaurus Property
C20989
UMLS 2011AA Property
C0031809
NCI Thesaurus ValueDomain
C25367
History of opportunistic diseases and predisposing disease
Descrição

OpportunisticInfectionSusceptibilityDiseasePersonalMedicalHistoryInd-2

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C3289
UMLS 2011AA ObjectClass
C0029118
NCI Thesaurus ObjectClass
C16505
UMLS 2011AA ObjectClass
C0220898
NCI Metathesaurus Property
C0262926
NCI Thesaurus ValueDomain
C38147
UMLS 2011AA ValueDomain
C1512698
Disease Type
Descrição

AcquiredImmunodeficiencySyndromeAssociatedDiseaseDiagnosisType

Tipo de dados

text

Alias
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ObjectClass
C2851
UMLS 2011AA ObjectClass
C0001175
NCI Thesaurus ObjectClass
C25281
UMLS 2011AA ObjectClass
C0332281
NCI Thesaurus Property
C15220
UMLS 2011AA Property
C0011900
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Disease status (Please select the disease status of the diseases listed)
Descrição

DiseaseResponseSiteStatus

Tipo de dados

text

Alias
NCI Thesaurus Property
C25755
UMLS 2011AA Property
C0871261
NCI Thesaurus Property
C25341
UMLS 2011AA Property
C0450429
NCI Thesaurus ObjectClass
C2991
UMLS 2011AA ObjectClass
C0012634
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Unnamed2
Descrição

Unnamed2

Comments
Descrição

ResearchCommentsText

Tipo de dados

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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Similar models

No Instruction available.

1 Formulários
  1. StudyEvent: AMC-052 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de dados
Alias
LesionAssessmentDate
Item
Date of Evaluation (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C0221198 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C25367 (NCI Thesaurus ValueDomain)
Item
History of opportunistic diseases and predisposing disease
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C3289 (NCI Thesaurus ObjectClass)
C0029118 (UMLS 2011AA ObjectClass)
C16505 (NCI Thesaurus ObjectClass)
C0220898 (UMLS 2011AA ObjectClass)
C0262926 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
CL.1
Code List
History of opportunistic diseases and predisposing disease
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Disease Type
text
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C2851 (NCI Thesaurus ObjectClass)
C0001175 (UMLS 2011AA ObjectClass)
C25281 (NCI Thesaurus ObjectClass)
C0332281 (UMLS 2011AA ObjectClass)
C15220 (NCI Thesaurus Property)
C0011900 (UMLS 2011AA Property)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
CL.2
Code List
Disease Type
CL Item
Candidiasis Of Bronchi, Trachea Or Lungs (Candidiasis of bronchi, trachea or lungs)
CL Item
Candidiasis, Esophageal (Candidiasis, esophageal)
CL Item
Cervical Cancer (Cervical cancer, invasive)
C0007847 (NCI Metathesaurus)
CL Item
Coccidioidomycosis, Disseminated Or Extrapulmonary (Coccidioidomycosis, disseminated or extrapulmonary)
CL Item
Cryptococcosis (Cryptococcosis, extrapulmonary)
C2967 (NCI Thesaurus)
C0010414 (UMLS 2011AA)
CL Item
Cryptosporidiosis, Chronic Intestinal (Cryptosporidiosis, chronic intestinal)
CL Item
Cmv Other Than Liver, Spleen Or Nodes, Onset At Age >1month (CMV other than liver, spleen or nodes, onset at age >1month)
CL Item
Cmv Retinitis (CMV retinitis)
CL Item
Encephalopathy (Encephalopathy, HIV-related)
C26920 (NCI Thesaurus)
C0085584 (UMLS 2011AA)
CL Item
Herpes Simplex: Chronic Ulcers (> 1 Month's Duration) Or Bronchitis, Pneumonitis Or Esophagitis (onset At Age > 1 Month) (Herpes simplex: chronic ulcers (> 1 month's duration) or bronchitis, pneumonitis or esophagitis (onset at age > 1 month))
CL Item
Histoplasmosis, Disseminated Or Extrapulmonary (Histoplasmosis, disseminated or extrapulmonary)
CL Item
Isosporiasis, Chronic Intestinal (> 1 Mon) (Isosporiasis, chronic intestinal (> 1 mon))
CL Item
Kaposi's Sarcoma Aids Related (Kaposi's sarcoma)
CL Item
Non-hodgkin's Lymphoma (Lymphoma, systemic non-Hodgkin's)
C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)
CL Item
Lymphoma, Primary, Of Brain (Lymphoma, primary, of brain)
CL Item
Mycobacterium Avium Complex Or Mycobacterium Kansasii Disseminated Or Extrapulmonary (Mycobacterium avium complex or Mycobacterium kansasii disseminated or extrapulmonary)
CL Item
Mycobacterium Tuberculosis Of Any Site, Pulmonary, Disseminated Or Extrapulmonary (Mycobacterium tuberculosis of any site, pulmonary, disseminated or extrapulmonary)
CL Item
Mycobacterium, Other Species Or Unidentified Species, Disseminated Or Extrapulmonary (Mycobacterium, other species or unidentified species, disseminated or extrapulmonary)
CL Item
Pneumocystis Jirovecii Pneumonia (Pneumocystis jirovecii pneumonia)
CL Item
Pneumonia (Pneumonia, recurrent)
C3333 (NCI Thesaurus)
C0032285 (UMLS 2011AA)
CL Item
Progressive Multifocal Leukoencephalopathy (pml) (Progressive multifocal leukoencephalopathy)
CL Item
Salmonella Septicemia, Recurrent (Salmonella septicemia, recurrent)
CL Item
Toxoplasmosis Of The Brain, Onset At Age >1month (Toxoplasmosis of the brain, onset at age >1month)
CL Item
Wasting Syndrome, Due To Hiv (Wasting syndrome, due to HIV)
Item
Disease status (Please select the disease status of the diseases listed)
text
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25341 (NCI Thesaurus Property)
C0450429 (UMLS 2011AA Property)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.3
Code List
Disease status (Please select the disease status of the diseases listed)
CL Item
Active (Currently active)
C45329 (NCI Thesaurus)
C0205177 (UMLS 2011AA)
CL Item
Present (Ever present)
C25626 (NCI Thesaurus)
C0150312 (UMLS 2011AA)
CL Item
Never Present (Never present)
Item Group
Unnamed2
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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