ID

1817

Beskrivning

S0502 Baseline Abnormalities Form S0502 Imatinib Mesylate With or Without Bevacizumab in Treating Patients With Metastatic or Unresectable Gastrointestinal Stromal Tumor Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBF779E-AB7C-7258-E034-0003BA3F9857

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FCBF779E-AB7C-7258-E034-0003BA3F9857

Nyckelord

Versioner (4)
  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
  4. 2015-07-05 2015-07-05 -
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19 september 2012

DOI

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Creative Commons BY-NC 3.0 Legacy
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    Gastrointestinal Stromal Tumor NCT00324987 On-Study - S0502 Baseline Abnormalities Form - 2320319v1.0

    Engelsk

    Intergroup Coalition Against Sarcomas (ICAS)

    1 Formulär  
    1. StudyEvent: S0502 Baseline Abnormalities Form
      1. Intergroup Coalition Against Sarcomas (ICAS)
    Unnamed1
    Beskrivning

    Unnamed1

    SWOG Patient ID
    Beskrivning

    PatientSouthwestOncologyGroupIdentifierNumber

    Datatyp

    double

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property
    C25699
    UMLS 2011AA Property
    C1519429
    SWOG Study No.
    Beskrivning

    ProtocolSWOGIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property
    C25699
    UMLS 2011AA Property
    C1519429
    Registration Step
    Beskrivning

    RegistrationStepNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25646
    UMLS 2011AA ObjectClass
    C1514821
    NCI Thesaurus Property
    C16154
    UMLS 2011AA Property
    C1704379
    NCI Thesaurus ValueDomain
    C16154
    UMLS 2011AA ValueDomain
    C1704379
    Patient Initials (L, F M)
    Beskrivning

    PatientInitialsName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25536
    UMLS 2011AA Property
    C1555582
    Institution/Affiliate
    Beskrivning

    CombinedInstitutionName

    Datatyp

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS 2011AA ObjectClass
    C0205195
    NCI Thesaurus ObjectClass
    C21541
    UMLS 2011AA ObjectClass
    C0018704
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ValueDomain
    C21541
    UMLS 2011AA ValueDomain
    C0018704
    Physician
    Beskrivning

    RegisteredInvestigatorName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C17089
    UMLS 2011AA ObjectClass
    C0035173
    NCI Thesaurus ObjectClass
    C25644
    Participating Group Name
    Beskrivning

    ParticipatingGroupName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25608
    UMLS 2011AA ObjectClass
    C0679823
    NCI Thesaurus ObjectClass
    C17005
    UMLS 2011AA ObjectClass
    C1257890
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participating Group Study No.
    Beskrivning

    ProtocolParticipatingIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C25320
    UMLS 2011AA ObjectClass
    C1507394
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Participating Group Patient ID
    Beskrivning

    PatientParticipatingIdentifierNumber

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25608
    UMLS 2011AA Property
    C0679823
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    Unnamed 2
    Beskrivning

    Unnamed 2

    CTC Adverse Event Term (Pre-Treatment)
    Beskrivning

    CommonToxicityCriteriaAdverseEventTermType

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS 2011AA ValueDomain
    C0332307
    NCI Thesaurus ObjectClass
    C49704
    UMLS 2011AA ObjectClass
    C1516728
    NCI Thesaurus Property
    C45559
    UMLS 2011AA Property
    C1705313
    CTC AE Grade (3.0 1-4)
    Beskrivning

    CommonToxicityCriteriaAdverseEventGrade

    Datatyp

    double

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS 2011AA ObjectClass
    C1516728
    NCI Thesaurus ValueDomain
    C18000
    UMLS 2011AA ValueDomain
    C0919553
    NCI Thesaurus Property
    C25365
    UMLS 2011AA Property
    C0678257
    CTC Adverse Event Term Other (pre-treatment specify using CTCAE 3.0 terminology)
    Beskrivning

    CTCAdverseEventTermSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus ObjectClass
    C49704
    UMLS 2011AA ObjectClass
    C1516728
    NCI Thesaurus Property
    C45559
    UMLS 2011AA Property
    C1705313
    Tillbaka till toppen

    Similar models

    Intergroup Coalition Against Sarcomas (ICAS)

    1 Formulär
    1. StudyEvent: S0502 Baseline Abnormalities Form
      1. Intergroup Coalition Against Sarcomas (ICAS)
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Unnamed1
    PatientSouthwestOncologyGroupIdentifierNumber
    Item
    SWOG Patient ID
    double
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25699 (NCI Thesaurus Property)
    C1519429 (UMLS 2011AA Property)
    ProtocolSWOGIdentifierNumber
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25699 (NCI Thesaurus Property)
    C1519429 (UMLS 2011AA Property)
    RegistrationStepNumber
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25646 (NCI Thesaurus ObjectClass)
    C1514821 (UMLS 2011AA ObjectClass)
    C16154 (NCI Thesaurus Property)
    C1704379 (UMLS 2011AA Property)
    C16154 (NCI Thesaurus ValueDomain)
    C1704379 (UMLS 2011AA ValueDomain)
    PatientInitialsName
    Item
    Patient Initials (L, F M)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25536 (NCI Thesaurus Property)
    C1555582 (UMLS 2011AA Property)
    CombinedInstitutionName
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C0205195 (UMLS 2011AA ObjectClass)
    C21541 (NCI Thesaurus ObjectClass)
    C0018704 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C21541 (NCI Thesaurus ValueDomain)
    C0018704 (UMLS 2011AA ValueDomain)
    RegisteredInvestigatorName
    Item
    Physician
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C17089 (NCI Thesaurus ObjectClass)
    C0035173 (UMLS 2011AA ObjectClass)
    C25644 (NCI Thesaurus ObjectClass)
    ParticipatingGroupName
    Item
    Participating Group Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25608 (NCI Thesaurus ObjectClass)
    C0679823 (UMLS 2011AA ObjectClass)
    C17005 (NCI Thesaurus ObjectClass)
    C1257890 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    ProtocolParticipatingIdentifierNumber
    Item
    Participating Group Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C25320 (NCI Thesaurus ObjectClass)
    C1507394 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    PatientParticipatingIdentifierNumber
    Item
    Participating Group Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25608 (NCI Thesaurus Property)
    C0679823 (UMLS 2011AA Property)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    Item Group
    Unnamed 2
    Item
    CTC Adverse Event Term (Pre-Treatment)
    text
    C25284 (NCI Thesaurus ValueDomain)
    C0332307 (UMLS 2011AA ValueDomain)
    C49704 (NCI Thesaurus ObjectClass)
    C1516728 (UMLS 2011AA ObjectClass)
    C45559 (NCI Thesaurus Property)
    C1705313 (UMLS 2011AA Property)
    CL.1
    Code List
    CTC Adverse Event Term (Pre-Treatment)
    CL Item
    Blood Alkaline Phosphatase Nos Increased (Alkaline phosphatase)
    CL Item
    Alanine Aminotransferase Increased (ALT, SGPT (serum glutamic pyruvic transaminase))
    C26948 (NCI Thesaurus)
    C0151905 (UMLS 2011AA)
    CL Item
    Anorexia (Anorexia)
    C2875 (NCI Thesaurus)
    C0003123 (UMLS 2011AA)
    CL Item
    Aspartate Aminotransferase Increased (AST, SGOT (serum glutamic oxaloacetic transaminase))
    C26947 (NCI Thesaurus)
    C0151904 (UMLS 2011AA)
    CL Item
    Blood Bilirubin Increased (Bilirubin (hyperbilirubinemia))
    CL039714 (NCI Metathesaurus)
    CL Item
    Blood Creatinine Increased (Creatinine)
    C0235431 (NCI Metathesaurus)
    CL Item
    Diarrhoea Nos (Diarrhea)
    CL Item
    Fatigue (Fatigue (asthenia, lethargy, malaise))
    C3036 (NCI Thesaurus)
    C0015672 (UMLS 2011AA)
    CL Item
    Febrile Neutropenia (fever Of Unknown Origin Without Clinically Or Microbiologically Documented Infection) (anc <1.0 X 10^9/l, Fever >=38.5 Degrees C) (Febrile neutropenia)
    CL Item
    Pyrexia (Fever (in the absence of neutropenia, where neutropenia is defined as ANC <1.0 x 10^9/L))
    CL Item
    Flatulence (Flatulence)
    C37954 (NCI Thesaurus)
    C0016204 (UMLS 2011AA)
    CL Item
    Dyspepsia (Heartburn/dyspepsia)
    C26756 (NCI Thesaurus)
    C0013395 (UMLS 2011AA)
    CL Item
    Haemoglobin Decreased (Hemoglobin)
    C0162119 (NCI Metathesaurus)
    CL Item
    Haemorrhagic Stroke (Hemorrhage, CNS)
    CL036983 (NCI Metathesaurus)
    CL Item
    Hemorrhage, Gi (Hemorrhage, GI - Liver)
    CL Item
    Hemorrhage, Gi (Hemorrhage, GI - Lower GI NOS)
    CL Item
    Haematemesis (Hemorrhage, GI - Stomach)
    C0018926 (NCI Metathesaurus)
    CL Item
    Hemorrhage, Gi (Hemorrhage, GI - Upper GI NOS)
    CL Item
    Haemoptysis (Hemorrhage, pulmonary/upper respiratory - Respiratory tract NOS)
    CL Item
    Hemorrhage, Pulmonary/upper Respiratory (Hemorrhage, pulmonary/upper respiratory - Trachea)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Abdomen NOS)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Anal/perianal)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Bladder (urinary))
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Cecum)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Colon)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Duodenum)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Esophagus)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Ileum)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Jejunum)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Kidney)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Larynx)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Liver)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Lung (pneumonia))
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Mediastinum NOS)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Mucosa)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Oral cavity-gums (gingivitis))
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Peritoneal cavity)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Small bowel NOS)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Soft tissue NOS)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Stomach)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Trachea)
    CL Item
    Infection With Normal Anc Or Grade 1 Or 2 Neutrophils (Infection with normal ANC or Grade 1 or 2 neutrophils - Upper aerodigestive NOS)
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Bladder (urinary))
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Bronchus)
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Colon)
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Esophagus)
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Lung (pneumonia))
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Oral cavity-gums (gingivitis))
    CL Item
    Infection With Unknown Anc (Infection with unknown ANC - Sinus)
    CL Item
    Leucopenia Nos (Leukocytes (total WBC))
    CL Item
    Lymphopenia (Lymphopenia)
    C26823 (NCI Thesaurus)
    C0024312 (UMLS 2011AA)
    CL Item
    Mucositis/stomatitis (clinical Exam) (Mucositis/stomatitis (clinical exam) - Oral cavity)
    CL Item
    Nausea (Nausea)
    C3258 (NCI Thesaurus)
    C0027497 (UMLS 2011AA)
    CL Item
    Neutropenia (Neutrophils/granulocytes (ANC/AGC))
    C3277 (NCI Thesaurus)
    CL Item
    Headache Nos (Pain - Head/headache)
    CL Item
    Myalgia (Pain - Muscle)
    C27009 (NCI Thesaurus)
    C0231528 (UMLS 2011AA)
    CL Item
    Platelet Count Decreased (Platelets)
    C0392386 (NCI Metathesaurus)
    CL Item
    Proteinuria Present (Proteinuria)
    CL Item
    Dermatitis Exfoliative Nos (Rash/desquamation)
    CL Item
    Rigors (Rigors/chills)
    C0424790 (NCI Metathesaurus)
    CL Item
    Thrombosis Nos (Thrombosis/thrombus/embolism)
    CL Item
    Vomiting Nos (Vomiting)
    CL Item
    Weight Increased (Weight gain)
    C0043094 (NCI Metathesaurus)
    Item
    CTC AE Grade (3.0 1-4)
    double
    C49704 (NCI Thesaurus ObjectClass)
    C1516728 (UMLS 2011AA ObjectClass)
    C18000 (NCI Thesaurus ValueDomain)
    C0919553 (UMLS 2011AA ValueDomain)
    C25365 (NCI Thesaurus Property)
    C0678257 (UMLS 2011AA Property)
    CL.2
    Code List
    CTC AE Grade (3.0 1-4)
    CL Item
    No Adverse Event Or Within Normal Limits (0)
    CL Item
    Mild Adverse Event (1)
    C41338 (NCI Thesaurus)
    C1513302 (UMLS 2011AA)
    CL Item
    Moderate Adverse Event (2)
    C41339 (NCI Thesaurus)
    C1513374 (UMLS 2011AA)
    CL Item
    Severe Adverse Event (3)
    C41340 (NCI Thesaurus)
    C1519275 (UMLS 2011AA)
    CL Item
    Life-threatening Or Disabling Adverse Event (4)
    CTCAdverseEventTermSpecify
    Item
    CTC Adverse Event Term Other (pre-treatment specify using CTCAE 3.0 terminology)
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C49704 (NCI Thesaurus ObjectClass)
    C1516728 (UMLS 2011AA ObjectClass)
    C45559 (NCI Thesaurus Property)
    C1705313 (UMLS 2011AA Property)
    Tillbaka till toppen 

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