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Fout:
ID
1917
Beschrijving
AE1 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=FF17F5D5-D70B-0080-E034-0003BA3F9857
Link
Trefwoorden
Versies (4)
- 19-09-12 19-09-12 -
- 09-01-15 09-01-15 - Martin Dugas
- 09-01-15 09-01-15 - Martin Dugas
- 08-07-15 08-07-15 -
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19 september 2012
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Leukemia, Myelocytic, Acute null Treatment - AE1 - 2394397v3.0
No Instruction available.
- StudyEvent: AE1
Similar models
No Instruction available.
- StudyEvent: AE1
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
AdverseEventOnsetDate
Item
Date of Onset
date
C25164 (NCI Thesaurus Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA Property)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25279 (NCI Thesaurus Property)
C0332162 (UMLS 2011AA Property)
AdverseEventDescriptiveText
Item
Event description
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C0678257 (NCI Metathesaurus Property)
C1527021 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C0678257 (NCI Metathesaurus Property)
Item
Was this event expected or anticipated
text
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25501 (NCI Thesaurus Property)
C1517001 (UMLS 2011AA Property)
C0021212 (NCI Metathesaurus ValueDomain)
C0877248 (UMLS 2011AA ObjectClass)
C25501 (NCI Thesaurus Property)
C1517001 (UMLS 2011AA Property)
C0021212 (NCI Metathesaurus ValueDomain)
CL Item
Yes (Yes)
CL Item
No (No)
Item
Record the severity of event
text
C25499 (NCI Thesaurus ObjectClass)
C0441471 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
C0441471 (UMLS 2011AA ObjectClass)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C25676 (NCI Thesaurus Property)
C0439793 (UMLS 2011AA Property)
CL Item
Mild (Mild)
C70666 (NCI Thesaurus)
C2945599 (UMLS 2011AA)
C2945599 (UMLS 2011AA)
CL Item
Moderate (Moderate)
CL Item
Severe (Severe)
CL Item
Life Threatening (Life Threatening)
CL Item
Fatal (Fatal)
Item
What is the relationship to study therapy/intervention
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property)
C0596130 (UMLS 2011AA Property)
C0349674 (UMLS 2011AA ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property)
C0596130 (UMLS 2011AA Property)
CL Item
Unrelated (Unrelated)
C25328 (NCI Thesaurus)
C0445356 (UMLS 2011AA)
C0445356 (UMLS 2011AA)
CL Item
Unlikely (Unlikely)
CL Item
Possible (Possible)
C0332149 (NCI Metathesaurus)
CL Item
Probable (Probable)
C0332148 (NCI Metathesaurus)
CL Item
Definite (Definite)
CL209464 (NCI Metathesaurus)
Item
Record the most severe outcome of the event
text
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
CL Item
Adverse Event Is Resolved (Resolved, No Residual Effects)
CL Item
Adverse Event Is Resolved With Sequelae (Resolved with Sequelae)
CL Item
Adverse Event Is Ongoing (Persistent Condition)
CL Item
Adverse Event Was Fatal (Resolved by Death)
CTCAdverseEventResolutionDate
Item
Record the date of resolution
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C25655 (NCI Thesaurus Property)
C1514893 (UMLS 2011AA Property)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C25655 (NCI Thesaurus Property)
C1514893 (UMLS 2011AA Property)
Item
Was this event associated with
text
C25664 (NCI Thesaurus ValueDomain)
C0349674 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property)
C0596130 (UMLS 2011AA Property)
C0349674 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property)
C0596130 (UMLS 2011AA Property)
CL Item
None of the following (None of the following)
CL Item
Death (Death)
C28554 (NCI Thesaurus)
C0011065 (UMLS 2011AA)
C0011065 (UMLS 2011AA)
CL Item
Life Threatening (Life-threatening event)
CL Item
Disability (Disability)
C21007 (NCI Thesaurus)
C0231170 (UMLS 2011AA)
C0231170 (UMLS 2011AA)
CL Item
Congenital Anomaly (Congenital anomaly)
CL Item
Intervention Required (Required intervention to prevent permanent impairment or damage)
CL Item
Hospitalized (Hospitalization (initial or prolonged))
CL Item
Other (Other SAE)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
Segment
Item
Segment
text
CL Item
Keep report active (Keep report active)
CL Item
Deactive - Report filed in error (Deactive - Report filed in error)
CL Item
Deactive - Key field error (Deactive - Key field error)
CL Item
Deactive - Other reason (Deactive - Other reason)
IfOther,specifyreasonfordeactivation
Item
If Other, specify reason for deactivation
text
Recorddatetransplantcenterbecameawareoftheevent
Item
Record date transplant center became aware of the event
text
Indicateweightattimeoftheevent
Item
Indicate weight at time of the event
text
CL Item
None apparent (None apparent)
CL Item
Study Disease (Study Disease)
CL Item
Other Pre-Existing Disease or Condition (Other Pre-Existing Disease or Condition)
CL Item
Accident, Trauma, or External Factors (Accident, Trauma, or External Factors)
CL Item
Concurrent Illness/Condition (Not Pre-Existing) (Concurrent Illness/Condition (Not Pre-Existing))
Item
What is the effect on study therapy/intervention schedule
text
CL Item
No Change - Completed (No Change - Completed)
CL Item
No Change - Ongoing (No Change - Ongoing)
CL Item
Dose Modified (Dose Modified)
CL Item
Temporarily Stopped (Temporarily Stopped)
CL Item
Permanently Stopped (Permanently Stopped)