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ID
3237
Description
Pharmacodynamics Form for Protocol #40 - PR4003 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=CCE4149D-4174-4BF9-E034-0003BA12F5E7
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Versions (2)
- 9/19/12 9/19/12 -
- 8/27/15 8/27/15 - Martin Dugas
Uploaded on
September 19, 2012
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License
Creative Commons BY-NC 3.0 Legacy
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Sarcoma, Kaposi xxx On-Study - Pharmacodynamics Form for Protocol #40 - PR4003 - 2267092v3.0
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- StudyEvent: Pharmacodynamics Form for Protocol #40 - PR4003
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- StudyEvent: Pharmacodynamics Form for Protocol #40 - PR4003
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
PatientInitials
Item
Patient Initials
text
Study#
Item
Study#
text
Site#
Item
Site#
text
ID#
Item
ID#
text
Cycle#
Item
Cycle#
text
VisitDate
Item
Visit Date
text
Height
Item
Height
text
CL Item
cm (cm)
CL Item
in (in)
Weight
Item
Weight
text
CL Item
kg (kg)
CL Item
lb (lb)
BodySurfaceArea
Item
Body Surface Area
text
TotalFlavopiridoldoseforthecycle
Item
Total Flavopiridol dose for the cycle
text
Justpriortothestartofflavopiridol,date
Item
Just prior to the start of flavopiridol, date
text
Justpriortothestartofflavopiridol,time
Item
Just prior to the start of flavopiridol, time
text
Atcompletionofflavopiridolinfusion,date
Item
At completion of flavopiridol infusion, date
text
Atcompletionofflavopiridolinfusion,time
Item
At completion of flavopiridol infusion, time
text
60minutespost-initiationofflavopiridolinfusion,date
Item
60 minutes post-initiation of flavopiridol infusion, date
text
60minutespost-initiationofflavopiridolinfusion,time
Item
60 minutes post-initiation of flavopiridol infusion, time
text
20hourspost-initiationofflavopiridolinfusion,date
Item
20 hours post-initiation of flavopiridol infusion, date
text
20hourspost-initiationofflavopiridolinfusion,time
Item
20 hours post-initiation of flavopiridol infusion, time
text