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ID
3258
Description
Concomitant Medication Form A Phase III, Randomized Study of Gemcitabine (Fixed-Dose Rate Infusion) and Oxaliplatin (NSC 266046) Versus Gemcitabine (Fixed-Dose Rate Infusion) Versus Gemcitabine (30-Minute Infusion) in Pancreatic Carcinoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A6277C4D-6BBD-3D79-E034-0003BA0B1A09
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Keywords
Versions (3)
- 9/19/12 9/19/12 - Philipp Bruland
- 1/9/15 1/9/15 - Martin Dugas
- 7/3/15 7/3/15 -
Uploaded on
September 19, 2012
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Pancreatic Cancer NCT00058149 Treatment - Concomitant Medication Form - 2047658v3.0
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- StudyEvent: Concomitant Medication Form
Similar models
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- StudyEvent: Concomitant Medication Form
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
RegistrationStep
Item
Registration Step
text
Patient'sName
Item
Patient?s Name
text
ECOGProtocolNo.
Item
ECOG Prot. No.
text
ECOGProtocolNo.
Item
ECOG Prot. No.
text
ECOGPatientID
Item
ECOG Patient Seq. No.
text
ECOGPatientID
Item
ECOG Patient Seq. No.
text
ParticipatingGroupProtocolNo.
Item
Participating Group Prot. No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID No.
text
StepNo.
Item
Step No.
text
ParticipatingGroupName
Item
Group
text
InstitutionName
Item
Institution
text
Network
Item
Network
text
AffiliateName
Item
Affiliate
text
Item
Are data amended? (If yes, please circle amended items in red)
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
IntervalReportFromDate
Item
Reporting period Start Date: (M D Y)
date
IntervalReportToDate
Item
Reporting period End Date: (M D Y)
date
AgentName
Item
Generic Name (Use brand or trade if generic name unknown)
text
Dose
Item
Dose
double
C15313 (NCI Thesaurus ObjectClass)
C1522449 (UMLS 2011AA ObjectClass)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
C1522449 (UMLS 2011AA ObjectClass)
C25256 (NCI Thesaurus Property)
C1265611 (UMLS 2011AA Property)
CL Item
capsules (caps) (capsules (caps))
CL Item
gram (gm) (gram (gm))
CL Item
drops (gtts) (drops (gtts))
CL Item
inch (inch) (inch (inch))
CL Item
kilogram (kg) (kilogram (kg))
CL Item
liter (l) (liter (l))
CL Item
microgram (mcg) (microgram (mcg))
CL Item
milliequivalent (mEq) (milliequivalent (mEq))
CL Item
milligram (mg) (milligram (mg))
CL Item
milliliter (ml) (milliliter (ml))
CL Item
ounce (oz) (ounce (oz))
CL Item
tablets (tabs) (tablets (tabs))
CL Item
tablespoon (tbsp) (tablespoon (tbsp))
CL Item
teaspoon (tsp) (teaspoon (tsp))
CL Item
unit (u) (unit (u))
CL Item
other, specify (other, specify)