Visit Date
Vital Signs
If Yes, complete below
boolean
Date of assessment
date
Check one box only
integer
Systolic BP
integer
Diastolic BP
integer
Heart Rate
integer
Respiration Rate
integer
Temperature
float
Check one box only
integer
Weight
float
Check one box only
integer
Hematology
If No, or if results are not available, please complete details on the comments page or the protocol deviations page.
boolean
Date and time of sample
datetime
(if different from main hospital laboratory)
text
Hematology
Parameter
integer
Result
text
Units
text
Check one box only. If any result is clinically significant, please record a diagnosis on the adverse event page.
integer
Not Done
integer
Clinical Chemistry, Coagulation and Electrolytes
If No, or if results are not available, please complete details on the comments page or the protocol deviations page.
boolean
Date and time of sample
datetime
(if different from main hospital laboratory)
text
Clinical Chemistry, Coagulation and Electrolytes
Parameter
integer
Results
text
Units
text
Check one box only. If any result is clinically significant, please record a diagnosis on the adverse event page.
integer
Not Done
integer
Bortezomib Administration
Was bortezomib administered at this visit?
boolean
Date administered
date
Lot #
integer
Time Administered
time
Dose Level
integer
BSA
integer
Dose Admin
integer