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Common Toxicity Report

1 Formulär  
  1. StudyEvent: ODM
    1. Common Toxicity Report
Administrative data
Beskrivning

Administrative data

Last Name
Beskrivning

Last Name

Datatyp

text

First Name
Beskrivning

First Name

Datatyp

text

Section
Beskrivning

Section

Datatyp

text

GOG #
Beskrivning

Inst.,Prot.,Seq.

Datatyp

integer

Common Toxicity Report
Beskrivning

Common Toxicity Report

Course Number
Beskrivning

The toxicities listed below occurred following this course of therapy

Datatyp

integer

Specific CTC Term or CTC Major Categories
Beskrivning

CTC Term

Datatyp

text

CTC Grade
Beskrivning

CTC Grade

Datatyp

integer

Due to Rx?
Beskrivning

potential connection to Rx

Datatyp

text

CTEP AER Submitted?
Beskrivning

CTEP AER

Datatyp

boolean

Specific CTC Term or Additional Information
Beskrivning

(e.g., lab values, clarifications)

Datatyp

text

Date
Beskrivning

Date

Datatyp

date

Was a transfusion administered at this course of therapy?
Beskrivning

administration at the course of therapy

Datatyp

text

Did hospitalisation occur as a result of the toxicities above?
Beskrivning

hospitalisation

Datatyp

boolean

Were cytokines administered this course?
Beskrivning

cytokines administered

Datatyp

text

Comments
Beskrivning

Comments

Datatyp

text

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Similar models

Common Toxicity Report

1 Formulär
  1. StudyEvent: ODM
    1. Common Toxicity Report
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative data
Last Name
Item
Last Name
text
First Name
Item
First Name
text
Section
Item
Section
text
Gynecologic Oncology Group Number
Item
GOG #
integer
Item Group
Common Toxicity Report
Course Number
Item
Course Number
integer
Item
Specific CTC Term or CTC Major Categories
text
CTC Term
Code List
Specific CTC Term or CTC Major Categories
CL Item
WBC (1)
CL Item
ANC/AGC (2)
CL Item
Platelets (3)
CL Item
Hemoglobin (4)
CL Item
Hematologic-other than above (5)
CL Item
Allergy/Immunology (6)
CL Item
Auditory/Hearing (7)
CL Item
Cardiovascular (8)
CL Item
Coagulation (9)
CL Item
Constitutional symptoms (10)
CL Item
Dermatology (11)
CL Item
Endocrine (12)
CL Item
Gastrointestinal (13)
CL Item
Genitourinary/Renal (14)
CL Item
Hemorrhage (15)
CL Item
Hepatic (16)
CL Item
Infection/Febr.neutropenia (17)
CL Item
Lymphatics (18)
CL Item
Metabolic/Laboratory (19)
CL Item
Musculoskeletal (20)
CL Item
Neurology (21)
CL Item
Ocular/Visual (22)
CL Item
Pain (23)
CL Item
Pulmonary (24)
CL Item
Sexual Function (25)
CTC Grade
Item
CTC Grade
integer
Item
Due to Rx?
text
potential connection to Rx
Code List
Due to Rx?
CL Item
Unlikely (1)
CL Item
Possible (2)
CL Item
Probable (3)
CL Item
Definite (4)
CTEP AER
Item
CTEP AER Submitted?
boolean
Specific CTC Term or Additional Information
Item
Specific CTC Term or Additional Information
text
Date
Item
Date
date
Item
Was a transfusion administered at this course of therapy?
text
administration at the course of therapy
Code List
Was a transfusion administered at this course of therapy?
CL Item
No (1)
CL Item
Yes, pRBC (2)
CL Item
Yes, platelets (3)
hospitalisation
Item
Did hospitalisation occur as a result of the toxicities above?
boolean
Item
Were cytokines administered this course?
text
cytokines administered
Code List
Were cytokines administered this course?
CL Item
No (1)
CL Item
Yes, G-CSF/GM-CSF (2)
CL Item
Yes, thrombopoietin (3)
CL Item
Yes, erythropoietin (4)
Comments
Item
Comments
text
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