Item
Specify Protocol I:
text
C2348563 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
Code List
Specify Protocol I:
CL Item
Prot. IA (Prot. IA)
CL Item
Prot. IAD (Prot. IAD)
CL Item
Prot. IA' (Prot. IA')
CL Item
Prot. IA-CPM (Prot. IA-CPM)
CL Item
Prot. IB (Prot. IB)
CL Item
Prot. IB-ASP+ (Prot. IB-ASP+)
Item
Specify Methotrexate protocol:
text
C2348563 (UMLS CUI [1,1])
C0025677 (UMLS CUI [1,2])
Code List
Specify Methotrexate protocol:
CL Item
1st HD-MTX (1st HD-MTX)
CL Item
2nd HD-MTX (2nd HD-MTX)
CL Item
3rd HD-MTX (3rd HD-MTX)
CL Item
4th HD-MTX (4th HD-MTX)
Item
Specify Protocol II:
text
C2348563 (UMLS CUI [1,1])
C0205436 (UMLS CUI [1,2])
Code List
Specify Protocol II:
CL Item
Prot. IIA (Prot. IIA)
CL Item
Prot. IIA-ASP+ (Prot. IIA-ASP+)
CL Item
Prot. IIB (Prot. IIB)
CL Item
Prot. IIB-ASP+ (Prot. IIB-ASP+)
Item
Specify high risk block:
text
C0684030 (UMLS CUI [1,1])
C0039798 (UMLS CUI [1,2])
Code List
Specify high risk block:
CL Item
DNX-FLA (DNX-FLA)
Item
Specify interval therapy:
text
C1272706 (UMLS CUI [1,1])
C0039798 (UMLS CUI [1,2])
Code List
Specify interval therapy:
CL Item
1st interval therapy (1st interval therapy)
CL Item
2nd interval therapy (2nd interval therapy)
Item
Specify maintenance therapy:
text
C0677908 (UMLS CUI [1])
Code List
Specify maintenance therapy:
CL Item
Maintenance therapy (Maintenance therapy)
Other therapeutic aspects
Item
Specify other therapeutic aspects:
text
C0039798 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Therapy start date
Item
Therapy start date
date
C3173309 (UMLS CUI [1])
Infection
Item
Severe adverse event: Infection
boolean
C0009450 (UMLS CUI [1])
Infection: reporting
Item
Severe adverse event: Infection: If "Yes", has it been reported?
boolean
C0009450 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Pancreas
Item
Severe adverse event: Pancreas
boolean
C0030274 (UMLS CUI [1])
Pancreas: reporting
Item
Severe adverse event: Pancreas: If "Yes", has it been reported?
boolean
C0030274 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Thrombosis
Item
Severe adverse event: Thrombosis
boolean
C0040053 (UMLS CUI [1])
Thrombosis: reporting
Item
Severe adverse event: Thrombosis: If "Yes", has it been reported?
boolean
C0040053 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Liver
Item
Severe adverse event: Liver
boolean
C0023884 (UMLS CUI [1])
Liver: reporting
Item
Severe adverse event: Liver: If "Yes", has it been reported?
boolean
C0023884 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Neurologic/ Psychologic aspects
Item
Severe adverse event: Neurologic/ Psychologic aspects
boolean
C0027763 (UMLS CUI [1])
C0205486 (UMLS CUI [2])
Neurologic/ Psychologic aspects: reporting
Item
Severe adverse event: Neurologic/ Psychologic aspects: If "Yes", has it been reported?
boolean
C0027763 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
C0205486 (UMLS CUI [2,1])
C0700287 (UMLS CUI [2,2])
Gastrointestinal aspects
Item
Severe adverse event: Gastrointestinal aspects
boolean
C0012240 (UMLS CUI [1])
Gastrointestinal aspects: reporting
Item
Severe adverse event: Gastrointestinal aspects: If "Yes", has it been reported?
boolean
C0012240 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Dermatologic aspects
Item
Severe adverse event: Dermatologic aspects
boolean
C0037274 (UMLS CUI [1])
Dermatologic aspects: reporting
Item
Severe adverse event: Dermatologic aspects: If "Yes", has it been reported?
boolean
C0037274 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Cardiac aspects
Item
Severe adverse event: Cardiac aspects
boolean
C1522601 (UMLS CUI [1])
Cardiac aspects: reporting
Item
Severe adverse event: Cardiac aspects: If "Yes", has it been reported?
boolean
C1522601 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Renal aspects
Item
Severe adverse event: Renal aspects
boolean
C0022646 (UMLS CUI [1])
Renal aspects: reporting
Item
Severe adverse event: Renal aspects: If "Yes", has it been reported?
boolean
C0022646 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Metabolic/ endocrinologic aspects
Item
Severe adverse event: Metabolic/ endocrinologic aspects
boolean
C0025517 (UMLS CUI [1])
C0694557 (UMLS CUI [2])
Metabolic/ endocrinologic aspects: reporting
Item
Severe adverse event: Metabolic/ endocrinologic aspects: If "Yes", has it been reported?
boolean
C0025517 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
C0694557 (UMLS CUI [2,1])
C0700287 (UMLS CUI [2,2])
Drug intolerance
Item
Severe adverse event: Drug intolerance
boolean
C0277585 (UMLS CUI [1])
Drug intolerance: reporting
Item
Severe adverse event: Drug intolerance: If "Yes", has it been reported?
boolean
C0277585 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Skeleton aspects
Item
Severe adverse event: Skeleton aspects
boolean
C0816871 (UMLS CUI [1])
Skeleton aspects: reporting
Item
Severe adverse event: Skeleton aspects: If "Yes", has it been reported?
boolean
C0816871 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Not classified aspects
Item
Severe adverse event: Not classified aspects
boolean
C0205426 (UMLS CUI [1])
Not classified aspects: reporting
Item
Severe adverse event: Not classified aspects: If "Yes", has it been reported?
boolean
C0205426 (UMLS CUI [1,1])
C0700287 (UMLS CUI [1,2])
Date of report
Item
Date of report
date
C1302584 (UMLS CUI [1])
Doctor's name
Item
Docotor's name
text
C0027365 (UMLS CUI [1,1])
C0031831 (UMLS CUI [1,2])
Doctor's signature
Item
Doctor's signature
text
C1519316 (UMLS CUI [1])