ID
43191
Beschreibung
NSABP B-35 Form ALERT NCT00053898 Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0587E1D-38C6-3AA5-E034-080020C9C0E0
Link
Stichworte
Versionen (4)
- 26.08.12 26.08.12 -
- 08.07.15 08.07.15 -
- 08.07.15 08.07.15 -
- 20.09.21 20.09.21 -
Hochgeladen am
20. September 2021
DOI
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Creative Commons BY-NC 3.0 Legacy
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NSABP B-35 Form ALERT NCT00053898
Form ALERT Instructions: *Use NCI's Common Toxicity Criteria (CTC) Version 2.0 to assess the adverse event (AE). *Report any grade 3 unexpected AE, or any grade 4 AE, or any grade 5 AE (as listed below). *Complete and FAX this form with all available supporting documentation to the NSABP Biostatistical Center (412/624-1082) within 24 hours of learning about the AE. *Report the AE regardless of attribution (relationship) to protocol therapy (tamoxifen/anastrozole). *Do not fax this report to the NCI, FDA or HPFB.
Beschreibung
AE Evaluation
Beschreibung
Date of this report (Month Day Year)
Datentyp
date
Alias
- UMLS CUI-1
- C1302584
Beschreibung
Patient's Age at Time of AE
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C20989
- NCI Thesaurus Property-2
- C41331
- NCI Thesaurus ValueDomain
- C29848
- NCI Thesaurus ValueDomain-2
- C25463
- UMLS CUI-1
- C0030705
- UMLS CUI-2
- C0001779
Beschreibung
Notify Local IRB?
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C25388
- NCI Thesaurus ObjectClass-2
- C16741
- NCI Thesaurus Property
- C41331
- NCI Thesaurus Property-2
- C25297
- NCI Thesaurus ValueDomain
- C38147
- UMLS CUI-1
- C0086911
- UMLS CUI-2
- C0422202
- UMLS CUI-3
- C1512698
Beschreibung
Institution Number
Datentyp
float
Alias
- UMLS CUI-1
- C1272753
- UMLS CUI-2
- C0237753
Beschreibung
Specify Type of Adverse Event (AE)
Datentyp
text
Alias
- UMLS CUI-1
- C0877248
- UMLS CUI-2
- C1521902
Beschreibung
AE (CTC Term)
Datentyp
text
Alias
- UMLS CUI-1
- C1879645
Beschreibung
4-Character NSABP Code
Datentyp
text
Alias
- UMLS CUI-1
- C1513905
- UMLS CUI-2
- C0805701
Beschreibung
Date of Adverse Event (Month Day Year)
Datentyp
date
Alias
- UMLS CUI-1
- C2985916
Beschreibung
PatientHospitalizationInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25179
- UMLS 2011AA Property
- C0019993
Beschreibung
Attribution (relationship) of the AE to protocol therapy?
Datentyp
text
Alias
- UMLS CUI-1
- C1510821
- UMLS CUI-2
- C0054605
Beschreibung
TamoxifenAnastrozole /Start Date (Month Day Year)
Datentyp
date
Alias
- UMLS CUI-1
- C0039286
- UMLS CUI-2
- C0290883
- UMLS CUI-3
- C2708155
Beschreibung
Tamoxifen/Anastrozole Date of Most Recent Dose (Month Day Year)
Datentyp
date
Alias
- UMLS CUI-1
- C0039286
- UMLS CUI-2
- C0290883
- UMLS CUI-3
- C1762893
Beschreibung
Briefly describe the AE (provide supporting documentation)
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0877248
- UMLS CUI-2
- C0678257
Ähnliche Modelle
Form ALERT Instructions: *Use NCI's Common Toxicity Criteria (CTC) Version 2.0 to assess the adverse event (AE). *Report any grade 3 unexpected AE, or any grade 4 AE, or any grade 5 AE (as listed below). *Complete and FAX this form with all available supporting documentation to the NSABP Biostatistical Center (412/624-1082) within 24 hours of learning about the AE. *Report the AE regardless of attribution (relationship) to protocol therapy (tamoxifen/anastrozole). *Do not fax this report to the NCI, FDA or HPFB.
C0030705 (UMLS CUI-2)
C0027365 (UMLS CUI-2)
C1301584 (UMLS CUI-2)
C1515258 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C3262828 (UMLS CUI-1)
C1443235 (UMLS CUI-2)
C3262828 (UMLS CUI-1)
C1515258 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C1511726 (UMLS CUI-1)
C1691222 (UMLS CUI-2)
C20989 (NCI Thesaurus Property)
C41331 (NCI Thesaurus Property-2)
C29848 (NCI Thesaurus ValueDomain)
C25463 (NCI Thesaurus ValueDomain-2)
C0030705 (UMLS CUI-1)
C0001779 (UMLS CUI-2)
C16741 (NCI Thesaurus ObjectClass-2)
C41331 (NCI Thesaurus Property)
C25297 (NCI Thesaurus Property-2)
C38147 (NCI Thesaurus ValueDomain)
C0086911 (UMLS CUI-1)
C0422202 (UMLS CUI-2)
C1512698 (UMLS CUI-3)
C0237753 (UMLS CUI-2)
C1521902 (UMLS CUI-2)
C1519789 (UMLS CUI-2)
C1517874 (UMLS CUI-2)
C1517874 (UMLS CUI-2)
C1705232 (UMLS CUI-2)
C1705232 (UMLS CUI-2)
C0805701 (UMLS CUI-2)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
C0054605 (UMLS CUI-2)
C0445356 (UMLS CUI-1)
C0290883 (UMLS CUI-2)
C2708155 (UMLS CUI-3)
C0290883 (UMLS CUI-2)
C1762893 (UMLS CUI-3)
C0877248 (UMLS CUI-1)
C0678257 (UMLS CUI-2)