ID
43433
Description
E5204 Adverse Event Form (CTCAE v3.0) Combination Chemotherapy With or Without Bevacizumab in Treating Patients Who Have Had Surgery for Stage II or Stage III Rectal Cancer NCT00303628 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=089B4062-6B32-38B1-E044-0003BA3F9857
Link
Keywords
Versions (6)
- 8/27/12 8/27/12 -
- 1/8/15 1/8/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 3/31/15 3/31/15 - Martin Dugas
- 9/20/21 9/20/21 -
Uploaded on
September 20, 2021
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer Toxicity NCT00303628 E5204
INSTRUCTIONS: Complete this form as indicated below and at the end of all protocol therapy. Submit original to the ECOG Coordinating Center. Keep a copy for your files.
- StudyEvent: E5204 Adverse Event Form (CTCAE v3.0)
Description
Adverse event
Alias
- UMLS CUI-1
- C0877248
Description
Cycle number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Description
PersonOff-TreatmentTimePeriodType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- NCI Thesaurus Property
- C25616
- NCI Thesaurus Property-2
- C25601
- NCI Thesaurus Property-3
- C25207
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1518544
- UMLS CUI-2
- C1948053
Description
AdverseEventCurrentAssessmentInd
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus Property
- C20989
- NCI Thesaurus Property-2
- C25471
- NCI Thesaurus ObjectClass
- C41331
- UMLS CUI-1
- C0877248
- UMLS CUI-2
- C1516048
Description
Adverse Event Start Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2697888
- NCI Thesaurus Property
- C25375
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C49704
Description
Adverse Event End Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2697886
- NCI Thesaurus Property
- C25375
- NCI Thesaurus ObjectClass
- C49704
Description
Adverse event blood, bone marrow lab
Alias
- UMLS CUI-1
- C0877248
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C45559
Description
CTC Adverse Event Grade (this report period)
Data type
integer
Alias
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
- UMLS CUI-1
- C2985911
Description
CTC Adverse Event Attribution Scale
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Description
Adverse event infections
Alias
- UMLS CUI-1
- C0877248
Description
CommonToxicityCriteriaAdverseEventShortNameType
Data type
text
Alias
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ObjectClass
- C49704
- NCI Metathesaurus ValueDomain
- C0332307
- NCI Thesaurus Property-2
- C25249
- UMLS CUI-1
- C1516728
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C38024
- NCI Thesaurus Property-2
- C45559
Description
Other Adverse Events
Alias
- UMLS CUI-1
- C0877248
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C45559
Description
CTC Adverse Event Reported Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2699044
- NCI Thesaurus Property
- C25161
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INSTRUCTIONS: Complete this form as indicated below and at the end of all protocol therapy. Submit original to the ECOG Coordinating Center. Keep a copy for your files.
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C1516048 (UMLS CUI-2)
C2697888 (UMLS CUI-1)
C25375 (NCI Thesaurus Property)
C25431 (NCI Thesaurus ValueDomain-2)
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C0015672 (UMLS 2011AA)
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C0038362 (UMLS 2011AA)
C0027497 (UMLS 2011AA)
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C1706735 (UMLS CUI-1)
C0445356 (UMLS CUI-1)
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C1709683 (UMLS CUI-1)
C1704787 (UMLS CUI-1)
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C0332307 (NCI Metathesaurus ValueDomain)
C25249 (NCI Thesaurus Property-2)
C1516728 (UMLS CUI-1)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
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