ID
6382
Beschreibung
CALGB: 49903 ADVERSE EVENT FORM Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D2363-5625-477E-E034-0003BA0B1A09
Link
Stichworte
Versionen (2)
- 18.12.14 18.12.14 - Martin Dugas
- 03.06.15 03.06.15 -
Hochgeladen am
18. Dezember 2014
DOI
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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053339 Toxicity - CALGB: 49903 ADVERSE EVENT FORM - 2054612v3.0
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
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Unnamed2
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Patient'sName
Datentyp
text
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ParticipatingGroup
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Beschreibung
PatientHospitalNumber
Datentyp
text
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ParticipatingGroupProtocolNo.
Datentyp
text
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AffiliateName
Datentyp
text
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ParticipatingGroupPatientID
Datentyp
text
Beschreibung
Unnamed3
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Expected Adverse Events
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IMTCodeduplicate
Datentyp
text
Beschreibung
CTCAdverseEventTerm
Datentyp
text
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CTCAdverseEventGrade
Datentyp
text
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CTCAdverseEventAttributionCode
Datentyp
text
Beschreibung
Unnamed4
Beschreibung
Ccrr Module For Calgb: 49903 Adverse Event Form
Ähnliche Modelle
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1521800 (UMLS 2011AA ObjectClass)
C25175 (NCI Thesaurus Property)
C1522646 (UMLS 2011AA Property)
C1298908 (UMLS 2011AA)
C1705108 (UMLS 2011AA)
C0445356 (UMLS 2011AA)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)