Description:

a set of data elements recommended for mapping the electronic fields for the ADEERS system for data collection. Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D9131777-7F1F-3B56-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D9131777-7F1F-3B56-E034-0003BA12F5E7

Keywords:
Versions (4) ▾
  1. 12/18/14
  2. 1/8/15
  3. 1/9/15
  4. 1/9/15
Uploaded on:

January 8, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Adverse Event Toxicity - AdEERs Screen Labels - 2264300v3.0

No Instruction available.

  1. StudyEvent: AdEERs Screen Labels
    1. No Instruction available.
AE report
Reporter_information
Physician_information
Submitter_information
Course_information
Description_of_event
Institution_information
Institution
Protocol_information
Patient_information
Race
Gender
Ethnicity
cm
Kg
Baseline Performance status at Initiation of protocol ECOG/Zubrod scale
Disease Name
Primary Site of Disease
Prior_therapy
Therapy
Chemoagents
Agent
Pre_existing_condition
Other Pre-Existing Condition
Site_name
Site of Metastatic Disease
Protocol_agent
Agent
Total Dose UOM
Agent Adjustment
Agent Delayed
Concomitant_medication
Other_contributing_cause
Adverse_event_ctc
Hospitalization/Prolongation of Hospitalization
Attribution_for_ae
Attribution
Lab_result
Lab Category
Lab
Baseline UOM
Additional_info
Additional Information