ID
6661
Beschrijving
CALGB 40503 Supplemental Adverse Event (AE) Form Tamoxifen or Letrozole With or Without Bevacizumab in Treating Women With Stage III or Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=604DB84A-54BF-38D2-E040-BB89AD43495E
Link
Trefwoorden
Versies (2)
- 26-08-12 26-08-12 -
- 08-01-15 08-01-15 - Martin Dugas
Geüploaded op
8 januari 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00601900 Toxicity - CALGB 40503 Supplemental Adverse Event (AE) Form - 2823361v1.0
If data are amended, circle amended items and check the "Yes" box. If submitting by mail, retain a copy for your records.
- StudyEvent: CALGB 40503 Supplemental Adverse Event (AE) Form
Beschrijving
Unnamed2
Beschrijving
Patient Initials
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2986440
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25536
Beschrijving
Medical Record Number
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1301894
- NCI Thesaurus ObjectClass
- C16960
- NCI Thesaurus Property
- C25261
- NCI Thesaurus Property-2
- C25198
Beschrijving
Institution Name
Datatype
text
Alias
- NCI Thesaurus ObjectClass
- C25454
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass-2
- C21541
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Beschrijving
Participating Group
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C2347449
- NCI Thesaurus ObjectClass
- C25608
- NCI Thesaurus ObjectClass-2
- C17005
- NCI Thesaurus Property
- C25364
Beschrijving
Study Number Participating Group
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C3274381
- NCI Thesaurus ObjectClass
- C25320
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Beschrijving
Trial subject ID Participating Group
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2348585
- NCI Thesaurus ObjectClass
- C16960
- UMLS CUI-2
- C2347449
- NCI Thesaurus Property
- C25608
- NCI Thesaurus Property-2
- C25364
Beschrijving
Expected Adverse Events
Beschrijving
MedDRACode
Datatype
float
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Metathesaurus ObjectClass
- CL104089
Beschrijving
MedDRACode
Datatype
float
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Metathesaurus ObjectClass
- CL104089
Beschrijving
CommonToxicityCriteriaAdverseEventTermType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Thesaurus Property
- C45559
- UMLS 2011AA Property
- C1705313
Beschrijving
CommonToxicityCriteriaAdverseEventTermType
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Thesaurus Property
- C45559
- UMLS 2011AA Property
- C1705313
Beschrijving
CommonToxicityCriteriaAdverseEventGrade
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Thesaurus ValueDomain
- C18000
- UMLS 2011AA ValueDomain
- C0919553
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
CommonToxicityCriteriaAdverseEventGrade
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Thesaurus ValueDomain
- C18000
- UMLS 2011AA ValueDomain
- C0919553
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschrijving
AdverseEventWorstSymptomDayDuration
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C4876
- UMLS 2011AA Property
- C1457887
- NCI Thesaurus Property-2
- C25719
- UMLS 2011AA Property-2
- C1522166
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ValueDomain-2
- C25330
- UMLS 2011AA ValueDomain-2
- C0449238
Beschrijving
AdverseEventWorstSymptomDayDuration
Datatype
float
Alias
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C4876
- UMLS 2011AA Property
- C1457887
- NCI Thesaurus Property-2
- C25719
- UMLS 2011AA Property-2
- C1522166
- NCI Thesaurus ValueDomain
- C25301
- UMLS 2011AA ValueDomain
- C0439228
- NCI Thesaurus ValueDomain-2
- C25330
- UMLS 2011AA ValueDomain-2
- C0449238
Beschrijving
AgentAdverseEventAttributionName
Datatype
text
Alias
- NCI Thesaurus Property
- C41331
- UMLS 2011AA Property
- C0877248
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus Property-2
- C25358
- UMLS 2011AA Property-2
- C0596130
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
Beschrijving
AgentAdverseEventAttributionName
Datatype
text
Alias
- NCI Thesaurus Property
- C41331
- UMLS 2011AA Property
- C0877248
- NCI Thesaurus ObjectClass
- C1708
- UMLS 2011AA ObjectClass
- C0450442
- NCI Thesaurus Property-2
- C25358
- UMLS 2011AA Property-2
- C0596130
- NCI Thesaurus ValueDomain
- C42614
- UMLS 2011AA ValueDomain
- C0027365
Beschrijving
Person Completing Form
Datatype
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25657
- NCI Thesaurus Property
- C25364
Beschrijving
Date Form Completed
Datatype
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C1115437
- NCI Thesaurus ObjectClass
- C40988
- NCI Thesaurus Property
- C25250
- NCI Thesaurus ValueDomain-2
- C25367
Similar models
If data are amended, circle amended items and check the "Yes" box. If submitting by mail, retain a copy for your records.
- StudyEvent: CALGB 40503 Supplemental Adverse Event (AE) Form
C3262252 (UMLS CUI-1)
C19464 (NCI Thesaurus ObjectClass)
C1516238 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25442 (NCI Thesaurus ObjectClass-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
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C25616 (NCI Thesaurus Property)
C2361257 (UMLS CUI-1)
C25651 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C2361259 (UMLS CUI-1)
C25616 (NCI Thesaurus Property)
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C25651 (NCI Thesaurus Property-2)
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C25536 (NCI Thesaurus Property)
C1301894 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25261 (NCI Thesaurus Property)
C25198 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
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C17005 (NCI Thesaurus ObjectClass-2)
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C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
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C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C0805701 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL104089 (NCI Metathesaurus ObjectClass)
C0805701 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL104089 (NCI Metathesaurus ObjectClass)
C0332307 (UMLS 2011AA ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C45559 (NCI Thesaurus Property)
C1705313 (UMLS 2011AA Property)
C0332307 (UMLS 2011AA ValueDomain)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C45559 (NCI Thesaurus Property)
C1705313 (UMLS 2011AA Property)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C1516728 (UMLS 2011AA ObjectClass)
C18000 (NCI Thesaurus ValueDomain)
C0919553 (UMLS 2011AA ValueDomain)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0877248 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25330 (NCI Thesaurus ValueDomain-2)
C0449238 (UMLS 2011AA ValueDomain-2)
C0877248 (UMLS 2011AA ObjectClass)
C4876 (NCI Thesaurus Property)
C1457887 (UMLS 2011AA Property)
C25719 (NCI Thesaurus Property-2)
C1522166 (UMLS 2011AA Property-2)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25330 (NCI Thesaurus ValueDomain-2)
C0449238 (UMLS 2011AA ValueDomain-2)
C0877248 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property-2)
C0596130 (UMLS 2011AA Property-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C0246421 (UMLS 2011AA)
C855 (NCI Thesaurus-3)
C0039286 (UMLS 2011AA-4)
C0032042 (UMLS 2011AA)
C2039 (NCI Thesaurus-3)
C0796392 (UMLS 2011AA-4)
C0877248 (UMLS 2011AA Property)
C1708 (NCI Thesaurus ObjectClass)
C0450442 (UMLS 2011AA ObjectClass)
C25358 (NCI Thesaurus Property-2)
C0596130 (UMLS 2011AA Property-2)
C42614 (NCI Thesaurus ValueDomain)
C0027365 (UMLS 2011AA ValueDomain)
C0246421 (UMLS 2011AA)
C855 (NCI Thesaurus-3)
C0039286 (UMLS 2011AA-4)
C0032042 (UMLS 2011AA)
C2039 (NCI Thesaurus-3)
C0796392 (UMLS 2011AA-4)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C1115437 (UMLS CUI-1)
C40988 (NCI Thesaurus ObjectClass)
C25250 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)