Description:

CALGB 90802 Supplemental Adverse Event Form (Thromboembolic Events) Everolimus With or Without Bevacizumab in Treating Patients With Advanced Kidney Cancer That Progressed After First-Line Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8785C648-8EAC-0F46-E040-BB89AD432B73

Link:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8785C648-8EAC-0F46-E040-BB89AD432B73
Keywords:
  1. 9/19/12 9/19/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
Uploaded on:

January 8, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Kidney Cancer NCT01198158 Toxicity - CALGB 90802 Supplemental Adverse Event Form (Thromboembolic Events) - 3103388v1.0

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 complete the form electronically. After entering all data, click the "Print and/or Submit to CALGB" button located at the bottom of the last page of the form. Retain a copy of the form for your records. Submit supporting documentation by fax (919-416-4990) or mail. If data are amended, circle amended items, check the "Yes" box, and submit by fax or mail

Header
Are data amended
Unnamed2
Unnamed 3
Medications received during this reporting period (Mark all that apply with an X.)
Medications received during this reporting period
Which of the following arterial thrombotic events (ATEs) occurred during this reporting period? (Mark all that apply with an X.)
Treatment for ATE (Mark all that apply with an X.)
Outcome of ATE
Which of the following venous thrombotic events (VTEs) occurred during this reporting period? (Mark all that apply with an X.)
Specify status
Treatment for VTE (Mark all that apply with an X.)
Outcome of VTE

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