Unnamed2
Patient Initials
text
Protocol Number ECOG
text
Patient ID ECOG
text
Study Number Participating Group
text
Trial subject ID Participating Group
text
Institution Name
text
Unnamed3
Data amended
text
Data amended date
date
Unnamed Module 4
Cycle number
text
Cycle number
text
Off Treatment Reporting Period
PersonOff-TreatmentTimePeriodType
text
Unnamed4
AdverseEventCurrentAssessmentInd
text
CTCAdverseEventReportBeginDate
date
CTCAdverseEventReportEndDate
date
Unnamed5
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventGrade
float
CTCAdverseEventAttributionScale
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
Unnamed5
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventShortNameType
text
CTCAdverseEventSpecifiedTermType
text
CommonToxicityCriteriaAdverseEventGrade
float
CTCAdverseEventAttributionScale
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
Unnamed5
CommonToxicityCriteriaAdverseEventTermType
text
CommonToxicityCriteriaAdverseEventGrade
float
CTCAdverseEventAttributionScale
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
Iii. Infections
CommonToxicityCriteriaAdverseEventShortNameType
text
CTCAdverseEventSpecifiedTermType
text
CommonToxicityCriteriaAdverseEventGrade
float
CTCAdverseEventAttributionScale
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
Iii. Infections
CommonToxicityCriteriaAdverseEventShortNameType
text
CTCAdverseEventSpecifiedTermType
text
CommonToxicityCriteriaAdverseEventGrade
float
CTCAdverseEventAttributionScale
text
DoseChemotherapyAdverseEventModificationStatus
text
DoseBevacizumabAdverseEventModificationStatus
text
Comments
Investigator Signature
text
Investigator Signature Date
date