ID

6927

Descripción

Melanoma-Adverse Event Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A99A-3FA4-E034-080020C9C0E0

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=99CD59C5-A99A-3FA4-E034-080020C9C0E0

Palabras clave

Versiones (2)
  1. 20/9/12 20/9/12 -
  2. 8/1/15 8/1/15 - Martin Dugas
Subido en

8 de enero de 2015

DOI

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Licencia

Creative Commons BY-NC 3.0 Legacy
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Toxicity - Melanoma-Adverse Event Form - 2020197v2.31

Inglés

No Instruction available.

1 formularios  
  1. StudyEvent: Melanoma-Adverse Event Form
    1. No Instruction available.
Crf Header
Descripción

Crf Header

Coordinating Group Protocol Number
Descripción

CoordinatingGroupProtocolNumber

Tipo de datos

text

Coordinating Group Code
Descripción

CoordinatingGroupCode

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Protocol Title
Descripción

Protocol Title

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25320
UMLS CUI-1
C2986303
NCI Thesaurus Property
C42774
Patient Study ID, Coordinating Group
Descripción

PatientStudyID,CoordinatingGroup

Tipo de datos

text

Patient Study ID, Participating Group
Descripción

PatientStudyID,ParticipatingGroup

Tipo de datos

text

Participating Group Code
Descripción

ParticipatingGroupCode

Tipo de datos

text

Alias
NCI Thesaurus ValueDomain
C25162
UMLS 2011AA ValueDomain
C0805701
Institution Name
Descripción

InstitutionName

Tipo de datos

text

Affiliate Name
Descripción

AffiliateName

Tipo de datos

text

Patient Name, Last
Descripción

PatientName,Last

Tipo de datos

text

Patient Name, First
Descripción

PatientName,First

Tipo de datos

text

Patient Name, Middle
Descripción

PatientName,Middle

Tipo de datos

text

Melanoma: Form Administration
Descripción

Melanoma: Form Administration

Person Completing Form, Last Name
Descripción

PersonCompletingForm,LastName

Tipo de datos

text

Person Completing Form, First Name
Descripción

PersonCompletingForm,FirstName

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25364
UMLS 2011AA Property
C0600091
Amended Data Ind
Descripción

AmendedDataInd

Tipo de datos

text

Alias
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C25416
UMLS 2011AA Property
C1691222
Melanoma: Adverse Events
Descripción

Melanoma: Adverse Events

CTC Adverse Event Report Begin Date
Descripción

CTCAdverseEventReportBeginDate

Tipo de datos

date

CTC Adverse Event Report End Date
Descripción

CTCAdverseEventReportEndDate

Tipo de datos

date

CTC Adverse Event Term
Descripción

CTCAdverseEventTerm

Tipo de datos

text

CTC Adverse Event Grade
Descripción

CTCAdverseEventGrade

Tipo de datos

text

CTC Adverse Event Term, Other
Descripción

CTCAdverseEventTerm,Other

Tipo de datos

text

Melanoma: Vaccine Injection Site Reacton
Descripción

Melanoma: Vaccine Injection Site Reacton

Assessment Date
Descripción

AssessmentDate

Tipo de datos

date

Vitiligo Ind
Descripción

VitiligoInd

Tipo de datos

text

Vaccine Site
Descripción

VaccineSite

Tipo de datos

text

Erythema
Descripción

Erythema

Tipo de datos

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Induration
Descripción

Induration

Tipo de datos

float

Alias
NCI Thesaurus ValueDomain
C25209
UMLS 2011AA ValueDomain
C0242485
Vaccine Site, Other
Descripción

VaccineSite,Other

Tipo de datos

text

Allows Documentation Of Any Additional Cooments
Descripción

Allows Documentation Of Any Additional Cooments

Comments
Descripción

Comments

Tipo de datos

text

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Similar models

No Instruction available.

1 formularios
  1. StudyEvent: Melanoma-Adverse Event Form
    1. No Instruction available.
Name
Tipo
Description | Question | Decode (Coded Value)
Tipo de datos
Alias
Item Group
Crf Header
CoordinatingGroupProtocolNumber
Item
Coordinating Group Protocol Number
text
CoordinatingGroupCode
Item
Coordinating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
Protocol Title
Item
Protocol Title
text
C25320 (NCI Thesaurus ObjectClass)
C2986303 (UMLS CUI-1)
C42774 (NCI Thesaurus Property)
PatientStudyID,CoordinatingGroup
Item
Patient Study ID, Coordinating Group
text
PatientStudyID,ParticipatingGroup
Item
Patient Study ID, Participating Group
text
ParticipatingGroupCode
Item
Participating Group Code
text
C25162 (NCI Thesaurus ValueDomain)
C0805701 (UMLS 2011AA ValueDomain)
InstitutionName
Item
Institution Name
text
AffiliateName
Item
Affiliate Name
text
PatientName,Last
Item
Patient Name, Last
text
PatientName,First
Item
Patient Name, First
text
PatientName,Middle
Item
Patient Name, Middle
text
Item Group
Melanoma: Form Administration
PersonCompletingForm,LastName
Item
Person Completing Form, Last Name
text
PersonCompletingForm,FirstName
Item
Person Completing Form, First Name
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
Item
Amended Data Ind
text
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
CL.1
Code List
Amended Data Ind
CL Item
Yes (YES)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
Unknown (UNKNOWN)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
No (NO)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
Item Group
Melanoma: Adverse Events
CTCAdverseEventReportBeginDate
Item
CTC Adverse Event Report Begin Date
date
CTCAdverseEventReportEndDate
Item
CTC Adverse Event Report End Date
date
Item
CTC Adverse Event Term
text
CL.2
Code List
CTC Adverse Event Term
CL Item
Ctep.info.nih.gov/ctc3/ctc.htm (http://ctep.info.nih.gov/CTC3/ctc.htm)
Item
CTC Adverse Event Grade
text
CL.3
Code List
CTC Adverse Event Grade
CL Item
Ctep.info.nih.gov/ctc3/ctc.htm (http://ctep.info.nih.gov/CTC3/ctc.htm)
CTCAdverseEventTerm,Other
Item
CTC Adverse Event Term, Other
text
Item Group
Melanoma: Vaccine Injection Site Reacton
AssessmentDate
Item
Assessment Date
date
Item
Vitiligo Ind
text
CL.4
Code List
Vitiligo Ind
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
Item
Vaccine Site
text
CL.5
Code List
Vaccine Site
CL Item
Left Lower Extremity (left lower extremity)
CL Item
Left Upper Extremity (left upper extremity)
CL Item
Trunk (trunk)
C33816 (NCI Thesaurus)
C0460005 (UMLS 2011AA)
CL Item
Right Lower Extremity (right lower extremity)
CL Item
Right Upper Extremity (right upper extremity)
CL Item
Other, Specify (other, specify)
Erythema
Item
Erythema
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
Induration
Item
Induration
float
C25209 (NCI Thesaurus ValueDomain)
C0242485 (UMLS 2011AA ValueDomain)
VaccineSite,Other
Item
Vaccine Site, Other
text
Item Group
Allows Documentation Of Any Additional Cooments
Comments
Item
Comments
text
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