ID
7556
Description
GOG-0240 Common Toxicity Reporting Form (Form T) Paclitaxel and Cisplatin or Topotecan With or Without Bevacizumab in Treating Patients With Stage IVB, Recurrent, or Persistent Cervical Cancer NCT00803062 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=45815094-13E7-14B9-E044-0003BA3F9857
Link
Keywords
Versions (3)
- 8/27/12 8/27/12 -
- 1/9/15 1/9/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Toxicity Reporting Form Cervical Cancer (NCT00803062)
No Instruction available.
- StudyEvent: GOG-0240 Common Toxicity Reporting Form (Form T)
Description
Adverse Events - Section 1
Description
Cycle Number Chemotherapeutics
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25471
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property-2
- C25379
Description
Transfusion
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25180
- NCI Thesaurus ObjectClass
- C15366
- NCI Thesaurus Property
- C25382
- UMLS CUI-1
- C1879316
Description
Hospitalization
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus ObjectClass
- C16696
- NCI Thesaurus ObjectClass-2
- C25182
- NCI Thesaurus Property
- C25385
- UMLS CUI-1
- C0019993
Description
Cytokine Therapy
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C20464
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property-2
- C25382
- UMLS CUI-1
- C0199974
Description
Cytokine Therapy, specify
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus Property
- C20464
- NCI Thesaurus ObjectClass
- C1708
- NCI Thesaurus Property-2
- C25382
- UMLS CUI-1
- C0199974
Description
Adverse Events - Section 2
Description
WBC done
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
Description
Leukocytes (WBC)
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ValueDomain
- C25712
- NCI Thesaurus ValueDomain-2
- C38024
Description
WBC date
Data type
date
Measurement units
- m d y
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C12529
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0023508
- UMLS CUI-2
- C0011008
Description
CTC Adverse Event Grade
Data type
integer
Alias
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
- UMLS CUI-1
- C2985911
Description
CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
Data type
integer
Alias
- NCI Thesaurus ValueDomain
- C25664
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
- UMLS CUI-1
- C1706735
Description
SAE report
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus Property
- C25375
- NCI Thesaurus ObjectClass-2
- C54035
- UMLS CUI-1
- C1519255
- UMLS CUI-2
- C0684224
Description
ANC
Data type
boolean
Alias
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus Property-3
- C63321
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C0948762
Description
Granulocyte count
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0857490
- NCI Thesaurus Property-2
- C12530
- NCI Thesaurus ValueDomain
- C25463
- NCI Thesaurus ObjectClass
- C25294
Description
Neutrophils date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C12533
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0200633
- UMLS CUI-2
- C0011008
Description
Platelets
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C20200
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0005821
Description
Platelets
Data type
float
Measurement units
- 1000/uL
Alias
- NCI Thesaurus Property
- C20200
- UMLS CUI-1
- C0005821
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
Description
Platelets date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0005821
- NCI Thesaurus Property
- C20200
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property-2
- C12520
- NCI Thesaurus ObjectClass
- C25294
Description
Hemoglobin
Data type
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- NCI Thesaurus Property
- C16676
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0019046
Description
Hemoglobin
Data type
float
Measurement units
- g/dL
Alias
- NCI Thesaurus Property
- C16676
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- NCI Thesaurus ValueDomain
- C25712
- UMLS CUI-1
- C0019046
Description
Hemoglobin Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus Property
- C16676
- NCI Thesaurus Property-2
- C20200
- NCI Thesaurus ObjectClass
- C25294
- UMLS CUI-1
- C0019046
- UMLS CUI-2
- C0011008
Description
Adverse Events - Section 3
Description
CTC Adverse Event Reported Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C45559
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2826934
Description
CTC Adverse Event Reported Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25161
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C2699044
Description
Adverse Event Onset Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25279
- UMLS CUI-1
- C2985916
Description
Adverse Event Outcome
Data type
text
Alias
- NCI Thesaurus Property
- C25626
- NCI Thesaurus ObjectClass
- C41331
- NCI Thesaurus ValueDomain
- C25688
- UMLS CUI-1
- C1705586
Description
CTCAE version
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25714
- UMLS CUI-1
- C1516728
- UMLS CUI-2
- C0333052
Similar models
No Instruction available.
- StudyEvent: GOG-0240 Common Toxicity Reporting Form (Form T)
C1549507 (UMLS CUI-1)
C25250 (NCI Thesaurus Property)
C25604 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C25250 (NCI Thesaurus Property)
C25416 (NCI Thesaurus Property-2)
C25164 (NCI Thesaurus ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C25190 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
C1547383 (UMLS CUI-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C16960 (NCI Thesaurus ObjectClass)
C25364 (NCI Thesaurus Property)
C25521 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C1512288 (UMLS CUI-2)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C1550483 (UMLS CUI-1)
C25657 (NCI Thesaurus ObjectClass-2)
C1301584 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25551 (NCI Thesaurus Property-2)
C25191 (NCI Thesaurus ValueDomain)
C2045829 (UMLS CUI-1)
C25471 (NCI Thesaurus Property)
C15368 (NCI Thesaurus ObjectClass)
C25379 (NCI Thesaurus Property-2)
C15366 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property)
C1879316 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25182 (NCI Thesaurus ObjectClass-2)
C25385 (NCI Thesaurus Property)
C0019993 (UMLS CUI-1)
C20464 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property-2)
C0199974 (UMLS CUI-1)
C20464 (NCI Thesaurus Property)
C1708 (NCI Thesaurus ObjectClass)
C25382 (NCI Thesaurus Property-2)
C0199974 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0023508 (UMLS CUI-1)
C0023508 (UMLS CUI-1)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25712 (NCI Thesaurus ValueDomain)
C38024 (NCI Thesaurus ValueDomain-2)
C12529 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0023508 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C2985911 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C41331 (NCI Thesaurus ObjectClass)
C25375 (NCI Thesaurus Property)
C54035 (NCI Thesaurus ObjectClass-2)
C1519255 (UMLS CUI-1)
C0684224 (UMLS CUI-2)
C20200 (NCI Thesaurus Property)
C12530 (NCI Thesaurus Property-2)
C63321 (NCI Thesaurus Property-3)
C38148 (NCI Thesaurus ValueDomain)
C0948762 (UMLS CUI-1)
C0857490 (UMLS CUI-1)
C12530 (NCI Thesaurus Property-2)
C25463 (NCI Thesaurus ValueDomain)
C25294 (NCI Thesaurus ObjectClass)
C12533 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0200633 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C20200 (NCI Thesaurus Property)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0005821 (UMLS CUI-1)
C0005821 (UMLS CUI-1)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0005821 (UMLS CUI-1)
C20200 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C12520 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C16676 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0019046 (UMLS CUI-1)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C25712 (NCI Thesaurus ValueDomain)
C0019046 (UMLS CUI-1)
C16676 (NCI Thesaurus Property)
C20200 (NCI Thesaurus Property-2)
C25294 (NCI Thesaurus ObjectClass)
C0019046 (UMLS CUI-1)
C0011008 (UMLS CUI-2)
C49704 (NCI Thesaurus ObjectClass)
C45559 (NCI Thesaurus Property)
C1516728 (UMLS CUI-1)
C2826934 (UMLS CUI-2)
C49704 (NCI Thesaurus ObjectClass)
C25161 (NCI Thesaurus Property)
C1516728 (UMLS CUI-1)
C2699044 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
C2985916 (UMLS CUI-1)
C41331 (NCI Thesaurus ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C1705586 (UMLS CUI-1)
C1709277 (UMLS 2011AA)
C1709862 (UMLS 2011AA)
C2827606 (UMLS 2011AA)
C1709864 (UMLS 2011AA)
C49704 (NCI Thesaurus ObjectClass)
C25714 (NCI Thesaurus Property)
C1516728 (UMLS CUI-1)
C0333052 (UMLS CUI-2)