ID
778
Descripción
NSABP B-35 Form ALERT Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0587E1D-38C6-3AA5-E034-080020C9C0E0
Link
Palabras clave
Versiones (4)
- 26/8/12 26/8/12 -
- 8/7/15 8/7/15 -
- 8/7/15 8/7/15 -
- 20/9/21 20/9/21 -
Subido en
26 de agosto de 2012
DOI
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Licencia
Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT00053898 Toxicity - NSABP B-35 Form ALERT - 2034153v3.0
Form ALERT Instructions: *Use NCI's Common Toxicity Criteria (CTC) Version 2.0 to assess the adverse event (AE). *Report any grade 3 unexpected AE, or any grade 4 AE, or any grade 5 AE (as listed below). *Complete and FAX this form with all available supporting documentation to the NSABP Biostatistical Center (412/624-1082) within 24 hours of learning about the AE. *Report the AE regardless of attribution (relationship) to protocol therapy (tamoxifen/anastrozole). *Do not fax this report to the NCI, FDA or HPFB.
Descripción
Unnamed2
Descripción
FormCompletionDate,Original
Tipo de datos
date
Descripción
PatientAdverseEventAssessmentAgeYearCount
Tipo de datos
double
Alias
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C20989
- UMLS 2011AA Property
- C0031809
- NCI Thesaurus Property
- C41331
- UMLS 2011AA Property
- C0877248
- NCI Thesaurus ValueDomain
- C29848
- UMLS 2011AA ValueDomain
- C0439234
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
Descripción
LocalInstitutionalReviewBoardAdverseEventNotificationInd-2
Tipo de datos
text
Alias
- NCI Thesaurus ObjectClass
- C25388
- UMLS 2011AA ObjectClass
- C1947913
- NCI Thesaurus ObjectClass
- C16741
- UMLS 2011AA ObjectClass
- C0086911
- NCI Thesaurus Property
- C41331
- UMLS 2011AA Property
- C0877248
- NCI Thesaurus Property
- C25297
- UMLS 2011AA Property
- C0422202
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Descripción
NCIInstitutionNumber
Tipo de datos
text
Descripción
SpecifyTypeofAdverseEvent(AE)
Tipo de datos
text
Descripción
CTCAdverseEventTerm
Tipo de datos
text
Descripción
4-CharacterNSABPCode
Tipo de datos
text
Descripción
CTCAdverseEvent,InitialReportDate
Tipo de datos
date
Descripción
PatientHospitalizationInd-2
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25179
- UMLS 2011AA Property
- C0019993
Descripción
CTCAdverseEventAttributionCode
Tipo de datos
text
Descripción
TreatmentStartDate
Tipo de datos
date
Descripción
DateofMostRecentTreatment
Tipo de datos
text
Descripción
BrieflydescribetheAE
Tipo de datos
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
Similar models
Form ALERT Instructions: *Use NCI's Common Toxicity Criteria (CTC) Version 2.0 to assess the adverse event (AE). *Report any grade 3 unexpected AE, or any grade 4 AE, or any grade 5 AE (as listed below). *Complete and FAX this form with all available supporting documentation to the NSABP Biostatistical Center (412/624-1082) within 24 hours of learning about the AE. *Report the AE regardless of attribution (relationship) to protocol therapy (tamoxifen/anastrozole). *Do not fax this report to the NCI, FDA or HPFB.
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C1527021 (UMLS 2011AA ValueDomain)
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0030705 (UMLS 2011AA ObjectClass)
C20989 (NCI Thesaurus Property)
C0031809 (UMLS 2011AA Property)
C41331 (NCI Thesaurus Property)
C0877248 (UMLS 2011AA Property)
C29848 (NCI Thesaurus ValueDomain)
C0439234 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C1947913 (UMLS 2011AA ObjectClass)
C16741 (NCI Thesaurus ObjectClass)
C0086911 (UMLS 2011AA ObjectClass)
C41331 (NCI Thesaurus Property)
C0877248 (UMLS 2011AA Property)
C25297 (NCI Thesaurus Property)
C0422202 (UMLS 2011AA Property)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1298908 (UMLS 2011AA)
C0445356 (UMLS 2011AA)
C1527021 (UMLS 2011AA ValueDomain)