Header
Form ID CALGB
text
Protocol ID CALGB
Trial subject ID CALGB
CTCAdverseEventReportBeginDate
date
CTCAdverseEventReportEndDate
Data amended
boolean
Unnamed2
Patient Initials
Medical Record Number
Institution Name
Participating Group
Study Number Participating Group
Trial subject ID Participating Group
Unnamed3
AdverseEventReportInd-3
Cycle Number
integer
Expected Adverse Events
MedDRACode
float
AdverseEventCommonTerminologyforAdverseEventsVersion4TermName
AdverseEventSeverityGrade
CTC Adverse Event Attribution Category
Person Completing Form
Date Form Completed