ID

8032

Beskrivning

GOG-0258 Common Toxicity Reporting Form (T) Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-E2E5-D7C8-E040-BB89AD4321CC

Länk

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-E2E5-D7C8-E040-BB89AD4321CC

Nyckelord

  1. 2012-09-19 2012-09-19 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den

9 januari 2015

DOI

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Licens

Creative Commons BY-NC 3.0 Legacy

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    Endometrial Cancer NCT00942357 Toxicity - GOG-0258 Common Toxicity Reporting Form (T) - 2845153v1.0

    No Instruction available.

    1. StudyEvent: GOG-0258 Common Toxicity Reporting Form (T)
      1. No Instruction available.
    Header Module
    Beskrivning

    Header Module

    Date form originally completed (m d y)
    Beskrivning

    Form Completion Date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C1549507
    NCI Thesaurus Property
    C25250
    NCI Thesaurus Property-2
    C25604
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Date form amended (m d y)
    Beskrivning

    Amendment date

    Datatyp

    date

    Alias
    NCI Thesaurus ObjectClass
    C19464
    UMLS CUI-1
    C0680532
    NCI Thesaurus Property
    C25250
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C25416
    NCI Thesaurus ValueDomain
    C25164
    NCI Thesaurus ValueDomain-2
    C25367
    Person amending form, last name
    Beskrivning

    Person Amending Form

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C0680532
    NCI Thesaurus ObjectClass
    C25190
    UMLS CUI-2
    C1547383
    NCI Thesaurus Property
    C25364
    Patient Initials (First, Middle, Last)
    Beskrivning

    Patient Initials

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Patient Study ID
    Beskrivning

    Patient ID GOG

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1512288
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25521
    Person Completing Form, Last Name
    Beskrivning

    ResponsiblePersonLastName

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS 2011AA ValueDomain
    C1547383
    NCI Thesaurus ObjectClass
    C25190
    UMLS 2011AA ObjectClass
    C0027361
    NCI Thesaurus ObjectClass-2
    C25657
    UMLS 2011AA ObjectClass-2
    C1273518
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C25551
    UMLS 2011AA Property-2
    C1517741
    Adverse Events - Section 1
    Beskrivning

    Adverse Events - Section 1

    Current Cycle Number
    Beskrivning

    Cycle Number Chemotherapeutics

    Datatyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25471
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25379
    Has the patient received any transfusions during this course of therapy?
    Beskrivning

    Transfusion

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS CUI-1
    C1879316
    NCI Thesaurus ObjectClass
    C15366
    NCI Thesaurus Property
    C25382
    Was patient hospitalized as a result of reported adverse events?
    Beskrivning

    Hospitalization

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0019993
    NCI Thesaurus ObjectClass
    C16696
    NCI Thesaurus ObjectClass-2
    C25182
    NCI Thesaurus Property
    C25385
    Were cytokines administered this course?
    Beskrivning

    Cytokine Therapy

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0199974
    NCI Thesaurus Property
    C20464
    NCI Thesaurus ObjectClass
    C1708
    NCI Thesaurus Property-2
    C25382
    Yes specify
    Beskrivning

    AgentCytokineAdministeredSpecify

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C20464
    UMLS 2011AA Property
    C0079189
    NCI Thesaurus ObjectClass
    C1708
    UMLS 2011AA ObjectClass
    C0450442
    NCI Thesaurus Property-2
    C25382
    UMLS 2011AA Property-2
    C1521801
    Adverse Events - Section 2
    Beskrivning

    Adverse Events - Section 2

    Peripheral WBC count done
    Beskrivning

    WBC done

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0023508
    NCI Thesaurus Property
    C12529
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    Peripheral WBC count (1000/mm3)
    Beskrivning

    Leukocytes (WBC)

    Datatyp

    float

    Måttenheter
    • 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
    1000/uL
    Date (m d y)
    Beskrivning

    WBC date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0023508
    NCI Thesaurus Property
    C12529
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    CTC Adverse Event Grade
    Beskrivning

    CTC Adverse Event Grade

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Grade
    Beskrivning

    CTC Adverse Event Grade

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Grade
    Beskrivning

    CTC Adverse Event Grade

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Grade
    Beskrivning

    CTC Adverse Event Grade

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    Beskrivning

    CTC Adverse Event Attribution Category

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    Beskrivning

    CTC Adverse Event Attribution Category

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    Beskrivning

    CTC Adverse Event Attribution Category

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    Beskrivning

    CTC Adverse Event Attribution Category

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    Peripheral Granulocytes count done (ANC/)
    Beskrivning

    LaboratoryProcedureAbsoluteNeutrophilCountGranulocyteOutcomeInd-3

    Datatyp

    boolean

    Alias
    NCI Thesaurus ObjectClass
    C25294
    UMLS 2011AA ObjectClass
    C0022885
    NCI Thesaurus Property
    C20200
    UMLS 2011AA Property
    C1274040
    NCI Thesaurus Property-2
    C12530
    UMLS 2011AA Property-2
    C0018183
    NCI Thesaurus Property-3
    C63321
    UMLS 2011AA Property-3
    C0948762
    NCI Thesaurus ValueDomain
    C38148
    UMLS 2011AA ValueDomain
    C1512699
    Peripheral Granulocytes count (ANC/ 1000/mm3)
    Beskrivning

    Granulocyte count

    Datatyp

    float

    Måttenheter
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0857490
    NCI Thesaurus Property-2
    C12530
    NCI Thesaurus ValueDomain
    C25463
    NCI Thesaurus ObjectClass
    C25294
    1000/uL
    Date
    Beskrivning

    Neutrophils date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0200633
    NCI Thesaurus Property
    C12533
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    SAE report submitted
    Beskrivning

    SAE report

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1519255
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-2
    C0684224
    NCI Thesaurus Property
    C25375
    NCI Thesaurus ObjectClass-2
    C54035
    SAE report submitted
    Beskrivning

    SAE report

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1519255
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-2
    C0684224
    NCI Thesaurus Property
    C25375
    NCI Thesaurus ObjectClass-2
    C54035
    SAE report submitted
    Beskrivning

    SAE report

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1519255
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-2
    C0684224
    NCI Thesaurus Property
    C25375
    NCI Thesaurus ObjectClass-2
    C54035
    SAE report submitted
    Beskrivning

    SAE report

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1519255
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-2
    C0684224
    NCI Thesaurus Property
    C25375
    NCI Thesaurus ObjectClass-2
    C54035
    Peripheral Platelet count done
    Beskrivning

    Platelets

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property
    C20200
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ObjectClass
    C25294
    Peripheral Platelet count (mm3)
    Beskrivning

    Platelets

    Datatyp

    float

    Måttenheter
    • 1000/uL
    Alias
    NCI Thesaurus Property
    C20200
    UMLS CUI-1
    C0005821
    NCI Thesaurus Property-2
    C12520
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    1000/uL
    Date
    Beskrivning

    Platelets date

    Datatyp

    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
    Hemoglobin done
    Beskrivning

    Hemoglobin

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C0019046
    NCI Thesaurus Property
    C16676
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    Hemoglobin (G/DL)
    Beskrivning

    Hemoglobin

    Datatyp

    float

    Måttenheter
    • g/dL
    Alias
    NCI Thesaurus Property
    C16676
    UMLS CUI-1
    C0019046
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    NCI Thesaurus ValueDomain
    C25712
    g/dL
    Date
    Beskrivning

    Hemoglobin Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C0019046
    NCI Thesaurus Property
    C16676
    UMLS CUI-2
    C0011008
    NCI Thesaurus Property-2
    C20200
    NCI Thesaurus ObjectClass
    C25294
    Adverse Events - Section 3
    Beskrivning

    Adverse Events - Section 3

    CTC Adverse Event Term
    Beskrivning

    CTC Adverse Event Term

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C1516728
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-2
    C2826934
    NCI Thesaurus Property
    C45559
    Current Cycle Number
    Beskrivning

    Cycle Number Chemotherapeutics

    Datatyp

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2045829
    NCI Thesaurus Property
    C25471
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25379
    Other, specify
    Beskrivning

    CTC Adverse Event Reported Term

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1516728
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-2
    C2699044
    NCI Thesaurus Property
    C25161
    CTC Adverse Event Grade
    Beskrivning

    CTC Adverse Event Grade

    Datatyp

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    Beskrivning

    CTC Adverse Event Attribution Category

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    AE Onset Date
    Beskrivning

    Adverse Event Onset Date

    Datatyp

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985916
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25279
    Present Status
    Beskrivning

    Adverse Event Outcome

    Datatyp

    text

    Alias
    NCI Thesaurus Property
    C25626
    UMLS CUI-1
    C1705586
    NCI Thesaurus ObjectClass
    C41331
    NCI Thesaurus ValueDomain
    C25688
    The CTCAE data entered above is
    Beskrivning

    CTCAE version

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C1516728
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-2
    C0333052
    NCI Thesaurus Property
    C25714
    SAE report submitted
    Beskrivning

    SAE report

    Datatyp

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38148
    UMLS CUI-1
    C1519255
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-2
    C0684224
    NCI Thesaurus Property
    C25375
    NCI Thesaurus ObjectClass-2
    C54035
    Comments
    Beskrivning

    Comments

    COMMENTS
    Beskrivning

    Research Comments

    Datatyp

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Similar models

    No Instruction available.

    1. StudyEvent: GOG-0258 Common Toxicity Reporting Form (T)
      1. No Instruction available.
    Name
    Typ
    Description | Question | Decode (Coded Value)
    Datatyp
    Alias
    Item Group
    Header Module
    Form Completion Date
    Item
    Date form originally completed (m d y)
    date
    C19464 (NCI Thesaurus ObjectClass)
    C1549507 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C25604 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Amendment date
    Item
    Date form amended (m d y)
    date
    C19464 (NCI Thesaurus ObjectClass)
    C0680532 (UMLS CUI-1)
    C25250 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C25416 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25367 (NCI Thesaurus ValueDomain-2)
    Person Amending Form
    Item
    Person amending form, last name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C0680532 (UMLS CUI-1)
    C25190 (NCI Thesaurus ObjectClass)
    C1547383 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials (First, Middle, Last)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Patient ID GOG
    Item
    Patient Study ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1512288 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25521 (NCI Thesaurus Property-2)
    ResponsiblePersonLastName
    Item
    Person Completing Form, Last Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1547383 (UMLS 2011AA ValueDomain)
    C25190 (NCI Thesaurus ObjectClass)
    C0027361 (UMLS 2011AA ObjectClass)
    C25657 (NCI Thesaurus ObjectClass-2)
    C1273518 (UMLS 2011AA ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C25551 (NCI Thesaurus Property-2)
    C1517741 (UMLS 2011AA Property-2)
    Item Group
    Adverse Events - Section 1
    Cycle Number Chemotherapeutics
    Item
    Current Cycle Number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25471 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25379 (NCI Thesaurus Property-2)
    Item
    Has the patient received any transfusions during this course of therapy?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1879316 (UMLS CUI-1)
    C15366 (NCI Thesaurus ObjectClass)
    C25382 (NCI Thesaurus Property)
    Code List
    Has the patient received any transfusions during this course of therapy?
    CL Item
    No Transfusion (No)
    CL Item
    Transfusion With Red Blood Cells (Yes, red blood cells)
    CL Item
    Transfusion With Platelets (Yes, platelets)
    Hospitalization
    Item
    Was patient hospitalized as a result of reported adverse events?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0019993 (UMLS CUI-1)
    C16696 (NCI Thesaurus ObjectClass)
    C25182 (NCI Thesaurus ObjectClass-2)
    C25385 (NCI Thesaurus Property)
    Cytokine Therapy
    Item
    Were cytokines administered this course?
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0199974 (UMLS CUI-1)
    C20464 (NCI Thesaurus Property)
    C1708 (NCI Thesaurus ObjectClass)
    C25382 (NCI Thesaurus Property-2)
    AgentCytokineAdministeredSpecify
    Item
    Yes specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C20464 (NCI Thesaurus Property)
    C0079189 (UMLS 2011AA Property)
    C1708 (NCI Thesaurus ObjectClass)
    C0450442 (UMLS 2011AA ObjectClass)
    C25382 (NCI Thesaurus Property-2)
    C1521801 (UMLS 2011AA Property-2)
    Item Group
    Adverse Events - Section 2
    WBC done
    Item
    Peripheral WBC count done
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0023508 (UMLS CUI-1)
    C12529 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Leukocytes (WBC)
    Item
    Peripheral WBC count (1000/mm3)
    float
    C25294 (NCI Thesaurus ObjectClass)
    C0023508 (UMLS CUI-1)
    C12529 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C25712 (NCI Thesaurus ValueDomain)
    C38024 (NCI Thesaurus ValueDomain-2)
    WBC date
    Item
    Date (m d y)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0023508 (UMLS CUI-1)
    C12529 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    CTC Adverse Event Grade
    Item
    CTC Adverse Event Grade
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC Adverse Event Grade
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC Adverse Event Grade
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC Adverse Event Grade
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    Item
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Possible (Possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (Probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (Definite)
    CL209464 (NCI Metathesaurus)
    Item
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Possible (Possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (Probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (Definite)
    CL209464 (NCI Metathesaurus)
    Item
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Possible (Possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (Probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (Definite)
    CL209464 (NCI Metathesaurus)
    Item
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Possible (Possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (Probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (Definite)
    CL209464 (NCI Metathesaurus)
    LaboratoryProcedureAbsoluteNeutrophilCountGranulocyteOutcomeInd-3
    Item
    Peripheral Granulocytes count done (ANC/)
    boolean
    C25294 (NCI Thesaurus ObjectClass)
    C0022885 (UMLS 2011AA ObjectClass)
    C20200 (NCI Thesaurus Property)
    C1274040 (UMLS 2011AA Property)
    C12530 (NCI Thesaurus Property-2)
    C0018183 (UMLS 2011AA Property-2)
    C63321 (NCI Thesaurus Property-3)
    C0948762 (UMLS 2011AA Property-3)
    C38148 (NCI Thesaurus ValueDomain)
    C1512699 (UMLS 2011AA ValueDomain)
    Granulocyte count
    Item
    Peripheral Granulocytes count (ANC/ 1000/mm3)
    float
    C20200 (NCI Thesaurus Property)
    C0857490 (UMLS CUI-1)
    C12530 (NCI Thesaurus Property-2)
    C25463 (NCI Thesaurus ValueDomain)
    C25294 (NCI Thesaurus ObjectClass)
    Neutrophils date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0200633 (UMLS CUI-1)
    C12533 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    SAE report
    Item
    SAE report submitted
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1519255 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C0684224 (UMLS CUI-2)
    C25375 (NCI Thesaurus Property)
    C54035 (NCI Thesaurus ObjectClass-2)
    SAE report
    Item
    SAE report submitted
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1519255 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C0684224 (UMLS CUI-2)
    C25375 (NCI Thesaurus Property)
    C54035 (NCI Thesaurus ObjectClass-2)
    SAE report
    Item
    SAE report submitted
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1519255 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C0684224 (UMLS CUI-2)
    C25375 (NCI Thesaurus Property)
    C54035 (NCI Thesaurus ObjectClass-2)
    SAE report
    Item
    SAE report submitted
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1519255 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C0684224 (UMLS CUI-2)
    C25375 (NCI Thesaurus Property)
    C54035 (NCI Thesaurus ObjectClass-2)
    Platelets
    Item
    Peripheral Platelet count done
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0005821 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Platelets
    Item
    Peripheral Platelet count (mm3)
    float
    C20200 (NCI Thesaurus Property)
    C0005821 (UMLS CUI-1)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    Platelets date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0005821 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C12520 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Hemoglobin
    Item
    Hemoglobin done
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C0019046 (UMLS CUI-1)
    C16676 (NCI Thesaurus Property)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Hemoglobin
    Item
    Hemoglobin (G/DL)
    float
    C16676 (NCI Thesaurus Property)
    C0019046 (UMLS CUI-1)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    C25712 (NCI Thesaurus ValueDomain)
    Hemoglobin Date
    Item
    Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0019046 (UMLS CUI-1)
    C16676 (NCI Thesaurus Property)
    C0011008 (UMLS CUI-2)
    C20200 (NCI Thesaurus Property-2)
    C25294 (NCI Thesaurus ObjectClass)
    Item Group
    Adverse Events - Section 3
    CTC Adverse Event Term
    Item
    CTC Adverse Event Term
    text
    C25284 (NCI Thesaurus ValueDomain)
    C1516728 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C2826934 (UMLS CUI-2)
    C45559 (NCI Thesaurus Property)
    Cycle Number Chemotherapeutics
    Item
    Current Cycle Number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C25471 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25379 (NCI Thesaurus Property-2)
    CTC Adverse Event Reported Term
    Item
    Other, specify
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1516728 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C2699044 (UMLS CUI-2)
    C25161 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC Adverse Event Grade
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    Item
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
    CL Item
    Unrelated (Unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (Unlikely)
    CL Item
    Possible (Possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (Probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (Definite)
    CL209464 (NCI Metathesaurus)
    Adverse Event Onset Date
    Item
    AE Onset Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985916 (UMLS CUI-1)
    C25367 (NCI Thesaurus ValueDomain-2)
    C49704 (NCI Thesaurus ObjectClass)
    C25279 (NCI Thesaurus Property)
    Item
    Present Status
    text
    C25626 (NCI Thesaurus Property)
    C1705586 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C25688 (NCI Thesaurus ValueDomain)
    Code List
    Present Status
    CL Item
    Fatal Or Died (Fatal/Died)
    CL Item
    Intervention For Adverse Event Continues (Intervention for AE Continues)
    CL Item
    Not Recovered Or Not Resolved (Not recovered/Not resolved)
    C49494 (NCI Thesaurus)
    C1709277 (UMLS 2011AA)
    CL Item
    Recovered Or Resolved With Sequelae (Recovered/Resolved with Sequelae)
    C49495 (NCI Thesaurus)
    C1709862 (UMLS 2011AA)
    CL Item
    Recovered Or Resolved Without Sequelae (Recovered/Resolved without Sequelae)
    C85257 (NCI Thesaurus)
    C2827606 (UMLS 2011AA)
    CL Item
    Recovering Or Resolving (Recovering/Resolving)
    C49496 (NCI Thesaurus)
    C1709864 (UMLS 2011AA)
    Item
    The CTCAE data entered above is
    text
    C25284 (NCI Thesaurus ValueDomain)
    C1516728 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C0333052 (UMLS CUI-2)
    C25714 (NCI Thesaurus Property)
    Code List
    The CTCAE data entered above is
    CL Item
    Version 2 (version 2)
    CL Item
    Version 3 (version 3)
    SAE report
    Item
    SAE report submitted
    boolean
    C38148 (NCI Thesaurus ValueDomain)
    C1519255 (UMLS CUI-1)
    C41331 (NCI Thesaurus ObjectClass)
    C0684224 (UMLS CUI-2)
    C25375 (NCI Thesaurus Property)
    C54035 (NCI Thesaurus ObjectClass-2)
    Item Group
    Comments
    Research Comments
    Item
    COMMENTS
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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