Description:

GOG-0241 Common Toxicity Reporting Form (T) Carboplatin and Paclitaxel or Oxaliplatin and Capecitabine, With or Without Bevacizumab, as First-Line Therapy in Treating Patients With Newly Diagnosed Stage II, Stage III, Stage IV, or Recurrent Stage I Epithelial Ovarian Cancer or Fallopian Tube Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D16EFA4-522E-082B-E040-BB89AD434B01

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=8D16EFA4-522E-082B-E040-BB89AD434B01

Keywords:
Versions (3) ▾
  1. 9/19/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

DOI:
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License:
Creative Commons BY-NC 3.0 Legacy
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Fallopian Tube Cancer NCT01081262 Toxicity - GOG-0241 Common Toxicity Reporting Form (T) - 3126386v1.0

No Instruction available.

  1. StudyEvent: GOG-0241 Common Toxicity Reporting Form (T)
    1. No Instruction available.
Header Module
Adverse Events - Section 1
Has the patient received any transfusions during this course of therapy?
Was patient hospitalized as a result of reported adverse events?
Were cytokines administered this course?
Adverse Events - Section 2
Peripheral WBC count done
1000/uL
CTC Adverse Event Attribution Code
CTC Adverse Event Attribution Code
CTC Adverse Event Attribution Code
CTC Adverse Event Attribution Code
Peripheral ANC/Granulocytes count done
1000/uL
SAE report submitted
SAE report submitted
SAE report submitted
SAE report submitted
Peripheral Platelet count done
1000/uL
Hemoglobin done
g/dL
Adverse Events - Section 3
CTC Adverse Event Attribution Code
Present Status
The CTCAE data entered above is
SAE report submitted
Comments

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