NCIC MA.32 Death Report Form A Phase III Randomized Trial of Metformin vs Placebo in Early Stage Breast Cancer Source Form: NCI FormBuilder:

  1. 8/27/12 8/27/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Breast Cancer NCT01101438 Off Treatment - NCIC MA.32 Death Report Form - 3017307v1.0

The aim of the "Death Report" Folder is to collect death information. The "Death Report" Folder should be completed at the time of death. It should be submitted electronically within 8 weeks of the patient's death.

Date/cause Of Death/autopsy
Other primary malignancy
Primary cause of death
Was autopsy performed
Cause of death (autopsy finding)
Adverse Events - Death Report
Has there been a new diagnosis of diabetes since the last report
Seriousness Attributed to Adverse Event
Cardiovascular Mobidity
Problem, cardiovascular

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