Description:

Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC) 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-E1C5-D7C8-E040-BB89AD4321CC

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-E1C5-D7C8-E040-BB89AD4321CC

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

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Endometrial Cancer NCT00942357 Toxicity - Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC) - 2845009v1.0

No Instruction available.

  1. StudyEvent: Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC)
    1. No Instruction available.
Header Module
Adverse Events - Section 1
Are there any adverse events to report
Was patient hospitalized as a result of reported adverse events? (during this reporting period)
Adverse Events - Section 3
CTC Adverse Event Attribution Code (Attribution Codes for Relationship of Event to Treatment: 1=Unrelated, 2=Unlikely, 3=Possibly, 4=Probably, 5=Definitely)
SAE report submitted
Present Status
Comments

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