Unnamed2
PlannedAssessmentPeriodType
text
Assessment Date
date
AdverseEventMostRecentAssessmentInd-3
boolean
Clinical Tolerance: Ctca (version 3.0)
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
CommonToxicityCriteriaAdverseEventOtherHypersensitivitySpecify
text
CommonToxicityCriteriaAdverseEventOtherCardiovascularSpecify
text
CommonToxicityCriteriaAdverseEventOtherConstitutionalSymptomSpecify
text
CommonToxicityCriteriaAdverseEventOtherSkinSpecify
text
CommonToxicityCriteriaAdverseEventOtherEndocrineSystemSpecify
text
CommonToxicityCriteriaAdverseEventOtherGastrointestinalSymptomSpecify
text
CommonToxicityCriteriaAdverseEventOtherHemorrhageSpecify
text
CommonToxicityCriteriaAdverseEventOtherInfectionSpecify
text
CommonToxicityCriteriaAdverseEventOtherLabSpecify
text
CommonToxicityCriteriaAdverseEventOtherMusculoskeletalSpecify
text
CommonToxicityCriteriaAdverseEventOtherNeurologicSpecify
text
CommonToxicityCriteriaAdverseEventOtherPainSpecify
text
CommonToxicityCriteriaAdverseEventOtherPulmonarySpecify
text
CommonToxicityCriteriaAdverseEventOtherGenitourinarySpecify
text
CommonToxicityCriteriaAdverseEventOtherReproductiveFunctionSpecify
text
CommonToxicityCriteriaAdverseEventOtherVascularSpecify
text
Unnamed6
CommonToxicityCriteriaAdverseEventShortNameType
text
CTC Adverse Event Term
text
CTC Adverse Event Grade
float
AdverseEventMostRecentAssessmentInd-3
boolean
Comments
Investigator Signature Date
date
Investigator Signature
text