ID
9172
Beschreibung
PRL1013: Adverse Event Form Postoperative Hypersensitivity Randomized Comparative Effectiveness Research Trial (POH RCERT) Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A651C58C-D9BC-9A03-E040-BB89AD4309CC
Link
Stichworte
Versionen (3)
- 27.08.12 27.08.12 -
- 09.01.15 09.01.15 - Martin Dugas
- 03.07.15 03.07.15 -
Hochgeladen am
9. Januar 2015
DOI
Für eine Beantragung loggen Sie sich ein.
Lizenz
Creative Commons BY-NC 3.0 Legacy
Modell Kommentare :
Hier können Sie das Modell kommentieren. Über die Sprechblasen an den Itemgruppen und Items können Sie diese spezifisch kommentieren.
Itemgroup Kommentare für :
Item Kommentare für :
Um Formulare herunterzuladen müssen Sie angemeldet sein. Bitte loggen Sie sich ein oder registrieren Sie sich kostenlos.
Dental Caries NCT01268605 Toxicity - PRL1013: Adverse Event Form - 3246990v1.0
No Instruction available.
- StudyEvent: PRL1013: Adverse Event Form
Beschreibung
Header
Beschreibung
AdverseEventTreatingDescriptionText
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS 2011AA ValueDomain
- C1527021
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25705
- UMLS 2011AA Property
- C1522326
- NCI Thesaurus Property-2
- C25365
- UMLS 2011AA Property-2
- C0678257
Beschreibung
Adverse Event Onset Date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2985916
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25279
Beschreibung
Unnamed2
Beschreibung
AdverseEventSeverityType
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
Beschreibung
AdverseEventDentalRestorationAttributionScale
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS 2011AA ValueDomain
- C0349674
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C60718
- UMLS 2011AA Property
- C0399059
- NCI Thesaurus Property-2
- C25358
- UMLS 2011AA Property-2
- C0596130
Beschreibung
AdverseEventExpectedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25501
- UMLS 2011AA Property
- C1517001
Beschreibung
Resin-BasedCompositeTherapyReplacementPerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C53610
- UMLS 2011AA Property-2
- C0559956
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
Resin-BasedCompositeTherapySedativeFillingPerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C62295
- UMLS 2011AA Property-2
- C1947975
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
Resin-BasedCompositeTherapyPulpectomyPerformedInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus ObjectClass-2
- C52586
- UMLS 2011AA ObjectClass
- C1711229
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus Property-2
- C52550
- UMLS 2011AA Property-2
- C1705872
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
EndodonticTreatmentPerformedIndicator
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C52575
- UMLS 2011AA ObjectClass
- C0700632
Beschreibung
ToothExtractionPerformedIndicator
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C25180
- UMLS 2011AA ValueDomain
- C1522602
- NCI Thesaurus Property
- C38000
- UMLS 2011AA Property
- C0884358
- NCI Thesaurus ObjectClass
- C12506
- UMLS 2011AA ObjectClass
- C0040426
- NCI Thesaurus ObjectClass-2
- C61575
- UMLS 2011AA ObjectClass-2
- C0185115
Beschreibung
NewAgentAdministeredInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C25586
- UMLS 2011AA ObjectClass
- C0205314
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschreibung
AdverseEventRequiredHospitalizationInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25652
- UMLS 2011AA Property
- C1514873
- NCI Thesaurus Property-2
- C25179
- UMLS 2011AA Property-2
- C0019993
Beschreibung
AdverseEventOtherResultInd-3
Datentyp
boolean
Alias
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus ValueDomain
- C38148
- UMLS 2011AA ValueDomain
- C1512699
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
Beschreibung
AdverseEventOtherResultSpecify
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
Beschreibung
AdverseEventDentalResultType
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus Property-2
- C41136
- UMLS 2011AA Property-2
- C0226984
Beschreibung
AdverseEventResolutionDate
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25655
- UMLS 2011AA Property
- C1514893
Beschreibung
SeriousAdverseEventReportInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25375
- UMLS 2011AA Property
- C0684224
- NCI Thesaurus ObjectClass-2
- C54035
- UMLS 2011AA ObjectClass-2
- C0205404
Beschreibung
SeriousAdverseEventDeathResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C28554
- UMLS 2011AA Property
- C0011065
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschreibung
SeriousAdverseEventLifeThreateningorDisablingResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C41337
- UMLS 2011AA Property-2
- C1517874
Beschreibung
SeriousAdverseEventDisabilityResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C21007
- UMLS 2011AA Property
- C0231170
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschreibung
SeriousAdverseEventCongenitalAbnormalityResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C2849
- UMLS 2011AA Property-2
- C0000768
Beschreibung
SeriousAdverseEventRequiredInterventionorProcedureResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property
- C25218
- UMLS 2011AA Property
- C1948041
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus Property-3
- C25652
- UMLS 2011AA Property-3
- C1514873
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
Beschreibung
SeriousAdverseEventHospitalizationResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C20200
- UMLS 2011AA Property
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
- NCI Thesaurus Property-2
- C25179
- UMLS 2011AA Property-2
- C0019993
Beschreibung
SeriousAdverseEventOtherResultInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschreibung
SeriousAdverseEventOtherResultSpecify
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25685
- UMLS 2011AA ValueDomain
- C1521902
- NCI Thesaurus Property
- C17649
- UMLS 2011AA Property
- C0205394
- NCI Thesaurus Property-2
- C20200
- UMLS 2011AA Property-2
- C1274040
- NCI Thesaurus ObjectClass
- C41335
- UMLS 2011AA ObjectClass
- C1519255
Beschreibung
Unnamed4
Ähnliche Modelle
No Instruction available.
- StudyEvent: PRL1013: Adverse Event Form
C0008972 (UMLS 2011AA ObjectClass)
C37901 (NCI Thesaurus ObjectClass-2)
C0205145 (UMLS 2011AA ObjectClass-2)
C52664 (NCI Thesaurus ObjectClass-3)
C1709628 (UMLS 2011AA ObjectClass-3)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25364 (NCI Thesaurus ValueDomain)
C0600091 (UMLS 2011AA ValueDomain)
C0030705 (UMLS 2011AA ObjectClass)
C52654 (NCI Thesaurus Property)
C0011441 (UMLS 2011AA Property)
C25716 (NCI Thesaurus Property-2)
C0545082 (UMLS 2011AA Property-2)
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25367 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1527021 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus Property)
C1522326 (UMLS 2011AA Property)
C25365 (NCI Thesaurus Property-2)
C0678257 (UMLS 2011AA Property-2)
C2985916 (UMLS CUI-1)
C25367 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C25279 (NCI Thesaurus Property)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C1513302 (UMLS 2011AA)
C1513374 (UMLS 2011AA)
C1519275 (UMLS 2011AA)
C1517874 (UMLS 2011AA)
C1705232 (UMLS 2011AA)
C0349674 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C60718 (NCI Thesaurus Property)
C0399059 (UMLS 2011AA Property)
C25358 (NCI Thesaurus Property-2)
C0596130 (UMLS 2011AA Property-2)
C0445356 (UMLS 2011AA)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25501 (NCI Thesaurus Property)
C1517001 (UMLS 2011AA Property)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C53610 (NCI Thesaurus Property-2)
C0559956 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C62295 (NCI Thesaurus Property-2)
C1947975 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C52586 (NCI Thesaurus ObjectClass-2)
C1711229 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52550 (NCI Thesaurus Property-2)
C1705872 (UMLS 2011AA Property-2)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C52575 (NCI Thesaurus ObjectClass)
C0700632 (UMLS 2011AA ObjectClass)
C1522602 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C12506 (NCI Thesaurus ObjectClass)
C0040426 (UMLS 2011AA ObjectClass)
C61575 (NCI Thesaurus ObjectClass-2)
C0185115 (UMLS 2011AA ObjectClass-2)
C1512698 (UMLS 2011AA ValueDomain)
C25586 (NCI Thesaurus ObjectClass)
C0205314 (UMLS 2011AA ObjectClass)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25652 (NCI Thesaurus Property)
C1514873 (UMLS 2011AA Property)
C25179 (NCI Thesaurus Property-2)
C0019993 (UMLS 2011AA Property-2)
C0205394 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C0332307 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41136 (NCI Thesaurus Property-2)
C0226984 (UMLS 2011AA Property-2)
C0011008 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25655 (NCI Thesaurus Property)
C1514893 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25375 (NCI Thesaurus Property)
C0684224 (UMLS 2011AA Property)
C54035 (NCI Thesaurus ObjectClass-2)
C0205404 (UMLS 2011AA ObjectClass-2)
C1512698 (UMLS 2011AA ValueDomain)
C28554 (NCI Thesaurus Property)
C0011065 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C41337 (NCI Thesaurus Property-2)
C1517874 (UMLS 2011AA Property-2)
C1512698 (UMLS 2011AA ValueDomain)
C21007 (NCI Thesaurus Property)
C0231170 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property-2)
C0000768 (UMLS 2011AA Property-2)
C1519255 (UMLS 2011AA ObjectClass)
C25218 (NCI Thesaurus Property)
C1948041 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C25652 (NCI Thesaurus Property-3)
C1514873 (UMLS 2011AA Property-3)
C38147 (NCI Thesaurus ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C1512698 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C25179 (NCI Thesaurus Property-2)
C0019993 (UMLS 2011AA Property-2)
C1512698 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C1521902 (UMLS 2011AA ValueDomain)
C17649 (NCI Thesaurus Property)
C0205394 (UMLS 2011AA Property)
C20200 (NCI Thesaurus Property-2)
C1274040 (UMLS 2011AA Property-2)
C41335 (NCI Thesaurus ObjectClass)
C1519255 (UMLS 2011AA ObjectClass)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)