ID
9199
Descrizione
CALGB: 10201 ADVERSE EVENT FORM Daunorubicin and Cytarabine With or Without Oblimersen in Treating Older Patients With Previously Untreated Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=AD846683-4685-2F05-E034-0003BA12F5E7
collegamento
Keywords
versioni (2)
- 19/09/12 19/09/12 -
- 09/01/15 09/01/15 - Martin Dugas
Caricato su
9 gennaio 2015
DOI
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Licenza
Creative Commons BY-NC 3.0 Legacy
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Leukemia NCT00085124 Toxicity - CALGB: 10201 ADVERSE EVENT FORM - 2070578v3.0
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
Descrizione
Expected Adverse Events
Descrizione
MedDRACode
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Metathesaurus ObjectClass
- CL104089
Descrizione
MedDRACode
Tipo di dati
text
Alias
- NCI Thesaurus ValueDomain
- C25162
- UMLS 2011AA ValueDomain
- C0805701
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Metathesaurus ObjectClass
- CL104089
Descrizione
CTCAdverseEventTerm
Tipo di dati
text
Descrizione
CTCAdverseEventTerm
Tipo di dati
text
Descrizione
Werethereanyotherevents(Hematologicgrade4-5onlyorNon-Hematologicgrade3-5only)notedduringthistimeperiod?
Tipo di dati
boolean
Descrizione
CTCAdverseEventGrade
Tipo di dati
float
Descrizione
CTCAdverseEventGrade
Tipo di dati
float
Descrizione
CTCAdverseEventAttributionCode
Tipo di dati
text
Descrizione
CTCAdverseEventAttributionCode
Tipo di dati
text
Descrizione
CompletedBy
Tipo di dati
text
Descrizione
DateCompleted
Tipo di dati
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS 2011AA ValueDomain
- C0011008
Descrizione
Ccrr Module For Calgb: 10201 Adverse Event Form
Similar models
Instructions: Complete and submit thie form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Cirlce amended items and check "Amended data" box to teh right. If submitting by mail, retain a copy for your records and send the original form for mazimum clarity in transmission and fax to 919-416-4990. If submistting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0805701 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL104089 (NCI Metathesaurus ObjectClass)
C0805701 (UMLS 2011AA ValueDomain)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
CL104089 (NCI Metathesaurus ObjectClass)
C0445356 (UMLS 2011AA)
C0445356 (UMLS 2011AA)
C0011008 (UMLS 2011AA ValueDomain)