ID
9235
Description
S0201 Melacine Arm Cycle-Specific Toxicity and Dosage Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A93417EC-7384-694A-E034-0003BA12F5E7
Link
Keywords
Versions (2)
- 9/19/12 9/19/12 -
- 1/9/15 1/9/15 - Martin Dugas
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Melanoma (Skin) null Toxicity - S0201 Melacine Arm Cycle-Specific Toxicity and Dosage Form - 2055710v3.0
Instructions: Complete at the end of weeks 12, 27, 54, 81. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in a Comments section. Place an X in appropriate boxes. Circle AMENDED items
- StudyEvent: S0201 Melacine Arm Cycle-Specific Toxicity and Dosage Form
Description
Disease Status
Description
Treatment Status
Description
Ispatientstillonprotocoltreatment?
Data type
boolean
Description
DoseModification(Change)
Data type
text
Description
DoseModificationReason
Data type
text
Description
NumberofMelacineinjections
Data type
text
Description
TreatmentFirstDoseBeginDate
Data type
date
Description
TreatmentLastDoseEndDate
Data type
date
Description
Toxicity
Description
Weretoxicitiesassessedduringthistimeperiod?
Data type
boolean
Description
SymptomAssessmentDate
Data type
date
Description
Unnamed3
Data type
text
Description
CTCCode
Data type
text
Description
CTCAdverseEventTerm
Data type
text
Description
CTCAdverseEventGrade
Data type
text
Description
CTCAdverseEventAttributionCode
Data type
text
Description
CTCAdverseEventTerm,Other
Data type
text
Description
Comments
Description
Ccrr Module For S0201 Melacine Arm Cycle-specific Toxicity And Dosage Form
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Instructions: Complete at the end of weeks 12, 27, 54, 81. All dates are MONTH, DAY, YEAR. Explain any blank fields or blank dates in a Comments section. Place an X in appropriate boxes. Circle AMENDED items
- StudyEvent: S0201 Melacine Arm Cycle-Specific Toxicity and Dosage Form
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C25741 (NCI Thesaurus ObjectClass)
C0031831 (UMLS 2011AA ObjectClass)
C25705 (NCI Thesaurus ObjectClass-2)
C1522326 (UMLS 2011AA ObjectClass-2)
C1298908 (UMLS 2011AA)
C0445356 (UMLS 2011AA)