ID

9266

Description

ANBL0321: Pre-Existing Conditions At Time of Study Entry Fenretinide in Treating Children With Recurrent or Resistant Neuroblastoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9B49D1C-054C-1FC6-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B9B49D1C-054C-1FC6-E034-0003BA12F5E7

Keywords

Versions (3)
  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 7/3/15 7/3/15 -
Uploaded on

January 9, 2015

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License

Creative Commons BY-NC 3.0 Legacy
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    Neuroblastoma NCT00053326 On-Study - ANBL0321: Pre-Existing Conditions At Time of Study Entry - 2089766v3.0

    English

    No Instruction available.

    1 forms  
    1. StudyEvent: ANBL0321: Pre-Existing Conditions At Time of Study Entry
      1. No Instruction available.
    Header
    Description

    Header

    Institution Name
    Description

    Institution Name

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass
    C21541
    NCI Thesaurus ValueDomain-2
    C21541
    NCI Thesaurus Property
    C25364
    Study Number
    Description

    Protocol ID COG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516477
    NCI Thesaurus Property
    C25364
    Study Number
    Description

    Protocol ID COG

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1516477
    NCI Thesaurus Property
    C25364
    COG Number
    Description

    PatientCOGIdentifierNumber

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS 2011AA ValueDomain
    C0237753
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus Property-2
    C39353
    UMLS 2011AA Property-2
    C1516477
    Patient's Initials
    Description

    Patient Initials

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Date worksheet entered into RDE
    Description

    DataEnteredDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C25474
    UMLS 2011AA ObjectClass
    C1511726
    NCI Thesaurus Property
    C37949
    UMLS 2011AA Property
    C1521975
    Unnamed2
    Description

    Unnamed2

    Name of Pre-existing condition (Use CTC version 2.0)
    Description

    CTC Adverse Event Term

    Data type

    text

    Alias
    NCI Thesaurus ObjectClass
    C41331
    UMLS CUI-1
    C1516728
    NCI Thesaurus Property
    C25703
    UMLS CUI-2
    C2826934
    CTC Code of Pre-existing condition
    Description

    CTCAdverseEventCOGCodeSpecify

    Data type

    float

    Alias
    NCI Thesaurus Property
    C25364
    UMLS 2011AA Property
    C0600091
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    Start Date (MM/DD/YYYY)
    Description

    CTCAdverseEventOnsetDate

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C25279
    UMLS 2011AA Property
    C0332162
    End Date (leave blank if on-going at the time of study enrollment)
    Description

    Adverse Event Resolution Date

    Data type

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985918
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25655
    Comment
    Description

    CTCAdverseEventDetailsText

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS 2011AA ValueDomain
    C1527021
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C25480
    UMLS 2011AA Property
    C1522508
    What is being done to treat the pre-existing condition? (Choices: No therapy, Supportive Care, Medication, Other : specify)
    Description

    PriorConditionTreatmentType

    Data type

    text

    Alias
    NCI Thesaurus Property
    C15368
    Other: specify [what is being done to treat pre-existing condition]
    Description

    PriorConditionTreatmentSpecify

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS 2011AA ValueDomain
    C1521902
    NCI Thesaurus Property
    C15368
    Unnamed3
    Description

    Unnamed3

    Comments
    Description

    Research Comments

    Data type

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393
    Ccrr Module For Anbl0321: Pre-existing Conditions At Time Of Study Entry
    Description

    Ccrr Module For Anbl0321: Pre-existing Conditions At Time Of Study Entry

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    No Instruction available.

    1 forms
    1. StudyEvent: ANBL0321: Pre-Existing Conditions At Time of Study Entry
      1. No Instruction available.
    Name
    Type
    Description | Question | Decode (Coded Value)
    Data type
    Alias
    Item Group
    Header
    Institution Name
    Item
    Institution Name
    text
    C25191 (NCI Thesaurus ValueDomain)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass)
    C21541 (NCI Thesaurus ValueDomain-2)
    C25364 (NCI Thesaurus Property)
    Protocol ID COG
    Item
    Study Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516477 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    Protocol ID COG
    Item
    Study Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1516477 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    PatientCOGIdentifierNumber
    Item
    COG Number
    text
    C25337 (NCI Thesaurus ValueDomain)
    C0237753 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C39353 (NCI Thesaurus Property-2)
    C1516477 (UMLS 2011AA Property-2)
    Patient Initials
    Item
    Patient's Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    DataEnteredDate
    Item
    Date worksheet entered into RDE
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C25474 (NCI Thesaurus ObjectClass)
    C1511726 (UMLS 2011AA ObjectClass)
    C37949 (NCI Thesaurus Property)
    C1521975 (UMLS 2011AA Property)
    Item Group
    Unnamed2
    CTC Adverse Event Term
    Item
    Name of Pre-existing condition (Use CTC version 2.0)
    text
    C41331 (NCI Thesaurus ObjectClass)
    C1516728 (UMLS CUI-1)
    C25703 (NCI Thesaurus Property)
    C2826934 (UMLS CUI-2)
    CTCAdverseEventCOGCodeSpecify
    Item
    CTC Code of Pre-existing condition
    float
    C25364 (NCI Thesaurus Property)
    C0600091 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    CTCAdverseEventOnsetDate
    Item
    Start Date (MM/DD/YYYY)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C25279 (NCI Thesaurus Property)
    C0332162 (UMLS 2011AA Property)
    Adverse Event Resolution Date
    Item
    End Date (leave blank if on-going at the time of study enrollment)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985918 (UMLS CUI-1)
    C25367 (NCI Thesaurus ValueDomain-2)
    C49704 (NCI Thesaurus ObjectClass)
    C25655 (NCI Thesaurus Property)
    CTCAdverseEventDetailsText
    Item
    Comment
    text
    C25704 (NCI Thesaurus ValueDomain)
    C1527021 (UMLS 2011AA ValueDomain)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C25480 (NCI Thesaurus Property)
    C1522508 (UMLS 2011AA Property)
    Item
    What is being done to treat the pre-existing condition? (Choices: No therapy, Supportive Care, Medication, Other : specify)
    text
    C15368 (NCI Thesaurus Property)
    CL.1
    Code List
    What is being done to treat the pre-existing condition? (Choices: No therapy, Supportive Care, Medication, Other : specify)
    CL Item
    No Therapy (No therapy)
    CL Item
    Supportive Care (Supportive Care)
    C15747 (NCI Thesaurus)
    C0344211 (UMLS 2011AA)
    CL Item
    Medication (Medication)
    C459 (NCI Thesaurus)
    C0013227 (UMLS 2011AA)
    CL Item
    Other, Specify (Other : specify)
    PriorConditionTreatmentSpecify
    Item
    Other: specify [what is being done to treat pre-existing condition]
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1521902 (UMLS 2011AA ValueDomain)
    C15368 (NCI Thesaurus Property)
    Item Group
    Unnamed3
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)
    Item Group
    Ccrr Module For Anbl0321: Pre-existing Conditions At Time Of Study Entry
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