ID

9294

Beschrijving

E1900 Cover Page for Adverse Event Form Combination Chemotherapy With or Without Monoclonal Antibody Therapy Followed by Stem Cell Transplant in Treating Patients With Acute Myeloid Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AAD35-91C7-25DB-E034-0003BA12F5E7

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B19AAD35-91C7-25DB-E034-0003BA12F5E7

Trefwoorden

  1. 25-05-12 25-05-12 -
  2. 09-01-15 09-01-15 - Martin Dugas
Geüploaded op

9 januari 2015

DOI

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Licentie

Creative Commons BY-NC 3.0 Legacy

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Leukemia NCT00049517 Toxicity - E1900 Cover Page for Adverse Event Form - 2075062v3.0

No Instruction available.

  1. StudyEvent: E1900 Cover Page for Adverse Event Form
    1. No Instruction available.
Header
Beschrijving

Header

DCI Name
Beschrijving

Generic drug form

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C3242750
NCI Thesaurus Property
C19464
NCI Thesaurus ObjectClass
C25474
NCI Thesaurus ObjectClass-2
C25452
Patient Initials
Beschrijving

Patient Initials

Datatype

text

Alias
NCI Thesaurus ValueDomain
C25191
UMLS CUI-1
C2986440
NCI Thesaurus ObjectClass
C16960
NCI Thesaurus Property
C25536
ECOG Protocol Number
Beschrijving

ECOGProtocolNumber

Datatype

text

ECOG Protocol Number
Beschrijving

ECOGProtocolNumber

Datatype

text

ECOG Protocol Number
Beschrijving

ECOGProtocolNumber

Datatype

text

ECOG Patient ID
Beschrijving

ECOGPatientID

Datatype

text

ECOG Patient ID
Beschrijving

ECOGPatientID

Datatype

text

Participating Group Protocol No.
Beschrijving

ParticipatingGroupProtocolNo.

Datatype

text

Participating Group Patient ID
Beschrijving

ParticipatingGroupPatientID

Datatype

text

Institution/Affiliate
Beschrijving

MainMemberInstitution/Affiliate

Datatype

text

On Treatment
Beschrijving

On Treatment

On Treatment Time Period
Beschrijving

OnTreatmentTimePeriod

Datatype

text

Off Treatment
Beschrijving

Off Treatment

Off Treatment Time Period
Beschrijving

OffTreatmentTimePeriod

Datatype

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25616
UMLS 2011AA Property
C1948053
NCI Thesaurus Property-2
C25601
UMLS 2011AA Property-2
C1518544
NCI Thesaurus Property-3
C25207
UMLS 2011AA Property-3
C0040223
NCI Thesaurus ValueDomain
C25284
UMLS 2011AA ValueDomain
C0332307
Ccrr Module For E1900 Cover Page For Adverse Event Form
Beschrijving

Ccrr Module For E1900 Cover Page For Adverse Event Form

Similar models

No Instruction available.

  1. StudyEvent: E1900 Cover Page for Adverse Event Form
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Header
Generic drug form
Item
DCI Name
text
C25191 (NCI Thesaurus ValueDomain)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
Patient Initials
Item
Patient Initials
text
C25191 (NCI Thesaurus ValueDomain)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGProtocolNumber
Item
ECOG Protocol Number
text
ECOGPatientID
Item
ECOG Patient ID
text
ECOGPatientID
Item
ECOG Patient ID
text
ParticipatingGroupProtocolNo.
Item
Participating Group Protocol No.
text
ParticipatingGroupPatientID
Item
Participating Group Patient ID
text
MainMemberInstitution/Affiliate
Item
Institution/Affiliate
text
Item Group
On Treatment
Item
On Treatment Time Period
text
Code List
On Treatment Time Period
CL Item
Induction (Induction)
CL042203 (NCI Metathesaurus)
CL Item
Induction, Additional Forms (Induction, additional Forms)
CL Item
Consolidation (Consolidation)
CL Item
Post-transplant (Post-Transplant)
Item Group
Off Treatment
Item
Off Treatment Time Period
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA ValueDomain)
Code List
Off Treatment Time Period
CL Item
3 Months (3 months)
CL Item
6 Months (6 months)
CL Item
9 Months (9 months)
CL Item
12 Months (12 months)
CL Item
15 Months (15 months)
CL Item
18 Months (18 months)
CL Item
24 Months (24 months)
CL Item
30 Months (30 months)
CL Item
36 Months (36 months)
CL Item
42 Months (42 months)
CL Item
48 Months (48 months)
CL Item
54 Months (54 months)
CL Item
60 Months (60 months)
CL Item
2 Years (2 years)
CL Item
3 Years (3 years)
CL Item
4 Years (4 years)
CL Item
5 Years (5 years)
CL Item
6 Years (6 years)
CL Item
7 Years (7 years)
CL Item
8 Years (8 years)
CL Item
9 Years (9 years)
CL Item
10 Years (10 years)
Item Group
Ccrr Module For E1900 Cover Page For Adverse Event Form

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