Information:
Error:
ID
9307
Description
AMC-045 Delayed Toxicity Form (TOX) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1BB3598F-7655-640C-E044-0003BA3F9857
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Keywords
Versions (2)
- 8/26/12 8/26/12 -
- 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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Anal Cancer NCT00324415 Toxicity - AMC-045 Delayed Toxicity Form (TOX) - 2514820v1.0
Please reference the protocol for a description of adverse event grading
- StudyEvent: AMC-045 Delayed Toxicity Form (TOX)
Similar models
Please reference the protocol for a description of adverse event grading
- StudyEvent: AMC-045 Delayed Toxicity Form (TOX)
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Visit number
Item
Visit number
float
C25337 (NCI Thesaurus ValueDomain)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
Item
CTC Select AE
text
C25284 (NCI Thesaurus ValueDomain)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
CL Item
Bladder (Bladder)
CL Item
Bone (Bone)
CL Item
Brain (Brain)
CL Item
Esophagus (Esophagus)
C12389 (NCI Thesaurus)
C0014876 (UMLS 2011AA)
C0014876 (UMLS 2011AA)
CL Item
Eye (Eye)
C12401 (NCI Thesaurus)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
CL Item
Heart (Heart)
C12727 (NCI Thesaurus)
C0018787 (UMLS 2011AA)
C0018787 (UMLS 2011AA)
CL Item
Joint (Joint)
CL Item
Kidney (Kidney)
C12415 (NCI Thesaurus)
C0022646 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
CL Item
Large Bowel (Large bowel)
CL Item
Larynx (Larynx)
C12420 (NCI Thesaurus)
C0023078 (UMLS 2011AA)
C0023078 (UMLS 2011AA)
CL Item
Liver (Liver)
C12392 (NCI Thesaurus)
C0023884 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
CL Item
Lung (Lung)
C12468 (NCI Thesaurus)
C0024109 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
CL Item
Mucosa (Mucosa)
CL Item
Salivary Gland (Salivary gland)
C12426 (NCI Thesaurus)
C0036098 (UMLS 2011AA)
C0036098 (UMLS 2011AA)
CL Item
Skin (Skin)
C12470 (NCI Thesaurus)
C1123023 (UMLS 2011AA)
C1123023 (UMLS 2011AA)
CL Item
Small Bowel (Small bowel)
CL Item
Spinal Cord (Spinal cord)
C12464 (NCI Thesaurus)
C0037925 (UMLS 2011AA)
C0037925 (UMLS 2011AA)
CL Item
Radiation (Radiation)
C54648 (NCI Thesaurus)
C1882536 (UMLS 2011AA)
C1882536 (UMLS 2011AA)
CL Item
Other (Other NOS)
C17649 (NCI Thesaurus)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
AdverseEventDescriptionSpecify
Item
Other, specify
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C1521902 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
CTC Adverse Event Grade
Item
CTC Adverse Event Grade
float
C49704 (NCI Thesaurus ObjectClass)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
Research Comments
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)