ID
9335
Beschreibung
NSABP PROTOCOL C-08 ADVERSE EVENT FORM Fluorouracil, Leucovorin, and Oxaliplatin With or Without Bevacizumab in Treating Patients Who Have Undergone Surgery for Stage II or Stage III Colon Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=EF511EA4-0C5D-199B-E034-0003BA3F9857
Link
Stichworte
Versionen (4)
- 27.08.12 27.08.12 -
- 08.01.15 08.01.15 - Martin Dugas
- 09.01.15 09.01.15 - Martin Dugas
- 23.03.15 23.03.15 - Martin Dugas
Hochgeladen am
9. Januar 2015
DOI
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Lizenz
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00096278 Toxicity - NSABP PROTOCOL C-08 ADVERSE EVENT FORM - 2292448v3.0
Fax to 412-622-2111
- StudyEvent: NSABP PROTOCOL C-08 ADVERSE EVENT FORM
Beschreibung
Unnamed2
Beschreibung
Institution Name
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25191
- UMLS CUI-1
- C1301943
- NCI Thesaurus ObjectClass
- C21541
- NCI Thesaurus ValueDomain-2
- C21541
- NCI Thesaurus Property
- C25364
Beschreibung
Affiliate Name
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C21541
- UMLS CUI-1
- C1510825
- NCI Thesaurus ObjectClass-2
- C25413
- NCI Thesaurus Property
- C25364
- NCI Thesaurus ValueDomain
- C25191
- NCI Thesaurus ValueDomain-2
- C21541
Beschreibung
Person Completing Form Last Name
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1301584
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25551
- NCI Thesaurus ValueDomain
- C25191
Beschreibung
Person Completing Form First Name
Datentyp
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass-2
- C25657
- UMLS CUI-2
- C1443235
- NCI Thesaurus Property
- C25364
- NCI Thesaurus Property-2
- C25509
- NCI Thesaurus ValueDomain
- C25191
Beschreibung
Person Completing Form Phone
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25337
- UMLS CUI-1
- C1550483
- NCI Thesaurus ObjectClass
- C25190
- UMLS CUI-2
- C1515258
- NCI Thesaurus ObjectClass-2
- C25657
- NCI Thesaurus Property
- C25395
Beschreibung
Data amended
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38148
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Beschreibung
Unnamed3
Beschreibung
Reporting Period Start Date
Datentyp
date
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25616
- UMLS CUI-1
- C2361257
- NCI Thesaurus Property-2
- C25651
- NCI Thesaurus ValueDomain
- C25164
- NCI Thesaurus ValueDomain-2
- C25431
Beschreibung
Reporting Period End Date
Datentyp
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2361259
- NCI Thesaurus Property
- C25616
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property-2
- C25651
Beschreibung
Typeofreport
Datentyp
text
Beschreibung
BevacizumabAgentAdministeredCount
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C2039
- UMLS 2011AA ObjectClass
- C0796392
- NCI Thesaurus ValueDomain
- C25463
- UMLS 2011AA ValueDomain
- C0750480
- NCI Thesaurus ObjectClass-2
- C1708
- UMLS 2011AA ObjectClass-2
- C0450442
- NCI Thesaurus Property
- C25382
- UMLS 2011AA Property
- C1521801
Beschreibung
Unnamed4
Beschreibung
PatientHospitalizationInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C16960
- UMLS 2011AA ObjectClass
- C0030705
- NCI Thesaurus Property
- C25179
- UMLS 2011AA Property
- C0019993
Beschreibung
AdverseEventGradeInd-2
Datentyp
boolean
Alias
- NCI Thesaurus ValueDomain
- C38147
- UMLS 2011AA ValueDomain
- C1512698
- NCI Thesaurus ObjectClass
- C41331
- UMLS 2011AA ObjectClass
- C0877248
- NCI Thesaurus Property
- C25365
- UMLS 2011AA Property
- C0678257
Beschreibung
CommonToxicityCriteriaAdverseEventShortNameType
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Metathesaurus ValueDomain
- C0332307
- NCI Thesaurus Property-2
- C25249
- UMLS 2011AA Property-2
- C1806781
Beschreibung
CTC Adverse Event Term
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C38024
- NCI Thesaurus Property-2
- C45559
Beschreibung
CTC Adverse Event Grade
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Beschreibung
Unnamed7
Beschreibung
CommonToxicityCriteriaAdverseEventShortNameType
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Metathesaurus ValueDomain
- C0332307
- NCI Thesaurus Property-2
- C25249
- UMLS 2011AA Property-2
- C1806781
Beschreibung
CTC Adverse Event Term
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C38024
- NCI Thesaurus Property-2
- C45559
Beschreibung
CTC Adverse Event Grade
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Beschreibung
Unnamed8
Beschreibung
CommonToxicityCriteriaAdverseEventShortNameType
Datentyp
text
Alias
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
- NCI Thesaurus ObjectClass
- C49704
- UMLS 2011AA ObjectClass
- C1516728
- NCI Metathesaurus ValueDomain
- C0332307
- NCI Thesaurus Property-2
- C25249
- UMLS 2011AA Property-2
- C1806781
Beschreibung
CTC Adverse Event Term
Datentyp
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C38024
- NCI Thesaurus Property-2
- C45559
Beschreibung
CTC Adverse Event Grade
Datentyp
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Beschreibung
Comments
Beschreibung
Instructions
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Fax to 412-622-2111
- StudyEvent: NSABP PROTOCOL C-08 ADVERSE EVENT FORM
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
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C25657 (NCI Thesaurus ObjectClass-2)
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C25191 (NCI Thesaurus ValueDomain)
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C1443235 (UMLS CUI-2)
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C25191 (NCI Thesaurus ValueDomain)
C1550483 (UMLS CUI-1)
C25190 (NCI Thesaurus ObjectClass)
C1515258 (UMLS CUI-2)
C25657 (NCI Thesaurus ObjectClass-2)
C25395 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property)
C2361257 (UMLS CUI-1)
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C25164 (NCI Thesaurus ValueDomain)
C25431 (NCI Thesaurus ValueDomain-2)
C2361259 (UMLS CUI-1)
C25616 (NCI Thesaurus Property)
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C25651 (NCI Thesaurus Property-2)
C0796392 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C1708 (NCI Thesaurus ObjectClass-2)
C0450442 (UMLS 2011AA ObjectClass-2)
C25382 (NCI Thesaurus Property)
C1521801 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C25179 (NCI Thesaurus Property)
C0019993 (UMLS 2011AA Property)
C1512698 (UMLS 2011AA ValueDomain)
C41331 (NCI Thesaurus ObjectClass)
C0877248 (UMLS 2011AA ObjectClass)
C25365 (NCI Thesaurus Property)
C0678257 (UMLS 2011AA Property)
C0600091 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C0332307 (NCI Metathesaurus ValueDomain)
C25249 (NCI Thesaurus Property-2)
C1806781 (UMLS 2011AA Property-2)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C0332307 (NCI Metathesaurus ValueDomain)
C25249 (NCI Thesaurus Property-2)
C1806781 (UMLS 2011AA Property-2)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C0332307 (NCI Metathesaurus ValueDomain)
C25249 (NCI Thesaurus Property-2)
C1806781 (UMLS 2011AA Property-2)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C0947611 (UMLS CUI-1)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)