CALGB 90802 Adverse Event (AE) Form Everolimus With or Without Bevacizumab in Treating Patients With Advanced Kidney Cancer That Progressed After First-Line Therapy Source Form: NCI FormBuilder:

  1. 9/19/12 9/19/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
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January 9, 2015

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Creative Commons BY-NC 3.0 Legacy
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Kidney Cancer NCT01198158 Toxicity - CALGB 90802 Adverse Event (AE) Form - 3103307v1.0

INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. If data are amended, circle amended items and check the "Yes" box. If submitting by mail, retain a copy for your records. If submitting by fax, use an original form for maximum clarity in transmission and fax to 919-416-4990. Use NCI CTCAE v4.0 or most current version with MedDRA codes posted at to grade each adverse event. Grade = -1 if category not evaluated. Grade = 0 if category evaluated but event not reported. AE is defined as adverse event. TREATMENT ATTRIBUTION CODES: 1 = unrelated, 2 = unlikely, 3 = possible, 4 = probable, 5 = definite

Are data amended
Has an AdEERS been filed (with Central Office based on an event reported below)
Expected Adverse Events
CTC AE Attribution Code (^3)
CTC AE Attribution Code (^3)
CTC AE Grade
CTC AE Grade

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