Description:

NSABP PROTOCOL R-04: ADVERSE EVENT FORM Radiation Therapy and Either Capecitabine or Fluorouracil With or Without Oxaliplatin Before Surgery in Treating Patients With Resectable Rectal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B7822175-F6A3-24E0-E034-0003BA12F5E7

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=B7822175-F6A3-24E0-E034-0003BA12F5E7

Keywords:
Versions (3) ▾
  1. 8/27/12
  2. 1/9/15
  3. 1/9/15
Uploaded on:

January 9, 2015

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License:
Creative Commons BY-NC 3.0 Legacy
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Colorectal Cancer NCT00058474 Toxicity - NSABP PROTOCOL R-04: ADVERSE EVENT FORM - 2082776v3.0

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  1. StudyEvent: NSABP PROTOCOL R-04: ADVERSE EVENT FORM
    1. No Instruction available.
Ccrr Module For Nsabp Protocol R-04: Adverse Event Form
Are Data Amended?
Any grade 2, 3, 4, or 5 adverse event?
Was the patient hospitalized for 24 hours or more?
Attirubtion
Attirubtion
Did the patient experience an episode of Grade 3 or greater diarrhea with Grade 4 granulocytopenia (neutropenia)?
Was the patient hospitalized for the management of diarrhea or dehydration, with radiographic or colonoscopic evidence of bowel wall injury?

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