ID

9591

Descrizione

SOUTHWEST ONCOLOGY GROUP S0205 ADVERSE EVENT FORM S0205 Gemcitabine With or Without Cetuximab as First-Line Therapy in Treating Patients With Locally Advanced Unresectable or Metastatic Adenocarcinoma of the Pancreas Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F2FD2A6F-B0D0-6409-E034-0003BA3F9857

collegamento

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=F2FD2A6F-B0D0-6409-E034-0003BA3F9857

Keywords

  1. 19/09/12 19/09/12 -
  2. 08/01/15 08/01/15 - Martin Dugas
  3. 09/01/15 09/01/15 - Martin Dugas
  4. 09/01/15 09/01/15 - Martin Dugas
Caricato su

9 gennaio 2015

DOI

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Licenza

Creative Commons BY-NC 3.0 Legacy

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    Pancreatic Cancer NCT00075686 Toxicity - SOUTHWEST ONCOLOGY GROUP S0205 ADVERSE EVENT FORM - 2307412v3.0

    No Instruction available.

    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0205 ADVERSE EVENT FORM
      1. No Instruction available.
    Header
    Descrizione

    Header

    SWOG Patient ID
    Descrizione

    Trial subject ID SWOG

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2348585
    NCI Thesaurus ObjectClass
    C16960
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    SWOG Study No.
    Descrizione

    Protocol ID SWOG

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C3274381
    NCI Thesaurus ObjectClass
    C25320
    UMLS CUI-2
    C1519429
    NCI Thesaurus Property
    C25364
    NCI Thesaurus Property-2
    C25699
    Registration Step
    Descrizione

    Registration Number

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C1514821
    NCI Thesaurus ObjectClass
    C25646
    UMLS CUI-2
    C0237753
    NCI Thesaurus Property
    C16154
    NCI Thesaurus ValueDomain-2
    C16154
    Cycle Number
    Descrizione

    Cycle Number

    Tipo di dati

    integer

    Alias
    NCI Thesaurus ValueDomain
    C25337
    UMLS CUI-1
    C2045829
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property
    C25379
    Patient Initials
    Descrizione

    Patient Initials

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2986440
    NCI Thesaurus ObjectClass
    C16960
    NCI Thesaurus Property
    C25536
    Institution/Affiliate
    Descrizione

    Institution Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ObjectClass
    C25454
    UMLS CUI-1
    C1301943
    NCI Thesaurus ObjectClass-2
    C21541
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ValueDomain
    C25191
    NCI Thesaurus ValueDomain-2
    C21541
    Physician (Instructions: Please complete this form after first cycle, then send every 3 cycles. Report all adverse events observed. Document the worst Grade seen during the reporting period.)
    Descrizione

    Investigator Name

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25191
    UMLS CUI-1
    C2826892
    NCI Thesaurus Property
    C25364
    NCI Thesaurus ObjectClass
    C17089
    NCI Thesaurus ObjectClass-2
    C25644
    Toxicity
    Descrizione

    Toxicity

    Was a physical exam performed during this cycle?
    Descrizione

    PatientPhysicalExaminationInd-2

    Tipo di dati

    boolean

    Alias
    NCI Thesaurus ValueDomain
    C38147
    UMLS 2011AA ValueDomain
    C1512698
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    Date physical exam performed (if yes,)
    Descrizione

    PatientPhysicalExaminationDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C16960
    UMLS 2011AA ObjectClass
    C0030705
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    Reporting period start date (Day after adverse event assessment date from previous form)
    Descrizione

    Reporting Period Start Date

    Tipo di dati

    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
    Reporting Period End Date
    Descrizione

    Reporting Period End Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2361259
    NCI Thesaurus Property
    C25616
    NCI Thesaurus ObjectClass
    C15368
    NCI Thesaurus Property-2
    C25651
    Were adverse events assessed during this time period?
    Descrizione

    AdverseEventCurrentAssessmentInd

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25180
    UMLS 2011AA ValueDomain
    C1522602
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus Property-2
    C25471
    UMLS 2011AA Property-2
    C0521116
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    Date of most recent adverse event assessment
    Descrizione

    AdverseEventMostRecentAssessmentDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property-2
    C25577
    UMLS 2011AA Property-2
    C1513491
    CTC Adverse Event Term
    Descrizione

    CTC Adverse Event Term

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25284
    UMLS CUI-1
    C1516728
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-2
    C2826934
    NCI Thesaurus Property
    C45559
    CTC Adverse Event Term, Other (specify using CTCAE 3.0 terminology)
    Descrizione

    CTC Adverse Event Term

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25685
    UMLS CUI-1
    C1516728
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-2
    C2826934
    NCI Thesaurus Property
    C45559
    CTC adverse event Grade (1 - 5)
    Descrizione

    CTC Adverse Event Grade

    Tipo di dati

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC adverse event Grade (1 - 5)
    Descrizione

    CTC Adverse Event Grade

    Tipo di dati

    float

    Alias
    NCI Thesaurus ObjectClass
    C49704
    UMLS CUI-1
    C2985911
    NCI Thesaurus ValueDomain
    C18000
    NCI Thesaurus Property
    C25365
    CTC Adverse Event Attribution Code
    Descrizione

    CTC Adverse Event Attribution Category

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    CTC Adverse Event Attribution Code
    Descrizione

    CTC Adverse Event Attribution Category

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25664
    UMLS CUI-1
    C1706735
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25358
    Adverse event onset date
    Descrizione

    Adverse Event Onset Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985916
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25279
    Adverse event onset date
    Descrizione

    Adverse Event Onset Date

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS CUI-1
    C2985916
    NCI Thesaurus ValueDomain-2
    C25367
    NCI Thesaurus ObjectClass
    C49704
    NCI Thesaurus Property
    C25279
    Adverse event end date
    Descrizione

    AdverseEventSymptomEndDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C4876
    UMLS 2011AA Property
    C1457887
    Adverse event end date
    Descrizione

    AdverseEventSymptomEndDate

    Tipo di dati

    date

    Alias
    NCI Thesaurus ValueDomain
    C25164
    UMLS 2011AA ValueDomain
    C0011008
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property
    C4876
    UMLS 2011AA Property
    C1457887
    AE status code
    Descrizione

    AdverseEventCourseAssessmentStatus

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property-2
    C25379
    UMLS 2011AA Property-2
    C0750729
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    AE status code
    Descrizione

    AdverseEventCourseAssessmentStatus

    Tipo di dati

    text

    Alias
    NCI Thesaurus Property
    C20989
    UMLS 2011AA Property
    C0031809
    NCI Thesaurus ObjectClass
    C41331
    UMLS 2011AA ObjectClass
    C0877248
    NCI Thesaurus Property-2
    C25379
    UMLS 2011AA Property-2
    C0750729
    NCI Thesaurus ValueDomain
    C25688
    UMLS 2011AA ValueDomain
    C0449438
    Select box if adverse event were assessed but none were seen
    Descrizione

    Selectboxifadverseeventwereassessedbutnonewereseen

    Tipo di dati

    text

    Comments
    Descrizione

    Comments

    Comments
    Descrizione

    Research Comments

    Tipo di dati

    text

    Alias
    NCI Thesaurus ValueDomain
    C25704
    UMLS CUI-1
    C0947611
    NCI Thesaurus ObjectClass
    C15319
    NCI Thesaurus Property
    C25393

    Similar models

    No Instruction available.

    1. StudyEvent: SOUTHWEST ONCOLOGY GROUP S0205 ADVERSE EVENT FORM
      1. No Instruction available.
    Name
    genere
    Description | Question | Decode (Coded Value)
    Tipo di dati
    Alias
    Item Group
    Header
    Trial subject ID SWOG
    Item
    SWOG Patient ID
    text
    C25337 (NCI Thesaurus ValueDomain)
    C2348585 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Protocol ID SWOG
    Item
    SWOG Study No.
    text
    C25337 (NCI Thesaurus ValueDomain)
    C3274381 (UMLS CUI-1)
    C25320 (NCI Thesaurus ObjectClass)
    C1519429 (UMLS CUI-2)
    C25364 (NCI Thesaurus Property)
    C25699 (NCI Thesaurus Property-2)
    Registration Number
    Item
    Registration Step
    text
    C25337 (NCI Thesaurus ValueDomain)
    C1514821 (UMLS CUI-1)
    C25646 (NCI Thesaurus ObjectClass)
    C0237753 (UMLS CUI-2)
    C16154 (NCI Thesaurus Property)
    C16154 (NCI Thesaurus ValueDomain-2)
    Cycle Number
    Item
    Cycle Number
    integer
    C25337 (NCI Thesaurus ValueDomain)
    C2045829 (UMLS CUI-1)
    C15368 (NCI Thesaurus ObjectClass)
    C25379 (NCI Thesaurus Property)
    Patient Initials
    Item
    Patient Initials
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2986440 (UMLS CUI-1)
    C16960 (NCI Thesaurus ObjectClass)
    C25536 (NCI Thesaurus Property)
    Institution Name
    Item
    Institution/Affiliate
    text
    C25454 (NCI Thesaurus ObjectClass)
    C1301943 (UMLS CUI-1)
    C21541 (NCI Thesaurus ObjectClass-2)
    C25364 (NCI Thesaurus Property)
    C25191 (NCI Thesaurus ValueDomain)
    C21541 (NCI Thesaurus ValueDomain-2)
    Investigator Name
    Item
    Physician (Instructions: Please complete this form after first cycle, then send every 3 cycles. Report all adverse events observed. Document the worst Grade seen during the reporting period.)
    text
    C25191 (NCI Thesaurus ValueDomain)
    C2826892 (UMLS CUI-1)
    C25364 (NCI Thesaurus Property)
    C17089 (NCI Thesaurus ObjectClass)
    C25644 (NCI Thesaurus ObjectClass-2)
    Item Group
    Toxicity
    PatientPhysicalExaminationInd-2
    Item
    Was a physical exam performed during this cycle?
    boolean
    C38147 (NCI Thesaurus ValueDomain)
    C1512698 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    PatientPhysicalExaminationDate
    Item
    Date physical exam performed (if yes,)
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C16960 (NCI Thesaurus ObjectClass)
    C0030705 (UMLS 2011AA ObjectClass)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    Reporting Period Start Date
    Item
    Reporting period start date (Day after adverse event assessment date from previous form)
    date
    C15368 (NCI Thesaurus ObjectClass)
    C25616 (NCI Thesaurus Property)
    C2361257 (UMLS CUI-1)
    C25651 (NCI Thesaurus Property-2)
    C25164 (NCI Thesaurus ValueDomain)
    C25431 (NCI Thesaurus ValueDomain-2)
    Reporting Period End Date
    Item
    Reporting Period End Date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2361259 (UMLS CUI-1)
    C25616 (NCI Thesaurus Property)
    C15368 (NCI Thesaurus ObjectClass)
    C25651 (NCI Thesaurus Property-2)
    Item
    Were adverse events assessed during this time period?
    text
    C25180 (NCI Thesaurus ValueDomain)
    C1522602 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C25471 (NCI Thesaurus Property-2)
    C0521116 (UMLS 2011AA Property-2)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    Code List
    Were adverse events assessed during this time period?
    CL Item
    No (No)
    C49487 (NCI Thesaurus)
    C1298908 (UMLS 2011AA)
    CL Item
    Yes (Yes)
    CL Item
    Yes, But No Reportable Adverse Events Occurred (Yes, but no reportable adverse events occurred)
    CL Item
    Yes, And Reportable Adverse Events Occurred (Yes, and reportable adverse events occurred)
    AdverseEventMostRecentAssessmentDate
    Item
    Date of most recent adverse event assessment
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C25577 (NCI Thesaurus Property-2)
    C1513491 (UMLS 2011AA Property-2)
    Item
    CTC Adverse Event Term
    text
    C25284 (NCI Thesaurus ValueDomain)
    C1516728 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C2826934 (UMLS CUI-2)
    C45559 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Term
    CL Item
    Hypersensitivity Nos (Allergic reaction/hypersensitivity)
    CL Item
    Haemoglobin Decreased (Hemoglobin)
    C0162119 (NCI Metathesaurus)
    CL Item
    Leucopenia Nos (Leukocytes)
    CL Item
    Neutropenia (Neutrophils/granulocytes)
    C3277 (NCI Thesaurus)
    CL Item
    Platelet Count Decreased (Platelets)
    C0392386 (NCI Metathesaurus)
    CL Item
    Supraventricular And Nodal Arrhythmia (Supraventricular and nodal arrhythmia - nodal/junction)
    CL Item
    Pericardial Effusion (Pericardial effusion)
    C3319 (NCI Thesaurus)
    C0031039 (UMLS 2011AA)
    CL Item
    Pericarditis (Pericarditis)
    C34915 (NCI Thesaurus)
    C0031046 (UMLS 2011AA)
    CL Item
    Fatigue (Fatigue)
    C3036 (NCI Thesaurus)
    C0015672 (UMLS 2011AA)
    CL Item
    Pyrexia (Fever)
    CL Item
    Insomnia Nec (Insomnia)
    CL Item
    Rigors (Rigors/chills)
    C0424790 (NCI Metathesaurus)
    CL Item
    Dry Skin (Dry skin)
    C0151908 (NCI Metathesaurus)
    CL Item
    Alopecia (Hair loss/alopecia)
    C2865 (NCI Thesaurus)
    CL Item
    Nail Abnormality Nos (Nail changes)
    CL038732 (NCI Metathesaurus)
    CL Item
    Dermatitis Exfoliative Nos (Rash/desquamation)
    CL Item
    Pruritus Nos (Pruritus/itching)
    CL Item
    Erythema Multiforme (Rash: erythema multiforme)
    C3024 (NCI Thesaurus)
    C0014742 (UMLS 2011AA)
    CL Item
    Anorexia (Anorexia)
    C2875 (NCI Thesaurus)
    C0003123 (UMLS 2011AA)
    CL Item
    Constipation (Constipation)
    C37930 (NCI Thesaurus)
    C0009806 (UMLS 2011AA)
    CL Item
    Diarrhoea Nos (Diarrhea)
    CL Item
    Dry Mouth (Dry mouth/salivary gland)
    C26917 (NCI Thesaurus)
    C0043352 (UMLS 2011AA)
    CL Item
    Mucositis/stomatitis (clinical Exam) (Mucositis/stomatitis (clinical exam) - oral cavity)
    CL Item
    Stomatitis (Mucositis/stomatitis (clinical exam) - pharynx)
    C26887 (NCI Thesaurus)
    C0038362 (UMLS 2011AA)
    CL Item
    Mucositis/stomatitis (functional/symptomatic) (Mucositis/stomatitis (functional/symptomatic) - oral cavity)
    CL Item
    Mucositis/stomatitis (functional/symptomatic) (Mucositis/stomatitis (functional/symptomatic) - pharynx)
    CL Item
    Nausea (Nausea)
    C3258 (NCI Thesaurus)
    C0027497 (UMLS 2011AA)
    CL Item
    Vomiting Nos (Vomiting)
    CL Item
    Hemorrhage, Gu (Hemorrhage, GU - bladder)
    CL Item
    Haematuria Present (Hemorrhage, GU - urinary NOS)
    CL Item
    Hemorrhage, Gu (Hemorrhage, GU - uterus)
    CL Item
    Alanine Aminotransferase Increased (ALT, SGPT)
    C26948 (NCI Thesaurus)
    C0151905 (UMLS 2011AA)
    CL Item
    Aspartate Aminotransferase Increased (AST, SGOT)
    C26947 (NCI Thesaurus)
    C0151904 (UMLS 2011AA)
    CL Item
    Blood Alkaline Phosphatase Nos Increased (Alkaline phosphatase)
    CL Item
    Blood Bilirubin Increased (Bilirubin)
    CL039714 (NCI Metathesaurus)
    CL Item
    Blood Creatinine Increased (Creatinine)
    C0235431 (NCI Metathesaurus)
    CL Item
    Muscle Weakness, Generalized Or Specific Area (not Due To Neuropathy) (Muscle weakness, generalized or specific area - extremity-lower)
    CL Item
    Muscle Weakness, Generalized Or Specific Area (not Due To Neuropathy) (Muscle weakness, generalized or specific area - extremity-upper)
    CL Item
    Muscle Weakness, Generalized Or Specific Area (not Due To Neuropathy) (Muscle weakness, generalized or specific area - whole body/generalized)
    CL Item
    Peripheral Sensory Neuropathy (Neuropathy - sensory)
    C3501 (NCI Thesaurus)
    C0151313 (UMLS 2011AA)
    CL Item
    Convulsions Nos (Seizure)
    CL Item
    Keratitis Nec (Keratitis)
    CL Item
    Conjunctivitis Nec (Ocular surface disease)
    CL Item
    Ocular/visual Other (Ocular/visual - other)
    CL Item
    Chest Pain (Pain - chest/thorax NOS)
    C38665 (NCI Thesaurus)
    C0008031 (UMLS 2011AA)
    CL Item
    Headache Nos (Pain - head/headache)
    CL Item
    Arthralgia (Pain - Joint)
    C0003862 (NCI Metathesaurus)
    CL Item
    Myalgia (Pain - muscle)
    C27009 (NCI Thesaurus)
    C0231528 (UMLS 2011AA)
    CL Item
    Tumour Pain (Pain - tumor pain)
    CL Item
    Pain Other (Pain - other)
    CL Item
    Dyspnoea Nos (Dyspnea)
    CL Item
    Pleural Effusion (Pleural effusion)
    C3331 (NCI Thesaurus)
    C0021071 (UMLS 2011AA)
    CL Item
    Pneumonitis Nos (Pneumonitis/pulmonary infiltrates)
    CTC Adverse Event Term
    Item
    CTC Adverse Event Term, Other (specify using CTCAE 3.0 terminology)
    text
    C25685 (NCI Thesaurus ValueDomain)
    C1516728 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C2826934 (UMLS CUI-2)
    C45559 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC adverse event Grade (1 - 5)
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    CTC Adverse Event Grade
    Item
    CTC adverse event Grade (1 - 5)
    float
    C49704 (NCI Thesaurus ObjectClass)
    C2985911 (UMLS CUI-1)
    C18000 (NCI Thesaurus ValueDomain)
    C25365 (NCI Thesaurus Property)
    Item
    CTC Adverse Event Attribution Code
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code
    CL Item
    Unrelated (unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (unlikely)
    CL Item
    Possible (possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (definite)
    CL209464 (NCI Metathesaurus)
    Item
    CTC Adverse Event Attribution Code
    text
    C25664 (NCI Thesaurus ValueDomain)
    C1706735 (UMLS CUI-1)
    C49704 (NCI Thesaurus ObjectClass)
    C25358 (NCI Thesaurus Property)
    Code List
    CTC Adverse Event Attribution Code
    CL Item
    Unrelated (unrelated)
    C25328 (NCI Thesaurus)
    C0445356 (UMLS 2011AA)
    CL Item
    Unlikely (unlikely)
    CL Item
    Possible (possible)
    C0332149 (NCI Metathesaurus)
    CL Item
    Probable (probable)
    C0332148 (NCI Metathesaurus)
    CL Item
    Definite (definite)
    CL209464 (NCI Metathesaurus)
    Adverse Event Onset Date
    Item
    Adverse event onset date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985916 (UMLS CUI-1)
    C25367 (NCI Thesaurus ValueDomain-2)
    C49704 (NCI Thesaurus ObjectClass)
    C25279 (NCI Thesaurus Property)
    Adverse Event Onset Date
    Item
    Adverse event onset date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C2985916 (UMLS CUI-1)
    C25367 (NCI Thesaurus ValueDomain-2)
    C49704 (NCI Thesaurus ObjectClass)
    C25279 (NCI Thesaurus Property)
    AdverseEventSymptomEndDate
    Item
    Adverse event end date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C4876 (NCI Thesaurus Property)
    C1457887 (UMLS 2011AA Property)
    AdverseEventSymptomEndDate
    Item
    Adverse event end date
    date
    C25164 (NCI Thesaurus ValueDomain)
    C0011008 (UMLS 2011AA ValueDomain)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C4876 (NCI Thesaurus Property)
    C1457887 (UMLS 2011AA Property)
    Item
    AE status code
    text
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C25379 (NCI Thesaurus Property-2)
    C0750729 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    AE status code
    CL Item
    New (New)
    C25586 (NCI Thesaurus)
    C0205314 (UMLS 2011AA)
    CL Item
    Continues At Same Or Lower Grade (Continues at same or lower grade)
    CL Item
    Increased Grade Or Improved Then Worsened (Increased grade or improved then worsened)
    Item
    AE status code
    text
    C20989 (NCI Thesaurus Property)
    C0031809 (UMLS 2011AA Property)
    C41331 (NCI Thesaurus ObjectClass)
    C0877248 (UMLS 2011AA ObjectClass)
    C25379 (NCI Thesaurus Property-2)
    C0750729 (UMLS 2011AA Property-2)
    C25688 (NCI Thesaurus ValueDomain)
    C0449438 (UMLS 2011AA ValueDomain)
    Code List
    AE status code
    CL Item
    New (New)
    C25586 (NCI Thesaurus)
    C0205314 (UMLS 2011AA)
    CL Item
    Continues At Same Or Lower Grade (Continues at same or lower grade)
    CL Item
    Increased Grade Or Improved Then Worsened (Increased grade or improved then worsened)
    Selectboxifadverseeventwereassessedbutnonewereseen
    Item
    Select box if adverse event were assessed but none were seen
    text
    Item Group
    Comments
    Research Comments
    Item
    Comments
    text
    C25704 (NCI Thesaurus ValueDomain)
    C0947611 (UMLS CUI-1)
    C15319 (NCI Thesaurus ObjectClass)
    C25393 (NCI Thesaurus Property)

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