ID
9612
Description
E1A06 Adverse Event Form (CTCAE v3) Melphalan, Prednisone, and Thalidomide or Lenalidomide in Treating Patients With Newly Diagnosed Multiple Myeloma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=406515E8-0840-569A-E044-0003BA3F9857
Link
Keywords
Versions (6)
- 9/19/12 9/19/12 -
- 1/8/15 1/8/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 1/9/15 1/9/15 - Martin Dugas
- 4/20/15 4/20/15 - Martin Dugas
- 9/20/21 9/20/21 -
Uploaded on
January 9, 2015
DOI
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License
Creative Commons BY-NC 3.0 Legacy
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Multiple Myeloma and Plasma Cell Neoplasm NCT00602641 Toxicity - E1A06 Adverse Event Form (CTCAE v3) - 2705272v1.0
No Instruction available.
- StudyEvent: E1A06 Adverse Event Form (CTCAE v3)
Description
Unnamed2
Description
Data amended
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- NCI Thesaurus Property
- C25416
Description
Data amended date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C0680532
- NCI Thesaurus ObjectClass
- C25474
- UMLS CUI-2
- C0011008
- NCI Thesaurus Property
- C25416
- NCI Thesaurus ValueDomain-2
- C25367
Description
On Treatment
Description
Cycle number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Description
Cycle number
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C2045829
- NCI Thesaurus Property
- C25214
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ObjectClass
- C15368
Description
Chemotherapy cycle
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C15368
- NCI Thesaurus Property
- C25214
- UMLS CUI-1
- C1302181
- NCI Thesaurus Property-2
- C25616
- NCI Thesaurus ValueDomain
- C25685
- NCI Thesaurus ValueDomain-2
- C25472
- NCI Thesaurus ValueDomain-3
- C25275
Description
Off Treatment
Description
PersonOff-TreatmentTimePeriodType
Data type
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25616
- UMLS 2011AA Property
- C1948053
- NCI Thesaurus Property-2
- C25601
- UMLS 2011AA Property-2
- C1518544
- NCI Thesaurus Property-3
- C25207
- UMLS 2011AA Property-3
- C0040223
- NCI Thesaurus ValueDomain
- C25284
- UMLS 2011AA ValueDomain
- C0332307
Description
Unnamed4
Description
AdverseEventCurrentAssessmentInd
Data type
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
Description
Adverse Event Start Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2697888
- NCI Thesaurus Property
- C25375
- NCI Thesaurus ValueDomain-2
- C25431
- NCI Thesaurus ObjectClass
- C49704
Description
Adverse Event End Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2697886
- NCI Thesaurus Property
- C25375
- NCI Thesaurus ObjectClass
- C49704
Description
Unnamed5
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C45559
Description
CTC Adverse Event Grade
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Description
CTC Adverse Event Attribution Category
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1706735
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
Description
Unnamed6
Description
CTC Adverse Event Term
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25284
- UMLS CUI-1
- C1516728
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-2
- C2826934
- NCI Thesaurus Property
- C45559
Description
CTC Adverse Event Grade
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Description
CTC Adverse Event Attribution Category
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1706735
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
Description
Iii. Infections
Description
CommonToxicityCriteriaAdverseEventShortNameType
Data type
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
Description
CTC Adverse Event Term
Data type
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
Description
CTC Adverse Event Grade
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Description
CTC Adverse Event Attribution Category
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1706735
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
Description
Other Adverse Events
Description
CommonToxicityCriteriaAdverseEventShortNameType
Data type
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
Description
CTC Adverse Event Term
Data type
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
Description
CTC Adverse Event Grade
Data type
float
Alias
- NCI Thesaurus ObjectClass
- C49704
- UMLS CUI-1
- C2985911
- NCI Thesaurus ValueDomain
- C18000
- NCI Thesaurus Property
- C25365
Description
CTC Adverse Event Attribution Category
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25664
- UMLS CUI-1
- C1706735
- NCI Thesaurus ObjectClass
- C49704
- NCI Thesaurus Property
- C25358
Description
Comments
Description
Investigator Signature
Data type
text
Alias
- NCI Thesaurus ValueDomain
- C25704
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- NCI Thesaurus ObjectClass
- C17089
Description
Investigator Signature Date
Data type
date
Alias
- NCI Thesaurus ValueDomain
- C25164
- UMLS CUI-1
- C2346576
- NCI Thesaurus Property
- C25678
- UMLS CUI-2
- C0011008
- NCI Thesaurus ValueDomain-2
- C25367
- NCI Thesaurus ObjectClass
- C17089
Similar models
No Instruction available.
- StudyEvent: E1A06 Adverse Event Form (CTCAE v3)
C3242750 (UMLS CUI-1)
C19464 (NCI Thesaurus Property)
C25474 (NCI Thesaurus ObjectClass)
C25452 (NCI Thesaurus ObjectClass-2)
C1514821 (UMLS CUI-1)
C25646 (NCI Thesaurus ObjectClass)
C0237753 (UMLS CUI-2)
C16154 (NCI Thesaurus Property)
C16154 (NCI Thesaurus ValueDomain-2)
C2986440 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C25536 (NCI Thesaurus Property)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C1512162 (UMLS CUI-2)
C25364 (NCI Thesaurus Property)
C25491 (NCI Thesaurus Property-2)
C3274381 (UMLS CUI-1)
C25320 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C2348585 (UMLS CUI-1)
C16960 (NCI Thesaurus ObjectClass)
C2347449 (UMLS CUI-2)
C25608 (NCI Thesaurus Property)
C25364 (NCI Thesaurus Property-2)
C1301943 (UMLS CUI-1)
C21541 (NCI Thesaurus ObjectClass-2)
C25364 (NCI Thesaurus Property)
C25191 (NCI Thesaurus ValueDomain)
C21541 (NCI Thesaurus ValueDomain-2)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C25416 (NCI Thesaurus Property)
C0680532 (UMLS CUI-1)
C25474 (NCI Thesaurus ObjectClass)
C0011008 (UMLS CUI-2)
C25416 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C2045829 (UMLS CUI-1)
C25214 (NCI Thesaurus Property)
C25616 (NCI Thesaurus Property-2)
C15368 (NCI Thesaurus ObjectClass)
C25214 (NCI Thesaurus Property)
C1302181 (UMLS CUI-1)
C25616 (NCI Thesaurus Property-2)
C25685 (NCI Thesaurus ValueDomain)
C25472 (NCI Thesaurus ValueDomain-2)
C25275 (NCI Thesaurus ValueDomain-3)
C0027361 (UMLS 2011AA ObjectClass)
C25616 (NCI Thesaurus Property)
C1948053 (UMLS 2011AA Property)
C25601 (NCI Thesaurus Property-2)
C1518544 (UMLS 2011AA Property-2)
C25207 (NCI Thesaurus Property-3)
C0040223 (UMLS 2011AA Property-3)
C25284 (NCI Thesaurus ValueDomain)
C0332307 (UMLS 2011AA 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)
C1298908 (UMLS 2011AA)
C2697888 (UMLS CUI-1)
C25375 (NCI Thesaurus Property)
C25431 (NCI Thesaurus ValueDomain-2)
C49704 (NCI Thesaurus ObjectClass)
C2697886 (UMLS CUI-1)
C25375 (NCI Thesaurus Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C45559 (NCI Thesaurus Property)
C0009676 (UMLS 2011AA)
C0009806 (UMLS 2011AA)
C0015672 (UMLS 2011AA)
C0027497 (UMLS 2011AA)
C0151313 (UMLS 2011AA)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C0445356 (UMLS 2011AA)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C45559 (NCI Thesaurus Property)
C0009676 (UMLS 2011AA)
C0009806 (UMLS 2011AA)
C0015672 (UMLS 2011AA)
C0027497 (UMLS 2011AA)
C0151313 (UMLS 2011AA)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C0445356 (UMLS 2011AA)
C0600091 (UMLS 2011AA Property)
C49704 (NCI Thesaurus ObjectClass)
C1516728 (UMLS 2011AA ObjectClass)
C0332307 (NCI Metathesaurus ValueDomain)
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C1806781 (UMLS 2011AA Property-2)
C0151905 (UMLS 2011AA)
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C0035222 (UMLS 2011AA)
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C0151904 (UMLS 2011AA)
C0013491 (UMLS 2011AA)
C0009676 (UMLS 2011AA)
C0009806 (UMLS 2011AA)
C0010200 (UMLS 2011AA)
C0878661 (UMLS 2011AA)
C0011175 (UMLS 2011AA)
C0012739 (UMLS 2011AA)
C0012569 (UMLS 2011AA)
C0011168 (UMLS 2011AA)
C0242350 (UMLS 2011AA)
C0014742 (UMLS 2011AA)
C0015672 (UMLS 2011AA)
C0015799 (UMLS 2011AA)
C0016382 (UMLS 2011AA)
C0151662 (UMLS 2011AA)
C0013395 (UMLS 2011AA)
C0020676 (UMLS 2011AA)
C0242184 (UMLS 2011AA)
C0021167 (UMLS 2011AA)
C0085605 (UMLS 2011AA)
C0024312 (UMLS 2011AA)
C0026975 (UMLS 2011AA)
C0027121 (UMLS 2011AA)
C0028754 (UMLS 2011AA)
C0029456 (UMLS 2011AA)
C0031039 (UMLS 2011AA)
C0085636 (UMLS 2011AA)
C0021071 (UMLS 2011AA)
C0020541 (UMLS 2011AA)
C0034069 (UMLS 2011AA)
C0677481 (UMLS 2011AA)
C0085612 (UMLS 2011AA)
C1516728 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C2826934 (UMLS CUI-2)
C38024 (NCI Thesaurus Property)
C45559 (NCI Thesaurus Property-2)
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C0007531 (UMLS 2011AA)
C0007874 (UMLS 2011AA)
C62484 (NCI Thesaurus)
C0205076 (UMLS 2011AA)
C0009368 (UMLS 2011AA)
C0009758 (UMLS 2011AA)
C0011065 (UMLS 2011AA)
C0011570 (UMLS 2011AA)
C0013303 (UMLS 2011AA)
C0014876 (UMLS 2011AA)
C0013453 (UMLS 2011AA)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
C0015450 (UMLS 2011AA)
C13071 (NCI Thesaurus-3)
C0015450 (UMLS 2011AA-4)
C0015450 (UMLS 2011AA)
C13071 (NCI Thesaurus-3)
C0015450 (UMLS 2011AA-4)
C0015560 (UMLS 2011AA)
C0016976 (UMLS 2011AA)
C0017562 (UMLS 2011AA)
C0018670 (UMLS 2011AA)
C0018787 (UMLS 2011AA)
C0205054 (UMLS 2011AA)
C0021853 (UMLS 2011AA)
C0022378 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0023078 (UMLS 2011AA)
C0023759 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0024204 (UMLS 2011AA)
C0025066 (UMLS 2011AA)
C12748 (NCI Thesaurus-3)
C0025066 (UMLS 2011AA-4)
C0025066 (UMLS 2011AA)
C12748 (NCI Thesaurus-3)
C0025066 (UMLS 2011AA-4)
C0026845 (UMLS 2011AA)
C0027423 (UMLS 2011AA)
C0027530 (UMLS 2011AA)
C0027530 (UMLS 2011AA)
C1527415 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0029939 (UMLS 2011AA)
C0030193 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0030580 (UMLS 2011AA)
C0030797 (UMLS 2011AA)
C0030797 (UMLS 2011AA)
C0030851 (UMLS 2011AA)
C0031050 (UMLS 2011AA)
C0031066 (UMLS 2011AA)
C1704247 (UMLS 2011AA)
C0031153 (UMLS 2011AA)
C0031354 (UMLS 2011AA)
C0032225 (UMLS 2011AA)
C0033572 (UMLS 2011AA)
C1882536 (UMLS 2011AA)
C0034896 (UMLS 2011AA)
C0035298 (UMLS 2011AA)
C0035359 (UMLS 2011AA)
C0036098 (UMLS 2011AA)
C0036471 (UMLS 2011AA)
C0037052 (UMLS 2011AA)
C0085610 (UMLS 2011AA)
C0039239 (UMLS 2011AA)
C1123023 (UMLS 2011AA)
C0037925 (UMLS 2011AA)
C0037993 (UMLS 2011AA)
C0042993 (UMLS 2011AA)
C0043202 (UMLS 2011AA)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
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C0009806 (UMLS 2011AA)
C0010200 (UMLS 2011AA)
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C0013395 (UMLS 2011AA)
C0020676 (UMLS 2011AA)
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C0085605 (UMLS 2011AA)
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C0026975 (UMLS 2011AA)
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C0007531 (UMLS 2011AA)
C0007874 (UMLS 2011AA)
C62484 (NCI Thesaurus)
C0205076 (UMLS 2011AA)
C0009368 (UMLS 2011AA)
C0009758 (UMLS 2011AA)
C0011065 (UMLS 2011AA)
C0011570 (UMLS 2011AA)
C0013303 (UMLS 2011AA)
C0014876 (UMLS 2011AA)
C0013453 (UMLS 2011AA)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
C0015392 (UMLS 2011AA)
C12401 (NCI Thesaurus-3)
C0015392 (UMLS 2011AA-4)
C0015450 (UMLS 2011AA)
C13071 (NCI Thesaurus-3)
C0015450 (UMLS 2011AA-4)
C0015450 (UMLS 2011AA)
C13071 (NCI Thesaurus-3)
C0015450 (UMLS 2011AA-4)
C0015560 (UMLS 2011AA)
C0016976 (UMLS 2011AA)
C0017562 (UMLS 2011AA)
C0018670 (UMLS 2011AA)
C0018787 (UMLS 2011AA)
C0205054 (UMLS 2011AA)
C0021853 (UMLS 2011AA)
C0022378 (UMLS 2011AA)
C0022646 (UMLS 2011AA)
C0023078 (UMLS 2011AA)
C0023759 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0024204 (UMLS 2011AA)
C0025066 (UMLS 2011AA)
C12748 (NCI Thesaurus-3)
C0025066 (UMLS 2011AA-4)
C0025066 (UMLS 2011AA)
C12748 (NCI Thesaurus-3)
C0025066 (UMLS 2011AA-4)
C0026845 (UMLS 2011AA)
C0027423 (UMLS 2011AA)
C0027530 (UMLS 2011AA)
C0027530 (UMLS 2011AA)
C1527415 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0029939 (UMLS 2011AA)
C0030193 (UMLS 2011AA)
C0030274 (UMLS 2011AA)
C0030580 (UMLS 2011AA)
C0030797 (UMLS 2011AA)
C0030797 (UMLS 2011AA)
C0030851 (UMLS 2011AA)
C0031050 (UMLS 2011AA)
C0031066 (UMLS 2011AA)
C1704247 (UMLS 2011AA)
C0031153 (UMLS 2011AA)
C0031354 (UMLS 2011AA)
C0032225 (UMLS 2011AA)
C0033572 (UMLS 2011AA)
C1882536 (UMLS 2011AA)
C0034896 (UMLS 2011AA)
C0035298 (UMLS 2011AA)
C0035359 (UMLS 2011AA)
C0036098 (UMLS 2011AA)
C0036471 (UMLS 2011AA)
C0037052 (UMLS 2011AA)
C0085610 (UMLS 2011AA)
C0039239 (UMLS 2011AA)
C1123023 (UMLS 2011AA)
C0037925 (UMLS 2011AA)
C0037993 (UMLS 2011AA)
C0042993 (UMLS 2011AA)
C0043202 (UMLS 2011AA)
C2985911 (UMLS CUI-1)
C18000 (NCI Thesaurus ValueDomain)
C25365 (NCI Thesaurus Property)
C1706735 (UMLS CUI-1)
C49704 (NCI Thesaurus ObjectClass)
C25358 (NCI Thesaurus Property)
C0445356 (UMLS 2011AA)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C17089 (NCI Thesaurus ObjectClass)
C2346576 (UMLS CUI-1)
C25678 (NCI Thesaurus Property)
C0011008 (UMLS CUI-2)
C25367 (NCI Thesaurus ValueDomain-2)
C17089 (NCI Thesaurus ObjectClass)