- 2021-09-20 - 16 Formulär, 16 Item-grupper, 68 Dataelement, 1 Språk
Item-grupper: Therapy cycle 10-13, Therapy after cycle, Propranolol, Propranolol therapy deviation, Celecoxib, Celecoxib deviation, Cyclophosphamide, Cyclophosphamide deviation, Vinblastine, Vinblastine deviation, Toxicity overview, Toxicity, Hospitalization, Comments, Transfusion, Footer module

Therapy and toxicity cycle > 13

16 Item-grupper 68 Dataelement

Therapy and toxicity cycle 1-3

16 Item-grupper 68 Dataelement

Therapy and toxicity cycle 4-6

16 Item-grupper 68 Dataelement

Therapy and toxicity cycle 7-9

16 Item-grupper 68 Dataelement

Baseline

13 Item-grupper 77 Dataelement

Reference

12 Item-grupper 111 Dataelement
- 2021-09-20 - 1 Formulär, 17 Item-grupper, 83 Dataelement, 2 Språk
Item-grupper: Patient demographics, Therapy, Chemotherapy Regimen, Intrathecal therapy, Supportive therapy, Administration of medication, Comorbidity at the therapy begin, Medication duration, G-CSF, Cycle duration, Therapy discontinuation, Stem Cell Mobilization, Lab results prior to chemotherapy cycle, Lab results during interval after chemotherapy cycle, Toxicity, Intercurrent disease, Footer module
- 2015-12-07 - 1 Formulär, 10 Item-grupper, 26 Dataelement, 2 Språk
Item-grupper: Allergy, Patient condition, Skin, Gastrointestinal, Hepatic, Metabolic / Laboratory, Pulmonary, Pain, Renal/Genitourinary, Appendix VI: BMT complex
- 2015-12-07 - 1 Formulär, 10 Item-grupper, 26 Dataelement, 2 Språk
Item-grupper: Hypersensitivity, Patient condition, Skin, Gastrointestinal, Hepatic, Metabolic/Laboratory, Pulmonary, Pain, Renal/Genitourinary, Appendix VI: BMT complex
- 2015-12-06 - 1 Formulär, 10 Item-grupper, 26 Dataelement, 2 Språk
Item-grupper: Allergy, Patient condition, Skin, Gastrointestinal, Hepatic, Metabolic/ Laboratory, Pulmonary, Pain, Renal/ Genitourinary, Appendix VI: BMT complex
- 2015-12-06 - 1 Formulär, 10 Item-grupper, 26 Dataelement, 2 Språk
Item-grupper: Allergy, Patient condition, Skin, Gastrointestinal, Hepatic, Metabolic/ Laboratory, Pulmonary, Pain, Renal / Genitourinary system, Appendix VI: BMT complex
- 2015-01-09 - 1 Formulär, 20 Item-grupper, 141 Dataelement, 1 Språk
Item-grupper: Adverse event, REPORTER_INFORMATION, PHYSICIAN_INFORMATION, SUBMITTER_INFORMATION, COURSE_INFORMATION, DESCRIPTION_OF_EVENT, INSTITUTION_INFORMATION, PROTOCOL_INFORMATION, PATIENT_INFORMATION, PRIOR_THERAPY, CHEMOAGENTS, PRE_EXISTING_CONDITION, SITE_NAME, PROTOCOL_AGENT, CONCOMITANT_MEDICATION, OTHER_CONTRIBUTING_CAUSE, ADVERSE_EVENT_CTC, ATTRIBUTION_FOR_AE, LAB_RESULT, ADDITIONAL_INFO

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