- 26.06.15 - 1 formulario, 24 itemgroups, 84 items, 2 idiomas
Itemgroups: General Info, Influenza-like symptoms, Constitutional symptoms, Ocular/Visual, Dermatologic, Cardiac, Pulmonary, Gastrointestinal, Vascular, Neurologic, Hematological, Infection sites, For each of the sites listed below, indicate the severity of infection present, Pain sites, Severity of pain, Donor Pre-Apheresis vital signs, Donor Pre-Apheresis hematology, First apheresis, Specify therapy, Second apheresis, Specify therapy, Third apheresis, Specify therapy, Donor post-apheresis hematology
- 24.04.18 - 1 formulario, 12 itemgroups, 36 items, 1 idioma
Itemgroups: Identification Numbers, Serious Adverse Experiences, 12-Lead Electrocardiogram, Echocardiogram or Multiple Gated Acquisition Scanning (MUGA), If Yes for the obtained Ejection Fraction, Chest X-Ray, Supportive Therapy (Including Erythropoietin), If Yes to Supportive Therapy (Including Erythropoietin), Supportive Anti-Infective Therapy, If Yes to Supportive Anti-Infective Therapy, Concominant Medication, If Yes to Concominant Medication
- 20.09.21 - 1 formulario, 49 itemgroups, 239 items, 2 idiomas
Itemgroups: General information, allergic reaction, Hämoglobin, Leukocytes, Neutrophils, Platelets, Arrhythmias, Cardiac ischemia/infarction, Hypertension, Hypotension, Left ventricular systolic dysfunction, Pericarditis, Pulmonary Hypertension, DIC, Fibrinogen, Fever (Neutrophils > 1,0 GPt/l), Neutropenic fever, Rash/desquamation, Pancreas endocrine, Diarrhea, Dysphagia/Esophagitis/Gastritis/Ileus, Enteritis, Mukositis/Stomatitis, Nausea and vomiting, Hemorrhage, Pankreatitis, Infection, Alkaline Phosphatase, ALAT, GPT, ASAT, GOT, Bilirubin, Creatinine, GGT, Ataxia, Motor neuropathy, Sensory neuropathy, Seizures, Nystagmus, Disorder of eye, Pain, Dyspnea, Hypoxia, Pleural effusion (non-malignant), Pneumonitis/pulmonary infiltrates, Cystitis, Tumor lysis syndrome, Thrombosis and Embolism, other, Unterschrift
- 24.04.18 - 1 formulario, 26 itemgroups, 84 items, 1 idioma
Itemgroups: Identification Numbers, Demography, Vital Signs, 12-Lead Electrocardiogram, Echocardiogram or Multiple Gated Acquisition Scanning (MUGA), If Yes for the obtained Ejection Fraction, Chest X-Ray, History of Myelodysplastic Syndrome / Acute Myelogenous Leukemia, Previous Chemotherapy for MDS or AML, If Yes to Previous Chemotherapy for MDS or AML, Previous Biologic Therapy and/or Immunotherapy for MDS or AML, If Yes to Previous Biologic Therapy and/or Immunotherapy for MDS or AML, Toxicities Related to Previous Therapy for MDS or AML, If Yes to Toxicities Related to Previous Therapy for MDS or AML, Prior Transfusion Therapy (Including Erythropoietin), If Yes to Prior Transfusion Therapy (Including Erythropoietin), Prior Anti-Infective Therapy, If Yes to Prior Anti-Infective Therapy, Prior and Concominant Medication, If Yes to Prior and Concominant Medication, Ongoing Medical Conditions Associated with MDS or AML, If Yes to Ongoing Medical Conditions Associated with MDS or AML, Prior Malignancies, If Yes to Prior Malignancies, Significant Medical/Surgery History and Physical Examination, If Yes to Significant Medical/Surgery History and Physical Examination

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