Zoekresultaten - Portaal voor medische datamodellen (MDM-portaal)

Breast Cancer Adverse Event NCT00382070 - rade 2 and 3 Adverse Event Report Breast Cancer NCT00382070 NSABP B-42

- 20-09-21 - 1 Formulier, 2 Itemgroepen, 9 Data-elementen, 1 Taal

Itemgroepen: Header, Adverse event

NSABP Protocol B-42 - Grade 2 and 3 Adverse Event (AE) Report Form Worksheet Letrozole in Treating Postmenopausal Women Who Have Received Hormone Therapy for Hormone Receptor-Positive Breast Cancer NCT00382070 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=17ADF05F-DB75-341D-E044-0003BA3F9857

Endometrial Cancer NCT00942357 Toxicity - Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC) - 2845009v1.0 - Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC)

- 09-01-15 - 1 Formulier, 4 Itemgroepen, 17 Data-elementen, 1 Taal

Itemgroepen: HEADER MODULE, ADVERSE EVENTS - SECTION 1, ADVERSE EVENTS - SECTION 2, COMMENTS

Gynecologic Oncology Group Follow-Up Period Adverse Event Reporting Form (TLC) Carboplatin and Paclitaxel With or Without Cisplatin and Radiation Therapy in Treating Patients With Stage I, Stage II, Stage III, or Stage IVA Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=644E86D7-E1C5-D7C8-E040-BB89AD4321CC

Endometrial Cancer NCT00807768 Toxicity - GOG-0249 Follow-Up Period Adverse Event Reporting Form - 2760083v1.0 - GOG-0249 Follow-Up Period Adverse Event Reporting Form

- 09-01-15 - 1 Formulier, 4 Itemgroepen, 18 Data-elementen, 1 Taal

Itemgroepen: HEADER MODULE, ADVERSE EVENTS - SECTION 1, ADVERSE EVENTS - SECTION 2, COMMENTS

GOG-0249 Follow-Up Period Adverse Event Reporting Form Pelvic Radiation Therapy or Vaginal Implant Radiation Therapy, Paclitaxel, and Carboplatin in Treating Patients With High-Risk Stage I or Stage II Endometrial Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=4FF32E53-FBDD-394B-E044-0003BA3F9857

Anal Cancer NCT00324415 Toxicity - AMC-045 Type III Adverse Event Reporting Form (TAE) - 2516535v1.0 - AMC-045 Type III Adverse Event Reporting Form (TAE)

- 13-04-21 - 1 Formulier, 3 Itemgroepen, 7 Data-elementen, 1 Taal

Itemgroepen: Administrative, Severe Adverse Event (Grade 3), Comments

AMC-045 Type III Adverse Event Reporting Form (TAE) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=1C146B28-823F-583B-E044-0003BA3F9857

NCT00113386 RTOG-0412 AE: Adverse Event Evaluation Form

- 08-07-15 - 1 Formulier, 6 Itemgroepen, 46 Data-elementen, 1 Taal

Itemgroepen: RTOG clinical trial administrative data, REPORT ALL CONTINUING OR NEW ADVERSE EVENTS, Laboratory Procedure Date, Blood, Chemistries, Other studies

NCT00113386 RTOG-0412 AE: Adverse Event Evaluation Form Cisplatin and Docetaxel With or Without Radiation Therapy in Treating Patients Who Are Undergoing Surgery for Newly Diagnosed Stage III Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E488DFC2-2D0B-654D-E034-0003BA3F9857

E2805 Adverse Event Form - (CTCAE v3) NCT00326898

- 08-07-15 - 1 Formulier, 11 Itemgroepen, 51 Data-elementen, 1 Taal

Itemgroepen: Header, Patient demographics, Data amendment, ON TREATMENT, OFF TREATMENT, Adverse Event Current Assessment, BLOOD/BONE MARROW/METABOLIC - LABS, NON-HEMATOLOGIC, II. INFECTIONS, Other Adverse Events, Comments

E2805 Adverse Event Form - (CTCAE v3) NCT00326898 Sunitinib or Sorafenib in Treating Patients With Kidney Cancer That Was Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0538F350-3C05-47A5-E044-0003BA3F9857

ECOG-E1505 Adverse Event Form (CTCAE v4) NCT00324805

- 08-07-15 - 1 Formulier, 14 Itemgroepen, 56 Data-elementen, 1 Taal

Itemgroepen: Header, Patient demographics, Data amendment, ON TREATMENT, OFF TREATMENT, Adverse Event Current Assessment, I. Non-Hematologic, II. GI Fistula , III. GI Perforations, IV. Pulmonary Hemorrhages, V. Non-Hematologic, VI. Infections, VII. Other Adverse Events, Footer Module

ECOG-E1505 Adverse Event Form (CTCAE v4) NCT00324805 Chemotherapy With or Without Bevacizumab in Treating Patients With Stage IB, Stage II, or Stage IIIA Non-Small Lung Cancer That Was Removed By Surgery Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=07D0D172-AF48-5791-E044-0003BA3F9857

Lung Cancer NCT00096265 Toxicity - AE RTOG Phase III Multiple Brain Metastases Adverse Event Evaluation Form - 2277984v3.0 - AE RTOG Phase III Multiple Brain Metastases Adverse Event Evaluation Form

- 09-01-15 - 1 Formulier, 1 Itemgroep, 65 Data-elementen, 1 Taal

Itemgroep: Header

AE RTOG Phase III Multiple Brain Metastases Adverse Event Evaluation Form Radiation Therapy and Stereotactic Radiosurgery With or Without Temozolomide or Erlotinib in Treating Patients With Brain Metastases Secondary to Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=D81D6073-C669-0831-E034-0003BA12F5E7

Toxicity - Lung Cancer - Adverse Event Form - 2262800v3.0 - Lung Cancer - Adverse Event Form

- 09-01-15 - 1 Formulier, 3 Itemgroepen, 15 Data-elementen, 1 Taal

Itemgroepen: CRF Header, Lung: Adverse Events, Comments

Lung Cancer - Adverse Event Form Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=DE33598D-A1FD-3B22-E034-0003BA12F5E7

Lung Cancer NCT01336894 Toxicity - ACOSOG-Z4099 Adverse Event Form - 3171942v1.0 - ACOSOG-Z4099 Adverse Event Form

- 09-01-15 - 1 Formulier, 4 Itemgroepen, 19 Data-elementen, 1 Taal

Itemgroepen: Header Module, Date of Evaluation, Required Adverse Events from Section 8 of Protocol, Additional Adverse Events

ACOSOG-Z4099 Adverse Event Form Surgery With or Without Internal Radiation Therapy Compared With Stereotactic Body Radiation Therapy in Treating Patients With High-Risk Stage I Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=97DED333-F731-8590-E040-BB89AD43483A

Prostate Cancer Toxicity - E1805 - Adverse Event Prostated Cancer E1805

- 20-09-21 - 1 Formulier, 6 Itemgroepen, 25 Data-elementen, 1 Taal

Itemgroepen: Header, ON TREATMENT, Adverse Event, Adverse event blood, bone marrow lab, Adverse event infection, Other Adverse Events

E1805 Adverse Event Form (CTCAE v3.0) Prostate Cancer Toxicity - E1805 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=0F33944C-5CE4-6FA2-E044-0003BA3F9857

Serious adverse events GSK study Prostatic neoplasms NCT00883909

- 26-11-17 - 1 Formulier, 14 Itemgroepen, 58 Data-elementen, 1 Taal

Itemgroepen: administrative data, Serious adverse event, Serious adverse event, SAE, Demography data, Recurrence of SAE, Causes of SAE, Relevant Medical Conditions, risk factors, concomitant medication, Drug Details, Assessments, Remarks, information Investigator

Study ID: 103094 Clinical Study ID: ARI103094 Study Title: ARI103094-Follow-Up Study for REDUCE Study Subjects Patient Level Data: Study Listed on ClinicalStudyDataRequest.com Clinicaltrials.gov Identifier: NCT00883909 Sponsor: GlaxoSmithKline Collaborators: N/A Phase: Phase 3 Study Recruitment Status: Completed Generic Name: dutasteride Trade Name: Zytefor,Zyfetor,Duagen,Avolve,Avodart,Avidart Study Indication: Neoplasms, Prostate

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