Search results - Portal of Medical Data Models (MDM-Portal)

Eligibility Lung Cancer NCT00193310

- 1/19/16 - 1 form, 2 itemgroups, 16 items, 1 language

Itemgroups: Inclusion Criteria, Exclusion Criteria

Preoperative or Postoperative Therapy of Patients With Stages IB, II, IIIA Non-Small Cell Lung Cancer; ODM derived from: https://clinicaltrials.gov/show/NCT00193310

Hypertension Status Form Lung Cancer E1505 NCT00324805

- 8/7/15 - 1 form, 3 itemgroups, 20 items, 1 language

Itemgroups: General information, Reporting Period, Footer Module

E1505 Hypertension Status Form 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=1C55F49C-6CD4-6958-E044-0003BA3F9857

Director's Challenge Lung Study Pathology Evaluation Form

- 7/30/15 - 1 form, 6 itemgroups, 20 items, 1 language

Itemgroups: Enrollment Requirements, Histologic Type, Histologic Grade, Pathological Attributes, Surgical-Pathological Results, Tissue Evaluation

Pathology documentation Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=E6E7E98D-6ED2-346C-E034-0003BA3F9857

ECOG-E1505 Adverse Event Form (CTCAE v4) NCT00324805

- 7/8/15 - 1 form, 14 itemgroups, 56 items, 1 language

Itemgroups: 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

NCT00113386 RTOG-0412 AE: Adverse Event Evaluation Form

- 7/8/15 - 1 form, 6 itemgroups, 46 items, 1 language

Itemgroups: 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

CALGB 30607 ADVERSE EVENT (AE) FORM NCT00693992

- 7/8/15 - 1 form, 4 itemgroups, 24 items, 1 language

Itemgroups: Header, Patient demographics, Adverse event report, EXPECTED ADVERSE EVENTS

CALGB 30607 ADVERSE EVENT (AE) FORM NCT00693992 Sunitinib as Maintenance Therapy in Treating Patients With Stage III or Stage IV Non-Small Cell Lung Cancer Previously Treated With Combination Chemotherapy Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3E7014BB-6920-2114-E044-0003BA3F9857

CALGB: 30801 Adverse Event (AE) Form NCT01041781

- 7/8/15 - 1 form, 4 itemgroups, 26 items, 1 language

Itemgroups: Header Module, Patient demographics, Adverse Event Expedited Reporting System filed?, EXPECTED ADVERSE EVENTS

CALGB: 30801 Adverse Event (AE) Form NCT01041781 Gemcitabine Hydrochloride or Pemetrexed Disodium and Carboplatin With or Without Celecoxib in Treating Patients With Advanced Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=6AF26CA3-DF39-EEE0-E040-BB89AD436D54

CALGB: Thoracic Surgical Complications Form NCT00499330

- 7/8/15 - 1 form, 6 itemgroups, 25 items, 1 language

Itemgroups: Header Module, Patient demographics, Adverse Drug Reaction Report, Expected Adverse Events, Specify any other events that occurred during this time period., Footer Module

CALGB: Thoracic Surgical Complications Form NCT00499330 Comparison of Different Types of Surgery in Treating Patients With Stage IA Non-Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=218BCF6D-8009-5542-E044-0003BA3F9857

CALGB 30610 ADVERSE EVENT (AE) FORM NCT00632853

- 7/8/15 - 1 form, 4 itemgroups, 24 items, 1 language

Itemgroups: Header, Patient demographics, Adverse event report, EXPECTED ADVERSE EVENTS

CALGB 30610 ADVERSE EVENT (AE) FORM NCT00632853 Three Different Radiation Therapy Regimens in Treating Patients With Limited-Stage Small Cell Lung Cancer Receiving Cisplatin and Etoposide Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=3C4CD434-CC4A-4FEC-E044-0003BA3F9857

Form 5 - On & Off Treatment Follow-Up Report NCT00049543

- 7/3/15 - 1 form, 18 itemgroups, 90 items, 1 language

Itemgroups: 1. PATIENT INFORMATION, 2. MONTH OF REPORT, 3. PHYSICAL EXAM, 4. DISEASE STATUS, 5. SYSTEMIC THERAPY REPORT, NCIC CTG use only, Header, 6. NOTICE OF NEW PRIMARY, NCIC CTG use, 7. HEMATOLOGY, 8. BIOCHEMISTRY, 9. TREATMENT GIVEN SINCE LAST REPORT TO NCIC CTG, NCIC CTG use2, 10. ON TREATMENT LONG TERM TOXICITY, 11. COMMENTS, 12. HAVE YOU ATTACHED COPIES OF, 13. INVESTIGATOR SIGNATURE, CCRR MODULE

Form 5 - On & Off Treatment Follow-Up Report NCT00049543 Gefitinib in Treating Patients With Non-Small Cell Lung Cancer That Has Been Surgically Removed Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0E01D72-7CAF-3016-E034-080020C9C0E0

Form 6 - Final Report NCT00049543

- 7/3/15 - 1 form, 13 itemgroups, 59 items, 1 language

Itemgroups: 1. PATIENT INFORMATION, 2. CAUSE OF DEATH, 3. AUTOPSY, 4. OTHER MALIGNANCIES OR MARROW DYSPLASIA, NCIC CTG use, NCIC CTG use only, 5. TREATMENT GIVEN SINCE LAST REPORT TO NCIC CTG, NCIC CTG use2, 6. DELAYED TOXICITY/ADVERSE EVENT/INTERCURRENT ILLNESS, 7. COMMENTS, 8. HAVE YOU ATTACHED COPIES OF, 9. INVESTIGATOR SIGNATURE, CCRR MODULE

Form 6 - Final Report NCT00049543 Gefitinib in Treating Patients With Non-Small Cell Lung Cancer That Has Been Surgically Removed Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A1AD599A-E8FC-3686-E034-080020C9C0E0

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH NCT00045162

- 7/3/15 - 1 form, 4 itemgroups, 22 items, 1 language

Itemgroups: SWOG clinical trial administrative data, Date of death, CAUSES OF DEATH, Comments

SOUTHWEST ONCOLOGY GROUP NOTICE OF DEATH NCT00045162 S0124: Cisplatin Combined With Either Irinotecan or Etoposide in Treating Patients With Extensive-Stage Small Cell Lung Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=001AE9A4-74CD-520B-E044-0003BA3F9857

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