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ID
10476
Beschrijving
ADVL0212- Review Form (Dr. Chin) FR901228 in Treating Children With Refractory or Recurrent Solid Tumors or Leukemia Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=C0F2E959-BAAB-54D8-E034-0003BA12F5E7 NCT00053963
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Versies (3)
- 26-08-12 26-08-12 -
- 22-05-15 22-05-15 -
- 03-06-15 03-06-15 - Julian Varghese
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3 juni 2015
DOI
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Licentie
Creative Commons BY-NC 3.0 Legacy
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ADVL0212- Review Form (Dr. Chin) NCT00053963
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- StudyEvent: ADVL0212- Review Form (Dr. Chin)
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- StudyEvent: ADVL0212- Review Form (Dr. Chin)
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
DateofECG
Item
Date of ECG
date
Item
Did patient experience any of the following: SVT, atrial fibrillation, or atrial flutter?
text
Code List
Did patient experience any of the following: SVT, atrial fibrillation, or atrial flutter?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
SVT (SVT)
CL Item
Atrial fibrillation (Atrial fibrillation)
CL Item
Atrial flutter (Atrial flutter)
Item
Did patient experience prolonged QTc compared to baseline?
text
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
To greater than or equal to 480 msec (To greater than or equal to 480 msec)
CL Item
Increase of greater than or equal to 50 msec (Increase of greater than or equal to 50 msec)
CL Item
Increase by 15 % (Increase by 15 %)
Item
Was there a T wave inversion in leads II, III, AVF (inferior leads) or V4, V5, and V6 (lateral leads)?
text
Code List
Was there a T wave inversion in leads II, III, AVF (inferior leads) or V4, V5, and V6 (lateral leads)?
CL Item
Yes (Yes)
CL Item
No (No)
Item
Was ST segment at the J-point greater than or equal to 2 mm below baseline in leads II, II AVF (inferior leads), V4, V5, V6 (lateral leads)?
text
Code List
Was ST segment at the J-point greater than or equal to 2 mm below baseline in leads II, II AVF (inferior leads), V4, V5, V6 (lateral leads)?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Yes, change in VT (Yes, change in VT)
CL Item
Yes, change in VF (Yes, change in VF)
CL Item
Yes, change in both VT and VF (Yes, change in both VT and VF)
CL Item
No (No)