ID
10615
Description
CALGB: 49903 Advanced Disease On-study Form NCT00053339 Trastuzumab With or Without Tamoxifen in Treating Women With Progressive Stage IV Breast Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A73D2625-44FB-4784-E034-0003BA0B1A09
Lien
Mots-clés
Versions (3)
- 26/08/2012 26/08/2012 -
- 22/05/2015 22/05/2015 -
- 03/06/2015 03/06/2015 -
Téléchargé le
3 juin 2015
DOI
Pour une demande vous connecter.
Licence
Creative Commons BY-NC 3.0 Legacy
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CALGB: 49903 Advanced Disease On-study Form NCT00053339
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
Description
Patient clinical trial data
Description
Patient'sName
Type de données
text
Description
ParticipatingGroup
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C17005
- UMLS 2011AA ObjectClass
- C1257890
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
PatientHospitalNumber
Type de données
text
Description
ParticipatingGroupProtocolNo.
Type de données
text
Description
AffiliateName
Type de données
text
Description
ParticipatingGroupPatientID
Type de données
text
Description
MenopausalStatus
Type de données
text
Description
Advanced Disease Description
Description
ERStatus
Type de données
text
Description
ERTiming,Other
Type de données
text
Description
PgRStatus
Type de données
text
Description
ReceptorStatusTiming
Type de données
text
Description
ReceptorStatusTiming
Type de données
text
Description
PgRTiming,Other
Type de données
text
Description
FirstPositiveBiopsyDate
Type de données
date
Description
RecurrenceDate
Type de données
date
Description
Sites Of Progression
Description
ProgressionSite
Type de données
text
Description
ProgressionSite,Other
Type de données
text
Description
Priorsystemictherapy
Type de données
text
Description
PriorTreatmentRegimenName(s)
Type de données
text
Description
PriorTreatmentRegimenBeginDate
Type de données
date
Description
PriorTreatmentRegimenEndDate
Type de données
date
Description
PriorTreatmentRegimenType
Type de données
text
Description
Laboratory
Description
Lab,Hematology,GranulocyteCount
Type de données
double
Description
Lab,Hepatic,Bilirubin
Type de données
double
Description
Lab,Renal,Creatinine
Type de données
double
Description
Lab,Hematology,Platelets
Type de données
double
Description
Bilirubin(mg/dl),ULN
Type de données
double
Alias
- NCI Thesaurus ValueDomain
- C25712
- UMLS 2011AA ValueDomain
- C1522609
- NCI Thesaurus ValueDomain
- C25706
- UMLS 2011AA ValueDomain
- C1519815
Description
Lab,Cardiovascular,LVEF
Type de données
text
Description
Lab,Hepatic,AlkalinePhosphatase
Type de données
double
Description
Lab,Hepatic,SGOT
Type de données
double
Description
Lab,Hepatic,SGPT
Type de données
double
Description
PersonCompletingForm,FirstName
Type de données
text
Alias
- NCI Thesaurus ObjectClass
- C25190
- UMLS 2011AA ObjectClass
- C0027361
- NCI Thesaurus Property
- C25364
- UMLS 2011AA Property
- C0600091
Description
FormCompletionDate,Original
Type de données
date
Description
%LowerlimitofinstitutionalnormalLVEF
Type de données
text
Description
Ccrr Module For Calgb: 49903 Advanced Disease On-study Form
Similar models
INSTRUCTIONS: Complete and submit this form as required by the protocol. Information in the upper right box must be completed for this form to be accepted. For optimal accuracy use black ink. Mark an X in the appropriate box for fields with a choice. Print text in capital letters. Avoid contact with the edges of the boxes. Circle amended items and check "Amended data" box to the right. If submitting by mail, retain a copy for your records and send the original to the CALGB Data Management Center. If faxing, use an original form for maximum clarity in transmission and fax to 919-416-4990. If submitting electronically, click the Send button when you have completed the PDF version of the form.
C1511726 (UMLS 2011AA ObjectClass)
C25416 (NCI Thesaurus Property)
C1691222 (UMLS 2011AA Property)
C1705108 (UMLS 2011AA)
C1257890 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205160 (UMLS 2011AA)
C1446409 (UMLS 2011AA)
C0439673 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0205394 (UMLS 2011AA)
C0262950 (UMLS 2011AA)
C0005953 (UMLS 2011AA)
C0024109 (UMLS 2011AA)
C0023884 (UMLS 2011AA)
C0281265 (UMLS 2011AA)
C1514455 (UMLS 2011AA)
C1514456 (UMLS 2011AA)
C1522609 (UMLS 2011AA ValueDomain)
C25706 (NCI Thesaurus ValueDomain)
C1519815 (UMLS 2011AA ValueDomain)
C0027361 (UMLS 2011AA ObjectClass)
C25364 (NCI Thesaurus Property)
C0600091 (UMLS 2011AA Property)