ID

10654

Description

CALGB 90601: Supplemental Adverse Event Form (Thromboembolic Events) NCT00942331 Gemcitabine Hydrochloride and Cisplatin With or Without Bevacizumab in Treating Patients With Advanced Urinary Tract Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=65940F04-CD97-54E2-E040-BB89AD435A8C

Link

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=65940F04-CD97-54E2-E040-BB89AD435A8C

Keywords

  1. 8/26/12 8/26/12 -
  2. 1/8/15 1/8/15 - Martin Dugas
  3. 6/3/15 6/3/15 -
Uploaded on

June 3, 2015

DOI

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License

Creative Commons BY-NC 3.0 Legacy

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CALGB 90601: Supplemental Adverse Event Form (Thromboembolic Events) NCT00942331

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.

Header
Are data amended
Patient demographics
Assessment of medication
Medications received during this reporting period (Mark one with an X)
Which of the following arterial thrombotic events (ATEs) occurred during this reporting period? (Mark one with an X)
Treatment for ATE (Mark one with an X)
Outcome of ATE (Mark one with an X)
Which of the following venous thrombotic events (VTEs) occurred during this reporting period? (Mark one with an X)
Specify status
Treatment for VTE (Mark one with an X)
Outcome of VTE (Mark one with an X)

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