Description:

NSABP B-35 ADVERSE EVENT FORM (AE) Anastrozole or Tamoxifen in Treating Postmenopausal Women With Ductal Carcinoma in Situ Who Are Undergoing Lumpectomy and Radiation Therapy NCT00053898 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A056A959-00D2-32FA-E034-080020C9C0E0

Lien:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A056A959-00D2-32FA-E034-080020C9C0E0
Mots-clés:
  1. 26/08/2012 26/08/2012 -
  2. 23/03/2015 23/03/2015 - Martin Dugas
  3. 20/09/2021 20/09/2021 -
Téléchargé le:

20 septembre 2021

DOI:
Pour une demande vous connecter.
Licence :
Creative Commons BY-NC 3.0 Legacy
Modèle Commentaires :

Ici, vous pouvez faire des commentaires sur le modèle. À partir des bulles de texte, vous pouvez laisser des commentaires spécifiques sur les groupes Item et les Item.

Groupe Item commentaires pour :

Item commentaires pour :

Vous devez être connecté pour pouvoir télécharger des formulaires. Veuillez vous connecter ou s’inscrire gratuitement.

Breast Cancer DCIS NCT00053898

Instructions: Use NCI's Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0 to report all grade 2, 3, 4, or 5 adverse events (AEs). To access the CTCAE, go to the NCI/CTEP web site: http://ctep.cancer.gov. Submit Form AE to the NSABP Biostatistical Center every 6 months during tamoxifen/anastrozole therapy and 6 months after the last administered dose. There should be no time lapse or overlap of dates between the Reporting Period End Date from the previous Form AE and the Reporting Period Start Date of the current Form AE.

Header
Are data amended? (If Yes, circle the amended items in red.)
Any grade 2, 3, 4 or 5 Adverse Event?
Was the patient hospitalized for 24 hours or more? (If "Yes", attach supporting documentation)
Adverse event
Adverse Event
Grade (highest grade this cycle INCLUDE GRADE 0's)

Similar models

Utilisez ce formulaire pour les retours, les questions et les améliorations suggérées.

Les champs marqués d’un * sont obligatoires.

Do you need help on how to use the search function? Please watch the corresponding tutorial video for more details and learn how to use the search function most efficiently.

Watch Tutorial