Description:

AMC-045 Adverse Events Form (ADV) Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72844558-6106-0B0B-E040-BB89AD4314AD

Link:

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72844558-6106-0B0B-E040-BB89AD4314AD

Versions (4)
  1. 8/26/12 8/26/12 -
  2. 1/9/15 1/9/15 - Martin Dugas
  3. 1/9/15 1/9/15 - Martin Dugas
  4. 1/9/15 1/9/15 - Martin Dugas
Uploaded on:

January 9, 2015

DOI:
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License :
Creative Commons BY-NC 3.0 Legacy
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Anal Cancer NCT00324415 Toxicity - AMC-045 Adverse Events Form (ADV) - 2936750v1.0

English
Details

Based on information entered, an AdEERS Report must be submitted. Please go to the CTEP website and access the AdEERS system

1 forms  
Header
Unnamed2
Was this event expected or anticipated
Therapy Name
CTC Adverse Event Attribution Code
CTC Adverse Event Attribution Code
Alternative etiology
Action Taken at Time of Adverse Event (check "Yes" for all that apply)
3 more items in the detailed view.
If modification was made to study therapy, who initiated modification
Unnamed3
Outcome of Adverse Event
Was this considered a Serious Adverse Event
Seriousness Attributed to Adverse Event (If "Yes" check "Yes" for all that apply Please note that checking "Yes" to any of the events below will require SAE notification according to protocol requirements.)
3 more items in the detailed view.
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