Beskrivning:

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

Länk:
https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72844558-6106-0B0B-E040-BB89AD4314AD
Nyckelord:
  1. 2012-08-26 2012-08-26 -
  2. 2015-01-09 2015-01-09 - Martin Dugas
  3. 2015-01-09 2015-01-09 - Martin Dugas
  4. 2015-01-09 2015-01-09 - Martin Dugas
Uppladdad den:

9 januari 2015

DOI:
För en begäran logga in.
Licens :
Creative Commons BY-NC 3.0 Legacy
Modellkommentarer :

Här kan du kommentera modellen. Med hjälp av pratbubblor i Item-grupperna och Item kan du lägga in specifika kommentarer.

Itemgroup-kommentar för :

Item-kommentar för :

Du måste vara inloggad för att kunna ladda ner formulär. Var vänlig logga in eller registrera dig utan kostnad.

Anal Cancer NCT00324415 Toxicity - AMC-045 Adverse Events Form (ADV) - 2936750v1.0

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

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)
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.)
Comments

Similar models

Använd detta formulär för feedback, frågor och förslag på förbättringar.

Fält markerade med * är obligatoriska.

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