Anal Cancer NCT00324415 On-Study - AMC-045 History of AIDS Defining Disease Form (F03) - 2937261v1.0

Cisplatin, Fluorouracil, Cetuximab, and Radiation Therapy in Treating Patients With HIV and Stage I, Stage II, or Stage III Anal Cancer NCT00324415 Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=72873427-47DC-3052-E040-BB89AD43686C

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  1. StudyEvent: AMC-045 History of AIDS Defining Disease Form (F03)
    1. No Instruction available.
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Header Module
HospitalAdmissionOrdinalNumber
Item
Visit number
integer
C25337 (NCI Thesaurus ValueDomain)
C16696 (NCI Thesaurus ObjectClass)
C25385 (NCI Thesaurus Property)
C1549755 (UMLS CUI-1)
LesionAssessmentDate
Item
Date of Evaluation
date
C25164 (NCI Thesaurus ValueDomain)
C3824 (NCI Thesaurus ObjectClass)
C20989 (NCI Thesaurus Property)
C25367 (NCI Thesaurus ValueDomain-2)
C0221198 (UMLS CUI-1)
C0031809 (UMLS CUI-2)
History of opportunistic diseases
Item
History of opportunistic diseases and predisposing disease
boolean
C2991 (NCI Thesaurus ObjectClass)
C3289 (NCI Thesaurus ObjectClass-2)
C16505 (NCI Thesaurus ObjectClass-3)
C0262926 (NCI Metathesaurus Property)
C38147 (NCI Thesaurus ValueDomain)
C0029118 (UMLS CUI-1)
Item
Disease Type
text
C2991 (NCI Thesaurus ObjectClass)
C2851 (NCI Thesaurus ObjectClass-2)
C25281 (NCI Thesaurus ObjectClass-3)
C15220 (NCI Thesaurus Property)
C25284 (NCI Thesaurus ValueDomain)
C0001175 (UMLS CUI-1)
C0683312 (UMLS CUI-2)
Code List
Disease Type
CL Item
Candidiasis Of Bronchi, Trachea Or Lungs (Candidiasis of bronchi, trachea or lungs)
CL Item
Candidiasis, Esophageal (Candidiasis, esophageal)
CL Item
Cervical Cancer (Cervical cancer, invasive)
C0007847 (NCI Metathesaurus)
CL Item
Coccidioidomycosis, Disseminated Or Extrapulmonary (Coccidioidomycosis, disseminated or extrapulmonary)
CL Item
Cryptococcosis (Cryptococcosis, extrapulmonary)
C2967 (NCI Thesaurus)
C0010414 (UMLS 2011AA)
CL Item
Cryptosporidiosis, Chronic Intestinal (Cryptosporidiosis, chronic intestinal)
CL Item
Cmv Other Than Liver, Spleen Or Nodes, Onset At Age >1month (CMV other than liver, spleen or nodes, onset at age >1month)
CL Item
Cmv Retinitis (CMV retinitis)
CL Item
Encephalopathy (Encephalopathy, HIV-related)
C26920 (NCI Thesaurus)
C0085584 (UMLS 2011AA)
CL Item
Herpes Simplex: Chronic Ulcers (> 1 Month's Duration) Or Bronchitis, Pneumonitis Or Esophagitis (onset At Age > 1 Month) (Herpes simplex: chronic ulcers (> 1 month's duration) or bronchitis, pneumonitis or esophagitis (onset at age > 1 month))
CL Item
Histoplasmosis, Disseminated Or Extrapulmonary (Histoplasmosis, disseminated or extrapulmonary)
CL Item
Isosporiasis, Chronic Intestinal (> 1 Mon) (Isosporiasis, chronic intestinal (> 1 mon))
CL Item
Kaposi's Sarcoma Aids Related (Kaposi's sarcoma)
CL Item
Non-hodgkin's Lymphoma (Lymphoma, systemic non-Hodgkin's)
C3211 (NCI Thesaurus)
C0024305 (UMLS 2011AA)
CL Item
Lymphoma, Primary, Of Brain (Lymphoma, primary, of brain)
CL Item
Mycobacterium Avium Complex Or Mycobacterium Kansasii Disseminated Or Extrapulmonary (Mycobacterium avium complex or Mycobacterium kansasii disseminated or extrapulmonary)
CL Item
Mycobacterium Tuberculosis Of Any Site, Pulmonary, Disseminated Or Extrapulmonary (Mycobacterium tuberculosis of any site, pulmonary, disseminated or extrapulmonary)
CL Item
Mycobacterium, Other Species Or Unidentified Species, Disseminated Or Extrapulmonary (Mycobacterium, other species or unidentified species, disseminated or extrapulmonary)
CL Item
Pneumocystis Jirovecii Pneumonia (Pneumocystis jirovecii pneumonia)
CL Item
Pneumonia (Pneumonia, recurrent)
C3333 (NCI Thesaurus)
C0032285 (UMLS 2011AA)
CL Item
Progressive Multifocal Leukoencephalopathy (pml) (Progressive multifocal leukoencephalopathy)
CL Item
Salmonella Septicemia, Recurrent (Salmonella septicemia, recurrent)
CL Item
Toxoplasmosis Of The Brain, Onset At Age >1month (Toxoplasmosis of the brain, onset at age >1month)
CL Item
Wasting Syndrome, Due To Hiv (Wasting syndrome, due to HIV)
Item
Disease status (Please select the disease status of the diseases listed)
text
C25755 (NCI Thesaurus Property)
C0871261 (UMLS 2011AA Property)
C25341 (NCI Thesaurus Property-2)
C0450429 (UMLS 2011AA Property-2)
C2991 (NCI Thesaurus ObjectClass)
C0012634 (UMLS 2011AA ObjectClass)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
Code List
Disease status (Please select the disease status of the diseases listed)
CL Item
Active (Currently active)
C45329 (NCI Thesaurus)
C0205177 (UMLS 2011AA)
CL Item
Present (Ever present)
C25626 (NCI Thesaurus)
C0150312 (UMLS 2011AA)
CL Item
Never Present (Never present)
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)

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