| # | Question | Response |
|---|---|---|
|
1
|
Adverse Event Verbatim
field_001
|
|
|
2
|
Event Category
field_002
|
|
|
3
|
Did the event start before administering first dose of study medication?
field_003
|
|
|
4
|
Date Started
field_004
|
|
|
5
|
Event ongoing?
field_005
|
|
|
6
|
Date Ended
field_006
|
|
|
7
|
Severity of the Event
field_007
|
|
|
8
|
Event Related to Study Drug
field_008
|
|
|
9
|
Toxicity Grade of the Event (CTCAE)
field_009
|
|
|
10
|
Action Taken with Study Drug because of Adverse Event
field_010
|
|
|
11
|
Other action taken?
field_011
|
|
|
12
|
Serious Event?
field_012
|
|
|
13
|
Resulted in Death?
field_013
|
|
|
14
|
Immediately Life Threatening?
field_014
|
|
|
15
|
Required Hospitalization or Prolonged Hospitalization?
field_015
|
|
|
16
|
If hospitalized,
field_016
|
|
|
17
|
date of hospitalization
field_017
|
|
|
18
|
Time of hospitalization
field_018
|
|
|
19
|
If hospitalized,
field_019
|
|
|
20
|
date of discharge
field_020
|
|
|
21
|
Time of discharge
field_021
|
|
|
22
|
Persistent or Significant Disability?
field_022
|
|
|
23
|
Congenital Anomaly/Birth Defect?
field_023
|
|
|
24
|
Other Medically Important Serious Event?
field_024
|
|
|
25
|
Outcome of the Event?
field_025
|
|
|
26
|
Was the event adjudicated
field_026
|
|
|
27
|
Adjudication Result
field_027
|
|
|
28
|
Relationship to Non-Study Treatment
field_028
|
| # | Question | Response |
|---|---|---|
|
1
|
Adverse Event Verbatim
AE_TERM
|
|
|
2
|
Event Category
AE_CAT
|
|
|
3
|
Start Date
AE_START
|
| # | Question | Response |
|---|---|---|
|
1
|
Adverse Event Verbatim
AE_TERM
|
|
|
3
|
Event Category
AE_CAT
|