Example Case Report Forms for CM domain
Sources: DB1, MANUAL | Forms loaded: 5
Form: Adverse Events2
Annotations
Domain name annotations
AE (ADVERSE EVENTS)
CM (CONCOMITANT MEDICATIONS)
Form specific annotations
AECAT=GENERAL
Show domain info
Primary Domain
AE
All Domains
AE, CM
# Question Response
1
Adverse Event Verbatim
AE_TERM
2
Event Category
AE_CAT
3
Start Date
AE_START
Example Case Report Forms for CM domain
Sources: DB1, MANUAL | Forms loaded: 5
Form: Anti-hyperglycemic agents
Show domain info
Primary Domain
CM
All Domains
CM
# Question Response
1
Collection Date
cm801_1.CMDAT
2
Did the subject take any anti-hyperglycemic agent in the last 10 years?
cm801_1.CMOCCUR
3
If yes, List the Treatments received
field_003
4
Treatment Name
cm801_1.CMTRT
5
Start Date
cm801_1.CMSTDAT
6
Ongoing?
cm801_1.CMONGO
7
End Date
cm801_1.CMENDAT
8
Dose
cm801_1.CMDOSE
9
Dose Unit
cm801_1.CMDOSU
10
Frequency
cm801_1.CMDOSFRQ
11
Route
cm801_1.CMROUTE
12
field_012
Example Case Report Forms for CM domain
Sources: DB1, MANUAL | Forms loaded: 5
Form: General Concomitant Medications
Show domain info
Primary Domain
CM
All Domains
CM
# Question Response
1
Treatment Name
cm801_2.CMTRT
2
Taken prior to the study?
cm801_2.CMPRIOR
3
Indication
cm801_2.CMINDC
4
Start Date
cm801_2.CMSTDAT
5
Ongoing?
cm801_2.CMONGO
6
End Date
cm801_2.CMENDAT
7
Dose
cm801_2.CMDOSE
8
Dose Unit
cm801_2.CMDOSU
9
Frequency
cm801_2.CMDOSFRQ
10
Route
cm801_2.CMROUTE
Example Case Report Forms for CM domain
Sources: DB1, MANUAL | Forms loaded: 5
Form: Prior Systemic Anti-Cancer Therapy Regimen
Annotations
Domain name annotations
CM (Concomitant/Prior Medications)
RS (Disease Response and Clin Classification)
Show domain info
Primary Domain
CM
All Domains
CM, RS
# Question Response
1
Category for Medication
CMCAT
2
Type of Therapy
CMSCAT
3
Therapy Setting
TRTSTT
4
Regimen Number
CMGRPID
5
Best Overall Response
RSORRES_BESTRESP
6
Date of Best Overall Response
RSDAT
7
Date of Progressive Disease
RSDAT_PD
8
Line Number
CMSPID
9
Agent (one agent or therapy per line)
CMTRT
10
Start Date
CMSTDAT
11
End Date
CMENDAT
12
Dose
CMDOSE
13
Dose (text)
CMDOSTXT
14
Dose Unit
CMDOSU
15
If Other, specify
CMDOSU_OTH
16
Frequency
CMDOSFRQ
17
If Other, specify
CMDOSFRQ_OTH
18
Number of Cycles
CMNCYC
Example Case Report Forms for CM domain
Sources: DB1, MANUAL | Forms loaded: 5
Form: Concomitant Medications
Show domain info
Primary Domain
CM
All Domains
CM
# Question Response
1
Medication category
conmeds.CMCAT
2
Medication
conmeds.CMVT
3
Taken prior to study?
field_003
4
Date First Taken
conmeds.CMSTDT_RAW
5
Date Last Taken
conmeds.CMENDT_RAW
6
Indication
conmeds.CMINDC
7
Dose
conmeds.CMDOSE_RAW
8
Unit
conmeds.CMDOSEU_RAW
9
Frequency
conmeds.CMDOSFRQ
10
Route
conmeds.ROUTE