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Forms in AE (1)
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Example Case Report Forms for AE domain
Sources: DB1 | Forms loaded: 1
All Domains
Form: Adverse Events
Show domain info
Primary Domain
AE
All Domains
AE, FA
# 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
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