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Eligible participant has to fullfill all of the following items | / / / / |
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Anyone with one of following items or more should be excluded: | / / / / / / / / |
- General information
- Medical history
- Physical examination
- Blood Routine Tests
- Urine Routine Test
- Blood Electrolytes Tests
- Coagulation Function Tests
- Serum Liver Function Tests
- HBV/HCV/HIV/Syphilis Markers Test
- Renel Function Test
- D-dimer
- hCG Test
- Image Examinations
- Visual Analogue Scale
- Blood Gas Analysis
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Date of signing the informed consent | 2024-1-23 |
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Date of birth | 2007-11-15 yyyy-mm-dd |
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Age | 16 Years |
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Education background | Middle school
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Occupation | Other
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Other (Description) | 学生 |
11小时。1个月前 级7天前疼过 小时 |
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无 |
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Number of pregnancy | 0 次 |
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Number of delivery | 0 次 |
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If has delivery history, select following items | |
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partus maturus | - 次 |
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premature delivery | - 次 |
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abortion | - 次 |
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Last pregnancy | - yyyy-mm-dd |
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Average times of menstrual onset a year | 12 次/年 |
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Average menstrual cycle | 30 天(days) |
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Menarche time | 12 岁(years) |
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The time of last Menstruation | 2024-01-11 年、月、日(yyyy-mm-dd) |
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The time of menstrual onset before the last one | 不详 年、月、日(yyyy-mm-dd) |
无 |
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-- 年/月/日（yyyy-mm-dd） |
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Namy of the drug to be allergied | 无 |
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Vulva | Normal
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Description in detail for abnormal | -- |
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Vagina | Not examined
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Description in detail for abnormal | -- |
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Uterine neck | Not examined
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Description in detail for abnormal | -- |
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Corpus uteri | Not examined
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Description in detail for abnormal | -- |
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Adnexa uteri | |
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Left side | Not examined
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Description in detail for abnormal | -- |
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Right side | Not examined
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Description in detail for abnormal | -- |
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Weight | 116 kg |
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Hight | 165 mm |
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Systolic pressure (SP) | 136 mmHg |
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Diastolic pressure | 77 mmHg |
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Temperature | 36.4 degree Celsius |
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Pulse rate | 88 次/分 |
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Breath frequency | 22 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-1-23 yyyy-mm-dd |
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WBC | 12.90 ×109 /L |
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NEUT% | 67.31 % |
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LY% | 25.46 % |
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MONO％ | 6.36 ％ |
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RBC | 4.55 ×10^12 /L |
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HGB | 132 g/L |
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PLT | 425 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-1-23 yyyy-mm-dd |
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Acidity and allkalinity | |
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pH value | -- |
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Urine protein | |
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Urine red cell | |
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Urine WBC | |
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Urine glucos | |
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Urine Bilirubin | |
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Urine HCG | |
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KET | |
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SG | -- |
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UBG | |
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NIT | |
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Date of test | -- yyyy-mm-dd |
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Date of test | 2024-1-23 yyyy-mm-dd |
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K | 4.34 mmol/L |
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Na | 138.9 mmol/L |
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Cl | 97.8 mmol/L |
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Ca | 2.52 mmol/L |
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P | 1.46 mmol/L |
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Date of examination | 2024-1-23 yyyy-mm-dd |
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Prothrombin time | 13.0 秒 |
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Thrombin time (TT) | 12.5 秒 |
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Activated partial thromboplastin time (APTT) | 32.3 秒 |
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Fibrinogen (FIB) | 3.86 g/L |
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ALT | 69.2 IU/L |
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AST | 35.8 IU/L |
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GGT | 24.0 U/L |
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Serum bilirubin | 18.80 μmol/L |
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Indirect bilirubin | 10.80 umol/L |
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Direct bilirubin | 8.00 umol/L |
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Serum albumin | 46.4 g/L |
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Serum globulin | 34.5 g/L |
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Serum total protein | 80.9 g/L |
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Date of test | 2024-1-23 yyyy-mm-dd |
Negative
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Date of test | 2024-1-23 yyyy-mm-dd |
Negative
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Date of test | 2024-1-23 yyyy-mm-dd |
Negative
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Date of test | 2024-1-23 yyyy-mm-dd |
Negative
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Date of test | 2024-1-23 yyyy-mm-dd |
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SCr | 64 μmol/L |
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Blood urea | 3.9 mmol/L |
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Blood uric acid | 424.0 μmol/L |
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Date of test | 2024-1-23 yyyy-mm-dd |
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D-dimer value | 0.11 ug/mL |
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Date of test | 2024-1-23 |
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Urine pregnancy test | Not tested
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Blood HCG concentration | -- mIU/mL |
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Date of test | -- yyyy-mm-dd |
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Size of the ulcer | 4.06*3.96*3.26 cm*cm |
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Uterine echo distribution | Not even
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Endometrial thickness | 8.8 mm |
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Left ovary size | 7.42*6.74*5.23 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 11.99*14.73*9.27cm |
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Right ovary size | 2.87*1.76 cm ×cm |
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Shape of right ovary | Normal
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Size of Ovarian cyst | -- |
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Description of other abnormal findings | 左卵巢回声弥漫性减低，周边见散在滤泡回声。 |
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Diagnosis of the Ultrasound B | 左卵巢囊肿蒂扭转 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-1-23 yyyy-mm-dd |
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Pain Visual Analogue Score | Very pain
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PH | -- |
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PCO2 | -- mmHg |
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P02 | -- mmHg |
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SO2 | -- ％ |
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HCO3 | -- mmol/l |
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SBE | -- mmol/l |
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LAC | -- mmol/L |
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Date of examination | -- (yyyy-mm-dd) |
左侧输卵管 |
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14*10*10 cm |
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顺时针720° ° |
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| / | |
刘义彬 |
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2024-1-24 |
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D-dimer value | 0.27/0.17 ug/mL |
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Date of test | 2024-1-24/25 |
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Body temperature | 36.8 ℃ |
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Systolic pressure (SP) | 136 mmHg |
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Diastolic pressure (DP) | 78 mmHg |
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Heart Rate, HR | 88 次/分 |
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Pulse | 23 次/秒 |
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WBC | 14.90 ×109 /L |
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NEUT% | 76.06 % |
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LY% | 16.35 % |
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MONO％ | 7.14 ％ |
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RBC | 3.89 ×10^12 /L |
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HGB | 112 g/L |
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PLT | 306 ×10^9 /L |
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Date | 2024-1-24 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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sample collection | |
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Volume | ml |
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Time of collection | yyyy-mm-dd-hh-min. |
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Label Number of the sample |
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Date received at DCC | yyyymmdd |
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Report type | |
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Name of this event |
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SAE start date | yyyymmdd |
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SAE stop date | yyyymmdd |
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Was this an unanticipated adverse event | |
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Attribution to Study Drug | |
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Outcome Type(check all that apply) | |
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Recovery Description: (check only one) | |
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Please provide a brief narrative of the SAE occurrence below |
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Name of the recorder |
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Data | yyyymmdd |
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Site Investigator’s signature |
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Data | yyyymmdd |