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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 | 2024-1-25 |
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Date of birth | 2008-09-24 yyyy-mm-dd |
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Age | 15 Years |
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Education background | Middle school
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Occupation | Other
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Other (Description) | 学生 |
间断2个月 小时 |
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剧烈活动后 |
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Number of pregnancy | - 次 |
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Number of delivery | - 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 | 28 天(days) |
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Menarche time | 12 岁(years) |
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The time of last Menstruation | 2024-1-12 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) |
-- |
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-- 年/月/日（yyyy-mm-dd） |
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Namy of the drug to be allergied | -- |
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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 | Normal
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Description in detail for abnormal |
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Adnexa uteri | |
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Left side | Normal
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Description in detail for abnormal | -- |
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Right side | Abnormal
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Description in detail for abnormal | 可触及4cm肿物边界清活动可 |
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Weight | 53 kg |
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Hight | 1620 mm |
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Systolic pressure (SP) | 118 mmHg |
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Diastolic pressure | 78 mmHg |
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Temperature | 36.4 degree Celsius |
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Pulse rate | 100 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 | 2024-1-25 yyyy-mm-dd |
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WBC | 7.2 ×109 /L |
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NEUT% | 58.22 % |
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LY% | 34.54 % |
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MONO％ | 5.72 ％ |
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RBC | 4.37 ×10^12 /L |
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HGB | 133 g/L |
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PLT | 259 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-1-25 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 | 2024-1-25 yyyy-mm-dd |
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K | 4.90 mmol/L |
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Na | 141.4 mmol/L |
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Cl | 102.8 mmol/L |
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Ca | 2.49 mmol/L |
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P | 1.23 mmol/L |
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Date of examination | 2024-1-25 yyyy-mm-dd |
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Prothrombin time | 12.0 秒 |
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Thrombin time (TT) | 13.7 秒 |
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Activated partial thromboplastin time (APTT) | 30.2 秒 |
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Fibrinogen (FIB) | 2.33 g/L |
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ALT | 19.0 IU/L |
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AST | 20.2 IU/L |
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GGT | 23.0 U/L |
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Serum bilirubin | 14.10 μmol/L |
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Indirect bilirubin | 8.70 umol/L |
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Direct bilirubin | 5.40 umol/L |
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Serum albumin | 46.8 g/L |
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Serum globulin | 23.4 g/L |
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Serum total protein | 70.2 g/L |
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Date of test | 2024-1-25 yyyy-mm-dd |
Negative
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Date of test | 2024-1-25 yyyy-mm-dd |
Negative
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Date of test | 2024-1-25 yyyy-mm-dd |
Negative
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Date of test | 2024-1-25 yyyy-mm-dd |
Negative
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Date of test | 2024-1-25 yyyy-mm-dd |
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SCr | 64 μmol/L |
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Blood urea | 5.4 mmol/L |
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Blood uric acid | 289.0 μmol/L |
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Date of test | 2024-1-24 yyyy-mm-dd |
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D-dimer value | 0.05 ug/mL |
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Date of test | 2024-1-25 |
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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 | 3.48*3.3*2.53 cm*cm |
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Uterine echo distribution | Not even
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Endometrial thickness | 0.76 mm |
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Left ovary size | 2.74*1.91 cm ×cm |
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Shape of Left ovary | Normal
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Size of the Ovarian cyst | -- |
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Right ovary size | 6.74*4.04 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 6.37cm |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 右卵巢畸胎瘤 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-1-25 yyyy-mm-dd |
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Pain Visual Analogue Score | Mild pain
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PH | 7.441 |
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PCO2 | 37.8 mmHg |
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P02 | 316.7 mmHg |
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SO2 | 98.7 ％ |
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HCO3 | 25.2 mmol/l |
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SBE | 1.2 mmol/l |
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LAC | 0.82 mmol/L |
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Date of examination | 2024-1-25 (yyyy-mm-dd) |
右卵巢 |
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7*6*6 cm |
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无 ° |
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| / | |
刘义彬 |
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2024-1-26 |
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D-dimer value | 0.22 ug/mL |
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Date of test | 2024-1-27 |
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Body temperature | 37.2 ℃ |
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Systolic pressure (SP) | 99 mmHg |
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Diastolic pressure (DP) | 70 mmHg |
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Heart Rate, HR | 88 次/分 |
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Pulse | 88 次/秒 |
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WBC | 11.40 ×109 /L |
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NEUT% | 74.20 % |
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LY% | 19.53 % |
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MONO％ | 5.69 ％ |
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RBC | 4.34 ×10^12 /L |
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HGB | 131 g/L |
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PLT | 260 ×10^9 /L |
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Date | 2024-1-27 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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sample collection | Collected
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Volume | 1 ml |
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Time of collection | 2024-1-25 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2560201 |
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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 |