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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 | 2024-2-8 |
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Date of birth | 1982-2-23 yyyy-mm-dd |
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Age | 41 Years |
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Education background | Middle school
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Occupation | Famer
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Other (Description) | -- |
10 小时 |
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无 |
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Number of pregnancy | 5 次 |
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Number of delivery | 1 次 |
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If has delivery history, select following items | |
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partus maturus | 1 次 |
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premature delivery | 0 次 |
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abortion | 4 次 |
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Last pregnancy | 不详 yyyy-mm-dd |
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Average times of menstrual onset a year | 12 次/年 |
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Average menstrual cycle | 4 天(days) |
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Menarche time | 15 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) |
小三阳 剖宫产 |
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14年前小三阳、 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 | 可见暗红色血迹 |
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Uterine neck | Normal
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Description in detail for abnormal | -- |
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Corpus uteri | Abnormal
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Description in detail for abnormal | 偏右侧 |
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Adnexa uteri | |
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Left side | Abnormal
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Description in detail for abnormal | 10*8*8cm包块，压痛。 |
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Right side | Normal
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Description in detail for abnormal | -- |
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Weight | 65 kg |
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Hight | 1600 mm |
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Systolic pressure (SP) | 160 mmHg |
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Diastolic pressure | 98 mmHg |
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Temperature | 36.4 degree Celsius |
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Pulse rate | 66 次/分 |
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Breath frequency | 17 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-2-8 yyyy-mm-dd |
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WBC | 9.5 ×109 /L |
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NEUT% | 88.16 % |
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LY% | 8.59 % |
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RBC | 4.37 ×10^12 /L |
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MONO％ | 2.92 ％ |
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HGB | 137 g/L |
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PLT | 287 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-2-8 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 | 未查 yyyy-mm-dd |
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Date of test | 2024-2-8 yyyy-mm-dd |
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K | 未查 mmol/L |
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Na | -- mmol/L |
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Cl | -- mmol/L |
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Ca | -- mmol/L |
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P | -- mmol/L |
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Date of examination | 2024-2-8 yyyy-mm-dd |
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Prothrombin time | 11.4 秒 |
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Thrombin time (TT) | 13.7 秒 |
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Activated partial thromboplastin time (APTT) | 28.4 秒 |
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Fibrinogen (FIB) | 3.23 g/L |
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ALT | 21.9 IU/L |
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AST | 22.0 IU/L |
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GGT | 13.0 U/L |
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Serum bilirubin | 16.60 μmol/L |
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Indirect bilirubin | 12.80 umol/L |
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Direct bilirubin | 3.80 umol/L |
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Serum albumin | 45.8 g/L |
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Serum globulin | 32.5 g/L |
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Serum total protein | 78.3 g/L |
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Date of test | 2024-2-8 yyyy-mm-dd |
Positive
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Date of test | 2024-2-8 yyyy-mm-dd |
Negative
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Date of test | 2024-2-8 yyyy-mm-dd |
Negative
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Date of test | 2024-2-8 yyyy-mm-dd |
Negative
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Date of test | 2024-2-8 yyyy-mm-dd |
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SCr | 59.0 μmol/L |
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Blood urea | 3.80 mmol/L |
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Blood uric acid | 214.0 μmol/L |
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Date of test | 2024-2-8 yyyy-mm-dd |
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D-dimer value | 0.09 ug/mL |
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Date of test | 2024-2-8 |
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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 | 2024-2-8 yyyy-mm-dd |
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Size of the ulcer | 3.8*3.96*3.78 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 0.45 mm |
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Left ovary size | 未描述 cm ×cm |
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Shape of Left ovary | |
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Size of the Ovarian cyst | 子宫后方12.86*9.59*7.2cm，混合性包块，内为强回声，部分为暗区，有的暗区内见短条状强回声 |
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Right ovary size | 未描述 cm ×cm |
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Shape of right ovary | |
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Size of Ovarian cyst | -- |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 卵巢肿物 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-2-8 yyyy-mm-dd |
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Pain Visual Analogue Score | Very pain
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SO2 | 95.4 ％ |
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P02 | 82.6 mmHg |
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PCO2 | 36.0 mmHg |
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PH | 7.385 |
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Date of examination | 2024-2-8 (yyyy-mm-dd) |
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LAC | 1.77 mmol/L |
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SBE | -3.4 mmol/l |
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HCO3 | 21.6 mmol/l |
左侧附件 |
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12*10*8 cm |
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逆时针540度 ° |
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| / | |
刘义彬 |
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2024-2-8 |
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D-dimer value | 0.56 ug/mL |
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Date of test | 2024-2-9 |
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Body temperature | 36.8 ℃ |
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Systolic pressure (SP) | 未查 mmHg |
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Diastolic pressure (DP) | 未查 mmHg |
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Heart Rate, HR | 82 次/分 |
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Pulse | 82 次/秒 |
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WBC | 7.3 ×109 /L |
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NEUT% | 62.81 % |
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LY% | 25.92 % |
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RBC | 3.71 ×10^12 /L |
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MONO％ | 10.33 ％ |
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HGB | 121 g/L |
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PLT | 241 ×10^9 /L |
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Date | 20234-2-9 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 |