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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 | 2018-11-21 |
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Date of birth | 1977-07-14 yyyy-mm-dd |
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Age | 41 Years |
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Education background | University
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Occupation | Other
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Other (Description) | 职员 |
2天 小时 |
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同房后 |
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Number of pregnancy | 0 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 | 4.5 天(days) |
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Menarche time | 14 岁(years) |
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The time of last Menstruation | 2018-10-24 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) |
1999年右卵巢囊肿剥除右侧输卵管切除，2004年左卵巢囊肿剥除左侧输卵管切除 |
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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 | Normal
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Description in detail for abnormal |
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Uterine neck | Normal
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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 | Abnormal
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Description in detail for abnormal | 可触及8*7*6cm包块，囊性，边界欠清，压痛反跳痛明显。 |
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Right side | Normal
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Description in detail for abnormal | -- |
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Weight | 47 kg |
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Hight | 1560 mm |
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Systolic pressure (SP) | 92 mmHg |
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Diastolic pressure | 61 mmHg |
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Temperature | 36.2 degree Celsius |
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Pulse rate | 76 次/分 |
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Breath frequency | 19 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2018-11-21 yyyy-mm-dd |
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WBC | 6.4 ×109 /L |
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NEUT% | 65.6 % |
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LY% | 24.8 % |
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MONO％ | 8.5 ％ |
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RBC | 3.98 ×10^12 /L |
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HGB | 124 g/L |
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PLT | 162 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2018-11-21 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 7.0 |
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Urine protein | Negative
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Urine red cell | Negative
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Urine WBC | Negative
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Urine glucos | Negative
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Urine Bilirubin | Negative
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Urine HCG | |
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KET | Negative
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SG | 1.005 |
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UBG | Negative
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NIT | Negative
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Date of test | 2018-11-21 yyyy-mm-dd |
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Date of test | 2018-11-21 yyyy-mm-dd |
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K | 3.41 mmol/L |
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Na | 142.2 mmol/L |
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Cl | 105.5 mmol/L |
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Ca | 2.20 mmol/L |
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P | 1.09 mmol/L |
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Date of examination | 2018-11-21 yyyy-mm-dd |
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Prothrombin time | 11.6 秒 |
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Thrombin time (TT) | 14.4 秒 |
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Activated partial thromboplastin time (APTT) | 27.8 秒 |
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Fibrinogen (FIB) | 2.88 g/L |
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ALT | 9.3 IU/L |
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AST | 9.5 IU/L |
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GGT | 9.0 U/L |
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Serum bilirubin | 12.6 μmol/L |
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Indirect bilirubin | 8.5 umol/L |
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Direct bilirubin | 4.1 umol/L |
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Serum albumin | 43.3 g/L |
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Serum globulin | 22.3 g/L |
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Serum total protein | 65.6 g/L |
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Date of test | 2018-11-21 yyyy-mm-dd |
Negative
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Date of test | 2018-11-21 yyyy-mm-dd |
Negative
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Date of test | 2018-11-21 yyyy-mm-dd |
Negative
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Date of test | 2018-11-21 yyyy-mm-dd |
Negative
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Date of test | 2018-11-21 yyyy-mm-dd |
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SCr | 47.0 μmol/L |
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Blood urea | 3.30 mmol/L |
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Blood uric acid | 229.0 μmol/L |
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Date of test | 2018-11-21 yyyy-mm-dd |
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D-dimer value | 0.04 ug/mL |
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Date of test | 2018-11-21 |
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Urine pregnancy test | Not tested
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Blood HCG concentration | 未做 mIU/mL |
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Date of test | 2018-11-21 yyyy-mm-dd |
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Size of the ulcer | 5.82*4.11*4.72 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 0.76 mm |
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Left ovary size | 6.33*6.7*4.58 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 6cm |
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Right ovary size | 2.76*1.66 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 | -- |
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Diagnosis of the Ultrasound B | 右卵巢囊肿蒂扭转 |
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Doctor signature | 刘义彬 |
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Date of examination | 2018-11-21 yyyy-mm-dd |
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Pain Visual Analogue Score | Quit pain barely tolerable
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PH | 7.412 |
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PCO2 | 36.2 mmHg |
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P02 | 92.1 mmHg |
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SO2 | 97.1 ％ |
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HCO3 | 22.5 mmol/l |
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SBE | -1.6 mmol/l |
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LAC | 0.79 mmol/L |
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Date of examination | 2018-11--21 (yyyy-mm-dd) |
左卵巢 |
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6*5*5 cm |
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无 ° |
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刘义彬 |
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2018-11-21 |
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D-dimer value | 未查 ug/mL |
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Date of test | 2018-11-22 |
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Body temperature | 37 ℃ |
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Systolic pressure (SP) | 92 mmHg |
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Diastolic pressure (DP) | 61 mmHg |
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Heart Rate, HR | 80 次/分 |
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Pulse | 80 次/秒 |
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WBC | 5.60 ×109 /L |
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NEUT% | 71.0 % |
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LY% | 19.5 % |
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MONO％ | 7.90 ％ |
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RBC | 3.05 ×10^12 /L |
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HGB | 99 g/L |
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PLT | 114 ×10^9 /L |
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Date | 2018-11-22 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 | 2018-11-21 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2099479 |
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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 |