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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 | 2024-2-26 |
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Date of birth | 1993-3-5 yyyy-mm-dd |
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Age | 30 Years |
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Education background | Middle school
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Occupation | Famer
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Other (Description) | 曾两次巧囊破裂病史 |
48 小时 |
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无 |
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Number of pregnancy | 1 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 | - 次 |
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abortion | - 次 |
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Last pregnancy | 2023-6 yyyy-mm-dd |
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Average times of menstrual onset a year | 12.5 次/年 |
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Average menstrual cycle | 28 天(days) |
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Menarche time | 13 岁(years) |
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The time of last Menstruation | 2024-2-9 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) |
两侧巧囊破裂病史 |
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5、 3年前 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 | 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 | 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 | 触及10*8*6cm包块，边界清无压痛活动 |
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Weight | 49 kg |
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Hight | 1670 mm |
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Systolic pressure (SP) | 119 mmHg |
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Diastolic pressure | 78 mmHg |
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Temperature | 36 degree Celsius |
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Pulse rate | 80 次/分 |
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Breath frequency | 20 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-2-26 yyyy-mm-dd |
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WBC | 3.3 ×109 /L |
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NEUT% | 45.77 % |
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LY% | 40.66 % |
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MONO％ | 10.5 ％ |
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RBC | 3.67 ×10^12 /L |
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HGB | 107 g/L |
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PLT | 154 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-2-27 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 6.0 |
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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 | 1.030 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-2-27 yyyy-mm-dd |
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Date of test | 2024-2-27 yyyy-mm-dd |
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K | 4.01 mmol/L |
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Na | 143.8 mmol/L |
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Cl | 111.2 mmol/L |
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Ca | 2.20 mmol/L |
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P | 1.39 mmol/L |
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Date of examination | 2024-2-27 yyyy-mm-dd |
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Prothrombin time | 12.0 秒 |
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Thrombin time (TT) | 16.5 秒 |
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Activated partial thromboplastin time (APTT) | 29.8 秒 |
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Fibrinogen (FIB) | 1.98 g/L |
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ALT | 6.4 IU/L |
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AST | 11.7 IU/L |
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GGT | 8.0 U/L |
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Serum bilirubin | 16.80 μmol/L |
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Indirect bilirubin | 12.00 umol/L |
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Direct bilirubin | 4.80 umol/L |
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Serum albumin | 38.2 g/L |
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Serum globulin | 17.8 g/L |
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Serum total protein | 56.2 g/L |
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Date of test | 2024-2-27 yyyy-mm-dd |
Negative
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Date of test | 2023-6-17 yyyy-mm-dd |
Negative
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Date of test | 2023-6-17 yyyy-mm-dd |
Negative
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Date of test | 2023-6-17 yyyy-mm-dd |
Negative
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Date of test | 2023-6-17 yyyy-mm-dd |
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SCr | 67.0 μmol/L |
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Blood urea | 6.70 mmol/L |
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Blood uric acid | 177.0 μmol/L |
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Date of test | 2024-2-27 yyyy-mm-dd |
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D-dimer value | 0.06 ug/mL |
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Date of test | 2024-2-27 |
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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 | 5.2*4.8*4.2 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 20 mm |
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Left ovary size | 2.1*1.8 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 | 10.2*8.7 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 8.9*7.3 |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 右卵巢巧囊 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-2-26 yyyy-mm-dd |
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Pain Visual Analogue Score | Generally pain easy to tolerable
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PH | 未查 |
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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 | 未查 (yyyy-mm-dd) |
右卵巢 |
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10 cm |
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0 ° |
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| / / | |
刘义彬 |
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2024-2-28 |
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D-dimer value | 0.17 ug/mL |
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Date of test | 202-29 |
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Body temperature | 36.2 ℃ |
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Systolic pressure (SP) | 107 mmHg |
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Diastolic pressure (DP) | 71 mmHg |
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Heart Rate, HR | 80 次/分 |
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Pulse | 80 次/秒 |
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WBC | 6.0 ×109 /L |
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NEUT% | 90.76 % |
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LY% | 6.56 % |
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MONO％ | 2.60 ％ |
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RBC | 3.77 ×10^12 /L |
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HGB | 108 g/L |
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PLT | 144 ×10^9 /L |
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Date | 2024-2-29 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 |