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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 | 1987-6-8 yyyy-mm-dd |
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Age | 36 Years |
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Education background | Middle school
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Occupation | Famer
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Other (Description) | -- |
间断6天 小时 |
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无 |
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Number of pregnancy | 3 次 |
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Number of delivery | 2 次 |
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If has delivery history, select following items | |
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partus maturus | 2 次 |
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premature delivery | 0 次 |
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abortion | 1 次 |
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Last pregnancy | 9年前 yyyy-mm-dd |
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Average times of menstrual onset a year | 12 次/年 |
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Average menstrual cycle | 5.5 天(days) |
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Menarche time | 13 岁(years) |
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The time of last Menstruation | 2024-2-18 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) |
剖宫产2次 |
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2009 2013 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 | 8*8*7cm包块 |
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Weight | 70 kg |
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Hight | 1620 mm |
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Systolic pressure (SP) | 118 mmHg |
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Diastolic pressure | 75 mmHg |
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Temperature | 36.3 degree Celsius |
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Pulse rate | 84 次/分 |
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Breath frequency | 21 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 | 4.6 ×109 /L |
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NEUT% | 57.95 % |
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LY% | 32.76 % |
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MONO％ | 6.73 ％ |
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RBC | 3.74 ×10^12 /L |
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HGB | 108 g/L |
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PLT | 279 ×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 | 6.5 |
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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 | 1.015 |
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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 | 4.05 mmol/L |
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Na | 142.5 mmol/L |
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Cl | 106.9 mmol/L |
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Ca | 2.15 mmol/L |
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P | 1.10 mmol/L |
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Date of examination | 2024-2-27 yyyy-mm-dd |
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Prothrombin time | 11.0 秒 |
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Thrombin time (TT) | 13.6 秒 |
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Activated partial thromboplastin time (APTT) | 29.8 秒 |
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Fibrinogen (FIB) | 3.42 g/L |
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ALT | 4.6 IU/L |
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AST | 13.4 IU/L |
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GGT | 14.0 U/L |
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Serum bilirubin | 10.0 μmol/L |
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Indirect bilirubin | 8.0 umol/L |
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Direct bilirubin | 2.00 umol/L |
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Serum albumin | 37.2 g/L |
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Serum globulin | 28.2 g/L |
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Serum total protein | 65.4 g/L |
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Date of test | 2024-2-27 yyyy-mm-dd |
Negative
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Date of test | 2024-2-27 yyyy-mm-dd |
Negative
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Date of test | 2024-2-27 yyyy-mm-dd |
Negative
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Date of test | 2024-2-27 yyyy-mm-dd |
Negative
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Date of test | 2024-2-27 yyyy-mm-dd |
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SCr | 49.0 μmol/L |
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Blood urea | 3.30 mmol/L |
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Blood uric acid | 231.0 μmol/L |
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Date of test | 2024-2-27 yyyy-mm-dd |
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D-dimer value | 0.19 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 | 5.19*5.78*4.77 cm*cm |
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Uterine echo distribution | Not even
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Endometrial thickness | 0.91 mm |
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Left ovary size | 4.38*1.63 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 | 8.96*7.0 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 6.86 4.33cm |
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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 | 2024-2-24 yyyy-mm-dd |
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Pain Visual Analogue Score | Rather pain tolerable
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PH | 7.387 |
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PCO2 | 39.6 mmHg |
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P02 | 152.4 mmHg |
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SO2 | 98.5 ％ |
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HCO3 | 23.3 mmol/l |
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SBE | -1.5 mmol/l |
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LAC | 1.12 mmol/L |
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Date of examination | 2024-3-1 (yyyy-mm-dd) |
右附件 |
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9*9*8 cm |
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顺时针 180 ° |
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| / | |
刘义彬 |
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2024-3-1 |
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D-dimer value | 0.63 ug/mL |
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Date of test | 2024-3-2 |
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Body temperature | 37 ℃ |
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Systolic pressure (SP) | 103 mmHg |
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Diastolic pressure (DP) | 77 mmHg |
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Heart Rate, HR | 84 次/分 |
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Pulse | 84 次/秒 |
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WBC | 10.90 ×109 /L |
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NEUT% | 79.92 % |
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LY% | 13.68 % |
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MONO％ | 6.27 ％ |
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RBC | 3.64 ×10^12 /L |
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HGB | 105 g/L |
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PLT | 232 ×10^9 /L |
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Date | 2024-3-2 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 | 2 ml |
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Time of collection | 2024-2-27 2024-3-2 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2568295 |
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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 |