|
Eligible participant has to fullfill all of the following items | / / / / / / / |
|
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
|
Date of signing the informed consent | 2024-3-6 |
|
Date of birth | 1987-4-5 yyyy-mm-dd |
|
Age | 36 Years |
|
Education background | Middle school
|
|
Occupation | Famer
|
|
Other (Description) | -- |
间断4+月 小时 |
|
无 |
|
|
Number of pregnancy | 4 次 |
|
Number of delivery | 2 次 |
|
If has delivery history, select following items | |
|
partus maturus | 2 次 |
|
premature delivery | 0 次 |
|
abortion | 0 次 |
|
Last pregnancy | 8年前 yyyy-mm-dd |
|
Average times of menstrual onset a year | 12.5 次/年 |
|
Average menstrual cycle | 28 天(days) |
|
Menarche time | 12 岁(years) |
|
The time of last Menstruation | 2024-2-27 年、月、日(yyyy-mm-dd) |
|
The time of menstrual onset before the last one | 不详 年、月、日(yyyy-mm-dd) |
无 |
|
-- 年/月/日（yyyy-mm-dd） |
|
|
Namy of the drug to be allergied | -- |
|
Vulva | Normal
|
|
Description in detail for abnormal | -- |
|
Vagina | Normal
|
|
Description in detail for abnormal | -- |
|
Uterine neck | Normal
|
|
Description in detail for abnormal | -- |
|
Corpus uteri | Normal
|
|
Description in detail for abnormal | -- |
|
Adnexa uteri | |
|
Left side | Abnormal
|
|
Description in detail for abnormal | 6cm包块，轻压痛 |
|
Right side | Normal
|
|
Description in detail for abnormal | - |
|
Weight | 56 kg |
|
Hight | 1600 mm |
|
Systolic pressure (SP) | 95 mmHg |
|
Diastolic pressure | 74 mmHg |
|
Temperature | 36.3 degree Celsius |
|
Pulse rate | 84 次/分 |
|
Breath frequency | 21 次/分 |
|
Doctor signature | 刘义彬 |
|
Date | 2024-3-6 yyyy-mm-dd |
|
WBC | 3.6 ×109 /L |
|
NEUT% | 50.33 % |
|
LY% | 34.92 % |
|
MONO％ | 12.6 ％ |
|
RBC | 3.97 ×10^12 /L |
|
HGB | 115 g/L |
|
PLT | 202 ×10^9 /L |
|
Researcher signature | 刘义彬 |
|
Date | 2024-3-7 yyyy-mm-dd |
|
Acidity and allkalinity | Acidity
|
|
pH value | 6.5 |
|
Urine protein | Negative
|
|
Urine red cell | Negative
|
|
Urine WBC | Negative
|
|
Urine glucos | Negative
|
|
Urine Bilirubin | Negative
|
|
Urine HCG | Negative
|
|
KET | Negative
|
|
SG | 1.023 |
|
UBG | Negative
|
|
NIT | Negative
|
|
Date of test | 2024-3-7 yyyy-mm-dd |
|
Date of test | 2024-3-7 yyyy-mm-dd |
|
K | 4.04 mmol/L |
|
Na | 142.4 mmol/L |
|
Cl | 107.0 mmol/L |
|
Ca | 2.20 mmol/L |
|
P | 1.30 mmol/L |
|
Date of examination | 2024-3-7 yyyy-mm-dd |
|
Prothrombin time | 12.5 秒 |
|
Thrombin time (TT) | 15.7 秒 |
|
Activated partial thromboplastin time (APTT) | 34.2 秒 |
|
Fibrinogen (FIB) | 2.25 g/L |
|
ALT | 9.1 IU/L |
|
AST | 16.0 IU/L |
|
GGT | 8.0 U/L |
|
Serum bilirubin | 14.5 μmol/L |
|
Indirect bilirubin | 10.60 umol/L |
|
Direct bilirubin | 3.90 umol/L |
|
Serum albumin | 40.4 g/L |
|
Serum globulin | 26.1 g/L |
|
Serum total protein | 66.5 g/L |
|
Date of test | 2024-3-7 yyyy-mm-dd |
Negative
|
|
|
Date of test | 2024-3-7 yyyy-mm-dd |
Negative
|
|
|
Date of test | 2024-3-7 yyyy-mm-dd |
Negative
|
|
|
Date of test | 2024-3-7 yyyy-mm-dd |
Negative
|
|
|
Date of test | 2024-3-7 yyyy-mm-dd |
|
SCr | 51.0 μmol/L |
|
Blood urea | 5.60 mmol/L |
|
Blood uric acid | 202.0 μmol/L |
|
Date of test | 2024-3-7 yyyy-mm-dd |
|
D-dimer value | 0.04 ug/mL |
|
Date of test | 2024-3-7 |
|
Urine pregnancy test | Not tested
|
|
Blood HCG concentration | -- mIU/mL |
|
Date of test | 2024-3-7 yyyy-mm-dd |
|
Size of the ulcer | 5.10*5.10*4.50 cm*cm |
|
Uterine echo distribution | Even
|
|
Endometrial thickness | 0.81 mm |
|
Left ovary size | 6.25*2.79cm， cm ×cm |
|
Shape of Left ovary | Ovarian cyst
|
|
Size of the Ovarian cyst | 3.63cm巧囊 +畸胎瘤 |
|
Right ovary size | 2.37*1.74 cm ×cm |
|
Shape of right ovary | Normal
|
|
Size of Ovarian cyst | -- |
|
Description of other abnormal findings | -- |
|
Diagnosis of the Ultrasound B | 畸胎瘤 |
|
Doctor signature | 刘义彬 |
|
Date of examination | 2024-2 yyyy-mm-dd |
|
Pain Visual Analogue Score | Occasionally very slight pain
|
|
PH | 7.429 |
|
PCO2 | 36.4 mmHg |
|
P02 | 315.6 mmHg |
|
SO2 | 99.2 ％ |
|
HCO3 | 23.6 mmol/l |
|
SBE | -0.4 mmol/l |
|
LAC | 0.98 mmol/L |
|
Date of examination | 2024-3-8 (yyyy-mm-dd) |
左卵巢 |
|
4*4*3 cm |
|
0 ° |
|
刘义彬 |
|
2024-3-8 |
|
D-dimer value | 0.08 ug/mL |
|
Date of test | 2024-3-9 |
|
Body temperature | 37.2 ℃ |
|
Systolic pressure (SP) | 103 mmHg |
|
Diastolic pressure (DP) | 67 mmHg |
|
Heart Rate, HR | 82 次/分 |
|
Pulse | 82 次/秒 |
|
WBC | 5.9 ×109 /L |
|
NEUT% | 75.86 % |
|
LY% | 16.87 % |
|
MONO％ | 6.79 ％ |
|
RBC | 3.83 ×10^12 /L |
|
HGB | 112 g/L |
|
PLT | 204 ×10^9 /L |
|
Date | 2024-3-9 yyyy-mm-dd |
| / | |
|
Pain Visual Analogue Score | Occasionally very slight pain
|
|
sample collection | Collected
|
|
Volume | 2 ml |
|
Time of collection | 2024-3-8 2024-3-9 yyyy-mm-dd-hh-min. |
|
Label Number of the sample | 2571190 |
|
Date received at DCC | -- yyyymmdd |
|
Report type | |
|
Name of this event | -- |
|
SAE start date | -- yyyymmdd |
|
SAE stop date | -- yyyymmdd |
|
Was this an unanticipated adverse event | |
|
Attribution to Study Drug | |
|
Outcome Type(check all that apply) | |
|
Recovery Description: (check only one) | |
|
Please provide a brief narrative of the SAE occurrence below | -- |
|
Name of the recorder | -- |
|
Data | -- yyyymmdd |
|
Site Investigator’s signature | -- |
|
Data | -- yyyymmdd |