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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 | 2024-3-14 |
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Date of birth | 2006-7-10 yyyy-mm-dd |
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Age | 17 Years |
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Education background | Middle school
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Occupation | Other
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Other (Description) | 学生 |
12 小时 |
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午睡后 |
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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 | 9.8 次/年 |
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Average menstrual cycle | 6.5 天(days) |
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Menarche time | 14 岁(years) |
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The time of last Menstruation | 2024-2-1 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) |
-- |
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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 | Not examined
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Description in detail for abnormal | -- |
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Uterine neck | Not examined
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Description in detail for abnormal | -- |
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Corpus uteri | Not examined
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Description in detail for abnormal | -- |
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Adnexa uteri | |
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Left side | Not examined
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Description in detail for abnormal | -- |
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Right side | Not examined
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Description in detail for abnormal | -- |
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Weight | 55 kg |
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Hight | 1500 mm |
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Systolic pressure (SP) | 89 mmHg |
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Diastolic pressure | 78 mmHg |
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Temperature | 36.2 degree Celsius |
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Pulse rate | 72 次/分 |
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Breath frequency | 18 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-3-14 yyyy-mm-dd |
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WBC | 13.30 ×109 /L |
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NEUT% | 88.09 % |
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LY% | 7.77 % |
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RBC | 2.97 ×10^12 /L |
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MONO％ | 3.93 ％ |
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HGB | 98 g/L |
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PLT | 239 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-3-14 yyyy-mm-dd |
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Acidity and allkalinity | |
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pH value | 未查 |
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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 | 未查 |
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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 | 2024-3-14 yyyy-mm-dd |
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K | 4.20 mmol/L |
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Na | 141.0 mmol/L |
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Cl | 102.3 mmol/L |
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Ca | 2.47 mmol/L |
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P | 1.02 mmol/L |
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Date of examination | 2024-3-14 yyyy-mm-dd |
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Prothrombin time | 12.2 秒 |
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Thrombin time (TT) | 17.8 秒 |
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Activated partial thromboplastin time (APTT) | 30.4 秒 |
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Fibrinogen (FIB) | 1.92 g/L |
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ALT | 26.3 IU/L |
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AST | 42.5 IU/L |
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GGT | 26.0 U/L |
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Serum bilirubin | 12.70 μmol/L |
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Indirect bilirubin | 11.40 umol/L |
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Direct bilirubin | 1.30 umol/L |
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Serum albumin | 49.3 g/L |
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Serum globulin | 29.6 g/L |
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Serum total protein | 78.9 g/L |
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Date of test | 2024-3-14 yyyy-mm-dd |
Negative
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Date of test | 2024-3-14 yyyy-mm-dd |
Negative
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Date of test | 2024-3-14 yyyy-mm-dd |
Negative
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Date of test | 2024-3-14 yyyy-mm-dd |
Negative
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Date of test | 2024-3-14 yyyy-mm-dd |
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SCr | 67 μmol/L |
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Blood urea | 4.40 mmol/L |
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Blood uric acid | 302.0 μmol/L |
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Date of test | 2024-3-14 yyyy-mm-dd |
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D-dimer value | 0.12 ug/mL |
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Date of test | 2024-3-14 |
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Urine pregnancy test | Not tested
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Blood HCG concentration | 未查 mIU/mL |
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Date of test | -- yyyy-mm-dd |
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Size of the ulcer | 5.3*5.2*4.2 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 1.2 mm |
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Left ovary size | 报告不清 cm ×cm |
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Shape of Left ovary | |
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Size of the Ovarian cyst | 子宫前方18㎝囊性肿物 |
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Right ovary size | -- 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 | 卵巢囊肿蒂扭转 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-3-14 yyyy-mm-dd |
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Pain Visual Analogue Score | Very pain
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P02 | mmHg |
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SO2 | ％ |
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SBE | mmol/l |
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HCO3 | mmol/l |
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Date of examination | 未查 (yyyy-mm-dd) |
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LAC | mmol/L |
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PCO2 | mmHg |
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PH | 未查 |
右卵巢 |
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18*18 cm |
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5周 ° |
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| / | |
刘义彬 |
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2024-3-14 |
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D-dimer value | 0.10 ug/mL |
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Date of test | 2024-3-15 |
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Body temperature | 37 ℃ |
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Systolic pressure (SP) | -- mmHg |
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Diastolic pressure (DP) | -- mmHg |
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Heart Rate, HR | 100 次/分 |
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Pulse | 100 次/秒 |
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WBC | 9.94 ×109 /L |
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NEUT% | 76.50 % |
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LY% | 16.60 % |
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MONO％ | 5.50 ％ |
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RBC | 2.56 ×10^12 /L |
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HGB | 82 g/L |
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PLT | 219 ×10^9 /L |
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Date | 2024-3-15 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 | 2024-3-14 -15 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2573853 |
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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 | 刘义彬 |
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Data | 2024-3-15 yyyymmdd |