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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 | 2024-3-11 |
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Date of birth | 1991-6-7 yyyy-mm-dd |
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Age | 32 Years |
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Education background | University
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Occupation | Teacher
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Other (Description) | -- |
间断7个月 小时 |
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-- |
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Number of pregnancy | 1 次 |
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Number of delivery | 0 次 |
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If has delivery history, select following items | |
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partus maturus | 0 次 |
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premature delivery | 0 次 |
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abortion | 1 次 |
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Last pregnancy | 2021年 葡萄胎 清宫 yyyy-mm-dd |
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Average times of menstrual onset a year | 11 次/年 |
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Average menstrual cycle | 8 天(days) |
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Menarche time | 14 岁(years) |
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The time of last Menstruation | 2023-1-6 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 | 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6cm包块 |
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Right side | Normal
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Description in detail for abnormal | -- |
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Weight | 48 kg |
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Hight | 1600 mm |
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Systolic pressure (SP) | 137 mmHg |
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Diastolic pressure | 96 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 | 2024-3-11 yyyy-mm-dd |
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WBC | 4.1 ×109 /L |
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NEUT% | 50.42 % |
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LY% | 42.02 % |
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MONO％ | 6.28 ％ |
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RBC | 3.84 ×10^12 /L |
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HGB | 115 g/L |
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PLT | 180 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-3-12 yyyy-mm-dd |
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Acidity and allkalinity | Acidity
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pH value | 6 |
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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 | 1.023 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-3-12 yyyy-mm-dd |
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Date of test | 2024-3-12 yyyy-mm-dd |
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K | 4.02 mmol/L |
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Na | 141.1 mmol/L |
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Cl | 106.3 mmol/L |
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Ca | 2.20 mmol/L |
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P | 1.40 mmol/L |
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Date of examination | 2024-3-12 yyyy-mm-dd |
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Prothrombin time | 10.0 秒 |
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Thrombin time (TT) | 15.5 秒 |
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Activated partial thromboplastin time (APTT) | 29.0 秒 |
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Fibrinogen (FIB) | 2.95 g/L |
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ALT | 30.4 IU/L |
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AST | 24.4 IU/L |
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GGT | 18.0 U/L |
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Serum bilirubin | 10.6 μmol/L |
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Indirect bilirubin | 9.10 umol/L |
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Direct bilirubin | 1.50 umol/L |
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Serum albumin | 40.5 g/L |
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Serum globulin | 22.0 g/L |
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Serum total protein | 62.5 g/L |
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Date of test | 2024-3-12 yyyy-mm-dd |
Negative
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Date of test | 2024-3-12 yyyy-mm-dd |
Negative
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Date of test | yyyy-mm-dd |
Negative
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Date of test | yyyy-mm-dd |
Negative
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Date of test | yyyy-mm-dd |
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SCr | 48.0 μmol/L |
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Blood urea | 5.70 mmol/L |
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Blood uric acid | 152.0 μmol/L |
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Date of test | 2024-3-12 yyyy-mm-dd |
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D-dimer value | 0.04 ug/mL |
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Date of test | 2024-3-12 |
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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 | 3.32*3.05*2.38 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 2.2 mm |
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Left ovary size | 6.87*4.39 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 6.74cm |
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Right ovary size | 2.48*1.5 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 | 左卵巢巧囊 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-3-11 yyyy-mm-dd |
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Pain Visual Analogue Score | Occasionally very slight pain
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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 | (yyyy-mm-dd) |
作乱操 |
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7 cm |
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0 ° |
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| / | |
刘义彬 |
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2024-3-14 |
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D-dimer value | 0.11 ug/mL |
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Date of test | 2024-3-15 |
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Body temperature | 36.7 ℃ |
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Systolic pressure (SP) | 未查 mmHg |
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Diastolic pressure (DP) | 未查 mmHg |
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Heart Rate, HR | 87 次/分 |
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Pulse | 87 次/秒 |
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WBC | 4.55 ×109 /L |
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NEUT% | 73.7 % |
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LY% | 19.8 % |
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MONO％ | 5.90 ％ |
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RBC | 3.92 ×10^12 /L |
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HGB | 115 g/L |
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PLT | 155 ×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 | 2024-3-11-15 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2572349 |
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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 |