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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 | 2024-5-12 |
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Date of birth | 2024-5-12 yyyy-mm-dd |
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Age | 12 Years |
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Education background | Primary school
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Occupation | Other
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Other (Description) | 学生 |
24 小时 |
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无 |
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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 | 12 次/年 |
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Average menstrual cycle | 30 天(days) |
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Menarche time | 10 岁(years) |
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The time of last Menstruation | 2024-4-20 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 | 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 | 可触及包块 |
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Right side | Normal
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Description in detail for abnormal | -- |
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Weight | 69 kg |
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Hight | 1600 mm |
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Systolic pressure (SP) | 120 mmHg |
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Diastolic pressure | 77 mmHg |
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Temperature | 36.3 degree Celsius |
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Pulse rate | 88 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 | 2024-5-12 yyyy-mm-dd |
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WBC | 6.2 ×109 /L |
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NEUT% | 48.69 % |
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LY% | 39.46 % |
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MONO％ | 9.18 ％ |
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RBC | 4.48 ×10^12 /L |
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HGB | 133 g/L |
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PLT | 215 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-5-13 yyyy-mm-dd |
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Acidity and allkalinity | alkalinity
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pH value | 7.0 |
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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 | 1.032 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-5-13 yyyy-mm-dd |
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Date of test | 2024-5-13 yyyy-mm-dd |
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K | 4.12 mmol/L |
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Na | 139.0 mmol/L |
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Cl | 106.6 mmol/L |
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Ca | 2.40 mmol/L |
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P | 1.60 mmol/L |
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Date of examination | 2024-5-13 yyyy-mm-dd |
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Prothrombin time | 10.8 秒 |
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Thrombin time (TT) | 14.8 秒 |
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Activated partial thromboplastin time (APTT) | 32.0 秒 |
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Fibrinogen (FIB) | 2.62 g/L |
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ALT | 9.4 IU/L |
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AST | 16.9 IU/L |
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GGT | 11.1 U/L |
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Serum bilirubin | 12.10 μmol/L |
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Indirect bilirubin | 9.50 umol/L |
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Direct bilirubin | 2.60 umol/L |
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Serum albumin | 41.1 g/L |
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Serum globulin | 20.6 g/L |
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Serum total protein | 61.7 g/L |
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Date of test | 2024-5-13 yyyy-mm-dd |
Negative
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Date of test | 2024-5-13 yyyy-mm-dd |
Negative
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Date of test | 2024-5-13 yyyy-mm-dd |
Negative
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Date of test | 2024-5-13 yyyy-mm-dd |
Negative
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Date of test | 2024-5-13 yyyy-mm-dd |
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SCr | 45.0 μmol/L |
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Blood urea | 5.50 mmol/L |
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Blood uric acid | 330.0 μmol/L |
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Date of test | 2024-5-13 yyyy-mm-dd |
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D-dimer value | 0.22 ug/mL |
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Date of test | 2024-5-13 |
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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 | 3.68*4.28*3.62 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 1.32 mm |
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Left ovary size | 未报告 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 7.34*6.37*5.79cm |
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Right ovary size | 2.94*2.04 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 | 左卵巢囊肿蒂扭转 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-5-15 yyyy-mm-dd |
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Pain Visual Analogue Score | Quit pain barely tolerable
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PH | 7.36 |
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PCO2 | 35.1 mmHg |
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P02 | 396.2 mmHg |
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SO2 | 100 ％ |
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HCO3 | 20.1 mmol/l |
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SBE | -5.29 mmol/l |
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LAC | 小于1.0 mmol/L |
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Date of examination | 2024-5-13 (yyyy-mm-dd) |
左附件 |
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7 cm |
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0 ° |
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| / | |
刘义彬 |
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2024-5-13 |
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D-dimer value | 0.25 ug/mL |
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Date of test | 2024-5-15 |
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Body temperature | 36.4 ℃ |
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Systolic pressure (SP) | 116 mmHg |
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Diastolic pressure (DP) | 78 mmHg |
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Heart Rate, HR | 84 次/分 |
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Pulse | 84 次/秒 |
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WBC | 9.80 ×109 /L |
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NEUT% | 71.61 % |
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LY% | 19.76 % |
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MONO％ | 8.06 ％ |
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RBC | 4.32 ×10^12 /L |
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HGB | 127 g/L |
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PLT | 227 ×10^9 /L |
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Date | 2024-5-15 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 | 5 ml |
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Time of collection | 2024-5-12 20024-5-15 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2594536 |
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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 |