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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 | 2024-6-4 |
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Date of birth | 2009-5-27 yyyy-mm-dd |
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Age | 15 Years |
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Education background | Middle school
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Occupation | Other
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Other (Description) | 学生 |
间断7*24 小时 |
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无 |
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Number of pregnancy | -- 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 | 28 天(days) |
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Menarche time | 12 岁(years) |
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The time of last Menstruation | 2024-5-23 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 | 无 |
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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 | 156 kg |
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Hight | 51 mm |
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Systolic pressure (SP) | 107 mmHg |
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Diastolic pressure | 73 mmHg |
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Temperature | 38 degree Celsius |
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Pulse rate | 78 次/分 |
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Breath frequency | 22 次/分 |
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Doctor signature | 刘义彬 |
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Date | 2024-6-4 yyyy-mm-dd |
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WBC | 12.30 ×109 /L |
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NEUT% | 78.39 % |
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LY% | 13.99 % |
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MONO％ | 7.24 ％ |
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RBC | 4.74 ×10^12 /L |
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HGB | 103 g/L |
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PLT | 346 ×10^9 /L |
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Researcher signature | 刘义彬 |
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Date | 2024-6-4 yyyy-mm-dd |
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Acidity and allkalinity | alkalinity
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pH value | 7 |
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Urine protein | Negative
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Urine red cell | Positive+
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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 | 1.003 |
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UBG | Negative
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NIT | Negative
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Date of test | 2024-6-4 yyyy-mm-dd |
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Date of test | 2024-6-4 yyyy-mm-dd |
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K | 3.90 mmol/L |
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Na | 138.7 mmol/L |
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Cl | 100.0 mmol/L |
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Ca | 2.46 mmol/L |
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P | 1.15 mmol/L |
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Date of examination | 2024-6-4 yyyy-mm-dd |
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Prothrombin time | 14.1 秒 |
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Thrombin time (TT) | 12.0 秒 |
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Activated partial thromboplastin time (APTT) | 29.3 秒 |
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Fibrinogen (FIB) | 4.98 g/L |
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ALT | 8.4 IU/L |
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AST | 13.9 IU/L |
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GGT | 16.6 U/L |
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Serum bilirubin | 24.2 μmol/L |
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Indirect bilirubin | 13.8 umol/L |
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Direct bilirubin | 10.4 umol/L |
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Serum albumin | 43.7 g/L |
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Serum globulin | 32.3 g/L |
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Serum total protein | 76 g/L |
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Date of test | 2024-6-4 yyyy-mm-dd |
Negative
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Date of test | 2024-6-4 yyyy-mm-dd |
Negative
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Date of test | 2024-6-4 yyyy-mm-dd |
Negative
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Date of test | 2024-6-4 yyyy-mm-dd |
Negative
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Date of test | 2024-6-4 yyyy-mm-dd |
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SCr | 65 μmol/L |
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Blood urea | 4.1 mmol/L |
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Blood uric acid | 245 μmol/L |
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Date of test | 2024-6-4 yyyy-mm-dd |
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D-dimer value | 0.4 ug/mL |
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Date of test | 2024-6-4 |
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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 | 2024-6-4 yyyy-mm-dd |
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Size of the ulcer | 4*3*3 cm*cm |
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Uterine echo distribution | Even
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Endometrial thickness | 未报告 mm |
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Left ovary size | 不详 cm ×cm |
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Shape of Left ovary | Ovarian cyst
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Size of the Ovarian cyst | 7.06*5.78*4.8cm混合型包块 |
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Right ovary size | 未报告 cm ×cm |
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Shape of right ovary | Ovarian cyst
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Size of Ovarian cyst | 5.18*4.02*3.79cm |
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Description of other abnormal findings | -- |
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Diagnosis of the Ultrasound B | 输卵管系膜囊肿蒂扭转 |
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Doctor signature | 刘义彬 |
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Date of examination | 2024-6-4 yyyy-mm-dd |
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Pain Visual Analogue Score | Rather pain tolerable
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PH | 7.355 |
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PCO2 | 36.1 mmHg |
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P02 | 432 mmHg |
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SO2 | 99.7 ％ |
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HCO3 | 19.7 mmol/l |
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SBE | -5.2 mmol/l |
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LAC | 1.26 mmol/L |
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Date of examination | 2.24-6-4 (yyyy-mm-dd) |
双侧输卵管系膜囊肿 |
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左侧5cm 右侧5cm cm |
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顺时针5周 ° |
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| / / | |
刘义彬 |
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2024-6-4 |
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D-dimer value | 0.48 ug/mL |
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Date of test | 2024-6-5 |
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Body temperature | 37.8 ℃ |
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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 | 96 次/分 |
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Pulse | 96 次/秒 |
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WBC | 12.7 ×109 /L |
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NEUT% | 85.76 % |
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LY% | 8.92 % |
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MONO％ | 5.12 ％ |
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RBC | 3.91 ×10^12 /L |
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HGB | 88 g/L |
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PLT | 277 ×10^9 /L |
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Date | 2024-6-5 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 | 2024-6-4 6-5 yyyy-mm-dd-hh-min. |
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Label Number of the sample | 2603069 |
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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 |