Adverse Event Clinical Research
1.0.1 - STU1 International flag

This page is part of the Adverse Event Clinical Research (v1.0.1: STU 1) based on FHIR (HL7® FHIR® Standard) v5.0.0. This is the current published version. For a full list of available versions, see the Directory of published versions

Example AdverseEvent: Patient reported AE during research study

Page standards status: Informative

Generated Narrative: AdverseEvent

Resource AdverseEvent "clinical-research-ae-example-medwatch-patient-report"

Profile: Adverse Event Clinical Research

Criteria reviewed in determining serious adverse event

url

criterionPresent

value: true

url

criterionCode

value: Required Intervention to Prevent Permanent Impairment/damage (NCI Thesaurus#C201939)

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Results In Persistent Or Significant Disability (NCI Thesaurus#C11338)

url

criterionPresent

value: false

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Requires Inpatient Hospitalization (NCI Thesaurus#C83052)

url

criterionPresent

value: false

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Death Related to Adverse Event (NCI Thesaurus#C48275)

url

criterionPresent

value: false

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Is Life Threatening (NCI Thesaurus#C84266)

url

criterionPresent

value: false

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Congenital Anomaly or Birth Defect (NCI Thesaurus#C83117)

url

criterionPresent

value: false

Criteria reviewed in determining serious adverse event

url

criterionCode

value: Other Medically Important Condition (NCI Thesaurus#C82521)

url

criterionPresent

value: false

status: completed

actuality: actual

code: Serious reportable event associated with product or device (SNOMED CT#370901008)

subject: Patient/JanetPatient: Janet " CLINICAL TRIAL PATIENT"

detected: 2023-04-10

resultingEffect: Condition/janetReported-condition

seriousness: Serious (AdverseEventSeriousness#serious)

outcome: Recovered/Resolved (NCI Thesaurus#C49498)

recorder: Patient/JanetPatient " CLINICAL TRIAL PATIENT"

study: ResearchStudy/BreastCancerTrial

suspectEntity

instance: Medication/bresentrik

Causalities

-EntityRelatednessAuthor
*Possibly Related (NCI Thesaurus#C53258)Patient/JanetPatient: Janet " CLINICAL TRIAL PATIENT"

suspectEntity

instance: ResearchStudy/BreastCancerTrial

Causalities

-EntityRelatednessAuthor
*Possibly Related (NCI Thesaurus#C53258)Patient/JanetPatient: Janet " CLINICAL TRIAL PATIENT"

supportingInfo

item: MedicationAdministration/medicationAdministration-for-bresentrik

supportingInfo

item: Observation/weight-janet

supportingInfo

item: Observation/blood-pressure-janet

supportingInfo

item: MedicationStatement/example001

supportingInfo

item: MedicationStatement/example007

supportingInfo

item: MedicationStatement/example003

note: A 64-year-old woman (Janet) is participating in a breast cancer clinical trial and taking an investigational drug. As part of her participation in the study, she was instructed to use a patient reported outcomes (ePRO) application to report an adverse event that resulted in any of the following: hospitalization, required help to prevent permanent harm, disability or health problem, birth defect, life-threatening, death, other serious/important medical incident (this list identifies the event as being serious events). The application is designed to capture data elements found on the 3500A Form. The Clinical Investigator (CI) receives a notification that Janet has an adverse event and reviews the event in Janet’s EHR system. The adverse event form is pre-populated from EHR data for the clinical investigator. The CI assesses causality for Janet’s adverse event and submits the serious adverse event to the sponsor. The sponsor reviews the received adverse event and performs its own causality assessment. Since this event is a Suspected Unexpected Serious Adverse Reaction (SUSAR) within FDA’s regulation. If the Suspected Unexpected Serious Adverse Reaction (SUSAR) was life threatening or death, it is submitted within 7 calendar days. Any other types of seriousness are submitted within 15 calendar days. (By Patient/JanetPatient @2023-04-12)