CONSENT FOR RESEARCH 
Patient Name: 
History Number: 
Consent version 5/23/94 
STUDY TITLE: AIS-1061-9406 
A PILOT STUDY OF AUTOLOGOUS HUMAN 
INTERLEUKIN 2 GENE MODIFIED TUMOR CELLS IN 
PATIENTS WITH REFRACTORY OR RECURRENT 
METASTATIC BREAST CANCER 
IRB # 302-94-3 
AUTOPSY: 
In the event of death, whether from accident or illness, even if it is unrelated to the experiment, an 
autopsy will be requested of the family. You should make your wishes known to your family. 
"I have read the above and have been given the opportunity to discuss it and to ask questions. I have 
been informed that I may contact Dr. H. Kim Lyerly at (919) 681-8350 to answer any questions that 
I may have during the investigation. I may contact the Office of Risk Management (919) 684-3277 
for any questions concerning my rights as a research subject. I agree to participate as a research 
subject and certify that I have been informed of the purposes, procedures, risks and possible benefits 
of this study. I agree to participate with the understanding that I may refuse to participate and may 
withdraw at any time without interfering with my regular medical care." 
Signature of Patient 
Date 
Signature of Person Obtaining Consent Date 
cc: Patient 
Medical Record 
Principal Investigator 
Business Office 
Applied Immune Sciences (sponsor) 
Patient Initials: 
Recomb inant DNA Research, Volume 20 
[272] 
