Attachment
Item
To be enclosed to
integer
C1999228 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1])
Physician
Item
Treating Physician
text
C1710470 (UMLS CUI [1])
Responsible Person Signature
Item
Signature
text
C1550483 (UMLS CUI [1])
G-CSF
Item
Administering of G-CSF
text
C0079459 (UMLS CUI [1])
Start time
Item
Start time
time
C1301880 (UMLS CUI [1])
End time
Item
End time
time
C1522314 (UMLS CUI [1])
Medication name
Item
Specify medication used:
text
C2360065 (UMLS CUI [1])
Dosage
Item
Dosage
float
C0178602 (UMLS CUI [1])
Erythrocyte concentrate
Item
Amount of erythrocyte concentrate administered
integer
C0086252 (UMLS CUI [1])
Erythrocyte concentrate
Item
Date of latest Transfusion
date
C0199962 (UMLS CUI [1])
Platelet concentrate
Item
Amount of Platelet concentrate administered
integer
C1293886 (UMLS CUI [1])
Platelet concentrate
Item
Date of latest platelet transfusion
date
C1293886 (UMLS CUI [1])
Item
Allergic reaction or hypersensitivity
text
C1527304|C0020517 (UMLS CUI [1])
Code List
Allergic reaction or hypersensitivity
CL Item
none , 1=transient erythema/drug fever <38°C , 2=urticaria/drug fever ≤ 38°C /mild bronchial spasm 3=serum sickness/bronchial spasms/parenteral therapy necessary , 4=anaphylaxis (0)
Item
Other
text
C0205394 (UMLS CUI [1])
CL Item
1 , 2=2, 3=3, 4=4 (1)
Item
Light Sensitivity
text
C0085636 (UMLS CUI [1])
Code List
Light Sensitivity
CL Item
normal , 2=symptoms without impairment of ADL , 3=symptoms, ADL impaired (0)
Item
Hearing
text
C0018767 (UMLS CUI [1])
CL Item
normal , 1=hearing loss only to be determined audiometrically , 2=moderate symptoms of tinnitus,mild hypacusis in audiometric testing , 3=severely impairing hearing loss,hearing aid required , 4=irreversible deafness (0)
Item
Audiometry
integer
C0004286 (UMLS CUI [1])
CL Item
no hearing loss (0)
CL Item
≤ 15dB at ≤ 2kHz (1)
CL Item
16-30dB at ≤ 2kHz (2)
CL Item
31-60dB at ≤ 2kHz (3)
CL Item
>60dB at ≤ 2kHz (4)
Cushingoid symptoms
Item
Cushingoid symptoms
boolean
C1559204 (UMLS CUI [1])
Item
Hypothyroidism
text
C0020676 (UMLS CUI [1])
CL Item
none , 1=asymptomatic/no treatment required , 2=symptomatic/treatment required , 3=hospitalization associated with hypothyroidism , 4=myxedema coma (0)
Inappropriate ADH Syndrome
Item
Inappropriate ADH Syndrome
boolean
C0021141 (UMLS CUI [1])
Item
Nausea
text
C0027497 (UMLS CUI [1])
CL Item
almost normal eating (1)
CL Item
severely reduced food intake but still eating (2)
CL Item
almost no food intake (3)
Item
Emesis
text
C0042963 (UMLS CUI [1])
CL Item
1 episode/24h (1)
CL Item
2-5 episodes/24h (2)
CL Item
6-10 episodes/24h (3)
CL Item
>10 episodes/24h or parenteral antiemesis (4)
Item
Diarrhea
text
C0011991 (UMLS CUI [1])
CL Item
>2-3 bowel movements/day (1)
CL Item
≥4-6 bowel movements/day, nightly tenesmus,moderate tenesmus at daytime (2)
CL Item
≥7-9 bowel movements/day, severe tenesmus,incontinence (3)
CL Item
≥10 bowel movements/day, bloody diarrhea, i.v infusions required (4)
Item
Taste perception
text
C0039336 (UMLS CUI [1])
Code List
Taste perception
CL Item
slightly altered (1)
CL Item
severly altered (2)
CL Item
irreversibly altered (4)
Item
Smell perception
text
C0037361 (UMLS CUI [1])
Code List
Smell perception
CL Item
slightly altered (1)
CL Item
severly altered (2)
CL Item
irreversibly altered (4)
Item
Constipation
text
C0332307 (UMLS CUI [1])
Item
Proctitis
text
C0033246 (UMLS CUI [1])
CL Item
increased frequency of bowel movement,blood spots (1)
CL Item
increased frequency of bowel movement,bloody feces (2)
CL Item
diarrhea,severly bloody and mucous feces, parenteral substitution required (3)
CL Item
perforation,bleeding,necrosis,other life threatening complication (4)
Item
Bleeding
text
C0005779 (UMLS CUI [1])
CL Item
mild, no pRBC´s required (1)
CL Item
pRBC required (3)
CL Item
life threatening bleeding,ICU required (4)
Item
PTT (partial thromboplastin time)
float
C0030605 (UMLS CUI [1])
Code List
PTT (partial thromboplastin time)
Item
Petechiae or purpura
text
C0031256|C0034150 (UMLS CUI [1])
Code List
Petechiae or purpura
CL Item
petechiae and purpura in larger area (2)
CL Item
generalised petechiae and purpura in skin and/or mucous membrane (4)
Item
Quick
text
C0483455 (UMLS CUI [1])
Item
Leucocytes
integer
C0023508 (UMLS CUI [1])
Item
Platelets
text
C0005821 (UMLS CUI [1])
Item
Hemoglobin
text
C0019046 (UMLS CUI [1])
Item
Lymphocytes
text
C0024264 (UMLS CUI [1])
Item
Granulocytes
text
C0857490 (UMLS CUI [1])
CL Item
> 2.000 1=< 2.000 2=< 1.500 3=< 1.000 4=< 500 (0)
Item
Hemorrhage
text
C0019080 (UMLS CUI [1])
CL Item
little,no pRBC required (1)
CL Item
severe,1-2 pRBC/episode (2)
CL Item
very severe, 3-4 pRBC/episode (3)
CL Item
massive,>4 pRBC/episode (4)
Item
Alopecia
text
C1559115 (UMLS CUI [1])
CL Item
severe/complete (2)
Item
Rash/Desquamation
text
C1559142 (UMLS CUI [1])
Code List
Rash/Desquamation
CL Item
macular/papular exanthema (1)
CL Item
macular/papular erythema with pruritus on 50% of body surface (2)
CL Item
generalised erythroderma/macular-papular or vesicular eruptions >50% body surface (3)
CL Item
generalised exfoliative/ulcerative dermatitis (4)
Item
Stomatitis
text
C0038362 (UMLS CUI [1])
CL Item
painless ulceration/erythema (1)
CL Item
painful erythema/edema/ulceration, but still able to eat (2)
CL Item
painful erythema/edema/ulceration, unable to eat (3)
CL Item
parenteral or enteral nutrition required (4)
Item
Urticaria
text
C0042109 (UMLS CUI [1])
CL Item
no treatment required (1)
CL Item
topical or systemic treatment < 24h required (2)
CL Item
systemic treatment > 24h required (3)
Item
Wound infection
text
C0043241 (UMLS CUI [1])
Code List
Wound infection
CL Item
superficial infection (2)
CL Item
iv antibiotics required (3)
CL Item
necrotizing fasciitis (4)
Item
Impaired healing
text
C0151692 (UMLS CUI [1])
Code List
Impaired healing
CL Item
suture dehiscence (1)
CL Item
suture hernia (2)
CL Item
fasciotomy with exposure of inner organs (4)
Item
Burn Injury
text
C0006434 (UMLS CUI [1])
CL Item
°I (painful rash and swelling) (1)
CL Item
°II (blistering,exuding skin-lesion) (2)
CL Item
°III (blistering,white-grey necrosis of dermis and subdermis,no pain,no epithelial regeneration (3)
CL Item
°IV (no regeneration, charring) (4)
Item
Burns classified according to percentage of body surface involved or size of burn blister
text
C0433219 (UMLS CUI [1,1])
C2003948 (UMLS CUI [1,2])
Code List
Burns classified according to percentage of body surface involved or size of burn blister
Item
Arrhythmia
text
C0003811 (UMLS CUI [1])
CL Item
asymtomatic,transient,no treatment required (1)
CL Item
reoccuring or persisting,no treatment required (2)
CL Item
antiarrhythmical treatment required (3)
CL Item
hypotension, ventricular tachycardy,ventricular fibrillation (4)
Item
Cardiac output
text
C0420202 (UMLS CUI [1])
CL Item
asymptomatic reduction of resting ef <20% from baseline (1)
CL Item
asymptomatic reduction of resting ef >20% from baseline (2)
CL Item
moderate heart failure, not refractory to treatment (3)
CL Item
severe heart failure (4)
Item
Hypotension
text
C0020649 (UMLS CUI [1])
CL Item
treatment required but no hospitalization (2)
CL Item
hospitalization,no long-term effects (3)
Item
Edema
text
C0013604 (UMLS CUI [1])
CL Item
treatment required (2)
CL Item
difficult treatment, impairing (3)
Item
Pericardial effusion or Pericarditis
text
C0031039 (UMLS CUI [1,1])
C1963211 (UMLS CUI [1,2])
Code List
Pericardial effusion or Pericarditis
CL Item
asymptomatic effusion, no intervention required (1)
CL Item
Pericarditis (pain,ecg-alterations...) (2)
CL Item
symptomatic effusion,drainage required (3)
CL Item
pericardial tamponade, immediate intervention required (4)
Item
Catheter related infection
text
C0860239 (UMLS CUI [1])
Code List
Catheter related infection
CL Item
minor, no treatment required (1)
CL Item
local infection,local or oral treatment sufficient (2)
CL Item
severe,systemic infection, iv antibiotics/antimycotics required, hospitalization (3)
CL Item
life threatening sepsis (4)
Item
Infection of unknown anc
text
C1559868 (UMLS CUI [1])
Code List
Infection of unknown anc
CL Item
lifethreatening sepsis (4)
Item
Alkalosis
text
C0002063 (UMLS CUI [1])
CL Item
pH≤ normal but >7,3 (1)
CL Item
pH<7,3 and lifethreatening (4)
Item
Acidosis
text
C0220981 (UMLS CUI [1])
CL Item
≥ normal but < 7,5 (1)
CL Item
< 7,5 and lifethreatening (4)
Item
Hyperglycemia
text
C0020456 (UMLS CUI [1])
Item
Hypoglycemia
text
C0020615 (UMLS CUI [1])
Item
Hypercalcemia
text
C0020437 (UMLS CUI [1])
Item
Hypocalcemia
text
C0020598 (UMLS CUI [1])
Item
Hypomagnesemia
text
C0151723 (UMLS CUI [1])
Item
Hypernatremia
text
C1522136 (UMLS CUI [1])
CL Item
ULN-150mmol/l (1)
CL Item
>150-155mmol/l (2)
CL Item
>155-160mmol/l (3)
Item
Hyponatremia
text
C0020625 (UMLS CUI [1])
CL Item
LSV-130mmol/l (1)
CL Item
120-130mmol/l (3)
Item
Hyperkalemia
text
C0020461 (UMLS CUI [1])
CL Item
>ULN-5,5mmol/l (1)
CL Item
>5,5-6,0mmol/l (2)
CL Item
>6,0-7,0mmol/l (3)
Item
Hypokalemia
text
C0020621 (UMLS CUI [1])
CL Item
<LSV-3,0 mmol/l (1)
CL Item
2,5-<3,0 mmol/l (3)
Item
Pulmonary function
text
C0024119 (UMLS CUI [1])
Code List
Pulmonary function
CL Item
asymptomatic,change in functional parameter (1)
CL Item
minor dyspnea on exertion (2)
CL Item
severe dyspnea on exertion (3)
CL Item
dyspnea at rest (4)
Item
Lymphatic system
text
C0024235 (UMLS CUI [1])
Code List
Lymphatic system
CL Item
minor lymph edema (1)
CL Item
major lymph edema, compression required (2)
CL Item
severe lymph edema, functional impairment (3)
CL Item
severe lymph edema, functional impairment,ulceration (4)
Item
Creatinine
text
C0201976 (UMLS CUI [1])
CL Item
<1,5 times ULN (1)
CL Item
>1,5 times ULN (2)
CL Item
> 3 times ULN (3)
Item
Proteinuria
text
C1962972 (UMLS CUI [1])
CL Item
nephrotic syndrome (4)
Item
Hematuria
text
C0018965 (UMLS CUI [1])
CL Item
microhaematuria (1)
CL Item
haematuria or blood clots (2)
CL Item
haematuria with blood clots (3)
CL Item
pRBC required (4)
Item
Tumor pain
text
C0854069 (UMLS CUI [1])
CL Item
minor pain,no functional impairment (1)
CL Item
distinct pain,functional impairment, no impairment of ADL (2)
CL Item
severe pain,impairment to ADL (3)
Item
Sensory function status
text
C1320986 (UMLS CUI [1])
Code List
Sensory function status
CL Item
mild paresthesia,loss of deep tendon reflexes (1)
CL Item
moderate objective sensory deficit,moderate paresthesia (2)
CL Item
severe objective sensory deficit or paresthesia with functional impairment (3)
Item
Motor function
text
C0234130 (UMLS CUI [1])
CL Item
subjective weakness without objective finding (1)
CL Item
moderate objective weakness without significant functional impairment (2)
CL Item
objective weakness with functional impairment (3)
Item
Mood and Psyche
text
C0026516|C1277043 (UMLS CUI [1])
Code List
Mood and Psyche
CL Item
minor anxiety or depression (1)
CL Item
moderate anxiety or depression (2)
CL Item
severe anxiety or depression (3)
Item
Headache
text
C0018681 (UMLS CUI [1])
CL Item
moderate or transient (2)
CL Item
permantly and severely (3)
Item
Other
text
C0205394 (UMLS CUI [1])
Item
Activity
text
C0026606 (UMLS CUI [1])
CL Item
normal , 1=weariness without impairment of ADL , 2=abnormal fatigue,impaired ADL (20% Lansky/Karnofsky) , 3=severe fatigue or loss of skills (40% Lansky/Karnofsky) , 4= bed-ridden (0)
Item
Fever
text
C0015967 (UMLS CUI [1])
CL Item
none , 1=38-39 , 2=39.1-40 , 3=>40<24h , 4=>40>24h (0)
Item
Febrile Neutropenia
text
C0746883 (UMLS CUI [1])
Code List
Febrile Neutropenia
CL Item
none , 1=38-39 , 2=39.1-40 , 3=>40<24h , 4=>40>24h (0)
Item
Fever with signs of infection
text
C0015967 (UMLS CUI [1])
Code List
Fever with signs of infection
CL Item
none , 1=38-39 , 2=39.1-40 , 3=>40<24h , 4=>40>24h (0)
Item
Weight loss
text
C0043096 (UMLS CUI [1])
CL Item
<5% , 1=5-10% , 2=10-20% , 3=>20% (0)
Item
Weight gain
text
C0043094 (UMLS CUI [1])
CL Item
<5% , 1=5-10% , 2=10-20% , 3=>20% (0)
Item
Shivering
text
C1142484 (UMLS CUI [1])
CL Item
none , 1=mild/symptomatic therapy sufficient , 2= severe/anesthesia required , 3=no response to anesthesia (0)
Item
Perspiration
text
C0038990 (UMLS CUI [1])
CL Item
normal , 1=little/sometimes , 2=severe/frequently , 3=severe/permanently (0)