From completed by
Item
Form completed by
text
C0557514 (UMLS CUI [1])
TelephoneNumber
Item
Telephone Number
text
C0039457 (UMLS CUI [1])
Pregnancy Report Date
Item
Date of initial report (within 24 hours)
date
C0032961 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Date follow up
Item
Date of follow up report (in case of new data).
date
C1522577 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Who has become pregnant?
integer
C0032961 (UMLS CUI [1])
Code List
Who has become pregnant?
CL Item
female patient (1)
C0150905 (UMLS CUI-1)
CL Item
partner of male patient (2)
C3874858 (UMLS CUI-1)
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
last menses
Item
Start date of last menses
date
C0425932 (UMLS CUI [1])
Date pregnancy confirmed
Item
Date pregnancy confirmed
date
C2584394 (UMLS CUI [1])
Anticipated date of childbirth
Item
Anticipated date of childbirth
date
C2825543 (UMLS CUI [1])
Item
Period of treatment/last given treatment at time of conception
integer
C1276413 (UMLS CUI [1,1])
C2348792 (UMLS CUI [1,2])
Code List
Period of treatment/last given treatment at time of conception
CL Item
before start protocol treatment (0)
C0087111 (UMLS CUI-1)
CL Item
induction cycle I (1)
C3179010 (UMLS CUI-1)
CL Item
induction cycle II (2)
C3179010 (UMLS CUI-1)
CL Item
post induction cycle III (3)
C3179010 (UMLS CUI-1)
CL Item
autoHSCT (4)
C0194037 (UMLS CUI-1)
CL Item
alloHSCT (5)
C1705576 (UMLS CUI-1)
CL Item
maintenance (1-6) (11-16)
C0481504 (UMLS CUI-1)
CL Item
follow up (17)
C1522577 (UMLS CUI-1)
CL Item
other* (18)
C0205394 (UMLS CUI-1)
Item
Pregnancy outcome
integer
C0032972 (UMLS CUI [1])
Code List
Pregnancy outcome
CL Item
not known at this date (please send in follow up report when new data are known) (1)
C0439673 (UMLS CUI-1)
CL Item
induced abortion (3)
C1704300 (UMLS CUI-1)
CL Item
spontaneous abortion (4)
C0000786 (UMLS CUI-1)
CL Item
still birth (5)
C0595939 (UMLS CUI-1)
CL Item
neonatal death (6)
C0410916 (UMLS CUI-1)
CL Item
birth defects (7)
C0000768 (UMLS CUI-1)
CL Item
other* (8)
C0205394 (UMLS CUI-1)
CL Item
uneventful (normal/healthy baby) (2)
C0686744 (UMLS CUI-1)
Specify
Item
Specify
text
C1521902 (UMLS CUI [1])