ID

15443

Description

reference: http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Link

http://www.ebmt.org/Contents/Data-Management/Registrystructure/MED-ABdatacollectionforms/Pages/MED-AB-data-collection-forms.aspx

Keywords

Versions (2)
  1. 11/20/15 11/20/15 -
  2. 5/31/16 5/31/16 -
Uploaded on

May 31, 2016

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Creative Commons BY-NC 3.0
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EBMT Donor Outcome Report on donation procedure and up to 30 days after

English

EBMT Donor Outcome Report on donation procedure and up to 30 days after

1 forms  
Report
Description

Report

Report on donation procedure and up to 30 days after
Description

Report on donation procedure and up to 30 days after

Data type

integer

Alias
UMLS CUI [1]
C2362505
TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION
Description

TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION

EBMT CIC
Description

Post if known

Data type

integer

Alias
UMLS CUI [1]
C3261212
EBMT database number
Description

post if known

Data type

integer

Alias
UMLS CUI [1]
C0242356
Center of HSCT
Description

Center of HSCT

Data type

integer

Alias
UMLS CUI [1,1]
C0565990
UMLS CUI [1,2]
C0472699
Hospital/ unit
Description

Hospital

Data type

integer

Alias
UMLS CUI [1]
C0019994
Unique Patient Number or Code
Description

Patient Number

Data type

integer

Alias
UMLS CUI [1]
C1830427
Initials
Description

first name(s) surname(s))

Data type

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Description

Date of birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Date of HSCT
Description

Date of HSCT

Data type

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C2584899
PRODUCT
Description

PRODUCT

Bone marrow
Description

Including collection of MSC

Data type

boolean

Alias
UMLS CUI [1]
C0005953
PBSC
Description

PBSC

Data type

boolean

Alias
UMLS CUI [1]
C1518999
Both BM and PBSC
Description

Both BM and PBSC

Data type

boolean

Alias
UMLS CUI [1]
C0005953
UMLS CUI [2]
C1518999
Unstimulated leukapheresis
Description

(e.g. donor lymphocytes (DLI), etc.)

Data type

boolean

Alias
UMLS CUI [1]
C0023416
other specify product
Description

other specify product

Data type

integer

Alias
UMLS CUI [1]
C1706452
DONOR DATA
Description

DONOR DATA

Donor number/ID
Description

Donor number/ID

Data type

integer

Alias
UMLS CUI [1]
C1718162
Donor signed Informed consent for data transmission to the EBMT Registry
Description

Compulsory, registrations will not be accepted without this item

Data type

boolean

Alias
UMLS CUI [1]
C0021430
Initials
Description

first name(s) surname(s)

Data type

text

Alias
UMLS CUI [1]
C2986440
Relationship to recipient
Description

Relationship to recipient

Data type

text

Alias
UMLS CUI [1]
C0449923
Describe relation to the recipient
Description

aunt, uncle, first cousin, etc.

Data type

text

Alias
UMLS CUI [1,1]
C0449923
UMLS CUI [1,2]
C0678257
Date of Birth
Description

Date of Birth

Data type

date

Alias
UMLS CUI [1]
C0421451
Sex
Description

Sex

Data type

integer

Alias
UMLS CUI [1]
C0079399
DONATION PROCEDURE
Description

DONATION PROCEDURE

First day of this collection
Description

First day of this collection

Data type

date

Alias
UMLS CUI [1,1]
C1318453
UMLS CUI [1,2]
C0011008
COLLECTION DATA
Description

COLLECTION DATA

EBMT Code (CIC)
Description

EBMT Code (CIC)

Data type

integer

Alias
UMLS CUI [1,1]
C3826859
UMLS CUI [1,2]
C0600091
Collection center
Description

Collection center

Data type

integer

Alias
UMLS CUI [1,1]
C0457411
UMLS CUI [1,2]
C0009469
Donor registry or CB bank
Description

Donor registry or CB bank

Data type

integer

Alias
UMLS CUI [1]
C0034975
Contact person
Description

Contact person

Data type

text

Alias
UMLS CUI [1]
C0337611
Date of this report
Description

Date of this report

Data type

date

Alias
UMLS CUI [1]
C1302584
Start date of donation procedure
Description

Start date of donation procedure

Data type

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C1318453
Chronological Number of this donation procedure
Description

Chronological Number of this donation procedure

Data type

integer

Alias
UMLS CUI [1,1]
C1318453
UMLS CUI [1,2]
C0449788
Centre of previous donation
Description

Centre of previous donation

Data type

text

Alias
UMLS CUI [1,1]
C0457411
UMLS CUI [1,2]
C0009469
Date of previous donation
Description

Date of previous donation

Data type

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C1318453
Was the product collection completed
Description

Was the product collection completed

Data type

boolean

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C3831330
Were haematopoietic growth factors used
Description

Were haematopoietic growth factors used

Data type

boolean

Alias
UMLS CUI [1]
C0079459
Were cell binding inhibitors used?
Description

Were cell binding inhibitors used,

Data type

integer

Alias
UMLS CUI [1]
C1955474
Was erythropoietin used
Description

Was erythropoietin used

Data type

boolean

Alias
UMLS CUI [1]
C0014822
Were other drugs used for mobilization
Description

Were other drugs used for mobilization

Data type

boolean

Alias
UMLS CUI [1]
C0001551
COMPLICATIONS in temporal association with the donation procedure
Description

COMPLICATIONS in temporal association with the donation procedure

Serious Adverse Events (SAE/SAR)
Description

Serious Adverse Events (SAE/SAR)

Data type

integer

Alias
UMLS CUI [1]
C0877248
Date of the SAE/SAR
Description

Date of the SAE/SAR

Data type

date

Alias
UMLS CUI [1]
C2985916
DONOR BEHAVIOUR
Description

DONOR BEHAVIOUR

Would the donor donate again
Description

Would the donor donate again

Data type

boolean

Alias
UMLS CUI [1]
C2362505
If no: reason
Description

If no: reason

Data type

integer

Alias
UMLS CUI [1]
C0566251
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Similar models

EBMT Donor Outcome Report on donation procedure and up to 30 days after

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Report
Report on donation procedure and up to 30 days after
Item
Report on donation procedure and up to 30 days after
integer
C2362505 (UMLS CUI [1])
Item Group
TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION
EBMT CIC
Item
EBMT CIC
integer
C3261212 (UMLS CUI [1])
EBMT database number
Item
EBMT database number
integer
C0242356 (UMLS CUI [1])
Center of HSCT
Item
Center of HSCT
integer
C0565990 (UMLS CUI [1,1])
C0472699 (UMLS CUI [1,2])
Hospital
Item
Hospital/ unit
integer
C0019994 (UMLS CUI [1])
Patient Number
Item
Unique Patient Number or Code
integer
C1830427 (UMLS CUI [1])
Initialen
Item
Initials
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Date of HSCT
Item
Date of HSCT
date
C0472699 (UMLS CUI [1,1])
C2584899 (UMLS CUI [1,2])
Item Group
PRODUCT
Bone marrow
Item
Bone marrow
boolean
C0005953 (UMLS CUI [1])
PBSC
Item
PBSC
boolean
C1518999 (UMLS CUI [1])
Both BM and PBSC
Item
Both BM and PBSC
boolean
C0005953 (UMLS CUI [1])
C1518999 (UMLS CUI [2])
Unstimulated leukapheresis
Item
Unstimulated leukapheresis
boolean
C0023416 (UMLS CUI [1])
other specify product
Item
other specify product
integer
C1706452 (UMLS CUI [1])
Item Group
DONOR DATA
Donor number/ID
Item
Donor number/ID
integer
C1718162 (UMLS CUI [1])
Donor signed Informed consent for data transmission to the EBMT Registry
Item
Donor signed Informed consent for data transmission to the EBMT Registry
boolean
C0021430 (UMLS CUI [1])
Initialen
Item
Initials
text
C2986440 (UMLS CUI [1])
Item
Relationship to recipient
text
C0449923 (UMLS CUI [1])
Relationship to recipient
Code List
Relationship to recipient
CL Item
syngeneic (identical twin) (1)
C2348628 (UMLS CUI-1)
CL Item
identical sibling/non identical twin (2)
C0337509 (UMLS CUI-1)
CL Item
other family member: matched (3)
C0086282 (UMLS CUI-1)
CL Item
unmatched (4)
C2711788 (UMLS CUI-1)
CL Item
unrelated donor (unrelated donor)
C3179133 (UMLS CUI-1)
Describe relation to the recipient
Item
Describe relation to the recipient
text
C0449923 (UMLS CUI [1,1])
C0678257 (UMLS CUI [1,2])
Date of Birth
Item
Date of Birth
date
C0421451 (UMLS CUI [1])
Item
Sex
integer
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
CL Item
Female (2)
Item Group
DONATION PROCEDURE
First day of this collection
Item
First day of this collection
date
C1318453 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
COLLECTION DATA
EBMT Code (CIC)
Item
EBMT Code (CIC)
integer
C3826859 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Collection center
Item
Collection center
integer
C0457411 (UMLS CUI [1,1])
C0009469 (UMLS CUI [1,2])
Donor registry or CB bank
Item
Donor registry or CB bank
integer
C0034975 (UMLS CUI [1])
Contact person
Item
Contact person
text
C0337611 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Start date of donation procedure
Item
Start date of donation procedure
date
C0808070 (UMLS CUI [1,1])
C1318453 (UMLS CUI [1,2])
Item
Chronological Number of this donation procedure
integer
C1318453 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Chronological Number of this donation procedure
Code List
Chronological Number of this donation procedure
CL Item
Number (1)
CL Item
If > 1: Same recipient: (2)
CL Item
Yes (3)
CL Item
No (4)
Centre of previous donation
Item
Centre of previous donation
text
C0457411 (UMLS CUI [1,1])
C0009469 (UMLS CUI [1,2])
Date of previous donation
Item
Date of previous donation
date
C0011008 (UMLS CUI [1,1])
C1318453 (UMLS CUI [1,2])
Was the product collection completed
Item
Was the product collection completed
boolean
C0011008 (UMLS CUI [1,1])
C3831330 (UMLS CUI [1,2])
Were haematopoietic growth factors used
Item
Were haematopoietic growth factors used
boolean
C0079459 (UMLS CUI [1])
Item
Were cell binding inhibitors used?
integer
C1955474 (UMLS CUI [1])
Were cell binding inhibitors used,
Code List
Were cell binding inhibitors used?
CL Item
Yes (1)
CL Item
No (2)
CL Item
If yes, specify: (3)
Was erythropoietin used
Item
Was erythropoietin used
boolean
C0014822 (UMLS CUI [1])
Were other drugs used for mobilization
Item
Were other drugs used for mobilization
boolean
C0001551 (UMLS CUI [1])
Item Group
COMPLICATIONS in temporal association with the donation procedure
Item
Serious Adverse Events (SAE/SAR)
integer
C0877248 (UMLS CUI [1])
Serious Adverse Events (SAE/SAR)
Code List
Serious Adverse Events (SAE/SAR)
CL Item
yes (1)
C1705108 (UMLS CUI-1)
CL Item
no (2)
C1298908 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
CL Item
ICD 10 Coding Serious Adverse Events (SAE/SAR) if yes (4)
C1137110 (UMLS CUI-1)
Date of the SAE/SAR
Item
Date of the SAE/SAR
date
C2985916 (UMLS CUI [1])
Item Group
DONOR BEHAVIOUR
Would the donor donate again
Item
Would the donor donate again
boolean
C2362505 (UMLS CUI [1])
If no: reason
Item
If no: reason
integer
C0566251 (UMLS CUI [1])
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