ID

15450

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 (1)
  1. 6/1/16 6/1/16 -
Uploaded on

June 1, 2016

DOI

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License

Creative Commons BY-NC 3.0
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EBMT Donor outcome Long term follow up report after last donation procedure

English

EBMT Donor outcome Long term follow up report after last donation procedure

1 forms  
Donor outcome Long term follow up report after last donation procedure
Description

Donor outcome Long term follow up report after last donation procedure

Long term follow up report after last donation procedure
Description

Long term follow up report after last donation procedure

Data type

integer

Alias
UMLS CUI [1]
C1704685
TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION
Description

TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION

EBMT CIC
Description

EBMT CIC

Data type

integer

Alias
UMLS CUI [1,1]
C3826859
UMLS CUI [1,2]
C0600091
EBMT database number
Description

EBMT database number

Data type

integer

Alias
UMLS CUI [1,1]
C3826859
UMLS CUI [1,2]
C0242356
Center of HSCT
Description

Center of HSCT

Data type

text

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

Initials

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
COLLECTION CENTRE IDENTIFICATION
Description

COLLECTION CENTRE IDENTIFICATION

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
Registry:
Description

Registry

Data type

integer

Alias
UMLS CUI [1]
C0034975
Contact person
Description

Contact person

Data type

integer

Alias
UMLS CUI [1]
C0337611
PRODUCT
Description

PRODUCT

BM (Including collection of MSC)
Description

BM

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]
C0023416
DONOR DATA
Description

DONOR DATA

Donor number/ID
Description

Donor number/ID

Data type

integer

Alias
UMLS CUI [1,1]
C0013018
UMLS CUI [1,2]
C0600091
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

Describe relation to the recipient

Data type

text

Alias
UMLS CUI [1,1]
C0449923
UMLS CUI [1,2]
C0678257
Donor date of birth
Description

Transplant Donor Birth Date

Data type

date

Alias
UMLS CUI [1,1]
C0040288
UMLS CUI [1,2]
C0449923
Sex
Description

Sex

Data type

text

Alias
UMLS CUI [1]
C0079399
FOLLOW UP OR DEATH REPORT
Description

FOLLOW UP OR DEATH REPORT

Date of last follow up or death
Description

Date of last follow up or death

Data type

integer

Alias
UMLS CUI [1]
C3694716
UMLS CUI [2]
C0011065
Date of follow up report
Description

Date of follow up report

Data type

date

Alias
UMLS CUI [1,1]
C1704685
UMLS CUI [1,2]
C1302584
SAE/SAR SINCE LAST REPORT
Description

SAE/SAR SINCE LAST REPORT

Hematological malignancy?
Description

If yes: ICD 10 Code

Data type

text

Alias
UMLS CUI [1]
C0376545
If yes: ICD 10 Code
Description

(see manual, list in Appendix l)

Data type

integer

Alias
UMLS CUI [1]
C1137110
Date of the SAE/SAR
Description

Date of the SAE/SAR

Data type

date

Alias
UMLS CUI [1]
C2985916
Confirmed by medical data
Description

Confirmed by medical data

Data type

integer

Alias
UMLS CUI [1,1]
C0521093
UMLS CUI [1,2]
C0025102
Non-hematological malignancy?
Description

Non-hematological malignancy?

Data type

integer

Alias
UMLS CUI [1]
C0012634
if yes: ICD 10 Code
Description

(see manual, list in Appendix l)

Data type

integer

Alias
UMLS CUI [1]
C1137110
Date of the SAE/SAR
Description

Date of the SAE/SAR

Data type

date

Confirmed by medical data
Description

Confirmed by medical data

Data type

text

Alias
UMLS CUI [1,1]
C0521093
UMLS CUI [1,2]
C0025102
DONOR STATUS ON THIS DATE
Description

DONOR STATUS ON THIS DATE

Donor Alive
Description

Donor Alive

Data type

boolean

Alias
UMLS CUI [1,1]
C0013018
UMLS CUI [1,2]
C2584946
Donor Dead
Description

Donor Dead

Data type

integer

Alias
UMLS CUI [1,1]
C0011065
UMLS CUI [1,2]
C0013018
Donation related death
Description

Donation related death

Data type

integer

Alias
UMLS CUI [1,1]
C0011065
UMLS CUI [1,2]
C2586230
ICD 10 code for main cause of death
Description

Select only one main cause

Data type

integer

Alias
UMLS CUI [1]
C0007465
ICD 10 code(s) for contributory causes of death
Description

(See manual: list of ICD 10 codes in Appendix l

Data type

integer

Alias
UMLS CUI [1,1]
C0804772
UMLS CUI [1,2]
C0332138
Describe below the cause of death if necessary
Description

Describe below the cause of death if necessary

Data type

text

Alias
UMLS CUI [1]
C0007465
Check here if donor lost to follow up
Description

Check here if donor lost to follow up

Data type

boolean

Alias
UMLS CUI [1]
C1302313
DONOR BEHAVIOUR
Description

DONOR BEHAVIOUR

Would the donor donate again?
Description

If no: reason

Data type

integer

Alias
UMLS CUI [1]
C0282366
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Similar models

EBMT Donor outcome Long term follow up report after last donation procedure

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Donor outcome Long term follow up report after last donation procedure
Long term follow up report after last donation procedure
Item
Long term follow up report after last donation procedure
integer
C1704685 (UMLS CUI [1])
Item Group
TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION
EBMT CIC
Item
EBMT CIC
integer
C3826859 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
EBMT database number
Item
EBMT database number
integer
C3826859 (UMLS CUI [1,1])
C0242356 (UMLS CUI [1,2])
Center of HSCT
Item
Center of HSCT
text
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])
Initials
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
COLLECTION CENTRE IDENTIFICATION
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])
Registry
Item
Registry:
integer
C0034975 (UMLS CUI [1])
Contact person
Item
Contact person
integer
C0337611 (UMLS CUI [1])
Item Group
PRODUCT
BM
Item
BM (Including collection of MSC)
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
C0023416 (UMLS CUI [1])
Item Group
DONOR DATA
Donor number/ID
Item
Donor number/ID
integer
C0013018 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
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 (3)
C0086282 (UMLS CUI-1)
CL Item
matched (4)
C0150103 (UMLS CUI-1)
CL Item
unmatched (5)
C2711788 (UMLS CUI-1)
CL Item
unrelated donor (6)
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])
Transplant Donor Birth Date
Item
Donor date of birth
date
C0040288 (UMLS CUI [1,1])
C0449923 (UMLS CUI [1,2])
Item
Sex
text
C0079399 (UMLS CUI [1])
Sex
Code List
Sex
CL Item
Male (1)
CL Item
Female (2)
Item Group
FOLLOW UP OR DEATH REPORT
Date of last follow up or death
Item
Date of last follow up or death
integer
C3694716 (UMLS CUI [1])
C0011065 (UMLS CUI [2])
Date of follow up report
Item
Date of follow up report
date
C1704685 (UMLS CUI [1,1])
C1302584 (UMLS CUI [1,2])
Item Group
SAE/SAR SINCE LAST REPORT
Item
Hematological malignancy?
text
C0376545 (UMLS CUI [1])
Serious Adverse Events (SAE/SAR)
Code List
Hematological malignancy?
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
If yes: ICD 10 Code
Item
If yes: ICD 10 Code
integer
C1137110 (UMLS CUI [1])
Date of the SAE/SAR
Item
Date of the SAE/SAR
date
C2985916 (UMLS CUI [1])
Item
Confirmed by medical data
integer
C0521093 (UMLS CUI [1,1])
C0025102 (UMLS CUI [1,2])
Confirmed by medical data
Code List
Confirmed by medical data
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes  (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
Item
Non-hematological malignancy?
integer
C0012634 (UMLS CUI [1])
Non-hematological malignancy?
Code List
Non-hematological malignancy?
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
if yes: ICD 10 Code
Item
if yes: ICD 10 Code
integer
C1137110 (UMLS CUI [1])
Date of the SAE/SAR
Item
Date of the SAE/SAR
date
Item
Confirmed by medical data
text
C0521093 (UMLS CUI [1,1])
C0025102 (UMLS CUI [1,2])
Confirmed by medical data
Code List
Confirmed by medical data
CL Item
no (no)
C1298908 (UMLS CUI-1)
CL Item
yes (yes)
C1705108 (UMLS CUI-1)
CL Item
unknown (unknown)
C0439673 (UMLS CUI-1)
Item Group
DONOR STATUS ON THIS DATE
Donor Alive
Item
Donor Alive
boolean
C0013018 (UMLS CUI [1,1])
C2584946 (UMLS CUI [1,2])
Donor Dead
Item
Donor Dead
integer
C0011065 (UMLS CUI [1,1])
C0013018 (UMLS CUI [1,2])
Item
Donation related death
integer
C0011065 (UMLS CUI [1,1])
C2586230 (UMLS CUI [1,2])
Donation related death
Code List
Donation related death
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
ICD 10 code for main cause of death
Item
ICD 10 code for main cause of death
integer
C0007465 (UMLS CUI [1])
ICD 10 code(s) for contributory causes of death
Item
ICD 10 code(s) for contributory causes of death
integer
C0804772 (UMLS CUI [1,1])
C0332138 (UMLS CUI [1,2])
Describe below the cause of death if necessary
Item
Describe below the cause of death if necessary
text
C0007465 (UMLS CUI [1])
Check here if donor lost to follow up
Item
Check here if donor lost to follow up
boolean
C1302313 (UMLS CUI [1])
Item Group
DONOR BEHAVIOUR
Item
Would the donor donate again?
integer
C0282366 (UMLS CUI [1])
Would the donor donate again?
Code List
Would the donor donate again?
CL Item
no (1)
C1298908 (UMLS CUI-1)
CL Item
yes (2)
C1705108 (UMLS CUI-1)
CL Item
unknown (3)
C0439673 (UMLS CUI-1)
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