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15450

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

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

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  1. 01/06/2016 01/06/2016 -
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1 juin 2016

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

    Anglais

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

    1 Formulaires  
    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

    Type de données

    integer

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

    TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION

    EBMT CIC
    Description

    EBMT CIC

    Type de données

    integer

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

    EBMT database number

    Type de données

    integer

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

    Center of HSCT

    Type de données

    text

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

    Hospital

    Type de données

    integer

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

    Patient Number

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C1830427
    Initials
    Description

    Initials

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2986440
    Date of birth
    Description

    Date of birth

    Type de données

    date

    Alias
    UMLS CUI [1]
    C0421451
    Date of HSCT
    Description

    Date of HSCT

    Type de données

    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)

    Type de données

    integer

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

    Collection center

    Type de données

    integer

    Alias
    UMLS CUI [1,1]
    C0457411
    UMLS CUI [1,2]
    C0009469
    Registry:
    Description

    Registry

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C0034975
    Contact person
    Description

    Contact person

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C0337611
    PRODUCT
    Description

    PRODUCT

    BM (Including collection of MSC)
    Description

    BM

    Type de données

    boolean

    Alias
    UMLS CUI [1]
    C0005953
    PBSC
    Description

    PBSC

    Type de données

    boolean

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

    Both (BM and PBSC)

    Type de données

    boolean

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

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

    Type de données

    boolean

    Alias
    UMLS CUI [1]
    C0023416
    other specify product
    Description

    other specify product

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C0023416
    DONOR DATA
    Description

    DONOR DATA

    Donor number/ID
    Description

    Donor number/ID

    Type de données

    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

    Type de données

    boolean

    Alias
    UMLS CUI [1]
    C0021430
    Initials
    Description

    first name(s)_surname(s)

    Type de données

    text

    Alias
    UMLS CUI [1]
    C2986440
    Relationship to recipient
    Description

    Relationship to recipient

    Type de données

    text

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

    Describe relation to the recipient

    Type de données

    text

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

    Transplant Donor Birth Date

    Type de données

    date

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

    Sex

    Type de données

    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

    Type de données

    integer

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

    Date of follow up report

    Type de données

    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

    Type de données

    text

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

    (see manual, list in Appendix l)

    Type de données

    integer

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

    Date of the SAE/SAR

    Type de données

    date

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

    Confirmed by medical data

    Type de données

    integer

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

    Non-hematological malignancy?

    Type de données

    integer

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

    (see manual, list in Appendix l)

    Type de données

    integer

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

    Date of the SAE/SAR

    Type de données

    date

    Confirmed by medical data
    Description

    Confirmed by medical data

    Type de données

    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

    Type de données

    boolean

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

    Donor Dead

    Type de données

    integer

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

    Donation related death

    Type de données

    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

    Type de données

    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

    Type de données

    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

    Type de données

    text

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

    Check here if donor lost to follow up

    Type de données

    boolean

    Alias
    UMLS CUI [1]
    C1302313
    DONOR BEHAVIOUR
    Description

    DONOR BEHAVIOUR

    Would the donor donate again?
    Description

    If no: reason

    Type de données

    integer

    Alias
    UMLS CUI [1]
    C0282366
    Retour au début de la page

    Similar models

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

    1 Formulaires
    Name
    Type
    Description | Question | Decode (Coded Value)
    Type de données
    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)
    Retour au début de la page 

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