ID

15450

Beschrijving

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

Trefwoorden

Versies (1)
  1. 01-06-16 01-06-16 -
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1 juni 2016

DOI

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

Engels

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

1 Formulieren  
Donor outcome Long term follow up report after last donation procedure
Beschrijving

Donor outcome Long term follow up report after last donation procedure

Long term follow up report after last donation procedure
Beschrijving

Long term follow up report after last donation procedure

Datatype

integer

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

TRANSPLANT CENTRE AND RECIPIENT IDENTIFICATION

EBMT CIC
Beschrijving

EBMT CIC

Datatype

integer

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

EBMT database number

Datatype

integer

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

Center of HSCT

Datatype

text

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

Hospital

Datatype

integer

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

Patient Number

Datatype

integer

Alias
UMLS CUI [1]
C1830427
Initials
Beschrijving

Initials

Datatype

text

Alias
UMLS CUI [1]
C2986440
Date of birth
Beschrijving

Date of birth

Datatype

date

Alias
UMLS CUI [1]
C0421451
Date of HSCT
Beschrijving

Date of HSCT

Datatype

date

Alias
UMLS CUI [1,1]
C0472699
UMLS CUI [1,2]
C2584899
COLLECTION CENTRE IDENTIFICATION
Beschrijving

COLLECTION CENTRE IDENTIFICATION

EBMT Code (CIC)
Beschrijving

EBMT Code (CIC)

Datatype

integer

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

Collection center

Datatype

integer

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

Registry

Datatype

integer

Alias
UMLS CUI [1]
C0034975
Contact person
Beschrijving

Contact person

Datatype

integer

Alias
UMLS CUI [1]
C0337611
PRODUCT
Beschrijving

PRODUCT

BM (Including collection of MSC)
Beschrijving

BM

Datatype

boolean

Alias
UMLS CUI [1]
C0005953
PBSC
Beschrijving

PBSC

Datatype

boolean

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

Both (BM and PBSC)

Datatype

boolean

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

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

Datatype

boolean

Alias
UMLS CUI [1]
C0023416
other specify product
Beschrijving

other specify product

Datatype

integer

Alias
UMLS CUI [1]
C0023416
DONOR DATA
Beschrijving

DONOR DATA

Donor number/ID
Beschrijving

Donor number/ID

Datatype

integer

Alias
UMLS CUI [1,1]
C0013018
UMLS CUI [1,2]
C0600091
Donor signed Informed consent for data transmission to the EBMT Registry
Beschrijving

Compulsory, registrations will not be accepted without this item

Datatype

boolean

Alias
UMLS CUI [1]
C0021430
Initials
Beschrijving

first name(s)_surname(s)

Datatype

text

Alias
UMLS CUI [1]
C2986440
Relationship to recipient
Beschrijving

Relationship to recipient

Datatype

text

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

Describe relation to the recipient

Datatype

text

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

Transplant Donor Birth Date

Datatype

date

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

Sex

Datatype

text

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

FOLLOW UP OR DEATH REPORT

Date of last follow up or death
Beschrijving

Date of last follow up or death

Datatype

integer

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

Date of follow up report

Datatype

date

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

SAE/SAR SINCE LAST REPORT

Hematological malignancy?
Beschrijving

If yes: ICD 10 Code

Datatype

text

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

(see manual, list in Appendix l)

Datatype

integer

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

Date of the SAE/SAR

Datatype

date

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

Confirmed by medical data

Datatype

integer

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

Non-hematological malignancy?

Datatype

integer

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

(see manual, list in Appendix l)

Datatype

integer

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

Date of the SAE/SAR

Datatype

date

Confirmed by medical data
Beschrijving

Confirmed by medical data

Datatype

text

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

DONOR STATUS ON THIS DATE

Donor Alive
Beschrijving

Donor Alive

Datatype

boolean

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

Donor Dead

Datatype

integer

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

Donation related death

Datatype

integer

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

Select only one main cause

Datatype

integer

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

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

Datatype

integer

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

Describe below the cause of death if necessary

Datatype

text

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

Check here if donor lost to follow up

Datatype

boolean

Alias
UMLS CUI [1]
C1302313
DONOR BEHAVIOUR
Beschrijving

DONOR BEHAVIOUR

Would the donor donate again?
Beschrijving

If no: reason

Datatype

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 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
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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