Blood samples CARLA

  1. StudyEvent: ODM
    1. Blood samples CARLA
General information
Description

General information

Subject ID
Description

Subject ID

Data type

text

Alias
UMLS CUI [1]
C2348585
B01 Examiner ID
Description

B01 Examiner ID

Data type

text

B02 Date
Description

B02 Date

Data type

date

B02 Time
Description

B02 Time

Data type

time

Preliminary questions
Description

Preliminary questions

B03 Examiner: Does the subject agree to the taking of blood samples?
Description

B03 Agreement of subject

Data type

integer

B03 If not, please specify reason:
Description

If subject does not agree to taking of blood samples, specify reason here.

Data type

text

B04 Do you suffer from haemophilia?
Description

Examiner: In case of haemophilia, do not take blood samples!

Data type

integer

B05 Have you been administered an anticoagulant?
Description

Examiner: Intake of Marcumar, Marcuphen, Coumadin, Falithrom, Phenproratiopharm

Data type

integer

B06 Have you already eaten today?
Description

B06 Food intake

Data type

integer

B07 When was the last time you ate something today?
Description

B07 Time of food intake

Data type

time

B08 Are you allergic to latex?
Description

B08 Latex allergy

Data type

integer

Taking of blood samples
Description

Taking of blood samples

1. Serum-Gel-Monovette (9 ml)
Description

color: brown (EN 14820)

Data type

float

Measurement units
  • ml
ml
2. EDTA-Monovette (2.7 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
3. EDTA-Monovette (9 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
4. Citrate-Monovette (coagulation tube, 5 ml)
Description

color: green (EN 14820)

Data type

float

Measurement units
  • ml
ml
5. Serum-Gel-Monovette (9 ml)
Description

color: brown (EN 14820)

Data type

float

Measurement units
  • ml
ml
6. EDTA-Monovette (2.7 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
7. Serum-Gel-Monovette (9 ml)
Description

color: brown (EN 14820)

Data type

float

Measurement units
  • ml
ml
8. EDTA-Monovette (9 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
9. Serum-Gel-Monovette (9 ml)
Description

color: brown (EN 14820)

Data type

float

Measurement units
  • ml
ml
10. Li-Heparin-Monovette (9 ml)
Description

color: orange (EN 14820)

Data type

float

Measurement units
  • ml
ml
11. EDTA-Monovette (4.9 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
12. EDTA-Monovette (9 ml)
Description

color: red (EN 14820)

Data type

float

Measurement units
  • ml
ml
13. Li-Heparin-Monovette (4.9 ml)
Description

13. Li-Heparin-Monovette (4.9 ml)

Data type

float

Measurement units
  • ml
ml
Final information
Description

Final information

B10 Examiner: Has the subject stated to suffer from hepatitis?
Description

B10 Hepatitis

Data type

integer

B11 Examiner: Has the subject stated to suffer from an HIV-infection?
Description

B11 HIV-infection

Data type

integer

B12 Could the blood samples be taken?
Description

B12 Could the blood samples be taken?

Data type

integer

B12 If not, please specify reason:
Description

If blood samples could not be taken, specify reason here.

Data type

text

B13 End of blood taking (exact time)
Description

B13 End of blood taking (exact time)

Data type

time

B14 Comments
Description

B14 Comments

Data type

text

Data entry
Description

Data entry

First data entry: DNo.
Description

First data entry: DNo.

Data type

text

First data entry: Date
Description

First data entry: Date

Data type

date

Second data entry: DNo.
Description

Second data entry: DNo.

Data type

text

Second data entry: Date
Description

Second data entry: Date

Data type

date

Similar models

Blood samples CARLA

  1. StudyEvent: ODM
    1. Blood samples CARLA
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
General information
Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
B01 Examiner ID
Item
B01 Examiner ID
text
B02 Date
Item
B02 Date
date
B02 Time
Item
B02 Time
time
Item Group
Preliminary questions
Item
B03 Examiner: Does the subject agree to the taking of blood samples?
integer
Code List
B03 Examiner: Does the subject agree to the taking of blood samples?
CL Item
Yes (1)
CL Item
Yes, but without storage of blood for follow-up projects (Do not take tubes 5-9!) (2)
CL Item
No (End) (3)
B03 Reason
Item
B03 If not, please specify reason:
text
Item
B04 Do you suffer from haemophilia?
integer
Code List
B04 Do you suffer from haemophilia?
CL Item
Yes (End) (1)
CL Item
No (2)
Item
B05 Have you been administered an anticoagulant?
integer
Code List
B05 Have you been administered an anticoagulant?
CL Item
Yes (1)
CL Item
No (2)
Item
B06 Have you already eaten today?
integer
Code List
B06 Have you already eaten today?
CL Item
Yes (1)
CL Item
No (Skip question B07) (2)
B07 Time of food intake
Item
B07 When was the last time you ate something today?
time
Item
B08 Are you allergic to latex?
integer
Code List
B08 Are you allergic to latex?
CL Item
Yes (Please use latex-free gloves when taking the blood sample!) (1)
CL Item
No (2)
Item Group
Taking of blood samples
1. Serum-Gel-Monovette (9 ml)
Item
1. Serum-Gel-Monovette (9 ml)
float
2. EDTA-Monovette (2.7 ml)
Item
2. EDTA-Monovette (2.7 ml)
float
3. EDTA-Monovette (9 ml)
Item
3. EDTA-Monovette (9 ml)
float
4. Citrate-Monovette (coagulation tube, 5 ml)
Item
4. Citrate-Monovette (coagulation tube, 5 ml)
float
5. Serum-Gel-Monovette (9 ml)
Item
5. Serum-Gel-Monovette (9 ml)
float
6. EDTA-Monovette (2.7 ml)
Item
6. EDTA-Monovette (2.7 ml)
float
7. Serum-Gel-Monovette (9 ml)
Item
7. Serum-Gel-Monovette (9 ml)
float
8. EDTA-Monovette (9 ml)
Item
8. EDTA-Monovette (9 ml)
float
9. Serum-Gel-Monovette (9 ml)
Item
9. Serum-Gel-Monovette (9 ml)
float
10. Li-Heparin-Monovette (9 ml)
Item
10. Li-Heparin-Monovette (9 ml)
float
11. EDTA-Monovette (4.9 ml)
Item
11. EDTA-Monovette (4.9 ml)
float
12. EDTA-Monovette (9 ml)
Item
12. EDTA-Monovette (9 ml)
float
13. Li-Heparin-Monovette (4.9 ml)
Item
13. Li-Heparin-Monovette (4.9 ml)
float
Item Group
Final information
Item
B10 Examiner: Has the subject stated to suffer from hepatitis?
integer
Code List
B10 Examiner: Has the subject stated to suffer from hepatitis?
CL Item
Yes (1)
CL Item
No (2)
Item
B11 Examiner: Has the subject stated to suffer from an HIV-infection?
integer
Code List
B11 Examiner: Has the subject stated to suffer from an HIV-infection?
CL Item
Yes (1)
CL Item
No (2)
Item
B12 Could the blood samples be taken?
integer
Code List
B12 Could the blood samples be taken?
CL Item
Yes (1)
CL Item
No (2)
B12 Reason
Item
B12 If not, please specify reason:
text
B13 End of blood taking (exact time)
Item
B13 End of blood taking (exact time)
time
B14 Comments
Item
B14 Comments
text
Item Group
Data entry
First data entry: DNo.
Item
First data entry: DNo.
text
First data entry: Date
Item
First data entry: Date
date
Second data entry: DNo.
Item
Second data entry: DNo.
text
Second data entry: Date
Item
Second data entry: Date
date