Subject ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
B01 Examiner ID Blood Taking
Item
B01 Examiner ID Blood Taking
text
B02 Examiner ID Documentation
Item
B02 Examiner ID Documentation
text
B03 Date
Item
B03 Date
date
B03 Time
Item
B03 Time
time
Item
B04 Examiner: Does the subject agree to the taking of blood samples?
integer
Code List
B04 Examiner: Does the subject agree to the taking of blood samples?
CL Item
Yes, but without storage of blood for follow-up projects (Do not take tubes 5-9!) (2)
B04 Reason
Item
B04 If not, please specify reason:
text
Item
B05 Do you suffer from haemophilia?
integer
Code List
B05 Do you suffer from haemophilia?
Item
B06 Have you been administered an anticoagulant?
integer
Code List
B06 Have you been administered an anticoagulant?
CL Item
I don't know (-8)
Item
B07 Do you suffer from a chronic infection?
integer
Code List
B07 Do you suffer from a chronic infection?
CL Item
No (Proceed with B11) (2)
CL Item
I don't know (-8)
Item
B08 Examiner: If yes, did the subject specify in detail?
integer
Code List
B08 Examiner: If yes, did the subject specify in detail?
Item
B09 Has the subject stated to suffer from hepatitis (B or C)?
integer
Code List
B09 Has the subject stated to suffer from hepatitis (B or C)?
CL Item
I don't know (-8)
Item
B10: Has the subject stated to suffer from an HIV-infection?
integer
Code List
B10: Has the subject stated to suffer from an HIV-infection?
CL Item
I don't know (-8)
Item
B11 Other infections?
integer
Code List
B11 Other infections?
CL Item
Yes (Please specify) (1)
B11 Other infections specified
Item
B11 Please specify any other infections
text
Item
B12 Did you suffer from any acute febrile disease or another severe illness during the last week?
integer
Code List
B12 Did you suffer from any acute febrile disease or another severe illness during the last week?
CL Item
Yes, other (Please specify) (2)
Item
B12 Which (non-febrile) illness did you suffer from?
text
Code List
B12 Which (non-febrile) illness did you suffer from?
Item
B13 When was the last time you ate something?
integer
Code List
B13 When was the last time you ate something?
B13 Time of food intake
Item
B13 Time of latest food intake
time
Item
B14 How much did you eat?
integer
Code List
B14 How much did you eat?
Item
B15 When was the last time you drank something containing caffeine (theine)?
integer
Code List
B15 When was the last time you drank something containing caffeine (theine)?
B15 Time of consumption of caffeine (theine)
Item
B15 Time of latest consumption of caffeine (theine)
time
Item
B16 Type of beverage (if latest consumption of caffeine/theine was today)
integer
Code List
B16 Type of beverage (if latest consumption of caffeine/theine was today)
CL Item
Coffee containing caffeine (1)
CL Item
Tea (containing theine) (2)
Item
B17 When was the last time you drank other (caffeine-free) beverages?
integer
Code List
B17 When was the last time you drank other (caffeine-free) beverages?
B17 Time of consumption of caffeine-free beverage
Item
B17 Time of latest consumption of a caffeine-free beverage
time
Item
B16 Type of beverage (if latest consumption of a caffeine-free beverage was today)
integer
Code List
B16 Type of beverage (if latest consumption of a caffeine-free beverage was today)
CL Item
Decaffeinated coffee (1)
CL Item
Decaffeinated tea (2)
CL Item
Juice/Lemonade (3)
CL Item
Fruit/Herbal tea (5)
Item
B19 Are you allergic to latex?
integer
Code List
B19 Are you allergic to latex?
CL Item
Yes (Please use latex-free gloves when taking the blood sample!) (1)
B20 Beginning of blood collection
Item
B20 Exact time at beginning of blood collection (see clock)
time
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. Serum-Gel-Monovette (9 ml)
Item
6. Serum-Gel-Monovette (9 ml)
float
7. EDTA-Monovette (9 ml)
Item
7. EDTA-Monovette (9 ml)
float
8. Serum-Gel-Monovette (9 ml)
Item
8. Serum-Gel-Monovette (9 ml)
float
9. EDTA-Monovette (9 ml)
Item
9. EDTA-Monovette (9 ml)
float
10. Li-Heparin-Monovette (4.9 ml)
Item
10. Li-Heparin-Monovette (4.9 ml)
float
Item
B22 Examiner: Could the blood samples be taken?
integer
Code List
B22 Examiner: Could the blood samples be taken?
CL Item
No (Please specify) (2)
B22 Reason
Item
B22 If not, please specify reason:
text
Item
B23 Are the blood samples complete (all tubes filled)?
integer
Code List
B23 Are the blood samples complete (all tubes filled)?
B24 End of blood collection
Item
B24 Exact time at the end of blood collection (see clock)
time
Item
B25 Any deviations/problems during blood collection?
integer
Code List
B25 Any deviations/problems during blood collection?
CL Item
Yes (Specify in B26) (1)
CL Item
No (Proceed with B27) (2)
B26 1. Congestion
Item
B26 1. Congestion > 1 min.
boolean
B26 2. Hot fomentation
Item
B26 2. Hot fomentation
boolean
B26 3. Forced aspiration, slow blood flow
Item
B26 3. Forced aspiration, slow blood flow
boolean
B26 4. Prolonged poking at the same site
Item
B26 4. Prolonged poking at the same site
boolean
B26 5. Secondary bleeding
Item
B26 5. Secondary bleeding
boolean
B 26 6. Other deviations/problems
Item
B 26 6. Other deviations/problems
text
B27 Comments
Item
B27 Comments
text
End of examination
Item
End of examination
time
B28 Succesful urine collection
Item
B28 Urine collection succesful?
boolean
B29 Time of urine collection
Item
B29 Time of urine collection
time