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Informatie:
Fout:
ID
16512
Beschrijving
DOCUMENTED PATHOGENS (Use this table for guidance on the pathogens of interest) Bacteria: S. pneumoniae, Other gram positive (i.e.: other streptococci, staphylococci, listeria …), Haemophilus influenzae, Other gram negative (i.e.: E. coli klebsiella, proteus, serratia, pseudomonas …), Legionella sp, Mycobacteria sp, Other Fungi: Candida sp, Aspergillus sp, Pneumocystis carinii, Other Parasites Toxoplasma gondii, Other Viruses: HSV, VZV, EBV, CMV, HHV-6, RSV, Other respiratory virus (influenza, parainfluenza,rhinovirus), Adenovirus, HBV, HCV, HIV, Papovavirus, Parvovirus, Other
Trefwoorden
Versies (3)
- 21-07-16 21-07-16 -
- 10-08-16 10-08-16 -
- 17-09-21 17-09-21 -
Geüploaded op
21 juli 2016
DOI
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Licentie
Creative Commons BY-NC 3.0
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19ppEBMT SLE 16SLE
19ppEBMT SLE 16SLE
- StudyEvent: ODM
Similar models
19ppEBMT SLE 16SLE
- StudyEvent: ODM
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
EBMT Centre Identification Code (CIC)
Item
EBMT Centre Identification Code (CIC)
text
C2348585 (UMLS CUI [1])
Hospital
Item
Name of the hospital
text
C0019994 (UMLS CUI [1])
Unit
Item
Unit
text
Contact person
Item
Name of contact person
text
C0337611 (UMLS CUI [1])
Telephone
Item
Telephone number of contact person
text
C1515258 (UMLS CUI [1])
ContactPersonFaxNumber
Item
Fax
text
C0027361 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0085205 (UMLS CUI [1,3])
C0237753 (UMLS CUI [1,4])
C0337611 (UMLS CUI [1,2])
C0085205 (UMLS CUI [1,3])
C0237753 (UMLS CUI [1,4])
E-Mail
Item
E-Mail
text
C1705961 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Code List
Patient following national / international study / trial
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Unique Identification Code (UIC)
Item
To be entered only if patient previously reported
text
C2348585 (UMLS CUI [1])
Hospital Unique Patient Number or Code
Item
Hospital Unique Patient Number or Code
text
C1827636 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
CL Item
Male (1)
CL Item
Female (2)
ABO Group
Item
ABO Group
text
CL Item
Absent (1)
CL Item
Present (2)
CL Item
Not evaluated (3)
Date of diagnosis
Item
Date of diagnosis
date
C2316983 (UMLS CUI [1])
Item
Check the disease for which this transplant was performed
text
C0277554 (UMLS CUI [1])
CL Item
Acute Leukaemia (Acute Leukaemia)
CL Item
Acute Lymphoblastic Leukaemia (ALL) (Acute Lymphoblastic Leukaemia (ALL))
CL Item
Acute Myelogenous Leukaemia (AML) (Acute Myelogenous Leukaemia (AML))
CL Item
Autoimmune disease (Autoimmune disease)
CL Item
Bone marrow failure including Aplastic anaemia (Bone marrow failure including Aplastic anaemia)
CL Item
Chronic Leukaemia (Chronic Leukaemia)
CL Item
Chronic Lymphocytic Leukaemia (Chronic Lymphocytic Leukaemia)
CL Item
Chronic Myeloid Leukaemia (CML) (Chronic Myeloid Leukaemia (CML))
CL Item
Haemoglobinopathiy (Haemoglobinopathiy)
CL Item
Histiocytic disorders (Histiocytic disorders)
CL Item
Hodgkin´s Disease (Hodgkin´s Disease)
CL Item
Inherited disorders (Inherited disorders)
CL Item
Juvenile Idiopathic Arthritis (Juvenile Idiopathic Arthritis)
CL Item
Lymphoma (Lymphoma)
CL Item
MD/ MPN (MD/ MPN)
CL Item
MDS (MDS)
CL Item
Metabolic disorders (Metabolic disorders)
CL Item
Multiple Sclerosis (Multiple Sclerosis)
CL Item
Myelodysplastic syndromes (Myelodysplastic syndromes)
CL Item
Myeloma/ Plasma cell disorder (Myeloma/ Plasma cell disorder)
CL Item
Myeloproliferative neoplasm (Myeloproliferative neoplasm)
CL Item
Non Hodgkin (Non Hodgkin)
CL Item
Other diagnosis (Other diagnosis)
CL Item
Primary immune deficiencies (Primary immune deficiencies)
CL Item
Secondary Acute Leukaemia (do not use if transformed from MDS/MPN) (Secondary Acute Leukaemia (do not use if transformed from MDS/MPN))
CL Item
Solid Tumour (Solid Tumour)
CL Item
Systemic Lupus (Systemic Lupus)
CL Item
Systemic Sclerosis (Systemic Sclerosis)
Name of Referring Physician
Item
Name of Referring Physician
text
Address
Item
Address
text
Fax
Item
Fax
text
C1549619 (UMLS CUI [1,1])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
C0337611 (UMLS CUI [1,2])
C0030664 (UMLS CUI [1,3])
Email
Item
Email
text
Item
Has the information requested in this section been submitted with a previous transplant registration?
text
Code List
Has the information requested in this section been submitted with a previous transplant registration?
CL Item
Yes: proceed to “Status of Disease at mobilisation” on page 3 (Yes: proceed to “Status of Disease at mobilisation” on page 3)
CL Item
No: proceed with this section (No: proceed with this section)
Item Group
DIAGNOSTIC CRITERIA FOR SYSTEMIC LUPUS ERYTHEMATOSUS
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Item
a) Persistent proteinuria >0.5 grams per day or >3+ on urine dipsCheck if quantitation not performed ~OR~ b) Cellular casts – may be red cell, hemoglobulin, granular, tubular or mixed
text
Code List
a) Persistent proteinuria >0.5 grams per day or >3+ on urine dipsCheck if quantitation not performed ~OR~ b) Cellular casts – may be red cell, hemoglobulin, granular, tubular or mixed
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
THERAPIES
Item
THERAPIES
boolean
Datestarted
Item
Date started
date
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
no (0)
CL Item
yes (1)
CL Item
unknown (9)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Other drugs
Item
Other drugs, please specify
boolean
PriorTransplantDate
Item
Date of Transplant
date
C0332152 (UMLS CUI [1,1])
C0332835 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
C0332835 (UMLS CUI [1,2])
C2745955 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
CL Item
Allogeneic (1)
CL Item
Autologous (2)
Date of 1st collection or pheresis
Item
Autologous
date
Item
Was lupus nephritis present at anytime prior to mobilisation?
integer
Code List
Was lupus nephritis present at anytime prior to mobilisation?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
date of most recent renal biopsy
Item
if renal biopsy done, date of most recent renal biopsy
date
CL Item
I Normal (I Normal)
CL Item
II Mesangial (II Mesangial)
CL Item
III Focal proliferative (III Focal proliferative)
CL Item
IV Diffuse proliferative (IV Diffuse proliferative)
CL Item
V Membranous (V Membranous)
CL Item
Other (Other)
Grade Histology
Item
if other, please specify
text
Item Group
SLEDAI (Systemic Lupus Erythematosus Disease Activity Index) score
CL Item
Yes (Yes )
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Seizures [255]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Psychosis [256]
Item
if yes, Scoe 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Organic brain syndrome [257]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Visual disturbance [109]
Item
if yes, Score 8
boolean
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Cranial nerve disorder [258]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Lupus headache [259]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CVA [260]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Vasculitis [234]
Item
if yes, Score 8
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Arthritis [226]
Item
if yes, Sore 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Myositis [261]
Item
if yes, Score 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Urinary casts [262]
Item
if yes, Score 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Hematuria [263]
Item
if yes, Score 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Proteinuria [264]
Item
if yes, Score 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Pyuria [265]
Item
if yes, score 4
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
New rash [249]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Alopecia [266]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Mucosal ulcers [252]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Pleurisy [267]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Pericarditis [268]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Low complement [269]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Increased DNA binding [270]
Item
if yes, Score 2
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Fever [271]
Item
if yes, Score 1
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Thrombocytopenia [272]
Item
if yes, Score 1
boolean
CL Item
Yes (1)
CL Item
No (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
Leukopenia [272]
Item
if yes, Score 1
boolean
Haemoglobin
Item
Haemoglobin
float
C0019046 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
ESR
Item
Erythrocyte Sedimentation Rate
integer
C1176468 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
platelets
Item
Platelets
integer
C0005821 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
WBC
Item
WBC
float
C0023508 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Serumcreatinine
Item
Serum creatinine
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Creatinine Clearance
Item
Creatinine Clearance
float
C0373595 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Total urinary protein excretion (mg/24 h)
Item
Total urinary protein excretion (mg/24 h)
float
C3897352 (UMLS CUI [1])
CL Item
Not evaluated (1)
CL Item
Unknown (2)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
No (No)
CL Item
Yes (Yes )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Unknown (Unknown)
CL Item
Normal (1)
CL Item
Elevated (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
Normal (1)
CL Item
Elevated (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
Normal (1)
CL Item
Elevated (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
Normal (1)
CL Item
Elevated (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Item Group
PATIENT’S SELF ASSESSMENT PRIOR TO MOBILISATION
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
CL Item
Transformed Score (range 0-100) (Transformed Score (range 0-100))
CL Item
Raw score (Raw score)
CL Item
Unknown (Unknown)
Physical Functioning
Item
Physical Functioning
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Role Functioning-Physical
Item
Role Functioning-Physical
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Role Functioning-Emotional
Item
Role Functioning-Emotional
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Social Functioning
Item
Social Functioning
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Bodily Pain
Item
Bodily Pain
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Mental Health
Item
Mental Health
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Vitality:
Item
Vitality:
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
General Health
Item
General Health
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Item
Did the patient complete a Health Assessment Questionnaire (HAQ)?
integer
Code List
Did the patient complete a Health Assessment Questionnaire (HAQ)?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Patient’s score
Item
Patient’s score
float
Worst possible score
Item
Worst possible score
float
Best possible score
Item
Best possible score
float
Item
Was lupus nephritis present at anytime prior to HSCT?
text
Code List
Was lupus nephritis present at anytime prior to HSCT?
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
Was lupus nephritis present at anytime prior to HSCT?
Item
if yes, date of most recent renal biopsy
date
CL Item
I Normal (I Normal)
CL Item
II Mesangial (II Mesangial)
CL Item
III Focal proliferative (III Focal proliferative)
CL Item
IV Diffuse proliferative (IV Diffuse proliferative)
CL Item
V Membranous (V Membranous)
CL Item
Other, (Other,)
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
ADDITIONAL DISEASE TREATMENT
Item
ADDITIONAL DISEASE TREATMENT
boolean
Item
ADDITIONAL DISEASE TREATMENT if yes
integer
C1706712 (UMLS CUI [1])
CL Item
Planned (planned before HSCT took place) (1)
CL Item
Not planned (for relapse/progression or persistent disease) (2)
CL Item
AUTOgraft, proceed to Autograft form (1)
CL Item
ALLOgraft or Syngeneic graft, proceed to Allograft form (2)
Unique Identification Code (UIC)
Item
Unique Identification Code (UIC) (if known)
text
C2348585 (UMLS CUI [1])
Date of this report
Item
Date of this report
date
C1302584 (UMLS CUI [1])
Item
Patient following national / international study / trial
integer
C1997894 (UMLS CUI [1])
Code List
Patient following national / international study / trial
CL Item
no (1)
CL Item
yes (2)
CL Item
unknown (3)
Name of study / trial
Item
Name of study / trial
text
C0008976 (UMLS CUI [1])
Hospital Unique Patient Number
Item
Hospital Unique Patient Number
text
C2348585 (UMLS CUI [1])
Initials
Item
First name(s)_surname(s)
text
C2986440 (UMLS CUI [1])
Date of birth
Item
Date of birth
date
C0421451 (UMLS CUI [1])
Date of last HSCT for this patient
Item
Date of last HSCT for this patient
date
C0472699 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Date last contact
Item
Date of Last Contact or Death
date
C0805839 (UMLS CUI [1])
Item Group
GRAFT VERSUS HOST DISEASE (GvHD) SINCE LAST REPORT
CL Item
grade 0 (Absent) (1)
CL Item
grade I (2)
CL Item
grade II (3)
CL Item
grade III (4)
CL Item
grade IV (5)
CL Item
Not evaluated (6)
Item
If present GvHD, Maximum grade
integer
C0856825 (UMLS CUI [1,1])
C0441800 (UMLS CUI [1,2])
C0441800 (UMLS CUI [1,2])
CL Item
New onset (1)
CL Item
Recurrent (2)
CL Item
Persistent (3)
CL Item
Tapering (1)
CL Item
DLI (2)
CL Item
Unexplained (3)
Date onset of this episode
Item
Date onset of this episode (if new or recurrent)
date
C0574845 (UMLS CUI [1])
Item
Date onset of this episode
integer
C0574845 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
Not applicable (1)
Item
Stage skin
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C1306673 (UMLS CUI [1,3])
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
Item
Stage liver
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0023884 (UMLS CUI [1,3])
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
Item
Stage gut
integer
C0856825 (UMLS CUI [1,1])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
C1306673 (UMLS CUI [1,2])
C0021853 (UMLS CUI [1,3])
CL Item
0 (1)
CL Item
1 (2)
CL Item
2 (3)
CL Item
3 (4)
CL Item
4 (5)
CL Item
Not evaluated (6)
CL Item
unknown (7)
CL Item
No (1)
CL Item
Yes (2)
aGvHD Date of resolution
Item
Date of resolution
date
C0856825 (UMLS CUI [1,1])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
C1514893 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
CL Item
No (No)
CL Item
Present continuously since last reported episode (Present continuously since last reported episode)
CL Item
Resolved (Resolved)
CL Item
Yes (Yes)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
CL Item
First episode (1)
CL Item
Recurrence (2)
Date of onset
Item
Date of onset
date
C0574845 (UMLS CUI [1])
CL Item
limited (1)
CL Item
Extensive (2)
CL Item
Skin (1)
CL Item
Gut (2)
CL Item
Liver (3)
CL Item
Mouth (4)
CL Item
Eyes (5)
CL Item
Lung (6)
CL Item
Other, specify (7)
CL Item
Unknown (8)
Date of Resolution
Item
If resolved, specify the date of resolution:
date
C1514893 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
Infection related complications
Item
Infection related complications
boolean
C0009450 (UMLS CUI [1,1])
C0009566 (UMLS CUI [1,2])
C0009566 (UMLS CUI [1,2])
Bacteremia / fungemia / viremia / parasites
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Bacteremia / fungemia / viremia / parasites
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Septic shock
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Septic shock
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
ARDS
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
ARDS
Item
Date Provide different dates for different episodes of the same complication if applicable
date
Multiorgan failure due to infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Multiorgan failure due to infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Pneumonia
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Pneumonia
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Hepatitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Hepatitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
CNS infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
CNS infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Gut infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Gut infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Skin infection
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Skin infection
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Cystitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Cystitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Retinitis
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Retinitis
Item
Date Provide different dates for different episodes of the same complication if applicable.
date
Other
Item
Pathogen Use the list of pathogens listed after this table for guidance. Use “unknown” if necessary.
text
Other
Item
Date Provide different dates for different episodes of the same complication if applicable
text
Non infection related complications
Item
Non infection related complications
boolean
C0009566 (UMLS CUI [1])
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Idiopathic pneumonia syndrome
Item
Idiopathic pneumonia syndrome
date
C1504431 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,2])
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
VOD
Item
VOD
date
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Cataract
Item
Cataract
date
Item
Check all that are applicable for this period Haemorrhagic cystitis, non infectious
text
C0085692 (UMLS CUI [1])
Code List
Check all that are applicable for this period Haemorrhagic cystitis, non infectious
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
Haemolytic anaemia due to blood group
Item
Haemolytic anaemia due to blood group
date
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
ARDS, non infectious
Item
ARDS, non infectious
date
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Multiorgan failure, non infectious
Item
Multiorgan failure, non infectious
date
Item
(Check all that are applicable for this period HSCT-associated microangiopathy
text
C0155765 (UMLS CUI [1])
Code List
(Check all that are applicable for this period HSCT-associated microangiopathy
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
HSCT-associated microangiopathy
Item
HSCT-associated microangiopathy
date
Item
(Check all that are applicable for this period) Renal failure requiring dialysis
text
C0035078 (UMLS CUI [1])
Code List
(Check all that are applicable for this period) Renal failure requiring dialysis
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Renal failure requiring dialysis
Item
Renal failure requiring dialysis
date
Item
(Check all that are applicable for this period) Haemolytic anaemia due to blood group
integer
C0002878 (UMLS CUI [1])
Code List
(Check all that are applicable for this period) Haemolytic anaemia due to blood group
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Haemolytic anaemia due to blood group
Item
Haemolytic anaemia due to blood group
date
Item
Check all that are applicable for this period) Aseptic bone necrosis
text
C0158452 (UMLS CUI [1])
Code List
Check all that are applicable for this period) Aseptic bone necrosis
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Aseptic bone necrosis
Item
Aseptic bone necrosis
date
Other
Item
Other type, (Check all that are applicable for this period)
boolean
Other type
Item
Other type
date
Item Group
GRAFT ASSESSMENT AND HAEMOPOIETIC CHIMAERISM
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Yes (Yes)
CL Item
Full (donor >95 %) (1)
CL Item
Mixed (partial) (2)
CL Item
Autologous reconstitution (recipient >95 %) (3)
CL Item
Aplasia (4)
CL Item
Not evaluated (5)
Date of test
Item
Date of test (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
date
C2826247 (UMLS CUI [1])
Identification
Item
Identification of donor or Cord Blood Unit given by the centre
text
C1718162 (UMLS CUI [1])
Number in the infusion order
Item
Number in the infusion order (if applicable) (Indicate the date(s) and results of all tests done for all donors. Split the results by donor and by the cell type on which the test was performed if applicable. Copy this table as many times as necessary.)
text
C0237753 (UMLS CUI [1])
CL Item
N/A (1)
Bone marrow
Item
Cell type on which test was performed (% Donor Cells): BM
float
C0005953 (UMLS CUI [1])
PB mononuclear cells (PBMC)
Item
Cell type on which test was performed (% Donor cells): PB mononuclear cells (PBMC)
float
C1321301 (UMLS CUI [1])
T-cell
Item
Cell type on which test was performed (% Donor cells):
float
Red blood cells
Item
Cell type on which test was performed (% Donor cells): Red blood cells
float
C0014772 (UMLS CUI [1])
Monocytes
Item
Cell type on which test was performed (% Donor cells): Monocytes
float
C0026473 (UMLS CUI [1])
PMNs (neutrophils)
Item
Cell type on which test was performed (% Donor cells): PMNs (neutrophils)
float
C0200633 (UMLS CUI [1])
Lymphocytes, NOS
Item
Cell type on which test was performed (% Donor cells): Lymphocytes, NOS
float
C0024264 (UMLS CUI [1])
Myeloid cells, NOS
Item
Cell type on which test was performed (% Donor cells): Myeloid cells, NOS
float
C0887899 (UMLS CUI [1])
Other
Item
Cell type on which test was performed
text
CL Item
ABO group (ABO group)
CL Item
Cytogenetic (Cytogenetic)
CL Item
FISH (FISH)
CL Item
Molecular (Molecular)
CL Item
Other (Other)
CL Item
unknown (unknown)
Item
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
integer
Code List
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
CL Item
Previously reported (1)
CL Item
Yes (2)
CL Item
No at date of this follow-up (3)
SECONDARY MALIGNANCY, LYMPHOPROLIFERATIVE OR MYELOPROLIFRATIVE DISORDER DIAGNOSED
Item
if yes, date of diagnosis
date
CL Item
AML (AML )
CL Item
MDS (MDS )
CL Item
Lymphoproliferative disorder (Lymphoproliferative disorder)
CL Item
Other (Other)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Date started
Item
if yes treatment given since last report
date
Item
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
integer
C0302189 (UMLS CUI [1])
Code List
If yes: Cellular therapy (One cell therapy regimen is defined as any number of infusions given within 10 weeks for the same indication. If more than one regimen of cell therapy has been given since last report, copy this section and complete it as many times as necessary.)
CL Item
No (1)
CL Item
Yes (Mark disease status before this cellular therapy) (2)
CL Item
Unknown (3)
Item
Disease status before this cellular therapy
integer
C0012634 (UMLS CUI [1])
CL Item
CR (CR)
CL Item
Not evaluated (Not evaluated)
CL Item
Not in CR (Not in CR)
CL Item
Donor lymphocyte infusion (DLI) (Donor lymphocyte infusion (DLI))
CL Item
Mesenchymal cells (Mesenchymal cells)
CL Item
Other (Other)
CL Item
Unknown (Unknown)
Type of cells
Item
If other
text
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
CD 34+
Item
specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
Item
If DLI, specify the number of cells infused by type: CD 34+
text
C3538723 (UMLS CUI [1])
CL Item
Evaluated (Evaluated)
CL Item
Not Evaluated (Not Evaluated)
CL Item
Unknown (Unknown)
CD 3+
Item
specify the number of cells infused by type: CD 3+
float
C3542405 (UMLS CUI [1])
CL Item
Evaluated (Evaluated )
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Number (1)
CL Item
Not evaluated (2)
CL Item
Unknown (3)
Chronological number
Item
Chronological number of this cell therapy for this patient
float
C2348184 (UMLS CUI [1])
Item
Indication (check all that apply)
text
C3146298 (UMLS CUI [1,1])
C0302189 (UMLS CUI [1,2])
C0302189 (UMLS CUI [1,2])
CL Item
Loss/decreased chimaerism (Loss/decreased chimaerism)
CL Item
Mixed chimaerism (Mixed chimaerism)
CL Item
Other (Other)
CL Item
Planned/ protocol (Planned/ protocol)
CL Item
Prophylactic (Prophylactic)
CL Item
Treatment for disease (Treatment for disease)
CL Item
Treatment of GvHD (Treatment of GvHD)
CL Item
Treatment PTLD, EBV, lymphoma (Treatment PTLD, EBV, lymphoma)
CL Item
Treatment viral infection (Treatment viral infection)
Number of Infusions
Item
Number of Infusions (within 10 weeks) (count only infusions that are part of same regimen and given for the same indication)
float
C2348184 (UMLS CUI [1,1])
C1289919 (UMLS CUI [1,2])
C1289919 (UMLS CUI [1,2])
CL Item
grade 0 (absent) (1)
CL Item
grade 1 (2)
CL Item
grade 2 (3)
CL Item
grade 3 (4)
CL Item
grade 4 (5)
CL Item
present, grade unknown (6)
Item
Disease treatment (apart from donor cell infusion or other type of cell therapy)
integer
C0087111 (UMLS CUI [1])
Code List
Disease treatment (apart from donor cell infusion or other type of cell therapy)
CL Item
No (1)
CL Item
Yes: Planned (planned before HSCT took place) (2)
CL Item
Yes: Not planned (for relapse/progression or persistent disease) (3)
Item Group
FIRST EVIDENCE OF DISEASE WORSENING SINCE LAST HSCT
CL Item
Continuous worsening since HSCT (Continuous worsening since HSCT)
CL Item
No (No)
CL Item
Previously reported (Previously reported)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
EVIDENCE OF DISEASE ACTIVITY
Item
Date First Noted (mm-dd-yyyy)
date
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
Yes (Yes )
CL Item
No (No)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Haemoglobin Blood
Item
Haemoglobin
float
C0518015 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Platelets
Item
Platelet count
float
C0005821 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
WBC
Item
WBC
float
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
ESR
Item
Erythrocyte Sedimentation Rate
float
C1176468 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Creatinine, Serum
Item
Serum creatinine
float
C0201976 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Creatinine Clearance
Item
Creatinine Clearance
float
C0373595 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
Total urinary protein excretion (mg/24 h)
Item
Total urinary protein excretion (mg/24 h)
float
C3897352 (UMLS CUI [1])
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Not evaluated (3)
CL Item
Unknown (4)
CL Item
No (No)
CL Item
Yes (Yes)
CL Item
Not evaluated (Not evaluated)
CL Item
Unknown (Unknown)
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
Normal (Normal )
CL Item
Elevated (Elevated )
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
CL Item
No (No )
CL Item
Yes (Yes )
CL Item
Unknown (Unknown)
CL Item
Transformed Score (Transformed Score )
CL Item
Raw score (Raw score )
CL Item
Unknown SCORE (range 0-100) (Unknown SCORE (range 0-100))
Physical Functioning
Item
Physical Functioning
float
CL Item
Not evaluated (Not evaluated )
CL Item
Unknown (Unknown)
Role Functioning-Physical
Item
Role Functioning-Physical
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Role Functioning-Emotional
Item
Role Functioning-Emotional
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Social Functioning
Item
Social Functioning
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Bodily Pain
Item
Bodily Pain
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Mental Health
Item
Mental Health
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Vitality
Item
Vitality
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
General Health
Item
General Health
float
CL Item
Not evaluated (1)
CL Item
Unknown (2)
Item
Did the patient complete a Health Assessment Questionnaire (HAQ)?
integer
Code List
Did the patient complete a Health Assessment Questionnaire (HAQ)?
CL Item
No (1)
CL Item
Yes (2)
CL Item
Unknown (3)
Patient’s score
Item
Patient’s score
float
Worst possible score
Item
Worst possible score
float
Best possible score
Item
Best possible score
float
Item
Has patient or partner become pregnant after this HSCT?
text
Code List
Has patient or partner become pregnant after this HSCT?
CL Item
Yes (Yes)
CL Item
No (No)
CL Item
Unknown (Unknown)
CL Item
alive (0)
CL Item
dead (1)
CL Item
Karnofsky (1)
CL Item
Lansky (2)
CL Item
100 (Normal, NED) (1)
CL Item
10 (Moribund) (10)
CL Item
Not evaluated (11)
CL Item
Unknown (12)
CL Item
90 (Normal activity) (2)
CL Item
80 (Normal with effort) (3)
CL Item
70 (Cares for self) (4)
CL Item
60 (Requires occasional assistance) (5)
CL Item
50 (Requires assistance) (6)
CL Item
40 (Disabled) (7)
CL Item
30 (Severely disabled) (8)
CL Item
20 (Very sick) (9)
CL Item
Relapse or progression (1)
CL Item
Secondary malignancy (including lymphoproliferative disease) (2)
CL Item
HSCT related cause (3)
CL Item
Unknown (4)
CL Item
Other (5)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
Item
Interstitial Pneumonitis
text
C0007465 (UMLS CUI [1,1])
C0206061 (UMLS CUI [1,2])
C0206061 (UMLS CUI [1,2])
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
No (No )
CL Item
Unknown (Unknown)
CL Item
Yes (Yes)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
bacterial (1)
CL Item
viral (2)
CL Item
fungal (3)
CL Item
parasitic (4)
CL Item
unknown (5)
Item
Rejection / poor graft function
integer
C0018129 (UMLS CUI [1])
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Veno-Occlusive disease (VOD)
integer
C0007465 (UMLS CUI [1,1])
C0948441 (UMLS CUI [1,2])
C0948441 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Central nervous system toxicity
integer
C0007465 (UMLS CUI [1,1])
C3160947 (UMLS CUI [1,2])
C3160947 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Gastro intestinal toxicity
integer
C0007465 (UMLS CUI [1,1])
C1142499 (UMLS CUI [1,2])
C1142499 (UMLS CUI [1,2])
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other related cause
Item
Other related cause
boolean
Comments
Item
Comments
text
IDENTIFICATION & SIGNATURE
Item
IDENTIFICATION & SIGNATURE
text