Number of medication
Item
Number of medication
integer
C0237753 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Name of medication
Item
Name of medication
text
C0013227 (UMLS CUI [1])
medication dose
Item
Dose of Medication
float
C3174092 (UMLS CUI [1])
Start of therapy
Item
Start of therapy
date
C1531783 (UMLS CUI [1])
therapy Stop date
Item
Stop of therapy
date
C1531784 (UMLS CUI [1])
Ongoing medication
Item
Ongoing
boolean
C2826666 (UMLS CUI [1])
indication for medication
Item
Indication
text
C2826696 (UMLS CUI [1])
Number of Adverse Event
Item
Number of Adverse Event
integer
C0877248 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Description of Adverse Event
Item
Description of Adverse Event
text
C0877248 (UMLS CUI [1])
Start of treatment
Item
Start of treatment
date
C1531783 (UMLS CUI [1])
End of treatment
Item
End of treatment
date
C1531784 (UMLS CUI [1])
adverse event intensity
Item
Intensity
text
C1710066 (UMLS CUI [1])
Adverse event related to study treatment
Item
Related to the Study Medication
boolean
C1510821 (UMLS CUI [1])
Action taken with study medication
Item
Action taken with study medication
boolean
C1704758 (UMLS CUI [1])
Adverse event outcome
Item
Outcome
text
C1705586 (UMLS CUI [1])
is the adverse event serious
Item
Is the AE serious?
boolean
C1519255 (UMLS CUI [1])
Date of blood transfusion
Item
Date of blood transfusion
date
C1264703 (UMLS CUI [1])
Number of units
Item
Number of units
integer
C0086252 (UMLS CUI [1,1])
C0449961 (UMLS CUI [1,2])
Item
Any special events circumstances transfusion?
integer
C0877248 (UMLS CUI [1,1])
C1879316 (UMLS CUI [1,2])
Code List
Any special events circumstances transfusion?
if yes, please specify
Item
if yes, please specify
text
C0877248 (UMLS CUI [1,1])
C1879316 (UMLS CUI [1,2])
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
Item
Investigator's signature
integer
C2346576 (UMLS CUI [1])
Code List
Investigator's signature
Item
Early Ending of the Study or Termination
integer
C2718058 (UMLS CUI [1])
Code List
Early Ending of the Study or Termination
Item
If yes, study termination by?
integer
C2348570 (UMLS CUI [1])
Code List
If yes, study termination by?
CL Item
the physician (1)
If yes, date of the Termination:
Item
If yes, date of the Termination:
date
C2983670 (UMLS CUI [1])
If yes, reason for the study termination
Item
text
specify
Item
specify
text
C0566251 (UMLS CUI [1,1])
C2348570 (UMLS CUI [1,2])
Comments on the patient
Item
Comments on the patient
text
C0947611 (UMLS CUI [1,1])
C0030705 (UMLS CUI [1,2])
Investigators name
Item
Investigator's name
text
C2826892 (UMLS CUI [1])
Stamp
Item
Stamp
text
C0032755 (UMLS CUI [1])
Signature date
Item
Signature date
date
C0807937 (UMLS CUI [1])
Item
Investigator's signature
integer
C2346576 (UMLS CUI [1])
Code List
Investigator's signature