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Genetic Screening For HLA-B*5701 Pregnancy Notification Form NCT00340080

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Pregnancy Notification Form
Beschrijving

Pregnancy Notification Form

Alias
UMLS CUI-1
C0032961
Subject Identifier
Beschrijving

Subject Identifier

Datatype

text

Alias
UMLS CUI [1]
C2348585
Mothers date of birth
Beschrijving

Mothers date of birth

Datatype

date

Alias
UMLS CUI [1,1]
C0026591
UMLS CUI [1,2]
C0421451
Date of last menstrual period
Beschrijving

Date of last menstrual period

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0025329
Estimated date of delivery
Beschrijving

Estimated date of delivery

Datatype

date

Alias
UMLS CUI [1]
C1287845
Was the mother using a method of contraception?
Beschrijving

contraception

Datatype

boolean

Alias
UMLS CUI [1]
C0700589
If Yes, please specify
Beschrijving

Was the mother using a method of contraception?

Datatype

text

Alias
UMLS CUI [1]
C0700589
Type of conception, check one:
Beschrijving

Type of conception

Datatype

integer

Alias
UMLS CUI [1]
C2598844
Relevant laboratory tests
Beschrijving

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Datatype

text

Alias
UMLS CUI [1]
C0022885
laboratory test date
Beschrijving

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0022885
Relevant procedures
Beschrijving

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Datatype

text

Alias
UMLS CUI [1]
C0184661
UMLS CUI [2]
C0087111
procedure date
Beschrijving

Relevant laboratory tests and procedures (e.g., ultrasound, aminocentesis and chorionic villi sampling, including dates of tests and procedures).

Datatype

date

Alias
UMLS CUI [1,1]
C0011008
UMLS CUI [1,2]
C0184661
UMLS CUI [2,1]
C0011008
UMLS CUI [2,2]
C0087111
Number of previous pregnancies: Pre-term
Beschrijving

Pre-term pregnancies

Datatype

integer

Alias
UMLS CUI [1,1]
C0032961
UMLS CUI [1,2]
C1547235
UMLS CUI [1,3]
C0449788
Number of previous pregnancies: Full-term
Beschrijving

Full-term pregnancy

Datatype

integer

Alias
UMLS CUI [1,1]
C2114495
UMLS CUI [1,2]
C0449788
Number of: Normal births
Beschrijving

Normal births

Datatype

integer

Alias
UMLS CUI [1]
C3665337
Number of: Stillbirths
Beschrijving

Stillbirths

Datatype

integer

Alias
UMLS CUI [1]
C0595939
Number of: Children born with defects
Beschrijving

Children born with defects

Datatype

integer

Alias
UMLS CUI [1,1]
C0000768
UMLS CUI [1,2]
C2229974
Record details of children born with defects
Beschrijving

Children born with defects

Datatype

text

Alias
UMLS CUI [1]
C0000768
Number of: Spontaneous abortion
Beschrijving

Spontaneous abortion

Datatype

integer

Alias
UMLS CUI [1]
C0000786
Number of: Elective abortion
Beschrijving

Elective abortion

Datatype

integer

Alias
UMLS CUI [1]
C0269439
Number of: Other
Beschrijving

other birth

Datatype

integer

Alias
UMLS CUI [1,1]
C0005615
UMLS CUI [1,2]
C0205394
Are there any additional factors that may have an impact on the outcome of this pregnancy?
Beschrijving

impact on the outcome of this pregnancy

Datatype

boolean

Alias
UMLS CUI [1,1]
C0032972
UMLS CUI [1,2]
C1521761
If Yes, please specify
Beschrijving

Are there any additional factors that may have an impact on the outcome of this pregnancy?

Datatype

text

Alias
UMLS CUI [1,1]
C0032972
UMLS CUI [1,2]
C1521761
Fathers relevant medical/family history
Beschrijving

Fathers relevant medical/family history

Datatype

text

Alias
UMLS CUI [1,1]
C0015671
UMLS CUI [1,2]
C0262926
UMLS CUI [2]
C0241889
Was the subject withdrawn from the study as a result of this pregnancy?
Beschrijving

withdrawn from the study

Datatype

boolean

Alias
UMLS CUI [1,1]
C0422727
UMLS CUI [1,2]
C0032961
Drug exposures
Beschrijving

Drug exposures

Alias
UMLS CUI-1
C0743284
UMLS CUI-2
C0032961
Drug Name
Beschrijving

Drug Name

Datatype

text

Alias
UMLS CUI [1,1]
C2360065
UMLS CUI [1,2]
C0013227
Route of Admin. or Formulation
Beschrijving

Route

Datatype

text

Alias
UMLS CUI [1]
C0013153
Total Daily Dose
Beschrijving

Total Daily Dose

Datatype

text

Alias
UMLS CUI [1,1]
C2348070
UMLS CUI [1,2]
C0013227
Units
Beschrijving

Units

Datatype

text

Alias
UMLS CUI [1,1]
C1519795
UMLS CUI [1,2]
C0013227
Started Pre-Study
Beschrijving

Started Pre-Study

Datatype

boolean

Alias
UMLS CUI [1,1]
C0013227
UMLS CUI [1,2]
C0451613
Start Date
Beschrijving

Start Date

Datatype

date

Alias
UMLS CUI [1,1]
C0808070
UMLS CUI [1,2]
C0013227
Stop Date
Beschrijving

Stop Date

Datatype

date

Alias
UMLS CUI [1,1]
C0806020
UMLS CUI [1,2]
C0013227
Ongoing Medication
Beschrijving

Ongoing Medication

Datatype

boolean

Alias
UMLS CUI [1]
C2826666
Reason for Medication
Beschrijving

Reason for Medication

Datatype

text

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0013227
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Similar models

Genetic Screening For HLA-B*5701 Pregnancy Notification Form NCT00340080

1 Formulieren
Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Pregnancy Notification Form
C0032961 (UMLS CUI-1)
Subject Identifier
Item
Subject Identifier
text
C2348585 (UMLS CUI [1])
Mothers date of birth
Item
Mothers date of birth
date
C0026591 (UMLS CUI [1,1])
C0421451 (UMLS CUI [1,2])
Date of last menstrual period
Item
Date of last menstrual period
date
C0011008 (UMLS CUI [1,1])
C0025329 (UMLS CUI [1,2])
Estimated date of delivery
Item
Estimated date of delivery
date
C1287845 (UMLS CUI [1])
contraception
Item
Was the mother using a method of contraception?
boolean
C0700589 (UMLS CUI [1])
contraception
Item
If Yes, please specify
text
C0700589 (UMLS CUI [1])
Item
Type of conception, check one:
integer
C2598844 (UMLS CUI [1])
Type of conception
Code List
Type of conception, check one:
CL Item
Normal (includes use of fertility drugs) (1)
CL Item
IVF (in vitro fertilisation) (2)
laboratory tests
Item
Relevant laboratory tests
text
C0022885 (UMLS CUI [1])
laboratory test date
Item
laboratory test date
date
C0011008 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
procedures
Item
Relevant procedures
text
C0184661 (UMLS CUI [1])
C0087111 (UMLS CUI [2])
procedure date
Item
procedure date
date
C0011008 (UMLS CUI [1,1])
C0184661 (UMLS CUI [1,2])
C0011008 (UMLS CUI [2,1])
C0087111 (UMLS CUI [2,2])
Pre-term pregnancies
Item
Number of previous pregnancies: Pre-term
integer
C0032961 (UMLS CUI [1,1])
C1547235 (UMLS CUI [1,2])
C0449788 (UMLS CUI [1,3])
Full-term pregnancy
Item
Number of previous pregnancies: Full-term
integer
C2114495 (UMLS CUI [1,1])
C0449788 (UMLS CUI [1,2])
Normal births
Item
Number of: Normal births
integer
C3665337 (UMLS CUI [1])
Stillbirths
Item
Number of: Stillbirths
integer
C0595939 (UMLS CUI [1])
Children born with defects
Item
Number of: Children born with defects
integer
C0000768 (UMLS CUI [1,1])
C2229974 (UMLS CUI [1,2])
Children born with defects
Item
Record details of children born with defects
text
C0000768 (UMLS CUI [1])
Spontaneous abortion
Item
Number of: Spontaneous abortion
integer
C0000786 (UMLS CUI [1])
Elective abortion
Item
Number of: Elective abortion
integer
C0269439 (UMLS CUI [1])
other birth
Item
Number of: Other
integer
C0005615 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
impact on the outcome of this pregnancy
Item
Are there any additional factors that may have an impact on the outcome of this pregnancy?
boolean
C0032972 (UMLS CUI [1,1])
C1521761 (UMLS CUI [1,2])
impact on the outcome of this pregnancy
Item
If Yes, please specify
text
C0032972 (UMLS CUI [1,1])
C1521761 (UMLS CUI [1,2])
Fathers relevant medical/family history
Item
Fathers relevant medical/family history
text
C0015671 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
C0241889 (UMLS CUI [2])
withdrawn from the study
Item
Was the subject withdrawn from the study as a result of this pregnancy?
boolean
C0422727 (UMLS CUI [1,1])
C0032961 (UMLS CUI [1,2])
Item Group
Drug exposures
C0743284 (UMLS CUI-1)
C0032961 (UMLS CUI-2)
Drug Name
Item
Drug Name
text
C2360065 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Route
Item
Route of Admin. or Formulation
text
C0013153 (UMLS CUI [1])
Total Daily Dose
Item
Total Daily Dose
text
C2348070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Units
Item
Units
text
C1519795 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Started Pre-Study
Item
Started Pre-Study
boolean
C0013227 (UMLS CUI [1,1])
C0451613 (UMLS CUI [1,2])
Start Date
Item
Start Date
date
C0808070 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Stop Date
Item
Stop Date
date
C0806020 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
Ongoing Medication
Item
Ongoing Medication
boolean
C2826666 (UMLS CUI [1])
Reason for Medication
Item
Reason for Medication
text
C0392360 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
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