ID

2451

Description

AMC-075 Pregnancy Outcome Form (PRO) Vorinostat and Combination Chemotherapy With Rituximab in Treating Patients With Previously Untreated HIV-Related Diffuse Large B-Cell Non-Hodgkin Lymphoma Source Form: NCI FormBuilder: https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0F9B852-8D17-8306-E040-BB89AD434EB4

Lien

https://formbuilder.nci.nih.gov/FormBuilder/formDetailsAction.do?method=getFormDetails&formIdSeq=A0F9B852-8D17-8306-E040-BB89AD434EB4

Mots-clés

Versions (2)
  1. 19/09/2012 19/09/2012 -
  2. 29/07/2017 29/07/2017 - Martin Dugas
Téléchargé le

19 septembre 2012

DOI

Pour une demande vous connecter.

Licence

Creative Commons BY-NC 3.0 Legacy
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Lymphoma NCT01193842 On-Study - AMC-075 Pregnancy Outcome Form (PRO) - 3228008v1.0

Anglais

For date fields, if the month and year are known, but the exact date is not, please enter "15" for the day.

1 Formulaires  
Unnamed1
Description

Unnamed1

Sequence number
Description

SequentialFormSubmissionCount

Type de données

double

Alias
NCI Thesaurus ObjectClass
C19464
UMLS 2011AA ObjectClass
C0376315
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C49153
UMLS 2011AA ObjectClass
C1705294
NCI Thesaurus Property
C25694
UMLS 2011AA Property
C1515022
Pregnancy Status
Description

Pregnancy Status

Pregnancy Status
Description

PersonPregnancyPregnancyStatus

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
NCI Thesaurus ValueDomain
C25688
UMLS 2011AA ValueDomain
C0449438
Pregnancy Outcome - Live Birth Only
Description

Pregnancy Outcome - Live Birth Only

Delivery Date
Description

PregnancyDeliveryDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C61560
Gestational age, Weeks
Description

PregnancyWeekNumberCount

Type de données

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C29844
UMLS 2011AA Property
C0439230
Gestational age, Days
Description

PregnancyDayCount

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C25301
UMLS 2011AA Property
C0439228
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Birth weight, pounds
Description

PersonMeasuredBirthPoundWeightCount

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
NCI Thesaurus Property
C48531
UMLS 2011AA Property
C0439219
NCI Thesaurus Property
C25155
UMLS 2011AA Property
C0005615
NCI Thesaurus Property
C44473
UMLS 2011AA Property
C0444706
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Birth weight, ounces
Description

PersonMeasuredBirthOunceWeightCount

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25208
UMLS 2011AA Property
C0043100
NCI Thesaurus Property
C48519
UMLS 2011AA Property
C0439218
NCI Thesaurus Property
C25155
UMLS 2011AA Property
C0005615
NCI Thesaurus Property
C44473
UMLS 2011AA Property
C0444706
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
Birth length, Inches
Description

PersonRecumbentLengthValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C25334
UMLS 2011AA Property
C1444754
NCI Thesaurus Property
C77532
UMLS 2011AA Property
C0444334
NCI Thesaurus ValueDomain
C25712
UMLS 2011AA ValueDomain
C1522609
NCI Thesaurus ValueDomain
C25334
UMLS 2011AA ValueDomain
C1444754
One minute Apgar Score
Description

ApgarScoreOneMinuteNumberValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C73437
UMLS 2011AA ObjectClass
C0003533
NCI Thesaurus Property
C48154
UMLS 2011AA Property
C0439232
NCI Thesaurus Property
C66832
UMLS 2011AA Property
C0205447
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C66833
UMLS 2011AA ValueDomain
C0205448
NCI Thesaurus ValueDomain
C73791
UMLS 2011AA ValueDomain
C0582802
Five minute Apgar Score
Description

ApgarScoreFiveMinuteNumberValue

Type de données

double

Alias
NCI Thesaurus ObjectClass
C73437
UMLS 2011AA ObjectClass
C0003533
NCI Thesaurus Property
C48154
UMLS 2011AA Property
C0439232
NCI Thesaurus Property
C66836
UMLS 2011AA Property
C0205451
NCI Thesaurus ValueDomain
C25337
UMLS 2011AA ValueDomain
C0237753
NCI Thesaurus ValueDomain
C66833
UMLS 2011AA ValueDomain
C0205448
NCI Thesaurus ValueDomain
C73791
UMLS 2011AA ValueDomain
C0582802
Unknown
Description

DataUnknownText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C25474
UMLS 2011AA ObjectClass
C1511726
NCI Thesaurus Property
C17998
UMLS 2011AA Property
C0439673
Were there any clinical problems with the infant
Description

PhysicalExaminationNewbornExaminationPerformedInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus ObjectClass
C20989
UMLS 2011AA ObjectClass
C0031809
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C84749
UMLS 2011AA Property
C2827500
Specify (If yes)
Description

PregnancyBirthOutcomeText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C25155
UMLS 2011AA Property
C0005615
Were there any problems with delivery
Description

PregnancyLaborandDeliveryComplicationPresentInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C87091
UMLS 2011AA Property
C0269815
Specify (If yes)
Description

NewbornAbnormalityContributingFactorText

Type de données

text

Alias
NCI Thesaurus ObjectClass
C16731
UMLS 2011AA ObjectClass
C2939425
NCI Thesaurus Property
C9440
UMLS 2011AA Property
C1704258
NCI Thesaurus Property
C61412
UMLS 2011AA Property
C1880177
NCI Thesaurus Property
C25506
UMLS 2011AA Property
C1521761
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
Is there a congenital anomaly (If Yes, report as an SAE.)
Description

PersonCongenitalAbnormalityPregnancyInd-3

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
Specify (If yes)
Description

PatientCongenitalAbnormalitySpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
Was neonatal testing performed
Description

DiagnosticProcedureFetalExaminationPerformedInd-3

Type de données

text

Alias
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus ObjectClass
C18020
UMLS 2011AA ObjectClass
C0430022
NCI Thesaurus Property
C92714
Were there any abnormal test results (If yes)
Description

AbnormalFindingDiagnosticProcedureFetalExaminationPerformedInd-3

Type de données

text

Alias
NCI Thesaurus ObjectClass
C18020
UMLS 2011AA ObjectClass
C0430022
NCI Thesaurus ObjectClass
C82547
UMLS 2011AA ObjectClass
C2826279
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C92714
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Specify (If yes including dates)
Description

TherapeuticProcedurePregnancyAssociatedPerformedAbnormalSpecify

Type de données

text

Alias
NCI Thesaurus ObjectClass
C49236
UMLS 2011AA ObjectClass
C0087111
NCI Thesaurus Property
C38000
UMLS 2011AA Property
C0884358
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
NCI Thesaurus Property
C25281
UMLS 2011AA Property
C0332281
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ValueDomain
C25401
UMLS 2011AA ValueDomain
C0205161
Pregnancy Outcome - Spontaneous Abortion, Still Birth, Or Elective Abortion Only
Description

Pregnancy Outcome - Spontaneous Abortion, Still Birth, Or Elective Abortion Only

Date (mm/dd/yyyy)
Description

PersonPregnancyOutcomeDate

Type de données

date

Alias
NCI Thesaurus ValueDomain
C25164
UMLS 2011AA ValueDomain
C0011008
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus Property
C20200
UMLS 2011AA Property
C1274040
NCI Thesaurus Property
C25742
UMLS 2011AA Property
C0032961
Gestational age, Weeks
Description

PregnancyWeekNumberCount

Type de données

double

Alias
NCI Thesaurus Property
C25337
UMLS 2011AA Property
C0237753
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C29844
UMLS 2011AA Property
C0439230
Gestational age, Days
Description

PregnancyDayCount

Type de données

double

Alias
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C25301
UMLS 2011AA Property
C0439228
NCI Thesaurus Property
C25275
UMLS 2011AA Property
C2745955
NCI Thesaurus ValueDomain
C25301
UMLS 2011AA ValueDomain
C0439228
NCI Thesaurus ValueDomain
C25463
UMLS 2011AA ValueDomain
C0750480
If spontaneous abortion or still birth, specify circumstances
Description

PregnancyPersonSpontaneousAbortionStillbirthPresentSpecify

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C25742
UMLS 2011AA ObjectClass
C0032961
NCI Thesaurus Property
C25626
UMLS 2011AA Property
C0150312
NCI Thesaurus Property
C34336
UMLS 2011AA Property
C0000786
NCI Thesaurus Property
C49151
UMLS 2011AA Property
C0595939
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
Was any congenital anomaly evident in the fetus (If Yes, report as an SAE.)
Description

FetusPersonCongenitalAbnormalityAbortionInd-3

Type de données

text

Alias
NCI Thesaurus ObjectClass
C25190
UMLS 2011AA ObjectClass
C0027361
NCI Thesaurus ObjectClass
C13235
UMLS 2011AA ObjectClass
C0015965
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
NCI Thesaurus Property
C35221
UMLS 2011AA Property
C0156543
NCI Thesaurus ValueDomain
C38148
UMLS 2011AA ValueDomain
C1512699
Specify (If yes)
Description

PatientCongenitalAbnormalitySpecify

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25685
UMLS 2011AA ValueDomain
C1521902
NCI Thesaurus ObjectClass
C16960
UMLS 2011AA ObjectClass
C0030705
NCI Thesaurus Property
C2849
UMLS 2011AA Property
C0000768
Comments
Description

Comments

Comments
Description

ResearchCommentsText

Type de données

text

Alias
NCI Thesaurus ValueDomain
C25704
UMLS 2011AA ValueDomain
C1527021
NCI Thesaurus ObjectClass
C15319
NCI Thesaurus Property
C25393
UMLS 2011AA Property
C0282411
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For date fields, if the month and year are known, but the exact date is not, please enter "15" for the day.

1 Formulaires
Name
Type
Description | Question | Decode (Coded Value)
Type de données
Alias
Item Group
Unnamed1
SequentialFormSubmissionCount
Item
Sequence number
double
C19464 (NCI Thesaurus ObjectClass)
C0376315 (UMLS 2011AA ObjectClass)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C49153 (NCI Thesaurus ObjectClass)
C1705294 (UMLS 2011AA ObjectClass)
C25694 (NCI Thesaurus Property)
C1515022 (UMLS 2011AA Property)
Item Group
Pregnancy Status
Item
Pregnancy Status
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C25688 (NCI Thesaurus ValueDomain)
C0449438 (UMLS 2011AA ValueDomain)
CL.1
Code List
Pregnancy Status
CL Item
Pregnancy Ongoing (Pregnancy ongoing)
CL Item
Live Birth (Live birth)
CL Item
Spontaneous Abortion/miscarriage (Spontaneous abortion/miscarriage)
CL Item
Still Birth (Still birth)
CL Item
Elective Abortion (Elective abortion)
CL Item
Unknown (Unknown)
Item Group
Pregnancy Outcome - Live Birth Only
PregnancyDeliveryDate
Item
Delivery Date
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C61560 (NCI Thesaurus Property)
PregnancyWeekNumberCount
Item
Gestational age, Weeks
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C29844 (NCI Thesaurus Property)
C0439230 (UMLS 2011AA Property)
PregnancyDayCount
Item
Gestational age, Days
double
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PersonMeasuredBirthPoundWeightCount
Item
Birth weight, pounds
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C48531 (NCI Thesaurus Property)
C0439219 (UMLS 2011AA Property)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
C44473 (NCI Thesaurus Property)
C0444706 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PersonMeasuredBirthOunceWeightCount
Item
Birth weight, ounces
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25208 (NCI Thesaurus Property)
C0043100 (UMLS 2011AA Property)
C48519 (NCI Thesaurus Property)
C0439218 (UMLS 2011AA Property)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
C44473 (NCI Thesaurus Property)
C0444706 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PersonRecumbentLengthValue
Item
Birth length, Inches
double
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25334 (NCI Thesaurus Property)
C1444754 (UMLS 2011AA Property)
C77532 (NCI Thesaurus Property)
C0444334 (UMLS 2011AA Property)
C25712 (NCI Thesaurus ValueDomain)
C1522609 (UMLS 2011AA ValueDomain)
C25334 (NCI Thesaurus ValueDomain)
C1444754 (UMLS 2011AA ValueDomain)
ApgarScoreOneMinuteNumberValue
Item
One minute Apgar Score
double
C73437 (NCI Thesaurus ObjectClass)
C0003533 (UMLS 2011AA ObjectClass)
C48154 (NCI Thesaurus Property)
C0439232 (UMLS 2011AA Property)
C66832 (NCI Thesaurus Property)
C0205447 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C66833 (NCI Thesaurus ValueDomain)
C0205448 (UMLS 2011AA ValueDomain)
C73791 (NCI Thesaurus ValueDomain)
C0582802 (UMLS 2011AA ValueDomain)
ApgarScoreFiveMinuteNumberValue
Item
Five minute Apgar Score
double
C73437 (NCI Thesaurus ObjectClass)
C0003533 (UMLS 2011AA ObjectClass)
C48154 (NCI Thesaurus Property)
C0439232 (UMLS 2011AA Property)
C66836 (NCI Thesaurus Property)
C0205451 (UMLS 2011AA Property)
C25337 (NCI Thesaurus ValueDomain)
C0237753 (UMLS 2011AA ValueDomain)
C66833 (NCI Thesaurus ValueDomain)
C0205448 (UMLS 2011AA ValueDomain)
C73791 (NCI Thesaurus ValueDomain)
C0582802 (UMLS 2011AA ValueDomain)
DataUnknownText
Item
Unknown
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C25474 (NCI Thesaurus ObjectClass)
C1511726 (UMLS 2011AA ObjectClass)
C17998 (NCI Thesaurus Property)
C0439673 (UMLS 2011AA Property)
Item
Were there any clinical problems with the infant
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C20989 (NCI Thesaurus ObjectClass)
C0031809 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C84749 (NCI Thesaurus Property)
C2827500 (UMLS 2011AA Property)
CL.2
Code List
Were there any clinical problems with the infant
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PregnancyBirthOutcomeText
Item
Specify (If yes)
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C25155 (NCI Thesaurus Property)
C0005615 (UMLS 2011AA Property)
Item
Were there any problems with delivery
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C87091 (NCI Thesaurus Property)
C0269815 (UMLS 2011AA Property)
CL.3
Code List
Were there any problems with delivery
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
NewbornAbnormalityContributingFactorText
Item
Specify (If yes)
text
C16731 (NCI Thesaurus ObjectClass)
C2939425 (UMLS 2011AA ObjectClass)
C9440 (NCI Thesaurus Property)
C1704258 (UMLS 2011AA Property)
C61412 (NCI Thesaurus Property)
C1880177 (UMLS 2011AA Property)
C25506 (NCI Thesaurus Property)
C1521761 (UMLS 2011AA Property)
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
Item
Is there a congenital anomaly (If Yes, report as an SAE.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
CL.4
Code List
Is there a congenital anomaly (If Yes, report as an SAE.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientCongenitalAbnormalitySpecify
Item
Specify (If yes)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
Item
Was neonatal testing performed
text
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C18020 (NCI Thesaurus ObjectClass)
C0430022 (UMLS 2011AA ObjectClass)
C92714 (NCI Thesaurus Property)
CL.5
Code List
Was neonatal testing performed
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
Item
Were there any abnormal test results (If yes)
text
C18020 (NCI Thesaurus ObjectClass)
C0430022 (UMLS 2011AA ObjectClass)
C82547 (NCI Thesaurus ObjectClass)
C2826279 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C92714 (NCI Thesaurus Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.6
Code List
Were there any abnormal test results (If yes)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
TherapeuticProcedurePregnancyAssociatedPerformedAbnormalSpecify
Item
Specify (If yes including dates)
text
C49236 (NCI Thesaurus ObjectClass)
C0087111 (UMLS 2011AA ObjectClass)
C38000 (NCI Thesaurus Property)
C0884358 (UMLS 2011AA Property)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
C25281 (NCI Thesaurus Property)
C0332281 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C25401 (NCI Thesaurus ValueDomain)
C0205161 (UMLS 2011AA ValueDomain)
Item Group
Pregnancy Outcome - Spontaneous Abortion, Still Birth, Or Elective Abortion Only
PersonPregnancyOutcomeDate
Item
Date (mm/dd/yyyy)
date
C25164 (NCI Thesaurus ValueDomain)
C0011008 (UMLS 2011AA ValueDomain)
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C20200 (NCI Thesaurus Property)
C1274040 (UMLS 2011AA Property)
C25742 (NCI Thesaurus Property)
C0032961 (UMLS 2011AA Property)
PregnancyWeekNumberCount
Item
Gestational age, Weeks
double
C25337 (NCI Thesaurus Property)
C0237753 (UMLS 2011AA Property)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C29844 (NCI Thesaurus Property)
C0439230 (UMLS 2011AA Property)
PregnancyDayCount
Item
Gestational age, Days
double
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C25301 (NCI Thesaurus Property)
C0439228 (UMLS 2011AA Property)
C25275 (NCI Thesaurus Property)
C2745955 (UMLS 2011AA Property)
C25301 (NCI Thesaurus ValueDomain)
C0439228 (UMLS 2011AA ValueDomain)
C25463 (NCI Thesaurus ValueDomain)
C0750480 (UMLS 2011AA ValueDomain)
PregnancyPersonSpontaneousAbortionStillbirthPresentSpecify
Item
If spontaneous abortion or still birth, specify circumstances
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C25742 (NCI Thesaurus ObjectClass)
C0032961 (UMLS 2011AA ObjectClass)
C25626 (NCI Thesaurus Property)
C0150312 (UMLS 2011AA Property)
C34336 (NCI Thesaurus Property)
C0000786 (UMLS 2011AA Property)
C49151 (NCI Thesaurus Property)
C0595939 (UMLS 2011AA Property)
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
Item
Was any congenital anomaly evident in the fetus (If Yes, report as an SAE.)
text
C25190 (NCI Thesaurus ObjectClass)
C0027361 (UMLS 2011AA ObjectClass)
C13235 (NCI Thesaurus ObjectClass)
C0015965 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
C35221 (NCI Thesaurus Property)
C0156543 (UMLS 2011AA Property)
C38148 (NCI Thesaurus ValueDomain)
C1512699 (UMLS 2011AA ValueDomain)
CL.7
Code List
Was any congenital anomaly evident in the fetus (If Yes, report as an SAE.)
CL Item
Yes (Yes)
C49488 (NCI Thesaurus)
C1705108 (UMLS 2011AA)
CL Item
No (No)
C49487 (NCI Thesaurus)
C1298908 (UMLS 2011AA)
CL Item
Unknown (Unknown)
C17998 (NCI Thesaurus)
C0439673 (UMLS 2011AA)
PatientCongenitalAbnormalitySpecify
Item
Specify (If yes)
text
C25685 (NCI Thesaurus ValueDomain)
C1521902 (UMLS 2011AA ValueDomain)
C16960 (NCI Thesaurus ObjectClass)
C0030705 (UMLS 2011AA ObjectClass)
C2849 (NCI Thesaurus Property)
C0000768 (UMLS 2011AA Property)
Item Group
Comments
ResearchCommentsText
Item
Comments
text
C25704 (NCI Thesaurus ValueDomain)
C1527021 (UMLS 2011AA ValueDomain)
C15319 (NCI Thesaurus ObjectClass)
C25393 (NCI Thesaurus Property)
C0282411 (UMLS 2011AA Property)
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