Patient ID; Centre Number
Item
Patient ID, Centre No.
text
C1269815 (UMLS CUI [1,1])
C2825181 (UMLS CUI [1,2])
C1300638 (UMLS CUI [1,3])
Patient ID; Envelope Number
Item
Patient ID, Envelope No.
text
C1269815 (UMLS CUI [1,1])
C2348585 (UMLS CUI [1,2])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Successful contact made
Item
Has successful contact been made?
boolean
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0597535 (UMLS CUI [1,3])
Successful contact made; date
Item
Date of this contact
date
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
date form completed
Item
Date this form completed
date
C0332158 (UMLS CUI [1,1])
C0681850 (UMLS CUI [1,2])
C1115437 (UMLS CUI [1,3])
Item
Who made this contact?
text
C0337611 (UMLS CUI [1,1])
C1272683 (UMLS CUI [1,2])
Code List
Who made this contact?
CL Item
Investigator/Co-Investigator (Investigator/Co-Investigator)
CL Item
Study Nurse (Study Nurse)
CL Item
Other qualified professional (specify) (Other qualified professional (specify))
Item
How were follow-up data obtained?
text
C1522577 (UMLS CUI [1,1])
C0025663 (UMLS CUI [1,2])
Code List
How were follow-up data obtained?
CL Item
late office visit (late office visit)
CL Item
home visit (home visit)
CL Item
written communication (written communication)
CL Item
patient in hospital (patient in hospital)
CL Item
telephone communication (telephone communication)
CL Item
other (specify) (other (specify))
Item
Who was contacted?
text
C0337611 (UMLS CUI [1])
Code List
Who was contacted?
CL Item
patient (patient)
CL Item
patient’s relative (relationship) (patient’s relative (relationship))
CL Item
patient’s physician (patient’s physician)
CL Item
other (please specify) (other (please specify))
Item
Did patient experience death since last seen and before 35 days after randomization?
text
C0011065 (UMLS CUI [1])
Code List
Did patient experience death since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience myocardial (re)infarction since last seen and before 35 days after randomization?
text
C0027051 (UMLS CUI [1])
C0948369 (UMLS CUI [2])
Code List
Did patient experience myocardial (re)infarction since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience a stroke since last seen and before 35 days after randomization?
text
C0038454 (UMLS CUI [1])
Code List
Did patient experience a stroke since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience a PCI/stent since last seen and before 35 days after randomization?
text
C1532338 (UMLS CUI [1,1])
C0038257 (UMLS CUI [1,2])
Code List
Did patient experience a PCI/stent since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience CABG since last seen and before 35 days after randomization?
text
C0010055 (UMLS CUI [1])
Code List
Did patient experience CABG since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Item
Did patient experience bleeding since last seen and before 35 days after randomization?
text
C0019080 (UMLS CUI [1])
Code List
Did patient experience bleeding since last seen and before 35 days after randomization?
CL Item
Unknown (Unknown)
CL Item
Yes (give date) (Yes (give date))
Comments
Item
Additional Comments
text
C0947611 (UMLS CUI [1])
