Study Site; Numbers
Item
Site number
text
C2825164 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Person Initials
Item
Patient's initials
text
C2986440 (UMLS CUI [1])
Clinical Trial Subject Unique Identifier
Item
Patient's trial number
text
C2348585 (UMLS CUI [1])
Menarche; Visit; Last; Since
Item
Has this patient become menarcheal since the last clinic visit?
boolean
C0025274 (UMLS CUI [1,1])
C0545082 (UMLS CUI [1,2])
C1517741 (UMLS CUI [1,3])
C1711239 (UMLS CUI [1,4])
Menarche | Pregnancy | Serum pregnancy test negative | Breast Feeding
Item
If patient become menarcheal since the last clinic visit, is this patient not currently pregnant (the result of a serum pregnancy test conducted at this visit is negative) or breastfeeding?
boolean
C0025274 (UMLS CUI [1])
C0032961 (UMLS CUI [2])
C0430061 (UMLS CUI [3])
C0006147 (UMLS CUI [4])
Contraceptive methods; Pharmaceutical Preparations | Contraceptive methods; Devices | Contraceptive methods; Abstinence
Item
Does this patient employ a contraceptive method (whether a drug, device or abstinence) acceptable to the investigator?
boolean
C0700589 (UMLS CUI [1,1])
C0013227 (UMLS CUI [1,2])
C0700589 (UMLS CUI [2,1])
C0699733 (UMLS CUI [2,2])
C0700589 (UMLS CUI [3,1])
C3843422 (UMLS CUI [3,2])
Statement; Signature; Pregnancy; avoidance
Item
Has this patient either signed or have had signed by a parent or guardian on their behalf, a statement of intent to avoid pregnancy?
boolean
C1710187 (UMLS CUI [1,1])
C1519316 (UMLS CUI [1,2])
C0032961 (UMLS CUI [1,3])
C0870186 (UMLS CUI [1,4])
Physical Examination Date
Item
Date of Examination (Vital Signs/ Weight, Physical Examination)
date
C2826643 (UMLS CUI [1])
Blood Pressure
Item
Blood pressure (systolic/ diastolic)
text
C0005823 (UMLS CUI [1])
Pulse Rate
Item
Pulse rate
integer
C0232117 (UMLS CUI [1])
Body Weight
Item
Weight
float
C0005910 (UMLS CUI [1])
Body Height; Length
Item
Hieght or lenght (if applicable)
float
C0005890 (UMLS CUI [1])
C1444754 (UMLS CUI [2])
Item
Method of collection
integer
C1516698 (UMLS CUI [1,1])
C2911685 (UMLS CUI [1,2])
Code List
Method of collection
Changing; Clinical Significance
Item
Are there any clinically significant changes from the Baseline Phase (Study Week 8) information? If Yes, list changes below.
boolean
C0392747 (UMLS CUI [1,1])
C2826293 (UMLS CUI [1,2])
Item
Body region/ system
integer
C0460002 (UMLS CUI [1])
Code List
Body region/ system
CL Item
Ears, nose, throat (2)
CL Item
Cardiovascular (3)
CL Item
Musculoskeletal (9)
CL Item
Other, specify (10)
body system; Other; Specification
Item
If other body region/ system, specify
text
C0460002 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Briefly specify change
integer
C0392747 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Code List
Briefly specify change
CL Item
Not examinated (3)
Neurologic Examination; Date in time
Item
Date of examination
date
C0027853 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Exam- either normal OR abnormalities present
integer
C1112287 (UMLS CUI [1])
C0437208 (UMLS CUI [2])
Code List
Exam- either normal OR abnormalities present
CL Item
Abnormalities present (2)
Item
Mental status abnormalities
integer
C1704258 (UMLS CUI [1,1])
C0278060 (UMLS CUI [1,2])
Code List
Mental status abnormalities
CL Item
Decreased attention (e.g. decreased consentration, poor/ short attention span) (1)
CL Item
Psychomotor slowing or retardation (developmental delay) (2)
CL Item
Somnolence (e.g. sedation, drowsiness, lethargy, sleepiness) (3)
CL Item
Depressed affect (4)
CL Item
Inapropriate affect (5)
CL Item
Hyperactivity (6)
CL Item
Behavioral discontrol (7)
CL Item
Other, specify (8)
Abnormality; Mental state; Other; Specification
Item
If other abnormal mental status, specify.
text
C1704258 (UMLS CUI [1,1])
C0278060 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item
Check if mental status changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0278060 (UMLS CUI [1,2])
Code List
Check if mental status changed or appeared.
Item
Intensity of abnormality (mental status)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0278060 (UMLS CUI [2])
Code List
Intensity of abnormality (mental status)
CL Item
NA, abnormality has resolved (4)
Item
Speech/ language abnormalities
integer
C0037822 (UMLS CUI [1])
C0023008 (UMLS CUI [2,1])
C1704258 (UMLS CUI [2,2])
Code List
Speech/ language abnormalities
CL Item
Dysphasia or aphasia (2)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0037817 (UMLS CUI [1,2])
C1704258 (UMLS CUI [2,1])
C0023008 (UMLS CUI [2,2])
Code List
Check if abnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (speech/ language)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0037817 (UMLS CUI [1,3])
C1704258 (UMLS CUI [2,1])
C0439793 (UMLS CUI [2,2])
C0023008 (UMLS CUI [2,3])
Code List
Intensity of abnormality (speech/ language)
CL Item
NA, abnormality has resolved (4)
Item
Cranial nerves abnormalities
integer
C0010268 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Cranial nerves abnormalities
CL Item
Nystagmus on lateral gaze (horizontal) (1)
CL Item
Other, specify (2)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0010268 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (cranial nerves)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0010268 (UMLS CUI [1,3])
Code List
Intensity of abnormality (cranial nerves)
CL Item
NA, abnormality has resolved (4)
Abnormality; Cranial Nerves; Other; Specification
Item
If other abnormality of cranial nerves, specify.
text
C1704258 (UMLS CUI [1,1])
C0010268 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item
Gait abnormalities
integer
C0016928 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Gait abnormalities
CL Item
Hemiplegic gait (2)
CL Item
Spasticity, bilateral (3)
CL Item
Other gait disturbance (4)
Item
Check ifabnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0016928 (UMLS CUI [1,2])
Code List
Check ifabnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (gait)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0016928 (UMLS CUI [1,3])
Code List
Intensity of abnormality (gait)
CL Item
NA, abnormality has resolved (4)
Item
Coordination abnormalities
integer
C0242414 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Coordination abnormalities
CL Item
Resting tremor (1)
CL Item
Intention tremor (2)
CL Item
Postural tremor (3)
CL Item
Dysdiadochokinesia (on rapid alt. movements) (4)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0242414 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (coordination)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0242414 (UMLS CUI [1,3])
Code List
Intensity of abnormality (coordination)
CL Item
NA, abnormality has resolved (4)
Item
Sensation abnormalities
integer
C0036658 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Sensation abnormalities
CL Item
Romberg positive (5)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0036658 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (sensation)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0036658 (UMLS CUI [1,3])
Code List
Intensity of abnormality (sensation)
CL Item
NA, abnormality has resolved (4)
Item
Muscle strength abnormalities
integer
C0517349 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Muscle strength abnormalities
CL Item
Decreased muscle strength (1)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0517349 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
abnormality changed or appeared (1)
Item
Intensity of abnormality (muscle strength)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0517349 (UMLS CUI [1,3])
Code List
Intensity of abnormality (muscle strength)
CL Item
NA, abnormality has resolved (4)
Item
Muscle tone abnormalities
integer
C0026841 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Muscle tone abnormalities
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0026841 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
Abnormality changed or appeared (1)
Item
Intensity of abnormality (muscle tone)
integer
C1704258 (UMLS CUI [1,1])
C0439793 (UMLS CUI [1,2])
C0026841 (UMLS CUI [1,3])
Code List
Intensity of abnormality (muscle tone)
CL Item
NA, abnormality has resolved (4)
Item
Reflexes abnormalities
integer
C0034929 (UMLS CUI [1,1])
C1704258 (UMLS CUI [1,2])
Code List
Reflexes abnormalities
CL Item
Brachioradialis left (3)
CL Item
Brachioradialis right (4)
CL Item
Plantar response left (9)
CL Item
Plantar response right (10)
Item
Check if abnormality changed or appeared.
integer
C1704258 (UMLS CUI [1,1])
C0034929 (UMLS CUI [1,2])
Code List
Check if abnormality changed or appeared.
CL Item
Abnormality changed or appeared (1)
Item
Type of abnormality (reflexes)
integer
C1704258 (UMLS CUI [1,1])
C0332307 (UMLS CUI [1,2])
C0034929 (UMLS CUI [1,3])
Code List
Type of abnormality (reflexes)
CL Item
NA, abnormality has resolved (5)