Administrative data
Study Name
text
Site
Subject
Visit Name
DCI Name/Shortname
Status
Doc#
integer
Visit #
float
Demography
Subject ID Number
Age
Date of Birth
date
Weight (kilogram)
Weight (pounds)
Height (centimeters)
Height (inches)
Race
Child Information
Baby Number
Sex
Weight (kilograms)
Apgar score 1 min
Apgar score 5 min
Outcome of pregnancy
If Spontaneous or Elective abortion, record the date
if Abnormal baby, congenital abnormality, stillborn, died at birth
Date of congenital abnormality identified/diagnosed
Pregnancy Outcome Information
Baby number
Date of delivery
Length of gestation (weeks)
select one
include live and stillbirth; if none, enter a zero
Comments
Important Note
If pregnancy outcome is serious (spontaneous abortion, congenital abnormality, stillbirth, prolonged hospitalization, etc.) please submit the SAE report.