Engelsk

30-Day Followup (+/- 14 Days)

1 Formulär  
Administrative Data
Beskrivning

Administrative Data

Alias
UMLS CUI-1
C1320722
Site #
Beskrivning

Study centre number

Datatyp

integer

Alias
UMLS CUI [1,1]
C0600091
UMLS CUI [1,2]
C0019994
Patient #
Beskrivning

patient ID

Datatyp

integer

Alias
UMLS CUI [1]
C2348585
Visit Date
Beskrivning

visit date

Datatyp

date

Alias
UMLS CUI [1]
C1320303
Investigator Name
Beskrivning

Investigator Name

Datatyp

text

Alias
UMLS CUI [1]
C2826892
Followup Visit
Beskrivning

Followup Visit

Alias
UMLS CUI-1
C0589121
Was telephone contact substituted for visit?
Beskrivning

Telephone call replacing visit

Datatyp

text

Alias
UMLS CUI [1,1]
C0302186
UMLS CUI [1,2]
C0559956
UMLS CUI [1,3]
C0545082
Date of follow-up:
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1]
C3694716
Time:
Beskrivning

(0000-2359)

Datatyp

time

Alias
UMLS CUI [1,1]
C0589121
UMLS CUI [1,2]
C0040223
Vital Signs
Beskrivning

Vital Signs

Alias
UMLS CUI-1
C0518766
Blood Pressure: Systolic:
Beskrivning

Blood pressure - systolic

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Blood Pressure: Diastolic:
Beskrivning

Blood pressure - diastolic

Datatyp

integer

Måttenheter
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Respiration:
Beskrivning

Respiratory rate

Datatyp

integer

Måttenheter
  • per min.
Alias
UMLS CUI [1]
C0231832
per min.
Heart Rate:
Beskrivning

Heart rate

Datatyp

text

Måttenheter
  • bpm
Alias
UMLS CUI [1]
C0018810
bpm
Temperature:
Beskrivning

Body temperature

Datatyp

float

Alias
UMLS CUI [1]
C0005903
Temperature: Unit:
Beskrivning

Body temperature unit

Datatyp

text

Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C1519795
Physical Examination
Beskrivning

Physical Examination

Alias
UMLS CUI-1
C0031809
System Code
Beskrivning

Body system examined

Datatyp

integer

Alias
UMLS CUI [1,1]
C0460002
UMLS CUI [1,2]
C0031809
Description of Change
Beskrivning

(one per line)

Datatyp

text

Alias
UMLS CUI [1,1]
C0031809
UMLS CUI [1,2]
C0678257
UMLS CUI [1,3]
C0443172
No Change
Beskrivning

No change in physical examination

Datatyp

boolean

Alias
UMLS CUI [1,1]
C0442739
UMLS CUI [1,2]
C0031809
Please mark all events that occurred during dosing:
Beskrivning

Please mark all events that occurred during dosing:

Alias
UMLS CUI-1
C2347784
(or None: please check this box)
Beskrivning

If None, check this Box and leave the following fields blank.

Datatyp

boolean

Alias
UMLS CUI [1,1]
C2347784
UMLS CUI [1,2]
C0549184
Venous thrombosis
Beskrivning

Venous thrombosis

Datatyp

text

Alias
UMLS CUI [1]
C0042487
Venous thrombosis - specify location:
Beskrivning

Venous thrombosis - location

Datatyp

text

Alias
UMLS CUI [1,1]
C0042487
UMLS CUI [1,2]
C0450429
Venous thrombosis - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C0042487
UMLS CUI [1,2]
C0011008
Pulmonary embolus
Beskrivning

Pulmonary embolus

Datatyp

text

Alias
UMLS CUI [1]
C0034065
Pulmonary embolus - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C0034065
UMLS CUI [1,2]
C0011008
Arterial thrombosis
Beskrivning

Arterial thrombosis

Datatyp

text

Alias
UMLS CUI [1]
C0151942
Arterial thrombosis - specify location:
Beskrivning

Arterial thrombosis - location

Datatyp

text

Alias
UMLS CUI [1,1]
C0151942
UMLS CUI [1,2]
C0450429
Arterial thrombosis - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C0151942
UMLS CUI [1,2]
C0011008
Clotting in any external circuit that requires immediate therapeutic intervention
Beskrivning

Clotting in external circuit that requires immediate intervention

Datatyp

text

Alias
UMLS CUI [1]
C0949072
UMLS CUI [2,1]
C1708545
UMLS CUI [2,2]
C0205253
Clotting in any external circuit that requires immediate therapeutic intervention - specify circuit location:
Beskrivning

Clotting in external circuit that requires immediate intervention - specify circuit location

Datatyp

text

Alias
UMLS CUI [1]
C0949072
UMLS CUI [2,1]
C1708545
UMLS CUI [2,2]
C0205253
UMLS CUI [3,1]
C2348235
UMLS CUI [3,2]
C0015354
Clotting in any external circuit that requires immediate therapeutic intervention - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1]
C0949072
UMLS CUI [2,1]
C1708545
UMLS CUI [2,2]
C0205253
UMLS CUI [3]
C0011008
Death due to thromboembolic complication
Beskrivning

Death due to thromboembolic complication

Datatyp

text

Alias
UMLS CUI [1,1]
C1705232
UMLS CUI [1,2]
C0040038
UMLS CUI [1,3]
C0009566
Death due to thromboembolic complication - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C1705232
UMLS CUI [1,2]
C0040038
UMLS CUI [1,3]
C0009566
UMLS CUI [1,4]
C1148348
Amputation due to thromboembolic complication
Beskrivning

Amputation due to thromboembolic complication

Datatyp

text

Alias
UMLS CUI [1,1]
C0002688
UMLS CUI [1,2]
C0040038
UMLS CUI [1,3]
C0009566
Amputation due to thromboembolic complication - Date
Beskrivning

(dd-mmm-yyyy)

Datatyp

date

Alias
UMLS CUI [1,1]
C0002688
UMLS CUI [1,2]
C0040038
UMLS CUI [1,3]
C0009566
UMLS CUI [1,4]
C0011008
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Similar models

30-Day Followup (+/- 14 Days)

1 Formulär
Name
Typ
Description | Question | Decode (Coded Value)
Datatyp
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Study centre number
Item
Site #
integer
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
patient ID
Item
Patient #
integer
C2348585 (UMLS CUI [1])
visit date
Item
Visit Date
date
C1320303 (UMLS CUI [1])
Investigator Name
Item
Investigator Name
text
C2826892 (UMLS CUI [1])
Item Group
Followup Visit
C0589121 (UMLS CUI-1)
Item
Was telephone contact substituted for visit?
text
C0302186 (UMLS CUI [1,1])
C0559956 (UMLS CUI [1,2])
C0545082 (UMLS CUI [1,3])
Telephone call replacing visit
Code List
Was telephone contact substituted for visit?
CL Item
Yes (Yes)
CL Item
No (No)
Follow-up visit date
Item
Date of follow-up:
date
C3694716 (UMLS CUI [1])
Follow-up visit time
Item
Time:
time
C0589121 (UMLS CUI [1,1])
C0040223 (UMLS CUI [1,2])
Item Group
Vital Signs
C0518766 (UMLS CUI-1)
Blood pressure - systolic
Item
Blood Pressure: Systolic:
integer
C0871470 (UMLS CUI [1])
Blood pressure - diastolic
Item
Blood Pressure: Diastolic:
integer
C0428883 (UMLS CUI [1])
Respiratory rate
Item
Respiration:
integer
C0231832 (UMLS CUI [1])
Heart rate
Item
Heart Rate:
text
C0018810 (UMLS CUI [1])
Body temperature
Item
Temperature:
float
C0005903 (UMLS CUI [1])
Item
Temperature: Unit:
text
C0005903 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Body temperature unit
Code List
Temperature: Unit:
CL Item
°F (°F)
CL Item
°C (°C)
Item Group
Physical Examination
C0031809 (UMLS CUI-1)
Item
System Code
integer
C0460002 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Body system examined
Code List
System Code
CL Item
General Appearance (1)
CL Item
Skin (2)
CL Item
Head and Neck  (3)
CL Item
Lymph Nodes (4)
CL Item
Breasts  (5)
CL Item
Heart  (6)
CL Item
Lungs  (7)
CL Item
Abdomen  (8)
CL Item
Genitalia  (9)
CL Item
Extremities  (10)
CL Item
Neurologic (11)
CL Item
Rectal (12)
CL Item
Other, specify (13)
Description of change in physical examination
Item
Description of Change
text
C0031809 (UMLS CUI [1,1])
C0678257 (UMLS CUI [1,2])
C0443172 (UMLS CUI [1,3])
No change in physical examination
Item
No Change
boolean
C0442739 (UMLS CUI [1,1])
C0031809 (UMLS CUI [1,2])
Item Group
Please mark all events that occurred during dosing:
C2347784 (UMLS CUI-1)
No clinical endpoints met
Item
(or None: please check this box)
boolean
C2347784 (UMLS CUI [1,1])
C0549184 (UMLS CUI [1,2])
Item
Venous thrombosis
text
C0042487 (UMLS CUI [1])
Telephone call replacing visit
Code List
Venous thrombosis
CL Item
Yes (Yes)
CL Item
No (No)
Venous thrombosis - location
Item
Venous thrombosis - specify location:
text
C0042487 (UMLS CUI [1,1])
C0450429 (UMLS CUI [1,2])
Venous thrombosis - date
Item
Venous thrombosis - Date
date
C0042487 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Pulmonary embolus
text
C0034065 (UMLS CUI [1])
Telephone call replacing visit
Code List
Pulmonary embolus
CL Item
Yes (Yes)
CL Item
No (No)
Pulmonary embolus - date
Item
Pulmonary embolus - Date
date
C0034065 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Arterial thrombosis
text
C0151942 (UMLS CUI [1])
Telephone call replacing visit
Code List
Arterial thrombosis
CL Item
Yes (Yes)
CL Item
No (No)
Arterial thrombosis - location
Item
Arterial thrombosis - specify location:
text
C0151942 (UMLS CUI [1,1])
C0450429 (UMLS CUI [1,2])
Arterial thrombosis - date
Item
Arterial thrombosis - Date
date
C0151942 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item
Clotting in any external circuit that requires immediate therapeutic intervention
text
C0949072 (UMLS CUI [1])
C1708545 (UMLS CUI [2,1])
C0205253 (UMLS CUI [2,2])
Telephone call replacing visit
Code List
Clotting in any external circuit that requires immediate therapeutic intervention
CL Item
Yes (Yes)
CL Item
No (No)
Clotting in external circuit that requires immediate intervention - specify circuit location
Item
Clotting in any external circuit that requires immediate therapeutic intervention - specify circuit location:
text
C0949072 (UMLS CUI [1])
C1708545 (UMLS CUI [2,1])
C0205253 (UMLS CUI [2,2])
C2348235 (UMLS CUI [3,1])
C0015354 (UMLS CUI [3,2])
Clotting in external circuit that requires immediate intervention - date
Item
Clotting in any external circuit that requires immediate therapeutic intervention - Date
date
C0949072 (UMLS CUI [1])
C1708545 (UMLS CUI [2,1])
C0205253 (UMLS CUI [2,2])
C0011008 (UMLS CUI [3])
Item
Death due to thromboembolic complication
text
C1705232 (UMLS CUI [1,1])
C0040038 (UMLS CUI [1,2])
C0009566 (UMLS CUI [1,3])
Telephone call replacing visit
Code List
Death due to thromboembolic complication
CL Item
Yes (Yes)
CL Item
No (No)
Death due to thromboembolic complication - date
Item
Death due to thromboembolic complication - Date
date
C1705232 (UMLS CUI [1,1])
C0040038 (UMLS CUI [1,2])
C0009566 (UMLS CUI [1,3])
C1148348 (UMLS CUI [1,4])
Item
Amputation due to thromboembolic complication
text
C0002688 (UMLS CUI [1,1])
C0040038 (UMLS CUI [1,2])
C0009566 (UMLS CUI [1,3])
Telephone call replacing visit
Code List
Amputation due to thromboembolic complication
CL Item
Yes (Yes)
CL Item
No (No)
Amputation due to thromboembolic complication - date
Item
Amputation due to thromboembolic complication - Date
date
C0002688 (UMLS CUI [1,1])
C0040038 (UMLS CUI [1,2])
C0009566 (UMLS CUI [1,3])
C0011008 (UMLS CUI [1,4])
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