Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative
C1320722 (UMLS CUI-1)
Centre Number
Item
Centre Number
text
C0600091 (UMLS CUI [1,1])
C0019994 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
text
C2348585 (UMLS CUI [1])
Item Group
(Glomerulo)Nephritis
C0017658 (UMLS CUI-1)
Item
(Glomerulo)Nephritis - Diagnosis
integer
C0017658 (UMLS CUI [1,1])
C0011900 (UMLS CUI [1,2])
Code List
(Glomerulo)Nephritis - Diagnosis
CL Item
Idiopathic Glomerulonephritis (1)
CL Item
IgA nephropathy (2)
CL Item
Goodpasture syndrome (3)
CL Item
Glomerulonephritis secondary to systemic diseases (systemic lupus erythematosus, rheumatoid arthritis, vasculitis, Wegener’s disease, periarteritis nodosa, Goodpasture syndrome, Henoch-Schonlein purpura, diabetes mellitus…) (4)
CL Item
Glomerulonephritis secondary to infection (Strepto., Staphylo, viral…) (5)
CL Item
Other, specify (6)
(Glomerulo)Nephritis - Specify other diagnosis
Item
(Glomerulo)Nephritis - Specify other diagnosis
text
C0017658 (UMLS CUI [1])
C0011900 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Please specify related adverse event: SAE Case No.
Item
Please specify related adverse event: SAE Case No.
integer
C1519255 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Please specify related adverse event: AE No.
Item
Please specify related adverse event: AE No.
integer
C1518404 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Date of final diagnosis:
Item
Date of final diagnosis:
date
C2316983 (UMLS CUI [1,1])
C1546485 (UMLS CUI [1,2])
Item Group
(Glomerulo)Nephritis - Signs and Symptoms
C0017658 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
Item
(Glomerulo)Nephritis - Signs and Symptoms
integer
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
Code List
(Glomerulo)Nephritis - Signs and Symptoms
CL Item
Flank tenderness (1)
CL Item
Bladder tenderness (3)
CL Item
Miction urgency (7)
CL Item
Hypertension (10)
CL Item
Increased prostate (12)
CL Item
Respiratory tract infection (15)
Item
(Glomerulo)Nephritis - Signs and Symptoms present
text
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0150312 (UMLS CUI [2,2])
Code List
(Glomerulo)Nephritis - Signs and Symptoms present
CL Item
Not Applicable (NA)
(Glomerulo)Nephritis - Signs and Symptoms start date
Item
(Glomerulo)Nephritis - Signs and Symptoms start date
date
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0808070 (UMLS CUI [2,2])
(Glomerulo)Nephritis - Signs and Symptoms end date
Item
(Glomerulo)Nephritis - Signs and Symptoms end date
date
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0806020 (UMLS CUI [2,2])
Item
(Glomerulo)Nephritis - Signs and Symptoms continuing at end of study
integer
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
Code List
(Glomerulo)Nephritis - Signs and Symptoms continuing at end of study
CL Item
Continuing at end of study (1)
Item Group
(Glomerulo)Nephritis - Other signs and symptoms
C0017658 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
Item
If any other signs and symptoms, please tick the box and complete below
integer
C0037088 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Code List
If any other signs and symptoms, please tick the box and complete below
CL Item
Other signs and symptoms (1)
Item Group
(Glomerulo)Nephritis - Other signs and symptoms
C0017658 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
(Glomerulo)Nephritis - Other signs and symptoms
Item
(Glomerulo)Nephritis - Other signs and symptoms
text
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
(Glomerulo)Nephritis - Other signs and symptoms start date
Item
(Glomerulo)Nephritis - Other signs and symptoms start date
date
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0808070 (UMLS CUI [3])
(Glomerulo)Nephritis - Other signs and symptoms end date
Item
(Glomerulo)Nephritis - Other signs and symptoms end date
date
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0806020 (UMLS CUI [3])
Item
(Glomerulo)Nephritis - Other signs and symptoms continuing at end of study
integer
C0017658 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
Code List
(Glomerulo)Nephritis - Other signs and symptoms continuing at end of study
CL Item
Continuing at end of study (1)
Item Group
(Glomerulo)Nephritis - Diagnostic Test Results
C0017658 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
Item
(Glomerulo)Nephritis - Test
integer
C0017658 (UMLS CUI [1])
C2826273 (UMLS CUI [2])
Code List
(Glomerulo)Nephritis - Test
CL Item
White Blood Cells (1)
CL Item
Red blood cells (7)
CL Item
Erythrocyte Sedimentation Rate (ESR) (9)
CL Item
Serum C-reactive protein (CRP) (10)
CL Item
Serum urea nitrogen (11)
CL Item
Serum creatinine (12)
CL Item
Serum electrolytes (13)
CL Item
Serum albumin (14)
CL Item
Serum lipids (15)
CL Item
LMW proteinuria (17)
CL Item
Urine sediment (20)
CL Item
Anti-Glomerular Basement (22)
CL Item
Membrane antibodies (anti-GBM) (23)
CL Item
Anti-neutrophil cytoplasmic autoantibodies (ANCAs) (24)
CL Item
Anti-nuclear antibodies (ANA) (25)
CL Item
Serum C3 complement (27)
CL Item
Antistreptolysin ADNase (28)
Item
(Glomerulo)Nephritis - Test done
text
C0017658 (UMLS CUI [1])
C0022885 (UMLS CUI [2,1])
C1272695 (UMLS CUI [2,2])
Code List
(Glomerulo)Nephritis - Test done
CL Item
Not Applicable (NA)
(Glomerulo)Nephritis - Test date
Item
(Glomerulo)Nephritis - Test date
date
C0017658 (UMLS CUI [1])
C2826247 (UMLS CUI [2])
(Glomerulo)Nephritis - Test Result
Item
(Glomerulo)Nephritis - Test Result
float
C0017658 (UMLS CUI [1])
C0587081 (UMLS CUI [2])
(Glomerulo)Nephritis - Test Units
Item
(Glomerulo)Nephritis - Test Units
text
C0017658 (UMLS CUI [1])
C1519795 (UMLS CUI [2])
(Glomerulo)Nephritis - Low Norm
Item
(Glomerulo)Nephritis - Low Norm
float
C0017658 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
(Glomerulo)Nephritis - High Norm
Item
(Glomerulo)Nephritis - High Norm
float
C0017658 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
(Glomerulo)Nephritis - Other Diagnostic Test Results
C0017658 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Item
If any other diagnostic test results are available, please tick the box and complete below
integer
C0456984 (UMLS CUI [1,1])
C0430022 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Code List
If any other diagnostic test results are available, please tick the box and complete below
CL Item
Other diagnostic test results available (1)
Item Group
(Glomerulo)Nephritis - Other Diagnostic Test Results
C0017658 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
(Glomerulo)Nephritis - Test
Item
(Glomerulo)Nephritis - Test
text
C0017658 (UMLS CUI [1])
C2826273 (UMLS CUI [2])
Idiopathic Thrombocytopenic Purpura - Test date
Item
(Glomerulo)Nephritis - Test date
date
C0017658 (UMLS CUI [1])
C2826247 (UMLS CUI [2])
(Glomerulo)Nephritis - Test Result
Item
(Glomerulo)Nephritis - Test Result
float
C0017658 (UMLS CUI [1])
C0587081 (UMLS CUI [2])
(Glomerulo)Nephritis - Test Units
Item
(Glomerulo)Nephritis - Test Units
text
C0017658 (UMLS CUI [1])
C1519795 (UMLS CUI [2])
(Glomerulo)Nephritis - Low Norm
Item
(Glomerulo)Nephritis - Low Norm
float
C0017658 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
(Glomerulo)Nephritis - High Norm
Item
(Glomerulo)Nephritis - High Norm
float
C0017658 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
(Glomerulo)Nephritis - Other diagnostic Procedure
C0017658 (UMLS CUI-1)
C0430022 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
Describe any other diagnostic procedure supporting the diagnosis
Item
Describe any other diagnostic procedure supporting the diagnosis (Pyelography, Kidney ultra-sound, Kidney tomography, Kidney biopsy)
text
C0430022 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0011900 (UMLS CUI [2])
C0034185 (UMLS CUI [3])
C1456803 (UMLS CUI [4,1])
C0022646 (UMLS CUI [4,2])
C0040405 (UMLS CUI [5,1])
C0022646 (UMLS CUI [5,2])
C0005558 (UMLS CUI [6,1])
C0022646 (UMLS CUI [6,2])
Item Group
Inflammatory skin diseases
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
Item
Inflammatory skin diseases diagnosis
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0011900 (UMLS CUI [2])
Code List
Inflammatory skin diseases diagnosis
CL Item
Bullous pemphigoid (2)
CL Item
Dermatitis herpetiformis (3)
CL Item
Stevens-Johnson syndrome (4)
CL Item
Raynaud's phenomenon secondary to autoimmune disease (7)
CL Item
Raynaud’s phenomenon secondary to other disorders (vibratory injury, infection, neoplasm, hematologic, metabolic, drugs, carpal tunnel syndrome, … ) (8)
CL Item
Raynaud disease (vasospasm alone) (9)
CL Item
Erythema nodosum (10)
CL Item
Other, specify (11)
Inflammatory skin diseases - Specify other diagnosis
Item
Inflammatory skin diseases - Specify other diagnosis
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0011900 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Please specify related adverse event: SAE Case No.
Item
Please specify related adverse event: SAE Case No.
integer
C1519255 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Please specify related adverse event: AE No.
Item
Please specify related adverse event: AE No.
integer
C1518404 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Date of final diagnosis:
Item
Date of final diagnosis:
date
C2316983 (UMLS CUI [1,1])
C1546485 (UMLS CUI [1,2])
Item Group
Inflammatory skin diseases - Signs and symptoms
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0037088 (UMLS CUI-3)
C1546485 (UMLS CUI-4)
Item
Inflammatory skin diseases - Signs and symptoms
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
Code List
Inflammatory skin diseases - Signs and symptoms
CL Item
Skin discoloration (1)
CL Item
Bullous lesions (5)
CL Item
Cutaneous pain (11)
CL Item
Mucous membrane lesions - Oral cavity lesions (12)
CL Item
Mucous membrane lesions - Conjunctive lesions (13)
CL Item
Mucous membrane lesions - Esophagous lesions (14)
CL Item
Mucous membrane lesions - Labial lesions (15)
CL Item
Mucous membrane lesions - Vaginal lesions (16)
CL Item
Mucous membrane lesions - Cervix lesions (17)
CL Item
Mucous membrane lesions - Penis lesions (18)
CL Item
Mucous membrane lesions - Urethral lesions (19)
CL Item
Mucous membrane lesions - Anus lesions (20)
CL Item
Mucous membrane lesion sudden onset (21)
CL Item
Mucous membrane lesion progressive onset (22)
CL Item
Secondary skin infection (23)
CL Item
Upper respiratory tract infections (28)
Item
Inflammatory skin diseases - Signs and symptoms present
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0150312 (UMLS CUI [3])
Code List
Inflammatory skin diseases - Signs and symptoms present
CL Item
Not Applicable (NA)
Inflammatory skin diseases - Signs and symptoms Start Date
Item
Inflammatory skin diseases - Signs and symptoms Start Date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0808070 (UMLS CUI [3])
Inflammatory skin diseases - Signs and symptoms End date
Item
Inflammatory skin diseases - Signs and symptoms End date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0806020 (UMLS CUI [3])
Item
Inflammatory skin diseases - Signs and symptoms continuing at the end of study
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
Code List
Inflammatory skin diseases - Signs and symptoms continuing at the end of study
CL Item
Continuing at end of study (1)
Item Group
Inflammatory skin diseases - Signs and symptoms (skin lesions)
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0037088 (UMLS CUI-3)
C0037284 (UMLS CUI-4)
Item
Inflammatory skin diseases - Signs and symptoms present (skin lesions)
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0150312 (UMLS CUI [3])
C0037284 (UMLS CUI [4])
Code List
Inflammatory skin diseases - Signs and symptoms present (skin lesions)
CL Item
Not Applicable (NA)
Inflammatory skin diseases - Signs and symptoms Start Date (skin lesions)
Item
Inflammatory skin diseases - Signs and symptoms Start Date (skin lesions)
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0808070 (UMLS CUI [3])
C0037284 (UMLS CUI [4])
Inflammatory skin diseases - Signs and symptoms End date (skin lesions)
Item
Inflammatory skin diseases - Signs and symptoms End date (skin lesions)
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0806020 (UMLS CUI [3])
C0037284 (UMLS CUI [4])
Item
Inflammatory skin diseases - Signs and symptoms continuing at the end of study (skin lesions)
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
C0037284 (UMLS CUI [4])
Code List
Inflammatory skin diseases - Signs and symptoms continuing at the end of study (skin lesions)
CL Item
Continuing at end of study (1)
Item
If skin lesions, please specify
integer
C0037284 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Code List
If skin lesions, please specify
CL Item
Skin lesions > 1 cm (1)
CL Item
Skin lesions < 1 cm (2)
CL Item
Skin lesions Drop size (3)
CL Item
Skin lesions circumscribed (4)
CL Item
Skin lesions diffuse (5)
CL Item
Skin lesions symmetric (6)
CL Item
Skin lesions asymmetric (7)
Skin lesion - specify localisation
Item
Skin lesion - specify localisation (Scalp, Face, Neck, Trunc, Segmental , Dermatome, Upper limbs, Lower limbs, Palms, Soles, Nails, Fingers, Footfingers, Anterior, surface of the lower extremities), specify
text
C0037284 (UMLS CUI [1])
C0475264 (UMLS CUI [2])
C0036270 (UMLS CUI [3])
C0015450 (UMLS CUI [4])
C0027530 (UMLS CUI [5])
C0460005 (UMLS CUI [6])
C0205122 (UMLS CUI [7])
C0448733 (UMLS CUI [8])
C1140618 (UMLS CUI [9])
C0023216 (UMLS CUI [10])
C0817662 (UMLS CUI [11])
C0230463 (UMLS CUI [12])
C0027342 (UMLS CUI [13])
C0016129 (UMLS CUI [14])
C0040357 (UMLS CUI [15])
C0205094 (UMLS CUI [16])
C0023216 (UMLS CUI [17,1])
C0005902 (UMLS CUI [17,2])
Inflammatory skin diseases - Number of skin lesions
Item
Inflammatory skin diseases - Number of skin lesions
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037284 (UMLS CUI [2,1])
C0237753 (UMLS CUI [2,2])
Inflammatory skin diseases - % body affected
Item
Inflammatory skin diseases - % body affected
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0392760 (UMLS CUI [2,1])
C0439165 (UMLS CUI [2,2])
C0005902 (UMLS CUI [2,3])
Item Group
Inflammatory skin diseases - Other Signs and symptoms
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0037088 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Item
If any other signs and symptoms, please tick the box and complete below
integer
C0037088 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Code List
If any other signs and symptoms, please tick the box and complete below
CL Item
Other signs and symptoms (1)
Item Group
Inflammatory skin diseases - Other Signs and symptoms
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0037088 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Inflammatory skin diseases - Other Signs and symptoms
Item
Inflammatory skin diseases - Other Signs and symptoms
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Inflammatory skin diseases - Other Signs and symptoms Start Date
Item
Inflammatory skin diseases - Other Signs and symptoms Start Date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0808070 (UMLS CUI [3])
Inflammatory skin diseases - Other Signs and symptoms End Date
Item
Inflammatory skin diseases - Other Signs and symptoms End Date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0806020 (UMLS CUI [3])
Item Group
Inflammatory skin diseases - Diagnostic Test Results
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0456984 (UMLS CUI-4)
Item
Inflammatory skin diseases - Test
integer
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C2826273 (UMLS CUI [2])
Code List
Inflammatory skin diseases - Test
CL Item
White Blood Cells (1)
CL Item
Red blood cells (7)
CL Item
Erythrocyte Sedimentation Rate (ESR) (9)
CL Item
Serum C-reactive protein (CRP) (10)
CL Item
Serum sodium (11)
CL Item
Serum chloride (12)
CL Item
Serum calcium (13)
CL Item
Anti-nuclear antibodies (ANA) (14)
CL Item
Rheumatoid factor (RF) (15)
CL Item
Serum anti-epididermis intercellular space autoantibodies (16)
CL Item
Serum anti-desmoglein 1 antibodies (17)
CL Item
Anti-skin basement membrane protein (18)
CL Item
Anti-BP1 protein (19)
CL Item
Anti-BP2 protein (20)
CL Item
IgA endomysial antibodies (21)
CL Item
Anti-transglutaminase antibodies (22)
CL Item
Anti-melanocyte antibodies (23)
CL Item
Serum urea nitrogen (24)
CL Item
Serum creatinine (25)
Item
Inflammatory skin diseases - Test done
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0022885 (UMLS CUI [2,1])
C1272695 (UMLS CUI [2,2])
Code List
Inflammatory skin diseases - Test done
CL Item
Not Applicable (NA)
Inflammatory skin diseases - Test date
Item
Inflammatory skin diseases - Test date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C2826247 (UMLS CUI [2])
Inflammatory skin diseases - Test Result
Item
Inflammatory skin diseases - Test Result
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0587081 (UMLS CUI [2])
Inflammatory skin diseases - Test Units
Item
Inflammatory skin diseases - Test Units
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C1519795 (UMLS CUI [2])
Inflammatory skin diseases - Low Norm
Item
Inflammatory skin diseases - Low Norm
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
Inflammatory skin diseases - High Norm
Item
Inflammatory skin diseases - High Norm
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
Inflammatory skin diseases - Other Diagnostic Test Results
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0456984 (UMLS CUI-3)
C0430022 (UMLS CUI-4)
C0205394 (UMLS CUI-5)
Item
If any other diagnostic test results are available, please tick the box and complete below
integer
C0456984 (UMLS CUI [1,1])
C0430022 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Code List
If any other diagnostic test results are available, please tick the box and complete below
CL Item
Other diagnostic test results available (1)
Item Group
Inflammatory skin diseases - Other Diagnostic Test Results
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0456984 (UMLS CUI-3)
C0430022 (UMLS CUI-4)
C0205394 (UMLS CUI-5)
Inflammatory skin diseases - Test
Item
Inflammatory skin diseases - Test
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C2826273 (UMLS CUI [2])
Inflammatory skin diseases - Test date
Item
Inflammatory skin diseases - Test date
date
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C2826247 (UMLS CUI [2])
Inflammatory skin diseases - Test Result
Item
Inflammatory skin diseases - Test Result
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0587081 (UMLS CUI [2])
Inflammatory skin diseases - Test Units
Item
Inflammatory skin diseases - Test Units
text
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C1519795 (UMLS CUI [2])
Inflammatory skin diseases - Low Norm
Item
Inflammatory skin diseases - Low Norm
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
Inflammatory skin diseases - High Norm
Item
Inflammatory skin diseases - High Norm
float
C0037274 (UMLS CUI [1,1])
C1290884 (UMLS CUI [1,2])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
Inflammatory skin diseases - Other diagnostic Procedure
C0037274 (UMLS CUI-1)
C1290884 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Describe any other diagnostic procedure supporting the diagnosis
Item
Describe any other diagnostic procedure supporting the diagnosis (Skin biopsy, Direct immunofluorescence on skin biopsy, Koebner phenomenon (psoriasis), Skin inspection with a Wood lamp (for vitiligo), other)
text
C0430022 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C0011900 (UMLS CUI [2])
C0150866 (UMLS CUI [3])
C0079603 (UMLS CUI [4,1])
C0150866 (UMLS CUI [4,2])
C0033860 (UMLS CUI [5])
C1123023 (UMLS CUI [6,1])
C0199219 (UMLS CUI [6,2])
C0042900 (UMLS CUI [6,3])
Item Group
Autoimmune Myocarditis
C1608389 (UMLS CUI-1)
Please specify related adverse event: SAE Case No.
Item
Please specify related adverse event: SAE Case No.
integer
C1519255 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Please specify related adverse event: AE No.
Item
Please specify related adverse event: AE No.
text
C1518404 (UMLS CUI [1,1])
C0237753 (UMLS CUI [1,2])
Date of final diagnosis:
Item
Date of final diagnosis:
date
C2316983 (UMLS CUI [1,1])
C1546485 (UMLS CUI [1,2])
Item Group
Autoimmune Myocarditis - Signs and symptoms
C1608389 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
C1546485 (UMLS CUI-3)
Item
Autoimmune Myocarditis - Signs and symptoms
integer
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
Code List
Autoimmune Myocarditis - Signs and symptoms
CL Item
Ventricular arrhythmia (7)
CL Item
Atrioventricular block (8)
CL Item
Mitral valve regurgitation (10)
CL Item
Peripheral edema (11)
Item
Autoimmune Myocarditis - Signs and symptoms present
text
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
C0150312 (UMLS CUI [3])
Code List
Autoimmune Myocarditis - Signs and symptoms present
CL Item
Not Applicable (NA)
Autoimmune Myocarditis - Signs and symptoms Start Date
Item
Autoimmune Myocarditis - Signs and symptoms Start Date
date
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
C0808070 (UMLS CUI [3])
Autoimmune Myocarditis - Signs and symptoms End date
Item
Autoimmune Myocarditis - Signs and symptoms End date
date
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
C0806020 (UMLS CUI [3])
Item
Autoimmune Myocarditis - Signs and symptoms continuing at the end of study
integer
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
Code List
Autoimmune Myocarditis - Signs and symptoms continuing at the end of study
CL Item
Continuing at end of study (1)
Item Group
Autoimmune Myocarditis - Other Signs and symptoms
C1608389 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
Item
If any other signs and symptoms, please tick the box and complete below
integer
C0037088 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Code List
If any other signs and symptoms, please tick the box and complete below
CL Item
Other signs and symptoms (1)
Item Group
Autoimmune Myocarditis - Other Signs and symptoms
C1608389 (UMLS CUI-1)
C0037088 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
Autoimmune Myocarditis - Other Signs and symptoms
Item
Autoimmune Myocarditis - Other Signs and symptoms
text
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
Autoimmune Myocarditis - Other Signs and symptoms Start Date
Item
Autoimmune Myocarditis - Other Signs and symptoms Start Date
date
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0808070 (UMLS CUI [3])
Autoimmune Myocarditis - Other Signs and symptoms End Date
Item
Autoimmune Myocarditis - Other Signs and symptoms End Date
date
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0806020 (UMLS CUI [3])
Item
Autoimmune Myocarditis - Other signs and symptoms continuing at the end of study
text
C1608389 (UMLS CUI [1])
C0037088 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0549178 (UMLS CUI [3,1])
C0444496 (UMLS CUI [3,2])
Code List
Autoimmune Myocarditis - Other signs and symptoms continuing at the end of study
CL Item
Continuing at end of study (1)
Item Group
Autoimmune Myocarditis - Diagnostic Test Results
C1608389 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
Item
Autoimmune Myocarditis - Test
integer
C1608389 (UMLS CUI [1])
C2826273 (UMLS CUI [2])
Code List
Autoimmune Myocarditis - Test
CL Item
White Blood Cells (1)
CL Item
Red blood cells (7)
CL Item
Serum C-reactive protein (CRP) (9)
CL Item
Erythrocyte Sedimentation Rate (ESR) (10)
CL Item
Serum creatine kinase (CK) (11)
CL Item
Serum creatine kinase MB (12)
CL Item
Serum cardiac troponin (13)
CL Item
Serum calcemia (14)
CL Item
Calciuria (24h) (15)
CL Item
Serum urea nitrogen (16)
CL Item
Serum creatinine (17)
CL Item
LMW proteinuria (20)
CL Item
Anti-nuclear antibodies (ANA) (22)
CL Item
Rheumatoid factor (RF) (23)
Item
Autoimmune Myocarditis - Test done
text
C1608389 (UMLS CUI [1])
C0022885 (UMLS CUI [2,1])
C1272695 (UMLS CUI [2,2])
Code List
Autoimmune Myocarditis - Test done
CL Item
Not Applicable (NA)
Autoimmune Myocarditis - Test date
Item
Autoimmune Myocarditis - Test date
date
C1608389 (UMLS CUI [1])
C2826247 (UMLS CUI [2])
Autoimmune Myocarditis - Test Result
Item
Autoimmune Myocarditis - Test Result
float
C1608389 (UMLS CUI [1])
C0587081 (UMLS CUI [2])
Autoimmune Myocarditis - Test Units
Item
Autoimmune Myocarditis - Test Units
text
C1608389 (UMLS CUI [1])
C1519795 (UMLS CUI [2])
Autoimmune Myocarditis - Low Norm
Item
Autoimmune Myocarditis - Low Norm
float
C1608389 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
Autoimmune Myocarditis - High Norm
Item
Autoimmune Myocarditis - High Norm
float
C1608389 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
Autoimmune Myocarditis - Other Diagnostic Test Results
C1608389 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Item
If any other diagnostic test results are available please tick the box and complete below
integer
C0456984 (UMLS CUI [1,1])
C0430022 (UMLS CUI [1,2])
C0205394 (UMLS CUI [1,3])
Code List
If any other diagnostic test results are available please tick the box and complete below
CL Item
Other diagnostic test results available (1)
Item Group
Autoimmune Myocarditis - Other Diagnostic Test Results
C1608389 (UMLS CUI-1)
C0456984 (UMLS CUI-2)
C0430022 (UMLS CUI-3)
C0205394 (UMLS CUI-4)
Autoimmune Myocarditis - Test
Item
Autoimmune Myocarditis - Test
text
C1608389 (UMLS CUI [1])
C2826273 (UMLS CUI [2])
Autoimmune Myocarditis - Test date
Item
Autoimmune Myocarditis - Test date
date
C1608389 (UMLS CUI [1])
C2826247 (UMLS CUI [2])
Autoimmune Myocarditis - Test Result
Item
Autoimmune Myocarditis - Test Result
float
C1608389 (UMLS CUI [1])
C0587081 (UMLS CUI [2])
Autoimmune Myocarditis - Test Units
Item
Autoimmune Myocarditis - Test Units
text
C1608389 (UMLS CUI [1])
C1519795 (UMLS CUI [2])
Autoimmune Myocarditis - Low Norm
Item
Autoimmune Myocarditis - Low Norm
float
C1608389 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205251 (UMLS CUI [2,2])
Autoimmune Myocarditis - High Norm
Item
Autoimmune Myocarditis - High Norm
float
C1608389 (UMLS CUI [1])
C0086715 (UMLS CUI [2,1])
C0205250 (UMLS CUI [2,2])
Item Group
Autoimmune Myocarditis - Other diagnostic Procedure
C1608389 (UMLS CUI-1)
C0430022 (UMLS CUI-2)
C0205394 (UMLS CUI-3)
C0011900 (UMLS CUI-4)
Describe any other diagnostic procedure supporting the diagnosis
Item
Describe any other diagnostic procedure supporting the diagnosis (Chest X-Ray, Electrocardiogram, Echocardiography, Cardiac MRI, Cardiac angiography, Cardiac Biopsy, Viral serology)
text
C1608389 (UMLS CUI [1])
C0430022 (UMLS CUI [2,1])
C0205394 (UMLS CUI [2,2])
C0011900 (UMLS CUI [3])
C0039985 (UMLS CUI [4])
C1623258 (UMLS CUI [5])
C0013516 (UMLS CUI [6])
C0412692 (UMLS CUI [7])
C0002971 (UMLS CUI [8])
C0189784 (UMLS CUI [9])
C0036743 (UMLS CUI [10,1])
C0521026 (UMLS CUI [10,2])