ID

41776

Description

This CRF is set up in modules to be used for recording data on the ISARIC COVID-19 Core Database or for independent studies. Module 1 and Module 2 complete on the first day of presentation/admission or on first day of COVID-19 assessment. Module 2 also complete on first day of admission to ICU or high dependency unit. In addition, complete daily for as many days as resources allow up to a maximum of 14 days. Continue to follow-up patients who transfer between wards. Module 3 (Outcome) complete at discharge or death GENERAL GUIDANCE - The CRF is designed to collect data obtained through examination, interview and review of hospital notes. Data may be collected retrospectively if the patient is enrolled after the admission date. - For more detailed guidance on how to complete these forms, please refer to the CRF Completion Guideline - Participant Identification Numbers consist of a 3 digit site code and a 4 digit participant number. You can obtain a site code and registering on the data management system by contacting ISARIC. Participant numbers should be assigned sequentially for each site beginning with 0001. In the case of a single site recruiting participants on different wards, or where it is otherwise difficult to assign sequential numbers, it is acceptable to assign numbers in blocks or incorporating alpha characters. E.g. Ward X will assign numbers from 0001 or A001 onwards and Ward Y will assign numbers from 5001 or B001 onwards. Enter the Participant Identification Number at the top of every page. - Printed paper CRFs may be used for later transfer of the data onto the electronic database. - For participants who return for re-admission to the same site, start a new form with a different Participant Identification Number. Please check “YES-admitted previously” in the ONSET & ADMISSION section. Enter as 2 separate entries in the electronic database. - For participants who transfer between two sites that are both collecting data on this form, it is preferred to have the data entered by a single site as a single admission, under the same Participant Identification Number. When this is not possible, the first site should record “Transfer to other facility” as an OUTCOME, and the second site should start a new form with a new patient number and indicate “YES-transferred” in ONSET & ADMISSION. - Complete every line of every section, except for where the instructions say to skip a section based on certain responses. - Mark ‘Not done’ for any results of laboratory values that are not available, not applicable or unknown. - Avoid recording data outside of the dedicated areas. Sections are available for recording additional information. - If using paper CRFs, we recommend writing clearly in ink, using BLOCK-CAPITAL LETTERS. Place an (X) when you choose the corresponding answer. To make corrections, strike through (-------) the data you wish to delete and write the correct data above it. Please initial and date all corrections. Please keep all of the sheets for a single participant together e.g. with a staple or participant-unique folder. - ISARIC would like the centers to enter data directly into their electronic data capture system. Please contact ISARIC about access. If your site would like to collect data independently, ISARIC can support you in the estabilishment of locally hosted databases. This version may serve as a basis for locally hosted databases. - Please contact ISARIC, if you need help with databases, have comments or to let ISARIC know that you are using the CRF. - Please let us know if you find any mistakes in the MDM Portal's version. FURTHER GUIDANCE AND DEFINITIONS (from the Completion guideline) Comorbidities: Comorbidities present before the onset of COVID-19 and are still present. Do not include those that developed following the onset of COVID-19 symptoms. More detailed guidance is provided. Hospital admission: For patients who were admitted to hospital with COVID-19 or symptoms consistent with possible COVID-19 infection, please enter details for the date of hospital admission. For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19, original admission date should be provided, but all subsequent references to admission should be taken as referring to day COVID-19 was first clinically suspected (or within the first 24 hours after first day of suspected or confirmed COVID-19 infection). Where a patient was admitted via multiple hospital departments, count admission from the time they came to the first department during the visit that led to their admission (e.g. arrival at the Emergency Department). Oxygen therapy: Include any form of supplemental oxygen received using any methods. Invasive ventilation: Please include any mechanical ventilation delivered following intubation or via a tracheostomy. Do not include patients who are breathing independently via a tracheostomy. Non-invasive ventilation: Please include any positive-pressure treatment given via a tight-fitted mask. This can be continuous positive pressure (CPAP) or bi-level positive pressure (BIPAP). Renal replacement therapy or dialysis: Please include any form of continuous renal replacement therapy or intermittent haemodialysis. Worst result: References to ‘worst result’ refer to those furthest from the normal physiological range or laboratory normal range. Results that were rejected by the clinical team (e.g. pulse oximetry on poorly perfused extremities, haemolysed blood samples, contaminated microbiology results) should not be reported. The following measures should be considered as a single observation and entered together: Blood gas results: Please report the measures from the blood gas with the lowest pH (most acidotic). Blood pressure: Please report the systolic and diastolic blood pressure from the observation with the lowest mean arterial pressure (if mean arterial pressure has not been calculated, report the measurement with lowest systolic blood pressure). Respiratory rate: If both abnormal low and high rate observed, record the abnormally high rate. General information about ISARIC ISARIC has developed a portfolio of resources to accelerate outbreak research and response. All resources are designed to address the most critical public health questions, have undergone extensive review by international clinical experts, and are free to use. ISARIC should be acknowledged and informed if you implement the protocol. Ethical apporval of the protocol and all necessary operational and financial arrangements are the responsibility of the investigators. This form refers to the CoV CASE RECORD FORM Version 1.3 25 Aug 2020. See https://isaric.tghn.org/COVID-19-CRF/

Link

https://isaric.tghn.org/COVID-19-CRF/

Keywords

Versions (1)
  1. 1/18/21 1/18/21 -
Copyright Holder

ISARIC on behalf of Oxford University

Uploaded on

January 18, 2021

DOI

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License

Creative Commons BY-SA 4.0
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ISARIC/WHO Novel Coronavirus (nCoV) / COVID-19 Case Report Form

English

MODULE 1: PRESENTATION/ADMISSION CASE REPORT FORM

1 forms  
Participant Identification
Description

Participant Identification

Alias
UMLS CUI-1
C3165543
Participant Identification Numbers
Description

Participant Identification Numbers consist of a 3 digit site code and a 4 digit participant number. You can obtain a site code and registering on the data management system by contacting ncov@isaric.org. Participant numbers should be assigned sequentially for each site beginning with 0001. In the case of a single site recruiting participants on different wards, or where it is otherwise difficult to assign sequential numbers, it is acceptable to assign numbers in blocks or incorporating alpha characters. E.g. Ward X will assign numbers from 0001 or A001 onwards and Ward Y will assign numbers from 5001 or B001 onwards. Enter the Participant Identification Number at the top of every page.

Data type

text

Alias
UMLS CUI [1]
C3165543
Clinical Inclusion Criteria
Description

Clinical Inclusion Criteria

Alias
UMLS CUI-1
C1512693
UMLS CUI-2
C0243161
Suspected or confirmed novel coronavirus (COVID-19) infection:
Description

Select yes if patient has either clinically suspected or laboratory-confirmed SARS-CoV-2 /COVID-19 infection.

Data type

boolean

Alias
UMLS CUI [1,1]
C0392360
UMLS CUI [1,2]
C0030673
UMLS CUI [1,3]
C3838696
UMLS CUI [2,1]
C0392360
UMLS CUI [2,2]
C0030673
UMLS CUI [2,3]
C0206750
UMLS CUI [2,4]
C0456369
Demographics
Description

Demographics

Alias
UMLS CUI-1
C1704791
Clinical centre name
Description

Clinical centre name

Data type

text

Alias
UMLS CUI [1,1]
C1552416
UMLS CUI [1,2]
C0027365
Country
Description

Country

Data type

text

Alias
UMLS CUI [1]
C0454664
Enrolment date /first COVID-19 assessment date:
Description

Date of enrolment into the study or for in-patients the date COVID-19 was first assessed as suspected or confirmed by a clinician.

Data type

date

Alias
UMLS CUI [1,1]
C1516879
UMLS CUI [1,2]
C0011008
UMLS CUI [2,1]
C0205435
UMLS CUI [2,2]
C5203670
UMLS CUI [2,3]
C2985720
Ethnic group: Arab
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C0282540
Ethnic group: Black
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C0005680
Ethnic group: East Asian
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C4540996
Ethnic group: South Asian
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C1519427
Ethnic group: West Asian
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1,1]
C0003984
UMLS CUI [1,2]
C0015031
Ethnic group: Latin American
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C1553378
Ethnic group: White
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C0007457
Ethnic group: Aboriginal/First Nations
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1]
C0935542
Other ethnic group
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0015031
If Other ethnic group, please specify:
Description

Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C0015031
UMLS CUI [1,3]
C2348235
Unknown ethnic group
Description

If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.

Data type

boolean

Alias
UMLS CUI [1,1]
C0439673
UMLS CUI [1,2]
C0015031
Employed as a Healthcare Worker?
Description

Employed as healthcare worker

Data type

integer

Alias
UMLS CUI [1,1]
C0557351
UMLS CUI [1,2]
C0018724
Employed in a microbiology laboratory?
Description

Employed in a microbiology laboratory

Data type

integer

Alias
UMLS CUI [1,1]
C0557351
UMLS CUI [1,2]
C0181826
Sex at Birth
Description

Sex at birth

Data type

integer

Alias
UMLS CUI [1]
C4019317
Estimated age in years
Description

Or use "estimated age in months"

Data type

integer

Measurement units
  • Year
Alias
UMLS CUI [1,1]
C0750572
UMLS CUI [1,2]
C1510829
Year
Estimated age in months
Description

Or use "estimated age in years"

Data type

integer

Measurement units
  • months
Alias
UMLS CUI [1,1]
C0750572
UMLS CUI [1,2]
C1510828
months
Pregnant?
Description

Pregnant

Data type

integer

Alias
UMLS CUI [1]
C0549206
If YES: Gestational weeks assessment:
Description

Gestational week assessment

Data type

integer

Measurement units
  • weeks
Alias
UMLS CUI [1]
C2825545
weeks
Post Partum
Description

Post Partum

Alias
UMLS CUI-1
C0032804
Post Partum?
Description

Post-partum: Defined as within six week of delivery. If NO or Unknown skip this section

Data type

integer

Alias
UMLS CUI [1]
C0032804
If post partum, pregnancy outcome:
Description

Pregnancy Outcome

Data type

integer

Alias
UMLS CUI [1]
C0032972
If post partum, delivery date:
Description

Delivery date

Data type

date

Alias
UMLS CUI [1]
C2053594
If post partum, baby tested for COVID-19/SARS-CoV-2 infection?
Description

Baby tested for mother's Sars-Cov-2-infection/COVID-19

Data type

integer

Alias
UMLS CUI [1,1]
C0021270
UMLS CUI [1,2]
C0022885
UMLS CUI [1,3]
C0884358
UMLS CUI [1,4]
C5203676
If baby got tested, result of the test:
Description

If the baby is positive for COVID-19 please complete a separate form for the baby as well.

Data type

integer

Alias
UMLS CUI [1,1]
C0021270
UMLS CUI [1,2]
C1254360
UMLS CUI [1,3]
C5203676
Infant – Less than 1 year old
Description

Infant – Less than 1 year old

Alias
UMLS CUI-1
C0021270
Infant – Less than 1 year old?
Description

If No skip this section

Data type

boolean

Alias
UMLS CUI [1]
C0021270
Birth weight
Description

Birth weight

Data type

float

Alias
UMLS CUI [1]
C0005612
Birth weight unit/unknown
Description

Birth weight Unit/Unknown

Data type

integer

Alias
UMLS CUI [1,1]
C0005612
UMLS CUI [1,2]
C0439148
UMLS CUI [2,1]
C0005612
UMLS CUI [2,2]
C0439673
UMLS CUI [3,1]
C0005612
UMLS CUI [3,2]
C0439148
UMLS CUI [3,3]
C0439673
Gestational outcome
Description

Gestational outcome

Data type

integer

Alias
UMLS CUI [1]
C1286282
Breastfed?
Description

Breastfed

Data type

integer

Alias
UMLS CUI [1]
C0006147
Vaccinations appropriate for age/country?
Description

Vaccinations appropriate for age/country

Data type

integer

Alias
UMLS CUI [1,1]
C1443394
UMLS CUI [1,2]
C1548787
UMLS CUI [1,3]
C0001779
UMLS CUI [2,1]
C1443394
UMLS CUI [2,2]
C1548787
UMLS CUI [2,3]
C0454664
Onset and admission
Description

Onset and admission

Alias
UMLS CUI-1
C0277793
UMLS CUI-2
C0184666
Onset date of first/earliest symptom:
Description

Please provide the date of patient reported onset of the first symptom that you clinically believe was related to this episode of COVID-19 infection.

Data type

date

Alias
UMLS CUI [1,1]
C0574845
UMLS CUI [1,2]
C0205435
UMLS CUI [1,3]
C1457887
Most recent presentation/admission date at this facility
Description

Where a patient was admitted via multiple hospital departments, count admission from the time they came to the first department during the visit that led to their admission (e.g. arrival at the Emergency Department). For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19 report the date of admission as the day they were admitted to the healthcare facility.

Data type

date

Alias
UMLS CUI [1]
C1302393
Was the patient admitted previously or transferred from any other facility during this illness episode?
Description

For participants who return for re-admission to the same site, start a new form with the same Participant Identification Number. Please check “YES-admitted previously to this facility”. Enter as 2 separate entries in the electronic database. For participants who transfer between two sites that are both collecting data on this form, it is preferred to have the data entered by a single site as a single admission, under the same Participant Identification Number. When this is not possible, the first site should record “Transfer to other facility” as an OUTCOME, and the second site should start a new form with a new patient number and indicate “YES-transferred from other facility” in ONSET & ADMISSION.

Data type

integer

Alias
UMLS CUI [1]
C4264524
Has this patient’s data been previously collected under a different patient number?
Description

Participant ID at transferring facility

Data type

integer

Alias
UMLS CUI [1,1]
C3165543
UMLS CUI [1,2]
C4264524
If YES, Participant Identification number (PIN):
Description

Participant ID at transferring facility

Data type

text

Alias
UMLS CUI [1,1]
C3165543
UMLS CUI [1,2]
C4264524
UMLS CUI [1,3]
C2348235
Signs and symptoms at hospital admission
Description

Signs and symptoms at hospital admission

Alias
UMLS CUI-1
C0037088
UMLS CUI-2
C0184666
Body temperature
Description

Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F). For all items in this group: Please provide details of clinical observations made as close to presentation/admission, or within 24 hours of admission. For observations not made immediately at admission, please record the first available data (patient reported and/or from medical records) within 24 hours of admission. For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19, complete these observations for the 24 hours after onset of symptoms of suspected or confirmed COVID-19 infection.

Data type

float

Alias
UMLS CUI [1]
C0005903
Temperature unit
Description

Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F).

Data type

integer

Alias
UMLS CUI [1,1]
C0005903
UMLS CUI [1,2]
C1519795
Heart Rate (HR):
Description

Enter the heart rate measured in beats per minute. This may be measured manually or by electronic monitoring.

Data type

integer

Measurement units
  • beats per minute
Alias
UMLS CUI [1]
C0018810
beats per minute
Respiratory rate (RR)
Description

Enter the respiratory rate in breaths per minute. Manual rather than electronic measurement is preferred where possible (this is achieved by counting the number of breaths for one minute, counting how many times the chest rises within this time period). Record the highest respiratory rate documented on admission.

Data type

integer

Measurement units
  • breaths per minute
Alias
UMLS CUI [1]
C0231832
breaths per minute
Systolic blood pressure
Description

Please enter the systolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 120 in the section marked ‘systolic BP’. Use any recognised method for measuring blood pressure.

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0871470
mmHg
Diastolic blood pressure
Description

Please enter the diastolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 85 in the section marked ‘diastolic BP’. Use any recognised method for measuring blood pressure.

Data type

integer

Measurement units
  • mmHg
Alias
UMLS CUI [1]
C0428883
mmHg
Oxygen saturation
Description

For all patients, irrespective of ventilation or supplemental oxygen requirement, please enter the percentage oxygen saturation (the percentage of haemoglobin binding sites in the bloodstream occupied by oxygen) at the time of admission. This may be measured by pulse oximetry or by arterial blood gas analysis.

Data type

integer

Measurement units
  • %
Alias
UMLS CUI [1]
C0523807
%
Oxygen saturation under which condition?
Description

Oxygen saturation condition

Data type

integer

Alias
UMLS CUI [1,1]
C0523807
UMLS CUI [1,2]
C0449438
Sternal capillary refill time >2seconds
Description

Sternal capillary refill time is measured by pressing on the sternum for five seconds with a finger or thumb until the underlying skin turns white and then noting the time in seconds needed for the colour to return once the pressure is released.

Data type

integer

Alias
UMLS CUI [1]
C1714880
Height:
Description

Height

Data type

integer

Measurement units
  • cm
Alias
UMLS CUI [1]
C0005890
cm
Weight:
Description

Weight

Data type

integer

Measurement units
  • kg
Alias
UMLS CUI [1]
C0005910
kg
Admission signs and symptoms
Description

Admission signs and symptoms

Alias
UMLS CUI-1
C0037088
UMLS CUI-2
C0184666
History of fever
Description

History of fever

Data type

integer

Alias
UMLS CUI [1,1]
C0015967
UMLS CUI [1,2]
C0019664
Cough
Description

Cough

Data type

integer

Alias
UMLS CUI [1]
C0010200
Sore throat
Description

Sore throat

Data type

integer

Alias
UMLS CUI [1]
C0242429
Runny nose (Rhinorrhoea)
Description

Rhinorrhoea

Data type

integer

Alias
UMLS CUI [1]
C1260880
Wheezing
Description

Wheezing

Data type

integer

Alias
UMLS CUI [1]
C0043144
Shortness of breath
Description

Shortness of breath

Data type

integer

Alias
UMLS CUI [1]
C0013404
Lower chest wall indrawing
Description

Lower chest wall indrawing

Data type

integer

Alias
UMLS CUI [1,1]
C0205076
UMLS CUI [1,2]
C0425469
Chest pain
Description

Chest pain

Data type

integer

Alias
UMLS CUI [1]
C0008031
Conjunctivitis
Description

Conjunctivitis

Data type

integer

Alias
UMLS CUI [1]
C0009763
Lymphadenopathy
Description

Lymphadenopathy

Data type

integer

Alias
UMLS CUI [1]
C0497156
Headache
Description

Headache

Data type

integer

Alias
UMLS CUI [1]
C0018681
Loss of smell (Anosmia)
Description

Loss of smell (Anosmia)

Data type

integer

Alias
UMLS CUI [1]
C0003126
Loss of taste (Ageusia)
Description

Loss of taste (Ageusia)

Data type

integer

Alias
UMLS CUI [1]
C2364111
Seizures
Description

Seizures

Data type

integer

Alias
UMLS CUI [1]
C0036572
Fatigue / Malaise
Description

Fatigue / Malaise

Data type

integer

Alias
UMLS CUI [1]
C0024528
Anorexia
Description

Anorexia

Data type

integer

Alias
UMLS CUI [1]
C0003123
Altered consciousness/confusion
Description

Altered consciousness/confusion

Data type

integer

Alias
UMLS CUI [1]
C0150450
UMLS CUI [2]
C0009676
Muscle aches (Myalgia)
Description

Muscle aches

Data type

integer

Alias
UMLS CUI [1]
C0231528
Joint pain (Arthralgia)
Description

Joint pain

Data type

integer

Alias
UMLS CUI [1]
C0003862
Inability to walk
Description

Inability to walk

Data type

integer

Alias
UMLS CUI [1]
C0560046
Abdominal pain
Description

Abdominal pain

Data type

integer

Alias
UMLS CUI [1]
C0000737
Diarrhoea
Description

Diarrhoea

Data type

integer

Alias
UMLS CUI [1]
C0011991
Vomiting / Nausea
Description

Vomiting / Nausea

Data type

integer

Alias
UMLS CUI [1]
C0027497
UMLS CUI [2]
C0042963
Skin rash
Description

Skin rash

Data type

integer

Alias
UMLS CUI [1]
C0015230
Bleeding (Haemorrhage)
Description

Haemorrhage

Data type

integer

Alias
UMLS CUI [1]
C0019080
If Bleeding: specify site(s):
Description

Haemorrhage Site

Data type

text

Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C1515974
Other symptom(s)
Description

Other symptom(s)

Data type

integer

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0205394
If YES, specify:
Description

Other symptom(s)

Data type

text

Alias
UMLS CUI [1,1]
C1457887
UMLS CUI [1,2]
C0205394
Pre-admission medication (taken within 14 days of admission/presentation at healthcare facility)
Description

Pre-admission medication (taken within 14 days of admission/presentation at healthcare facility)

Alias
UMLS CUI-1
C0559269
UMLS CUI-2
C0013227
UMLS CUI-3
C0332285
UMLS CUI-4
C5142984
Angiotensin converting enzyme inhibitors (ACE inhibitors)
Description

Include alacepril, captopril, zefnopril, enalapril, ramipril, quinapril, perindopril, lisinopril, benazepril, imidapril, trandolapril, and cilazapril.

Data type

integer

Alias
UMLS CUI [1]
C0003015
Angiotensin II receptor blockers (ARBs)
Description

Examples include losartan, irbesartan, olmesartan, candesartan, valsartan, fimasartan, azilsartan, saprisartan and telmisartan

Data type

integer

Alias
UMLS CUI [1]
C0521942
Non-steroidalanti-inflammatory(NSAIDs)
Description

Examples include aspirin, ibuprofen, naproxen, celecoxib, diclofenac, diflunisal, etodolac, indomethacin, ketoprofen, ketorolac, nabumetone, oxaprozin, piroxicam, salsalate, sulindac, tolmetin

Data type

integer

Alias
UMLS CUI [1]
C0003211
Oral steroids
Description

Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.

Data type

integer

Alias
UMLS CUI [1,1]
C0038317
UMLS CUI [1,2]
C1527415
Oral steroids - If Yes, agent(s):
Description

Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.

Data type

text

Alias
UMLS CUI [1,1]
C0038317
UMLS CUI [1,2]
C1527415
UMLS CUI [1,3]
C2348235
Other immunosuppressant agents (not oral steroids)
Description

Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.

Data type

integer

Alias
UMLS CUI [1,1]
C0021081
UMLS CUI [1,2]
C0205394
Other immunosuppressant agents (not oral steroids) - If Yes, agent(s):
Description

Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.

Data type

text

Alias
UMLS CUI [1,1]
C0021081
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C2348235
Antivirals
Description

Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.

Data type

integer

Alias
UMLS CUI [1]
C0003451
Antivirals - If Yes, agent(s):
Description

Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.

Data type

text

Alias
UMLS CUI [1,1]
C0003451
UMLS CUI [1,2]
C2348235
Antibiotics
Description

‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.

Data type

integer

Alias
UMLS CUI [1]
C0003232
Antibiotics - If Yes, agent(s):
Description

‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.

Data type

text

Alias
UMLS CUI [1,1]
C0003232
UMLS CUI [1,2]
C2348235
Other targeted COVID-19 Medications
Description

Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.

Data type

integer

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C5203670
UMLS CUI [1,3]
C0013227
Other targeted COVID-19 Medications - If Yes, agent(s):
Description

Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.

Data type

text

Alias
UMLS CUI [1,1]
C0205394
UMLS CUI [1,2]
C5203670
UMLS CUI [1,3]
C0013227
UMLS CUI [1,4]
C2348235
Co-morbidities and risk factors
Description

Co-morbidities and risk factors

Alias
UMLS CUI-1
C0009488
UMLS CUI-2
C0035648
Chronic cardiac disease, including congenital heart disease (not hypertension)
Description

Please include any of coronary artery disease, heart failure, congenital heart disease, cardiomyopathy, rheumatic heart disease. For all items in this group: Please record if any of these comorbidities existed prior to admission. In general, do not include past comorbidities that are no longer ongoing. Additional details are given below. Where example conditions are given, these are not intended to be exhaustive and other conditions of equivalent severity should be included.

Data type

integer

Alias
UMLS CUI [1]
C1290386
Hypertension
Description

Elevated arterial blood pressure diagnosed clinically, >140mmHg systolic or >90mmHg diastolic.

Data type

integer

Alias
UMLS CUI [1]
C0020538
Chronic pulmonary disease (not asthma)
Description

Please include any of chronic obstructive pulmonary disease (chronic bronchitis, emphysema), cystic fibrosis, bronchiectasis, interstitial lung disease, pre-existing requirement for long term oxygen therapy. Do not include asthma.

Data type

integer

Alias
UMLS CUI [1,1]
C0746102
UMLS CUI [1,2]
C0332300
UMLS CUI [1,3]
C0004096
Asthma (physician diagnosed)
Description

Clinician-diagnosed asthma

Data type

integer

Alias
UMLS CUI [1]
C0004096
Chronic kidney disease
Description

Please include any of clinician-diagnosed chronic kidney disease, chronic estimated glomerular filtration rate < 60 mL/min/1.73 squaremetre , history of kidney transplantation

Data type

integer

Alias
UMLS CUI [1]
C1561643
Moderate or severe liver disease
Description

This is defined as cirrhosis with portal hypertension, with or without bleeding or a history of variceal bleeding

Data type

integer

Alias
UMLS CUI [1,1]
C0023895
UMLS CUI [1,2]
C0205081
UMLS CUI [2,1]
C0205082
UMLS CUI [2,2]
C0023895
Mild liver disease
Description

This is defined as cirrhosis without portal hypertension or chronic hepatitis

Data type

integer

Alias
UMLS CUI [1,1]
C2945599
UMLS CUI [1,2]
C0023895
Asplenia
Description

Please include any of splenectomy, non-functional spleen, and congenital asplenia.

Data type

integer

Alias
UMLS CUI [1]
C3810472
Chronic neurological disorder
Description

Please include any of cerebral palsy, multiple sclerosis, motor neurone disease, muscular dystrophy, myasthenia gravis, Parkinson’s disease, stroke, severe learning difficulty

Data type

integer

Alias
UMLS CUI [1,1]
C0027765
UMLS CUI [1,2]
C0008679
Malignant neoplasm
Description

Current solid organ or haematological malignancy. Please do not include malignancies that have been declared ‘cured’ ≥5 years ago with no evidence of ongoing disease. Do not include non- melanoma skin cancers. Do not include benign growths or dysplasia.

Data type

integer

Alias
UMLS CUI [1]
C0006826
Chronic hematologic disease
Description

Any long-term disorder of the red or white blood cells, platelets or coagulation system requiring regular or intermittent treatment. Do not include leukaemia, lymphoma or myeloma, which should be entered under malignancy. Do not include iron-deficiency anaemia which is explained by diet or chronic blood loss.

Data type

integer

Alias
UMLS CUI [1]
C1275398
AIDS / HIV
Description

History of laboratory-confirmed HIV infection.

Data type

integer

Alias
UMLS CUI [1]
C0019693
UMLS CUI [2]
C0001175
Obesity (as defined by clinical staff)
Description

This refers to patients for whom an attending clinician has assessed them to be obese - ideally but not necessarily with an objective measurement of obesity, such as calculation of the body mass index (BMI of 30 or more) or measurement of abdominal girth.

Data type

integer

Alias
UMLS CUI [1]
C0028754
Diabetes
Description

Type 1 or Type 2 diabetes mellitus requiring oral or subcutaneous treatment. Please indicate whether type 1 or type 2.

Data type

integer

Alias
UMLS CUI [1]
C0011849
Rheumatologic disorder
Description

This is defined as an inflammatory and degenerative diseases of connective tissue structures. It includes chronic arthropathies and arthritis, connective tissue disorders and vasculitides.

Data type

integer

Alias
UMLS CUI [1,1]
C0035452
UMLS CUI [1,2]
C0012634
Dementia
Description

This is defined as clinical diagnosis of dementia

Data type

integer

Alias
UMLS CUI [1]
C0497327
Tuberculosis
Description

Patients currently receiving treatment for tuberculosis. Do not include latent tuberculosis.

Data type

integer

Alias
UMLS CUI [1]
C0041296
Malnutrition
Description

Any clinically identified deficiency in intake, either of total energy or of specific nutrients that led to a dietetic intervention or referral prior to the onset of COVID-19 symptoms. Do not include people who needed supplementary nutrition solely due to reduced intake during their current illness episode.

Data type

integer

Alias
UMLS CUI [1]
C0162429
Smoking
Description

Smoking at least one cigarette, cigar, pipe or equivalent per day before the onset of the current illness. Do not include smoke-free tobacco products such as chewed tobacco or electronic nicotine delivery devices.

Data type

integer

Alias
UMLS CUI [1]
C1519386
Other relevant risk factor
Description

List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.

Data type

integer

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C0205394
If other relevant risk factors are known, please specify:
Description

List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.

Data type

text

Alias
UMLS CUI [1,1]
C0035648
UMLS CUI [1,2]
C0205394
UMLS CUI [1,3]
C2348235
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Similar models

MODULE 1: PRESENTATION/ADMISSION CASE REPORT FORM

1 forms
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Participant Identification
C3165543 (UMLS CUI-1)
Participant Identification Numbers
Item
Participant Identification Numbers
text
C3165543 (UMLS CUI [1])
Item Group
Clinical Inclusion Criteria
C1512693 (UMLS CUI-1)
C0243161 (UMLS CUI-2)
Suspected or proven Coronavirus infection
Item
Suspected or confirmed novel coronavirus (COVID-19) infection:
boolean
C0392360 (UMLS CUI [1,1])
C0030673 (UMLS CUI [1,2])
C3838696 (UMLS CUI [1,3])
C0392360 (UMLS CUI [2,1])
C0030673 (UMLS CUI [2,2])
C0206750 (UMLS CUI [2,3])
C0456369 (UMLS CUI [2,4])
Item Group
Demographics
C1704791 (UMLS CUI-1)
Clinical centre name
Item
Clinical centre name
text
C1552416 (UMLS CUI [1,1])
C0027365 (UMLS CUI [1,2])
Country
Item
Country
text
C0454664 (UMLS CUI [1])
Enrollment date / first covid-19 assessment
Item
Enrolment date /first COVID-19 assessment date:
date
C1516879 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
C0205435 (UMLS CUI [2,1])
C5203670 (UMLS CUI [2,2])
C2985720 (UMLS CUI [2,3])
Ethnic group: Arab
Item
Ethnic group: Arab
boolean
C0282540 (UMLS CUI [1])
Ethnic group: Black
Item
Ethnic group: Black
boolean
C0005680 (UMLS CUI [1])
Ethnic group: East Asian
Item
Ethnic group: East Asian
boolean
C4540996 (UMLS CUI [1])
Ethnic group: South Asian
Item
Ethnic group: South Asian
boolean
C1519427 (UMLS CUI [1])
Ethnic group: West Asian
Item
Ethnic group: West Asian
boolean
C0003984 (UMLS CUI [1,1])
C0015031 (UMLS CUI [1,2])
Ethnic group: Latin American
Item
Ethnic group: Latin American
boolean
C1553378 (UMLS CUI [1])
Ethnic group: White
Item
Ethnic group: White
boolean
C0007457 (UMLS CUI [1])
Ethnic group: Aboriginal/First Nations
Item
Ethnic group: Aboriginal/First Nations
boolean
C0935542 (UMLS CUI [1])
Other ethnic group
Item
Other ethnic group
boolean
C0205394 (UMLS CUI [1,1])
C0015031 (UMLS CUI [1,2])
Other ethnic group Specification
Item
If Other ethnic group, please specify:
text
C0205394 (UMLS CUI [1,1])
C0015031 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Unknown ethnic group
Item
Unknown ethnic group
boolean
C0439673 (UMLS CUI [1,1])
C0015031 (UMLS CUI [1,2])
Item
Employed as a Healthcare Worker?
integer
C0557351 (UMLS CUI [1,1])
C0018724 (UMLS CUI [1,2])
Employed as healthcare worker
Code List
Employed as a Healthcare Worker?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Employed in a microbiology laboratory?
integer
C0557351 (UMLS CUI [1,1])
C0181826 (UMLS CUI [1,2])
Employed as healthcare worker
Code List
Employed in a microbiology laboratory?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Sex at Birth
integer
C4019317 (UMLS CUI [1])
Employed as healthcare worker
Code List
Sex at Birth
CL Item
Male (1)
CL Item
Female (2)
CL Item
Not specified/Unknown (3)
Estimated Age in years
Item
Estimated age in years
integer
C0750572 (UMLS CUI [1,1])
C1510829 (UMLS CUI [1,2])
Estimated Age in months
Item
Estimated age in months
integer
C0750572 (UMLS CUI [1,1])
C1510828 (UMLS CUI [1,2])
Item
Pregnant?
integer
C0549206 (UMLS CUI [1])
Employed as healthcare worker
Code List
Pregnant?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Gestational week assessment
Item
If YES: Gestational weeks assessment:
integer
C2825545 (UMLS CUI [1])
Item Group
Post Partum
C0032804 (UMLS CUI-1)
Item
Post Partum?
integer
C0032804 (UMLS CUI [1])
Post Partum
Code List
Post Partum?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
If post partum, pregnancy outcome:
integer
C0032972 (UMLS CUI [1])
Post Partum
Code List
If post partum, pregnancy outcome:
CL Item
Live birth (1)
CL Item
Still birth (2)
Delivery date
Item
If post partum, delivery date:
date
C2053594 (UMLS CUI [1])
Item
If post partum, baby tested for COVID-19/SARS-CoV-2 infection?
integer
C0021270 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
C0884358 (UMLS CUI [1,3])
C5203676 (UMLS CUI [1,4])
Baby tested for mother's ARI infection
Code List
If post partum, baby tested for COVID-19/SARS-CoV-2 infection?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
If baby got tested, result of the test:
integer
C0021270 (UMLS CUI [1,1])
C1254360 (UMLS CUI [1,2])
C5203676 (UMLS CUI [1,3])
Baby tested for mother's ARI infection
Code List
If baby got tested, result of the test:
CL Item
Positive (1)
(Comment:en)
CL Item
Negative (2)
(Comment:en)
CL Item
Unknown (3)
(Comment:en)
Item Group
Infant – Less than 1 year old
C0021270 (UMLS CUI-1)
Infant
Item
Infant – Less than 1 year old?
boolean
C0021270 (UMLS CUI [1])
Birth weight
Item
Birth weight
float
C0005612 (UMLS CUI [1])
Item
Birth weight unit/unknown
integer
C0005612 (UMLS CUI [1,1])
C0439148 (UMLS CUI [1,2])
C0005612 (UMLS CUI [2,1])
C0439673 (UMLS CUI [2,2])
C0005612 (UMLS CUI [3,1])
C0439148 (UMLS CUI [3,2])
C0439673 (UMLS CUI [3,3])
Birth weight specification
Code List
Birth weight unit/unknown
CL Item
kg (1)
CL Item
lbs (2)
CL Item
unknown (3)
Item
Gestational outcome
integer
C1286282 (UMLS CUI [1])
Gestational outcome
Code List
Gestational outcome
CL Item
Term birth (≥37wk GA) (1)
CL Item
Preterm birth (<37wk GA) (2)
CL Item
Unknown (3)
Item
Breastfed?
integer
C0006147 (UMLS CUI [1])
Gestational outcome
Code List
Breastfed?
CL Item
Yes - currently breastfeeding (1)
CL Item
Yes - breastfeeding discontinued (2)
CL Item
No (3)
CL Item
Unknown (4)
Item
Vaccinations appropriate for age/country?
integer
C1443394 (UMLS CUI [1,1])
C1548787 (UMLS CUI [1,2])
C0001779 (UMLS CUI [1,3])
C1443394 (UMLS CUI [2,1])
C1548787 (UMLS CUI [2,2])
C0454664 (UMLS CUI [2,3])
Appropriate development for age
Code List
Vaccinations appropriate for age/country?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item Group
Onset and admission
C0277793 (UMLS CUI-1)
C0184666 (UMLS CUI-2)
Onset date of first/earliest symptom
Item
Onset date of first/earliest symptom:
date
C0574845 (UMLS CUI [1,1])
C0205435 (UMLS CUI [1,2])
C1457887 (UMLS CUI [1,3])
Admission date at this facility
Item
Most recent presentation/admission date at this facility
date
C1302393 (UMLS CUI [1])
Item
Was the patient admitted previously or transferred from any other facility during this illness episode?
integer
C4264524 (UMLS CUI [1])
Transfer from other facility
Code List
Was the patient admitted previously or transferred from any other facility during this illness episode?
CL Item
YES - admitted previously to this facility (1)
CL Item
YES - transferred from other facility (2)
CL Item
No (3)
CL Item
Unknown (4)
Item
Has this patient’s data been previously collected under a different patient number?
integer
C3165543 (UMLS CUI [1,1])
C4264524 (UMLS CUI [1,2])
undefined item
Code List
Has this patient’s data been previously collected under a different patient number?
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Participant ID at transferring facility
Item
If YES, Participant Identification number (PIN):
text
C3165543 (UMLS CUI [1,1])
C4264524 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item Group
Signs and symptoms at hospital admission
C0037088 (UMLS CUI-1)
C0184666 (UMLS CUI-2)
Body temperature
Item
Body temperature
float
C0005903 (UMLS CUI [1])
Item
Temperature unit
integer
C0005903 (UMLS CUI [1,1])
C1519795 (UMLS CUI [1,2])
Temperature unit
Code List
Temperature unit
CL Item
Celsius (1)
CL Item
Fahrenheit (2)
Heart Rate
Item
Heart Rate (HR):
integer
C0018810 (UMLS CUI [1])
Respiratory rate
Item
Respiratory rate (RR)
integer
C0231832 (UMLS CUI [1])
Systolic BP
Item
Systolic blood pressure
integer
C0871470 (UMLS CUI [1])
Diastolic BP
Item
Diastolic blood pressure
integer
C0428883 (UMLS CUI [1])
Oxygen saturation
Item
Oxygen saturation
integer
C0523807 (UMLS CUI [1])
Item
Oxygen saturation under which condition?
integer
C0523807 (UMLS CUI [1,1])
C0449438 (UMLS CUI [1,2])
Severe dehydration
Code List
Oxygen saturation under which condition?
CL Item
Room air (1)
CL Item
Oxygen therapy (2)
CL Item
N/A (3)
Item
Sternal capillary refill time >2seconds
integer
C1714880 (UMLS CUI [1])
Severe dehydration
Code List
Sternal capillary refill time >2seconds
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Height
Item
Height:
integer
C0005890 (UMLS CUI [1])
Weight
Item
Weight:
integer
C0005910 (UMLS CUI [1])
Item Group
Admission signs and symptoms
C0037088 (UMLS CUI-1)
C0184666 (UMLS CUI-2)
Item
History of fever
integer
C0015967 (UMLS CUI [1,1])
C0019664 (UMLS CUI [1,2])
History of fever
Code List
History of fever
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Cough
integer
C0010200 (UMLS CUI [1])
History of fever
Code List
Cough
CL Item
YES-non-productive (1)
CL Item
YES-productive (2)
CL Item
YES-with haemoptysis (3)
CL Item
No (4)
CL Item
Unknown (5)
Item
Sore throat
integer
C0242429 (UMLS CUI [1])
History of fever
Code List
Sore throat
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Runny nose (Rhinorrhoea)
integer
C1260880 (UMLS CUI [1])
History of fever
Code List
Runny nose (Rhinorrhoea)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Wheezing
integer
C0043144 (UMLS CUI [1])
History of fever
Code List
Wheezing
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Shortness of breath
integer
C0013404 (UMLS CUI [1])
History of fever
Code List
Shortness of breath
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Lower chest wall indrawing
integer
C0205076 (UMLS CUI [1,1])
C0425469 (UMLS CUI [1,2])
History of fever
Code List
Lower chest wall indrawing
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Chest pain
integer
C0008031 (UMLS CUI [1])
History of fever
Code List
Chest pain
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Conjunctivitis
integer
C0009763 (UMLS CUI [1])
History of fever
Code List
Conjunctivitis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Lymphadenopathy
integer
C0497156 (UMLS CUI [1])
History of fever
Code List
Lymphadenopathy
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Headache
integer
C0018681 (UMLS CUI [1])
History of fever
Code List
Headache
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Loss of smell (Anosmia)
integer
C0003126 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Loss of smell (Anosmia)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Loss of taste (Ageusia)
integer
C2364111 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Loss of taste (Ageusia)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Seizures
integer
C0036572 (UMLS CUI [1])
History of fever
Code List
Seizures
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Fatigue / Malaise
integer
C0024528 (UMLS CUI [1])
History of fever
Code List
Fatigue / Malaise
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Anorexia
integer
C0003123 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Anorexia
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Altered consciousness/confusion
integer
C0150450 (UMLS CUI [1])
C0009676 (UMLS CUI [2])
History of fever
Code List
Altered consciousness/confusion
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Muscle aches (Myalgia)
integer
C0231528 (UMLS CUI [1])
History of fever
Code List
Muscle aches (Myalgia)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Joint pain (Arthralgia)
integer
C0003862 (UMLS CUI [1])
History of fever
Code List
Joint pain (Arthralgia)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Inability to walk
integer
C0560046 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Inability to walk
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Abdominal pain
integer
C0000737 (UMLS CUI [1])
History of fever
Code List
Abdominal pain
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Diarrhoea
integer
C0011991 (UMLS CUI [1])
History of fever
Code List
Diarrhoea
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Vomiting / Nausea
integer
C0027497 (UMLS CUI [1])
C0042963 (UMLS CUI [2])
History of fever
Code List
Vomiting / Nausea
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Skin rash
integer
C0015230 (UMLS CUI [1])
History of fever
Code List
Skin rash
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Bleeding (Haemorrhage)
integer
C0019080 (UMLS CUI [1])
History of fever
Code List
Bleeding (Haemorrhage)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Haemorrhage Site
Item
If Bleeding: specify site(s):
text
C0019080 (UMLS CUI [1,1])
C1515974 (UMLS CUI [1,2])
Item
Other symptom(s)
integer
C1457887 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Other symptom(s)
Code List
Other symptom(s)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other symptom(s)
Item
If YES, specify:
text
C1457887 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Item Group
Pre-admission medication (taken within 14 days of admission/presentation at healthcare facility)
C0559269 (UMLS CUI-1)
C0013227 (UMLS CUI-2)
C0332285 (UMLS CUI-3)
C5142984 (UMLS CUI-4)
Item
Angiotensin converting enzyme inhibitors (ACE inhibitors)
integer
C0003015 (UMLS CUI [1])
Angiotensin converting enzyme inhibitors (ACE inhibitors)
Code List
Angiotensin converting enzyme inhibitors (ACE inhibitors)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Angiotensin II receptor blockers (ARBs)
integer
C0521942 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Angiotensin II receptor blockers (ARBs)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Non-steroidalanti-inflammatory(NSAIDs)
integer
C0003211 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Non-steroidalanti-inflammatory(NSAIDs)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Oral steroids
integer
C0038317 (UMLS CUI [1,1])
C1527415 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Oral steroids
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Oral steroids - Specification
Item
Oral steroids - If Yes, agent(s):
text
C0038317 (UMLS CUI [1,1])
C1527415 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Other immunosuppressant agents (not oral steroids)
integer
C0021081 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Other immunosuppressant agents (not oral steroids)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other immunosuppressant agents - Specification
Item
Other immunosuppressant agents (not oral steroids) - If Yes, agent(s):
text
C0021081 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
Item
Antivirals
integer
C0003451 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Antivirals
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Antivirals - Specification
Item
Antivirals - If Yes, agent(s):
text
C0003451 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
Antibiotics
integer
C0003232 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Antibiotics
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Antibiotics - Specification
Item
Antibiotics - If Yes, agent(s):
text
C0003232 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
Item
Other targeted COVID-19 Medications
integer
C0205394 (UMLS CUI [1,1])
C5203670 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
Travel to an area with documentet nCoV infection cases
Code List
Other targeted COVID-19 Medications
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Other targeted COVID-19 Medications - Specification
Item
Other targeted COVID-19 Medications - If Yes, agent(s):
text
C0205394 (UMLS CUI [1,1])
C5203670 (UMLS CUI [1,2])
C0013227 (UMLS CUI [1,3])
C2348235 (UMLS CUI [1,4])
Item Group
Co-morbidities and risk factors
C0009488 (UMLS CUI-1)
C0035648 (UMLS CUI-2)
Item
Chronic cardiac disease, including congenital heart disease (not hypertension)
integer
C1290386 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Chronic cardiac disease, including congenital heart disease (not hypertension)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Hypertension
integer
C0020538 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Hypertension
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Chronic pulmonary disease (not asthma)
integer
C0746102 (UMLS CUI [1,1])
C0332300 (UMLS CUI [1,2])
C0004096 (UMLS CUI [1,3])
Travel to an area with documentet nCoV infection cases
Code List
Chronic pulmonary disease (not asthma)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Asthma (physician diagnosed)
integer
C0004096 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Asthma (physician diagnosed)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Chronic kidney disease
integer
C1561643 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Chronic kidney disease
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Moderate or severe liver disease
integer
C0023895 (UMLS CUI [1,1])
C0205081 (UMLS CUI [1,2])
C0205082 (UMLS CUI [2,1])
C0023895 (UMLS CUI [2,2])
Travel to an area with documentet nCoV infection cases
Code List
Moderate or severe liver disease
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Mild liver disease
integer
C2945599 (UMLS CUI [1,1])
C0023895 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Mild liver disease
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Asplenia
integer
C3810472 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Asplenia
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Chronic neurological disorder
integer
C0027765 (UMLS CUI [1,1])
C0008679 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Chronic neurological disorder
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Malignant neoplasm
integer
C0006826 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Malignant neoplasm
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Chronic hematologic disease
integer
C1275398 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Chronic hematologic disease
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
AIDS / HIV
integer
C0019693 (UMLS CUI [1])
C0001175 (UMLS CUI [2])
AIDS / HIV
Code List
AIDS / HIV
CL Item
Yes - on ART (1)
CL Item
Yes - not on ART (2)
CL Item
No (3)
CL Item
Unknown (4)
Item
Obesity (as defined by clinical staff)
integer
C0028754 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Obesity (as defined by clinical staff)
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Diabetes
integer
C0011849 (UMLS CUI [1])
Chronic cardiac disease
Code List
Diabetes
CL Item
Yes - Type 1  (1)
CL Item
Yes - Type 2  (2)
CL Item
No (3)
CL Item
Unknown (4)
Item
Rheumatologic disorder
integer
C0035452 (UMLS CUI [1,1])
C0012634 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Rheumatologic disorder
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Dementia
integer
C0497327 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Dementia
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Tuberculosis
integer
C0041296 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Tuberculosis
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Malnutrition
integer
C0162429 (UMLS CUI [1])
Travel to an area with documentet nCoV infection cases
Code List
Malnutrition
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Item
Smoking
integer
C1519386 (UMLS CUI [1])
Chronic cardiac disease
Code List
Smoking
CL Item
Yes (1)
CL Item
Never smoked (2)
CL Item
Former smoker (3)
CL Item
Unknown (4)
Item
Other relevant risk factor
integer
C0035648 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
Travel to an area with documentet nCoV infection cases
Code List
Other relevant risk factor
CL Item
Yes (1)
CL Item
No (2)
CL Item
Unknown (3)
Specification of relevant risk factor
Item
If other relevant risk factors are known, please specify:
text
C0035648 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
C2348235 (UMLS CUI [1,3])
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