Site Number
Item
Site Number:
integer
C0018704 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Patient Number
Item
Patient Number
integer
C1830427 (UMLS CUI [1])
Patient Initials
Item
Patient Initials
text
C2986440 (UMLS CUI [1])
Hematology Date
Item
Hematology Date
date
C0474523 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Lab Nr.
Item
Lab # (Worksheet B)
text
C1300638 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
WBC
Item
WBC
float
C0023508 (UMLS CUI [1])
RBC
Item
RBC
float
C0014772 (UMLS CUI [1])
Hemoglobin
Item
Hemoglobin
float
C0019046 (UMLS CUI [1])
Hematocrit
Item
Hematocrit
float
C0518014 (UMLS CUI [1])
Platelets
Item
Platelets
float
C0005821 (UMLS CUI [1])
Neutrophils
Item
Neutrophils
float
C0200633 (UMLS CUI [1])
Lymphocytes
Item
Lymphocytes
float
C0200635 (UMLS CUI [1])
Monocytes
Item
Monocytes
float
C0200637 (UMLS CUI [1])
Eosinophils
Item
Eosinophils
float
C0200638 (UMLS CUI [1])
Basophils
Item
Basophils
float
C0200641 (UMLS CUI [1])
Other Differential
Item
Other Differential
text
C0022885 (UMLS CUI [1,1])
C0205394 (UMLS CUI [1,2])
ANC-Absolute Neutrophile Count
Item
Absolute Neutrophile Count-ANC (10³/mm³)
float
C0948762 (UMLS CUI [1])
Chemistry Date
Item
Chemistry Date
date
C0011008 (UMLS CUI [1,1])
C0005774 (UMLS CUI [1,2])
Lab Nr.
Item
Lab # (Worksheet B)
text
C1300638 (UMLS CUI [1,1])
C0022877 (UMLS CUI [1,2])
Sodium
Item
Sodium
float
C0337443 (UMLS CUI [1])
Potassium
Item
Potassium
float
C0202194 (UMLS CUI [1])
Chloride
Item
Chloride
float
C0201952 (UMLS CUI [1])
BUN
Item
BUN
float
C0005845 (UMLS CUI [1])
Creatinine
Item
Creatinine
float
C0201976 (UMLS CUI [1])
AST (SGOT)
Item
AST (SGOT)
float
C0201899 (UMLS CUI [1])
ALT (SGPT)
Item
ALT (SGPT)
float
C0201836 (UMLS CUI [1])
Alkaline Phosphatase
Item
Alkaline Phosphatase
float
C0201850 (UMLS CUI [1])
LDH
Item
LDH
float
C0202113 (UMLS CUI [1])
Total Bilirubin
Item
Total Bilirubin
float
C0201913 (UMLS CUI [1])
TSH
Item
TSH
float
C0202230 (UMLS CUI [1])
Total T3
Item
Total T3
float
C0428419 (UMLS CUI [1])
Free T4
Item
Free T4
float
C0202225 (UMLS CUI [1])
N/A
Item
N/A
boolean
C1272460 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Date
Item
Date
date
C0011008 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Item
Sample
integer
C0200345 (UMLS CUI [1,1])
C0032976 (UMLS CUI [1,2])
Item
Result
integer
C0427777 (UMLS CUI [1])
Date
Item
Date
date
C0011008 (UMLS CUI [1,1])
C0022885 (UMLS CUI [1,2])
C0005149 (UMLS CUI [1,3])
Result
Item
Result
text
C1274040 (UMLS CUI [1,1])
C0005149 (UMLS CUI [1,2])
Date Administered
Item
Date Administered
date
C1533734 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Baseline HAMA date
Item
Baseline HAMA date
date
C1291910 (UMLS CUI [1,1])
C1442488 (UMLS CUI [1,2])
C0011008 (UMLS CUI [1,3])
Item
Baseline HAMA Result
integer
C1442488 (UMLS CUI [1,1])
C1291910 (UMLS CUI [1,2])
C1274040 (UMLS CUI [1,3])
Code List
Baseline HAMA Result
Time Started (cold)
Item
Time Started (24 hour clock) (cold)
time
C1301880 (UMLS CUI [1])
Time Finished (24 hour clock) (cold)
Item
Time Finished (24 hour clock) (cold)
time
C1522314 (UMLS CUI [1])
Time Started (24 hour clock) (cold flush)
Item
Time Started (24 hour clock) (cold flush)
time
C1301880 (UMLS CUI [1])
Time Finished (24 hour clock) (cold flush)
Item
Time Finished (24 hour clock) (cold flush)
time
C1522314 (UMLS CUI [1])
Time Started (24 hour clock) (hot)
Item
Time Started (24 hour clock) (hot)
time
C1301880 (UMLS CUI [1])
Time Finished (24 hour clock) (hot)
Item
Time Finished (24 hour clock) (hot)
time
C1522314 (UMLS CUI [1])
Time Started (24 hour clock) (hot flush)
Item
Time Started (24 hour clock) (hot flush)
time
C1301880 (UMLS CUI [1])
Time Finished (24 hour clock) (hot flush)
Item
Time Finished (24 hour clock) (hot flush)
time
C1522314 (UMLS CUI [1])
Anti-B1 Dose (cold dose)
Item
Anti-B1 Dose (cold dose)
float
C0768182 (UMLS CUI [1,1])
C3174092 (UMLS CUI [1,2])
Lot number of Anti-B1 (cold)
Item
Lot number of Anti-B1 (cold)
text
C1115660 (UMLS CUI [1,1])
C0768182 (UMLS CUI [1,2])
Anti-B1 Dose (hot dose)
Item
Anti-B1 Dose (hot dose)
float
C0768182 (UMLS CUI [1,1])
C3174092 (UMLS CUI [1,2])
Lot number of Anti-B1 (hot)
Item
Lot number of Anti-B1 (hot)
text
C1115660 (UMLS CUI [1,1])
C0768182 (UMLS CUI [1,2])
Iodine-131 Anti-B1 (prescribed)
Item
Iodine-131 Anti-B1 (prescribed)
text
C0768182 (UMLS CUI [1])
Lot Number (Nordion)
Item
Lot Number (Nordion)
text
C1115660 (UMLS CUI [1,1])
C3854006 (UMLS CUI [1,2])
Infusion rate need to be adjusted?
Item
Did infusion rate need to be adjusted?
boolean
C2964135 (UMLS CUI [1,1])
C2826232 (UMLS CUI [1,2])
Item
If yes, was infusion rate
integer
C2964135 (UMLS CUI [1,1])
C2826232 (UMLS CUI [1,2])
Code List
If yes, was infusion rate
CL Item
Decreased by 1/2 (1)
Item
If the infusion rate was adjusted, was it for (check all that apply)
integer
C2964135 (UMLS CUI [1,1])
C2826232 (UMLS CUI [1,2])
Code List
If the infusion rate was adjusted, was it for (check all that apply)
CL Item
mucosal congestion/edema (4)
Did the patient have any adverse experiences?
Item
Did the patient have any adverse experiences? (If yes, please record on AE page)
boolean
C0877248 (UMLS CUI [1])
(Note; only Day 7) Compliance with SSKI, Lugol`s solution or Potassium iodide
Item
(Note; only Day 7) Was patient compliant with SSKI, Lugol`s solution or Potassium iodide as described in protocol?
boolean
C1321605 (UMLS CUI [1,1])
C0032831 (UMLS CUI [1,2])
C0065234 (UMLS CUI [1,3])
(Note; only Day 7) If No to previous question please explain
Item
(Note; only Day 7) If No to previous question please explain
text
C0947611 (UMLS CUI [1,1])
C0681841 (UMLS CUI [1,2])