CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Infection Form (IFN)
Sub-Domain: Additional Proposed Instruments
CRF: Infection Form (IFN)
21 results.
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C58928 | Organism code | OrgCode | Code indicating organism. | Code indicating organism. | Organism: | B52;B53;B54;B55;B56;B57;B58;B59;B60;B99;V01;V02;V03;V04;V05;V06;V07;V08;V09;V10;V11;V12;V13;V14;V15;V16;V17;V18;V19;V20;V21;V22;P1;P2;P3;P4;P5;P6;P7;P8;O1;O2;O3;O4;F01;F02;F03;F04;F05;F06;F07;F08;F09;F10;F11;F12;F13;F14;F15;B01;B02;B03;B04;B05;B06;B07;B08;B09;B11;B12;B13;B14;B15;B16;B17;B18;B19;B20;B21;B22;B23;B24;B25;B26;B27;B28;B29;B30;B31;B32;B33;B34;B35;B36;B37;B38;B39;B40;B41;B42;B43;B44;B45;B46;B47;B48;B49;B50;B51 | Staphylococcus (coag-);Staphylococcus (coag +);Staphylococcus (NOS);Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Treponema (syphilis);Tuberculosis (NOS, AFB, acid fast bacillus, Koch bacillus);Typical Tuberculosis (TB, Tuberculosis);Vibrio (all species);Other Bacteria;Herpes Simplex (HSV1, HSV2);Herpes Zoster (Chicken Pox, Varicella);Cytomegalovirus (CMV);Adenovirus;Enterovirus (Coxsackie, Echo, Polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (includes non-A and non-B, HCV);HIV-1, HITLV-III;Influenza (Flu);Measles (Rubeola);Mumps;Papovavirus;Respiratory Syncytial virus (RSV);Rubella (German Measles);Parainfluenza;HHV-6 (Human Herpes Virus);Epstein-Barr Virus (EBV);Polyomavirus;Rotavirus;Rhinovirus (Common Cold);Other Viral;Pneumoncystis (PCP);Toxoplasma;Giardia;Cryptosporidium;Amebiasis;Echinoco ocalcyst;Trichomonas (either vaginal or gingivitis);Other Protozoal (parasite);Mycobacterium Tuberculosis;Other Mycobacterium;Mycoplasma;Other Organism;Candida Albicans;Candida Krusei;Candida Parasilosis;Candida Tropicalis;Torulopsis Galbrata (a subspecies of Candida);Candida (NOS);Asperguillus Flavus;Asperguillus Fumigatus;Asperguillus Niger;Asperguillus (NOS);Cryptococcus Species;Fusarium Species;Mucormycosis (Zygomycetes, Rhizopus);Yeast (NOS);Other Fungus;Acinetobacter (baumanii, calcoaceticus, lwoffi, other species);Agrobacterium radiobacter;Alcaligenes xylosoxidans;Anaerobic bacteria (NOS, except for Bacteroides, Clostridium);Bacillus (cereus, other species);Bacteroides (gracillis, uniformis, vulgaris, other species);Borrelia (Lyme Disease);Branhamelia or Moraxella catarrhalis (other species);Campylobacter (all species);Chlamydia;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium diificile;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium nucleatum;Gram Negative Diplococci (NOS);Gram Negative Rod (NOS);Gram Positive Cocci (NOS);Gram Positive Rod (NOS);Haemophilus (all species including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus, other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus (NOS);Mycobacteria (avium, bovium, haemophilum, intercellulare);Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pharyngeal/Respiratory Flora;Propionbacterium (acnes, avidum, granulosum, other species);Pseudomonas (all species except cepacia and maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-19 13:21:14.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | FN1ORGN | |||||||||||||||||||||||||||
| C58940 | Specific event type | SpecEvntTyp | Specific event type that lead to an advanced care intervention or Intensive Care Unit admission/transfer as outlined in the AE reporting section of chapter 4 of the protocol. | Specific event type that lead to an advanced care intervention or Intensive Care Unit admission/transfer as outlined in the AE reporting section of chapter 4 of the protocol. | Specify event(s): | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-03 15:24:38.0 | Infection Form (IFN) | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFNAESP | ||||||||||||||||||||||||||||
| C58929 | Infection severity code | InfectionSeverityCode | Code indicating the severity of the infection. | Code indicating the severity of the infection. | Severity of infection: | 2;3 | Grade 2;Grade 3 | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-19 13:25:56.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1SVRT | |||||||||||||||||||||||||||
| C18027 | Comment text | CmmntTxt | Provide any additional information that pertains to the question. | Provide any additional information that pertains to the question. | Comments: | Alphanumeric | Adult;Pediatric | Proposed | 3.00 | 2013-07-16 14:01:43.01 | Infection Form (IFN) | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C58930 | Specific other infection type | SpecificOtherInfectionTyp | The specific type of infection if not otherwise listed. | The specific type of infection if not otherwise listed. | Specify other organism: | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-19 13:34:53.0 | Infection Form (IFN) | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1OTSP | ||||||||||||||||||||||||||||
| C58915 | Nonmicrobiologically defined infection code | NonmcblgyDfnIfnCode | Code indicating whether infection is nonmicrobiologically defined. | Code indicating whether infection is nonmicrobiologically defined. | Is the infection a nonmicrobiologically defined infection? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:35:14.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1NMCR | |||||||||||||||||||||||||||
| C58931 | Sepsis evidence code | SepsisEvdnceCode | Code indicating whether there was evidence of sepsis. | Code indicating whether there was evidence of sepsis. | Was there evidence of sepsis? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-19 14:44:13.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1EVSP) | |||||||||||||||||||||||||||
| C58917 | Infection related to pneumonia or bronchopneumonia code | IfnRltdToPneuOrBrnpneuCode | Code indicating whether the patient has evidence of pneumonia or bronchopneumonia related to an infection. | Code indicating whether the patient has evidence of pneumonia or bronchopneumonia related to an infection. | Did the patient have evidence of pneumonia or bronchopneumonia related to an infection? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:39:31.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1PTPN | |||||||||||||||||||||||||||
| C58932 | New or worsening infiltrates evidence infection time code | NOWInfltrtsEvInfTmCode | Code indicating whether there was evidence of new or worsening infiltrates at the time of infection. | Code indicating whether there was evidence of new or worsening infiltrates at the time of infection. | Was there evidence of new or worsening infiltrates at the tie of the infection? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-24 10:39:43.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1EVIN | |||||||||||||||||||||||||||
| C58919 | Mechanical ventilation required code | MechnclVentlnReqCode | Code indicating whether the patient required mechanical ventilation. | Code indicating whether the patient required mechanical ventilation. | Did the patient require mechanical ventilation? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:43:39.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1PTVT | |||||||||||||||||||||||||||
| C58933 | Infection treated by administered agent code | InfnTrtByAdminAgntCode | Code indicating whether an agent(s) was administered to treat infection(s). | Code indicating whether an agent(s) was administered to treat infection(s). | Was an agent(s) administered to treat the infection? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values |
Agents administered for prophylaxis should not be reported. |
Adult;Pediatric | Proposed | 1.00 | 2018-12-24 11:27:48.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFNAGTRT | ||||||||||||||||||||||||||
| C58923 | Patient typhlitis code | PtntTyphlitisCode | Code indicating whether the patient had typhlitis. | Code indicating whether the patient had typlitis. | Did the patient have typhlitis? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:52:21.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1PTTY | |||||||||||||||||||||||||||
| C58934 | Infection administered agent name | InfcnAdminAgentName | Name indicating the agent(s) administered for the infection(s). | Name indicating the agent(s) administered for the infection(s). | Provide agent(s) administered to treat the infection(s): | Abacavir (Ziagen);Acyclovir (Zovirax);Albendazole (Albenza);Amantadine (Symmetrel, Symadine);Amikacin (Amikin);Amoxicillin/clavulanate (Augmentin);Amphotericin b (Abelcet, Amphotec, Fungizone);Ampicillin (Omnipen, Polycillin);Ampicillin/Sulbactam (Unasyn);Amprenavir (Agenerase);Atovaquone (Meprone);Azithromycin (Zithromax, Z-Pack);Cefaclor (Ceclor);Cefadroxil (Duricef, Ultracef);Cefazolin (Ancef, Kefzol);Cefdinir (Omnicef);Cefepime (Maxipime);Cefixime (Suprax);Cefoperazone (Cefobid);Cefotaxime (Claforan);Cefotetan (Cefotan);Cefoxitin (Mefoxin);Cefpodoxime (Vantin);Cefprozil (Cefzil);Ceftazidime (Fortaz, Tazicef);Ceftriaxone (Rocephin);Cefuroxime (Ceftin, Kefurox, Zinacef);Cephalexin (Keflet, Keflex, Keftab);Chloramphenicol (Chloromycetin);Cidofovir (Vistide);Ciprofloxacin (Cipro);Clarithromycin (Biaxin);Clindamycin (Cleocin);Clotrimazole (Mycelex, Lotrimin);Clotrimoxazole/betamethasone (Lotrisone);Co-trimoxazole (Bactrim, Septra, Sulfamethoprim);Dapsone (DDS);Dicloxacillin (Dycill, Dynapen, Pathocil);Didanosine (Videx, ddl);Doxycycline (Vibramycin);Efavirenz (Sustiva);Erythromycin (Ery-Tab, llosone, Pediamycin);Erythromycin ethyl/sulfisoxazole (Pediazole);Erythromycin topical (Akne-mycin, Eryderm);Ethambutol (Myambutol);Famciclovir (Famvir);Fluconazole (Diflucan);Flucytosine (Ancobon);Foscarnet (Foscavir);Ganciclovir (Cytovene);Gatifloxican (Tequin);Gentamicin (Garamycin, Gentacidin);Grepafloxacin (Raxar);Hepatitis A Vaccine (Havrix, Vaqta);Hepatitis B Vaccine (Recombivax HB, Energix-B);Hepatitis C Vaccine;Imipenem/Cilastatin (Primaxin);Imiquimod (Aldara);Indinavir (Crixivan);Interferon Alfacon-1 (Infergen);Interferon beta-1a (Avonex);Interferon beta-1b (Betaseron);Isoniazid (INH, Lanizid, Nydrazid);Itraconazole (Sporonox);Ivermectin (Stromectol);Kanamycin (Kantrex);Ketoconazole (Nizoral);Lamivudine (Epivir, 3TC);Levofloxacin (Levaquin);Linezolid (Zyvox);Lopinavir/Ritonavir (Kaletra);Mefloquine (Larium);Meropenem (Merrem I.V.);Metronidazole (Flagyl, Protostat);Minocycline (Arestin);Moxifloxacin hydrochloride (Avelox);Mupirocin (Bactroban);Nafcillin (Nallpen, Unipen);Nelfinavir (Viracept);Neomycin (Mycifradin, Myciguent);Neomycin/Polymxin/Hydrocortisone (Cortisporin);Nevirapine (Viramune);Nitrofurantoin (Macrobid);Nystatin (Mycostatin);Oseltamivir (Tamiflu);Oxacillin (Bactocill);Palivizumab (Synagis);Penicillin G (Bicillin);Penicillin vk (V-Cillin K, Veetids);Pentamidine (Pentam 300);Piperacillin (Pipracil);Piperacillin/Tazobactam (Zosyn);Podofilox (Condylox);Polymyxin (Ak-Spore H.C., Cortisporin Opthalmic Suspension);PPD Skin test (Mantoux Test, Tine Test);Pyrazinamide (Rifater);Pyrimethamine (Daraprim);Quinidine gluconate (Duraquin, Cardioqiuin);Quinupristin/Dalfopristin (Synercid);Respiratory syncytial immune globulin (Respigam);Ribavirin (Virazole);Rifampin (Rifadin, Rimactane);Rifampin/Isoniazid (Rifamate, Rimactane/INH);Rifampin/isoniazid/Pyrazinamide (Rifater);Rimantadine (Flumadine);Ritonavir (Norvir);Saquinavir mesylate (Fortovase, Invirase);Stavudine (d4T, Zerit);Streptomycin (Streptomycin sulfate);Sulfamethoxazole/Trimethoprim (Bactrim);Terbinafine (Lamisil);Terconazole (Terazol);Tetracycline (Achromycin);Ticarcillin/Clavulanate (Ticar, Timentin);Tobramycin (Nebcin, Tobrex, TobraDex);Trimethoprim/Sulfamethoxazole (Bactrim, Spetra, Co-trimoxazole);Valganciclovir (Valtrex);Valganciclovir (Valcyte);Vancomycin (Vancocin);Zidovudine (AZT, Retrovir);Other | Abacavir (Ziagen);Acyclovir (Zovirax);Albendazole (Albenza);Amantadine (Symmetrel, Symadine);Amikacin (Amikin);Amoxicillin/clavulanate (Augmentin);Amphotericin b (Abelcet, Amphotec, Fungizone);Ampicillin (Omnipen, Polycillin);Ampicillin/Sulbactam (Unasyn);Amprenavir (Agenerase);Atovaquone (Meprone);Azithromycin (Zithromax, Z-Pack);Cefaclor (Ceclor);Cefadroxil (Duricef, Ultracef);Cefazolin (Ancef, Kefzol);Cefdinir (Omnicef);Cefepime (Maxipime);Cefixime (Suprax);Cefoperazone (Cefobid);Cefotaxime (Claforan);Cefotetan (Cefotan);Cefoxitin (Mefoxin);Cefpodoxime (Vantin);Cefprozil (Cefzil);Ceftazidime (Fortaz, Tazicef);Ceftriaxone (Rocephin);Cefuroxime (Ceftin, Kefurox, Zinacef);Cephalexin (Keflet, Keflex, Keftab);Chloramphenicol (Chloromycetin);Cidofovir (Vistide);Ciprofloxacin (Cipro);Clarithromycin (Biaxin);Clindamycin (Cleocin);Clotrimazole (Mycelex, Lotrimin);Clotrimoxazole/betamethasone (Lotrisone);Co-trimoxazole (Bactrim, Septra, Sulfamethoprim);Dapsone (DDS);Dicloxacillin (Dycill, Dynapen, Pathocil);Didanosine (Videx, ddl);Doxycycline (Vibramycin);Efavirenz (Sustiva);Erythromycin (Ery-Tab, llosone, Pediamycin);Erythromycin ethyl/sulfisoxazole (Pediazole);Erythromycin topical (Akne-mycin, Eryderm);Ethambutol (Myambutol);Famciclovir (Famvir);Fluconazole (Diflucan);Flucytosine (Ancobon);Foscarnet (Foscavir);Ganciclovir (Cytovene);Gatifloxican (Tequin);Gentamicin (Garamycin, Gentacidin);Grepafloxacin (Raxar);Hepatitis A Vaccine (Havrix, Vaqta);Hepatitis B Vaccine (Recombivax HB, Energix-B);Hepatitis C Vaccine;Imipenem/Cilastatin (Primaxin);Imiquimod (Aldara);Indinavir (Crixivan);Interferon Alfacon-1 (Infergen);Interferon beta-1a (Avonex);Interferon beta-1b (Betaseron);Isoniazid (INH, Lanizid, Nydrazid);Itraconazole (Sporonox);Ivermectin (Stromectol);Kanamycin (Kantrex);Ketoconazole (Nizoral);Lamivudine (Epivir, 3TC);Levofloxacin (Levaquin);Linezolid (Zyvox);Lopinavir/Ritonavir (Kaletra);Mefloquine (Larium);Meropenem (Merrem I.V.);Metronidazole (Flagyl, Protostat);Minocycline (Arestin);Moxifloxacin hydrochloride (Avelox);Mupirocin (Bactroban);Nafcillin (Nallpen, Unipen);Nelfinavir (Viracept);Neomycin (Mycifradin, Myciguent);Neomycin/Polymxin/Hydrocortisone (Cortisporin);Nevirapine (Viramune);Nitrofurantoin (Macrobid);Nystatin (Mycostatin);Oseltamivir (Tamiflu);Oxacillin (Bactocill);Palivizumab (Synagis);Penicillin G (Bicillin);Penicillin vk (V-Cillin K, Veetids);Pentamidine (Pentam 300);Piperacillin (Pipracil);Piperacillin/Tazobactam (Zosyn);Podofilox (Condylox);Polymyxin (Ak-Spore H.C., Cortisporin Opthalmic Suspension);PPD Skin test (Mantoux Test, Tine Test);Pyrazinamide (Rifater);Pyrimethamine (Daraprim);Quinidine gluconate (Duraquin, Cardioqiuin);Quinupristin/Dalfopristin (Synercid);Respiratory syncytial immune globulin (Respigam);Ribavirin (Virazole);Rifampin (Rifadin, Rimactane);Rifampin/Isoniazid (Rifamate, Rimactane/INH);Rifampin/isoniazid/Pyrazinamide (Rifater);Rimantadine (Flumadine);Ritonavir (Norvir);Saquinavir mesylate (Fortovase, Invirase);Stavudine (d4T, Zerit);Streptomycin (Streptomycin sulfate);Sulfamethoxazole/Trimethoprim (Bactrim);Terbinafine (Lamisil);Terconazole (Terazol);Tetracycline (Achromycin);Ticarcillin/Clavulanate (Ticar, Timentin);Tobramycin (Nebcin, Tobrex, TobraDex);Trimethoprim/Sulfamethoxazole (Bactrim, Spetra, Co-trimoxazole);Valganciclovir (Valtrex);Valganciclovir (Valcyte);Vancomycin (Vancocin);Zidovudine (AZT, Retrovir);Other | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-24 11:31:56.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1AGNT | |||||||||||||||||||||||||||
| C58924 | Severe sepsis patient no identified organism code | SvreSpsPntNoIdnfdOrgansmCode | Code indicating whether the patient had severe sepsis without an identified organism. | Code indicating whether the patient had severe sepsis without an identified organism. | Did the patient have severe sepsis without an identified organism? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 15:59:42.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1PSEP | |||||||||||||||||||||||||||
| C58935 | Infection required additional agents administered code | InfcnReqAddAgntsAdmnCode | Code indicating whether additional agents were administered for infection(s). | Code indicating whether additional agents were administered for infection(s). | Were additional agents administered for the infection(s): | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-24 15:08:51.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFNADDAG) | |||||||||||||||||||||||||||
| C58925 | Infection type | InfectionTyp | Type of infection. | Type of infection. | Type of infection: | B;F;V;P;O | Bacterial;Fungal;Viral;Protozoal;Other | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 16:03:14.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1TYPE | |||||||||||||||||||||||||||
| C58936 | Advanced care intervention ICU required code | AdvCareIntvnICUReqCode | Code indicating whether the reported event lead to an advanced care intervention or Intensive Care Unit admission/transfer. | Code indicating whether the reported event lead to an advanced care intervention or Intensive Care Unit admission/transfer. | Did any of the events reported above lead to an advanced care intervention or Intensive Care Unit admission/transfer as outlined in the AE reporting section of chapter 4 of the protocol? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-24 15:12:43.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFNAEICU | |||||||||||||||||||||||||||
| C58926 | Infection site code | InfectionSiteCode | Code indicating the site of infection. | Code indicating the site of infection. | Infection site | 01;02;03;04;05;06;07;08;09;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30;31;32;33;34;35;36;37;38;39;40;41;42;43;99 | Blood/Buffy Coat;Disseminated - Generalized, Isolated at 2 or More Distinct Sites;Brain;Spinal Cord;Meninges and CSF;Central Nervous System Unspecified;Lips;Tongue, Oral Cavity, and Oro-Pharynx;Esophagus;Stomach;Gallbladder and Billary Tree (Not Hepatitis), Pancreas;Small Intestine;Large Intestine;Feces/Stool;Peritoneum;Liver;Gastrointestinal Tract Unspecified;Upper Airway and Nasopharynx;Larynx;Lower Respiratory Tract (Lung);Pleural Cavity, Pleural Fluid;Sinuses;Respiratory Tract Unspecified;Kidneys, Renal Pelvis, Ureters and Bladder;Prostate;Testes;Fallopian Tubes, Uterus, Cervix;Vagina;Genito-Urinary Tract Unspecified;Genital Area;Rash, Pustules, or Abscesses Not Typical of Any of the Above;Skin Unspecified;Woundsite;Catheter Tip;Eyes;Ears;Joints;Bone Marrow;Bone Cortex (Osteomyelitis);Muscle (Excluding Cardiac);Cardiac (Endocardium, Myocardium, Pericardium);Lymph Nodes;Spleen;Other Unspecified | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2018-12-17 16:10:26.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | INFSITE | |||||||||||||||||||||||||||
| C58938 | Specify other agent type | SpcfyOthAgntTyp | Type of agent specified if agent is not listed. | Type of agent specified if agent is not listed. | Specify other agent: | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-03 15:11:51.0 | Infection Form (IFN) | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFN1AGSP | ||||||||||||||||||||||||||||
| C58927 | Infection start date | InfectionStartDate | Date indicating the start of the infection. | Date indicating the start of the infection. | Infection start date: | Date or Date & Time |
Data sharing instructions: When date/time data are prepared for aggregation or sharing, they should be converted to the format specified by ISO 8601; YYYY-MM-DD T:hh:mm:ss. |
Adult;Pediatric | Proposed | 1.00 | 2018-12-17 16:12:14.0 | Infection Form (IFN) | Additional Proposed Instruments | Other |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | INFSTDT | ||||||||||||||||||||||||||||
| C58939 | Additional agents administered type | AddlAgntAdminTyp | Type of specific additional agent administered for an infection. | Type of specific additional agent administered for an infection. | If yes, specify additional agents administered: | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-03 15:21:49.0 | Infection Form (IFN) | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Infection Form (IFN) | IFNADDSP |
21 results.