CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Withdrawal of Consent Form (WOC)
Sub-Domain: Additional Proposed Instruments
CRF: Withdrawal of Consent Form (WOC)
8 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C59085 | Study procedure consent withdrawal code | StdyPrcdrCnsntWdrwlCode | Code indicating whether the patient withdrew consent to all study procedures | Code indicating whether the patient withdrew consent to all study procedures | Did the patient withdraw consent to all study procedures? | 1;2;1;2 | Yes;No;Yes;No | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 11:38:34.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCSTP | |||||||||||||||||||||||||||
| C59086 | Consent withdrawal date | ConsentWithdrwlDate | Date indicating when patient withdrew consent | Date indicating when patient withdrew consent | Date patient withdrew consent: | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:14:15.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCSTPDT | |||||||||||||||||||||||||||||
| C59087 | Investigational study drug consent withdrawal code | InvstglStdyDrgCnsntWdrlCode | Code indicating whether patient's consent to investigational study drug was withdrawn | Code indicating whether patient's consent to investigational study drug was withdrawn | Did the patient withdraw consent to receive investigational study drug? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:17:21.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCISD | |||||||||||||||||||||||||||
| C59088 | Future research blood sample consent withdrawal code | FtrRsrchBldSmplCnstWdrlcode | Code indicating whether or not patient withdrew consent to provide optional blood samples for future research or ancillary studies | Code indicating whether or not patient withdrew consent to provide optional blood samples for future research or ancillary studies | Did the patient withdraw consent to provide optional blood samples for future research or ancillary studies? | 1;2;3 | Yes;No;Not Applicable | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:21:41.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCFRB | |||||||||||||||||||||||||||
| C59089 | Bone marrow sample future research consent withdrawal code | BnMrrwSmplFtrRschCnstWdlCode | Code indicating whether the patient withdrew consent to provide optional bone marrow samples for future research or ancillary studies | Code indicating whether the patient withdrew consent to provide optional bone marrow samples for future research or ancillary studies | Did the patient withdraw consent to provide optional bone marrow samples for future research or ancillary studies? | 1;2;3 | Yes;No;Not Applicable | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:45:07.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCFBM | |||||||||||||||||||||||||||
| C59090 | Consent withdrawn provide study data code | CnstWthdrwnPrvdStdyDtaCode | Code indicating whether patient withdrew consent to provide data for the study | Code indicating whether patient withdrew consent to provide data for the study | Did the patient withdraw consent to provide data for the study? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:50:45.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCPDA | |||||||||||||||||||||||||||
| C59091 | Urine sample research consent withdrawal code | UrineSmplRsrchCnsntWdrlCode | Code indicating whether patient withdrew consent to provide optional urine samples for research or ancillary studies | Code indicating whether patient withdrew consent to provide optional urine samples for research or ancillary studies | Did the patient withdraw consent to provide optional urine samples for research or ancillary studies? | 1;2;3 | Yes;No;Not Applicable | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-14 14:55:10.0 | Withdrawal of Consent Form (WOC) | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Withdrawal of Consent Form (WOC) | WOCURSAM |
8 results.