Sub-Domain: Treatment/Intervention Data
CRF:
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 |
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C58954 | Etiology upper GI abnormality conditioning regimen toxicity indicate code | EtioUpGIAbnConRegToxIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be conditioning regimen toxicity. | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be conditioning regimen toxicity. | Upper intestinal tract etiologies: Conditioning regimen toxicity | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETCON | |||||||||||||||||||||||||||
C58965 | Etiology lower GI abnormality other indicate code | EtiolLoGIAbnrmOthrIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be Other. | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be Other. | Lower intestinal tract etiologies: Other | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETOTH | |||||||||||||||||||||||||||
C58944 | Blood sample date | BloodSampleDate | Date on which blood sample was obtained. | Date on which blood sample was obtained. | Record date blood sample obtained | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:56:08.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | TROUGHDT | |||||||||||||||||||||||||||||
C58976 | Liver biopsy GVHD result code | LivrBiopsyGVHDResultCode | Code for the result of the liver biopsy performed for graft-versus-host disease (GVHD) | Code for the result of the liver biopsy performed for graft-versus-host disease (GVHD) | Liver biopsy for GVHD | 1;2;3;4 | Positive;Negative;Equivocal;Not done | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:12:38.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHLIVRB | |||||||||||||||||||||||||||
C58955 | Etiology upper GI abnormality total parenteral nutrition indicate code | EtioUpGIAbnrmTPNIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be TPN (total parenteral nutrition). | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be TPN (total parenteral nutrition). | Upper intestinal tract etiologies: TPN | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:24:15.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETTPN | |||||||||||||||||||||||||||
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 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 4000 |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||
C58966 | Etiology lower GI abnormality other indicate code other text | EtiolLoGIAbnrmOthrIndCodeOTH | The free-text field related to 'Etiology lower GI abnormality other indicate code' specifying other text. | The free-text field related to 'Etiology lower GI abnormality other indicate code' specifying other text. | Specify other lower intestinal tract etiologies | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:09:08.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETSPC | ||||||||||||||||||||||||||||
C58945 | Etiology skin abnormality GVHD indicate code | EtiolSkinAbnormGVHDIndCode | Code indicating whether the etiology of the skin abnormality was determined to be GVHD (graft-versus-host disease). | Code indicating whether the etiology of the skin abnormality was determined to be GVHD (graft-versus-host disease). | Skin etiologies: GVHD | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | SETGVHD | |||||||||||||||||||||||||||
C58977 | GVHD treatment modify assess period indicate code | GVHDTreatModAssesPerIndCode | Code indicating whether treatment for GVHD (graft-versus-host disease) was modified during the assessment period. | Code indicating whether treatment for GVHD (graft-versus-host disease) was modified during the assessment period. | Was any treatment of GVHD modified during this assessment period? | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 15:00:44.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHTHERP | |||||||||||||||||||||||||||
C58956 | Etiology upper GI abnormality infection indicate code | EtiolUpGIAbnrmInfctnIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be an infection. | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be an infection. | Upper intestinal tract etiologies: Infection | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETINF | |||||||||||||||||||||||||||
C58823 | Assessment period start date | AssessmentPeriodStartDate | Date of the beginning of the assessment period | Date of the beginning of the assessment period | Start of GVHD assessment period | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:06:29.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | DTPRVAST | |||||||||||||||||||||||||||||
C58967 | Lower GI biopsy GVHD result code | LoGIBiopsyGVHDResultCode | Code for the result of the lower GI (gastrointestinal tract) biopsy performed for GVHD (graft-versus-host disease). | Code for the result of the lower GI (gastrointestinal tract) biopsy performed for GVHD (graft-versus-host disease). | Lower intestinal tract biopsy for GVHD | 1;2;3;4 | Positive;Negative;Equivocal;Not done | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:12:38.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIBIORS | |||||||||||||||||||||||||||
C58946 | Etiology skin abnormality drug reaction indicate code | EtiolSkinAbnormDrRxnIndCode | Code indicating whether the etiology of the skin abnormality was determined to be a drug reaction. | Code indicating whether the etiology of the skin abnormality was determined to be a drug reaction. | Skin etiologies: Drug reaction | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | SETDRGRX | |||||||||||||||||||||||||||
C58978 | GVHD treatment agent name code | GVHDTreatmentAgentNameCode | Code denoting the name of the GVHD treatment agent. | Code denoting the name of the GVHD treatment agent. | Specify agent name | 1;2;3;4;5;6;7;8;9 | CSA;FK506;Topical steroids;Prednisone;ATG;MMF;Daclizumab;Methylprednisolone;Other | Numeric Values | Adult | Proposed | 1.00 | 2019-01-04 15:04:13.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHAGENT | |||||||||||||||||||||||||||
C58957 | Etiology upper GI abnormality other indicate code | EtiolUpGIAbnrmOthrIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be Other. | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be Other. | Upper intestinal tract etiologies: Other | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETOTH | |||||||||||||||||||||||||||
C58824 | Assessment period end date | AssessmentPeriodEndDate | Date of the end of the assessment period | Date of the end of the assessment period | End of GVHD assessment period | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:06:29.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | DTASSESS | |||||||||||||||||||||||||||||
C58968 | Etiology liver abnormality GVHD indicate code | EtiolLivrAbnormGVHDIndCode | Code indicating whether the etiology of the liver abnormality was determined to be GVHD (graft-versus-host disease). | Code indicating whether the etiology of the liver abnormality was determined to be GVHD (graft-versus-host disease). | Liver etiologies: GVHD | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETGVH | |||||||||||||||||||||||||||
C58947 | Etiology skin abnormality conditioning regimen toxicity indicate code | EtioSknAbnConRegToxIndCode | Code indicating whether the etiology of the skin abnormality was determined to be conditioning regimen toxicity. | Code indicating whether the etiology of the skin abnormality was determined to be conditioning regimen toxicity. | Skin etiologies: Conditioning regimen toxicity | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | SETCRTOX | |||||||||||||||||||||||||||
C58979 | GVHD treatment agent name code other text | GVHDTreatmentAgentNameCodeOTH | The free-text field related to 'GVHD treatment agent name code' specifying other text. | The free-text field related to 'GVHD treatment agent name code' specifying other text. | Specify other agent | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 15:12:11.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHAGNSP | ||||||||||||||||||||||||||||
C58958 | Etiology upper GI abnormality other indicate code other text | EtiolUpGIAbnrmOthrIndCodeOTH | The free-text field related to 'Etiology upper GI abnormality other indicate code' specifying other text. | The free-text field related to 'Etiology upper GI abnormality other indicate code' specifying other text. | Specify other upper intestinal tract etiologies | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:09:08.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETSPC | ||||||||||||||||||||||||||||
C58828 | Skin abnormality severity at acute GVHD maximum overall grade code | SknAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of skin abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of skin abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Skin abnormalities | 0;1;2;3;4 | No rash;Maculopapular rash, <25% of body surface;Maculopapular rash, 25–50% of body surface;Generalized erythrodema;Generalized erythrodema with bullus formation and desquamation | Numeric Values |
Record the highest level of organ abnormalities |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGASKNAB | ||||||||||||||||||||||||||
C58969 | Etiology liver abnormality drug reaction indicate code | EtiolLivrAbnormDrRxnIndCode | Code indicating whether the etiology of the liver abnormality was determined to be a drug reaction. | Code indicating whether the etiology of the liver abnormality was determined to be a drug reaction. | Liver etiologies: Drug reaction | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETDRG | |||||||||||||||||||||||||||
C58948 | Etiology skin abnormality infection indicate code | EtiolSknAbnrmInfctnIndCode | Code indicating whether the etiology of the skin abnormality was determined to be an infection. | Code indicating whether the etiology of the skin abnormality was determined to be an infection. | Skin etiologies: Infection | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | SETINFCT | |||||||||||||||||||||||||||
C58980 | Treatment modify type code | TreatmentModifyTypeCode | Code denoting the type of treatment modification instituted. | Code denoting the type of treatment modification instituted. | Indicate treatment modification | 1;2;4;5 | Started;Stopped;Tapered;Increased | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 15:14:16.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHTRMOD | |||||||||||||||||||||||||||
C58959 | Upper GI biopsy GVHD result code | UpGIBiopsyGVHDResultCode | Code for the result of the upper GI (gastrointestinal tract) biopsy performed for GVHD (graft-versus-host disease). | Code for the result of the upper GI (gastrointestinal tract) biopsy performed for GVHD (graft-versus-host disease). | Upper intestinal tract biopsy for GVHD | 1;2;3;4 | Positive;Negative;Equivocal;Not done | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:12:38.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIBIORS | |||||||||||||||||||||||||||
C58829 | Upper GI abnormality severity at acute GVHD maximum overall grade code | UGIAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of upper GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of upper GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Upper GI abnormalities | 1;0 | Persistent nausea, vomiting or anorexia;No protracted nausea and vomiting | Numeric Values |
Record the highest level of organ abnormalities |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGAUGIAB | ||||||||||||||||||||||||||
C58970 | Etiology liver abnormality conditioning regimen toxicity indicate code | EtioLivrAbnConRegToxIndCode | Code indicating whether the etiology of the liver abnormality was determined to be conditioning regimen toxicity. | Code indicating whether the etiology of the liver abnormality was determined to be conditioning regimen toxicity. | Liver etiologies: Conditioning Regimen Toxicity | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETCND | |||||||||||||||||||||||||||
C58949 | Etiology skin abnormality other indicate code | EtiolSknAbnrmOthrIndCode | Code indicating whether the etiology of the skin abnormality was determined to be Other. | Code indicating whether the etiology of the skin abnormality was determined to be Other. | Skin etiologies: Other | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | SETOTHER | |||||||||||||||||||||||||||
C58960 | Etiology lower GI abnormality GVHD indicate code | EtiolLoGIAbnormGVHDIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be GVHD (graft-versus-host disease). | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be GVHD (graft-versus-host disease). | Lower intestinal tract etiologies: GVHD | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETGVH | |||||||||||||||||||||||||||
C58830 | Lower GI abnormality severity at acute GVHD maximum overall grade code | LGIAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of lower GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of lower GI (gastrointestinal tract) abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Lower GI abnormalities | 0;1;2;3;4;5 | No diarrhea;Diarrhea less than or equal to 500 mL/day or <280 mL/m^2;Diarrhea >500 but less than or equal to 1000 mL/day or 280–555 mL/m^2;Diarrhea >1000 but less than or equal to 1500 mL/day or 556–833 mL/m^2;Diarrhea >1500 mL/day or >833 mL/m^2;Severe abdominal pain with or without ileus, or stool with frank blood or melena | Numeric Values |
Record the highest level of organ abnormalities. Use mL/day for adult patients and mL/m^2 for pediatric patients |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGALGIAB | ||||||||||||||||||||||||||
C58971 | Etiology liver abnormality total parenteral nutrition indicate code | EtioLivrAbnrmTPNIndCode | Code indicating whether the etiology of the liver abnormality was determined to be TPN (total parenteral nutrition). | Code indicating whether the etiology of the liver abnormality was determined to be TPN (total parenteral nutrition). | Liver etiologies: TPN | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:24:15.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETTPN | |||||||||||||||||||||||||||
C58950 | Etiology skin abnormality other indicate code other text | EtiolSknAbnrmOthrIndCodeOTH | The free-text field related to 'Etiology skin abnormality other indicate code' specifying other text. | The free-text field related to 'Etiology skin abnormality other indicate code' specifying other text. | Specify other skin etiologies | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:09:08.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHSKNSP | ||||||||||||||||||||||||||||
C58961 | Etiology lower GI abnormality drug reaction indicate code | EtiolLoGIAbnormDrRxnIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be a drug reaction. | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be a drug reaction. | Lower intestinal tract etiologies: Drug reaction | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETDRG | |||||||||||||||||||||||||||
C58834 | Liver abnormality severity at acute GVHD maximum overall grade code | LvrAbnSvrAtActGVHDMaxOvlGrdCod | Code for the highest severity of liver abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Code for the highest severity of liver abnormalities at the time of the maximum overall grade of GVHD (Graft Versus Host Disease) | Liver abnormalities | 0;1;2;3;4 | Bilirubin <2.0 mg/dL;Bilirubin 2.0–3.0 mg/dL;Bilirubin 3.1–6.0 mg/dL;Bilirubin 6.1–15.0 mg/dL;Bilirubin >15.0 mg/dL | Numeric Values |
Record the highest level of organ abnormalities |
Adult;Pediatric | Proposed | 1.00 | 2018-12-12 15:24:41.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Follow Up/Chronic GVHD Form (FGV) | FGALVRAB | ||||||||||||||||||||||||||
C58972 | Etiology liver abnormality infection indicate code | EtiolLivrAbnrmInfctnIndCode | Code indicating whether the etiology of the liver abnormality was determined to be an infection. | Code indicating whether the etiology of the liver abnormality was determined to be an infection. | Liver etiologies: Infection | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETINF | |||||||||||||||||||||||||||
C58951 | Skin biopsy GVHD result code | SkinBiopsyGVHDResultCode | Code for the result of the skin biopsy performed for GVHD (graft-versus-host disease). | Code for the result of the skin biopsy performed for GVHD (graft-versus-host disease). | Skin biopsy for GVHD | 1;2;3;4 | Positive;Negative;Equivocal;Not done | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:12:38.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHSKINB | |||||||||||||||||||||||||||
C58962 | Etiology lower GI abnormality conditioning regimen toxicity indicate code | EtioLoGIAbnConRegToxIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be conditioning regimen toxicity. | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be conditioning regimen toxicity. | Lower intestinal tract etiologies: Conditioning regimen toxicity | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETCON | |||||||||||||||||||||||||||
C58941 | GVHD stage date | GVHDStageDate | Date on which GVHD (graft-versus-host disease) stage was determined. | Date on which GVHD (graft-versus-host disease) stage was determined. | Date of staging | Date or Date & Time | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:36:16.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | STAGEDT | |||||||||||||||||||||||||||||
C58973 | Etiology liver abnormality veno-occlusive disease indicate code | EtiolLivrAbnrmVODIndCode | Code indicating whether the etiology of the liver abnormality was determined to be VOD (veno-occlusive disease). | Code indicating whether the etiology of the liver abnormality was determined to be VOD (veno-occlusive disease). | Liver etiologies: VOD | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETVOD | |||||||||||||||||||||||||||
C58952 | Etiology upper GI abnormality GVHD indicate code | EtiolUpGIAbnormGVHDIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be GVHD (graft-versus-host disease). | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be GVHD (graft-versus-host disease). | Upper intestinal tract etiologies: GVHD | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETGVH | |||||||||||||||||||||||||||
C58963 | Etiology lower GI abnormality total parenteral nutrition indicate code | EtioLoGIAbnrmTPNIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be TPN (total parenteral nutrition). | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be TPN (total parenteral nutrition). | Lower intestinal tract etiologies: TPN | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:24:15.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETTPN | |||||||||||||||||||||||||||
C58942 | GVHD immunosuppressant prophylaxis receive type code | GVHDImmunsupProphRcvTypCode | Code for the type of prophylactic immunosuppressant for GVHD (graft-versus-host disease) received by the patient during the assessment period. | Code for the type of prophylactic immunosuppressant for GVHD (graft-versus-host disease) received by the patient during the assessment period. | Immunosuppressant (prophylaxis) received | 2;1;0;3 | Tacrolimus;Cyclosporine;Prednisone;Not taken during assessment | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:43:11.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | IMMUNORC | |||||||||||||||||||||||||||
C58974 | Etiology liver abnormality other indicate code | EtiolLivrAbnrmOthrIndCode | Code indicating whether the etiology of the liver abnormality was determined to be Other. | Code indicating whether the etiology of the liver abnormality was determined to be Other. | Liver etiologies: Other | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LIVETOTH | |||||||||||||||||||||||||||
C58953 | Etiology upper GI abnormality drug reaction indicate code | EtiolUpGIAbnormDrRxnIndCode | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be a drug reaction. | Code indicating whether the etiology of the upper GI (gastrointestinal tract) abnormality was determined to be a drug reaction. | Upper intestinal tract etiologies: Drug reaction | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | UGIETDRG | |||||||||||||||||||||||||||
C58964 | Etiology lower GI abnormality infection indicate code | EtiolLoGIAbnrmInfctnIndCode | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be an infection. | Code indicating whether the etiology of the lower GI (gastrointestinal tract) abnormality was determined to be an infection. | Lower intestinal tract etiologies: Infection | 1;2;1;2 | Yes;No;Yes;No | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:57:59.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Single Pre-Defined Value Selected |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | LGIETINF | |||||||||||||||||||||||||||
C58943 | GVHD immunosuppressant prophylaxis blood level measurement | GVHDImmsupProphBldLvlMeasr | Measurement in nanograms per milliliter of the blood level of prophylactic immunosuppressant received by the patient for GVHD (graft-versus-host disease). | Measurement in nanograms per milliliter of the blood level of prophylactic immunosuppressant received by the patient for GVHD (graft-versus-host disease). | Record most recent blood level of immunosuppressant (prophylaxis) | Numeric Values | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 13:51:07.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant |
Free-Form Entry |
0 | 9999.9 | nanogram per milliliter | BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | TROUGHLV | ||||||||||||||||||||||||||
C58975 | Etiology liver abnormality other indicate code other text | EtiolLivrAbnrmOthrIndCodeOTH | The free-text field related to 'Etiology liver abnormality other indicate code' specifying other text. | The free-text field related to 'Etiology liver abnormality other indicate code' specifying other text. | Specify other liver etiologies | Alphanumeric | Adult;Pediatric | Proposed | 1.00 | 2019-01-04 14:09:08.0 | Acute GVHD Form | Treatment/Intervention Data | Transplantation/Stem Cell Transplant | 100 |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Acute GVHD Form (GVH) | GVHLIVRS |