CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Disease Related Events
CRF: Chronic GVHD Provider Survey (PCG)

22 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
C59045 Liver symptom score LiverSymptomScore Score indicating the severity of liver symptoms as it relates to chronic GVHD Score indicating the severity of liver symptoms as it relates to chronic GVHD Liver Score 0;1;2;3 Normal LFTs;Elevated bilirubin, alkaline phosphatase, AST or ALT <2xULN;Bilirubin >3 mg/dl or bilirubin, AST or ALT 2-5x ULN;Bilirubin, AST or ALT >5x ULN Numeric Values Adult;Pediatric Proposed 1.00 2019-01-10 12:53:59.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGLIVER
C59080 Chronic GVHD severity 2 scale ChrncGVHDSev2Scl Scale indicating the level of chronic graft-versus-host disease (GVHD) from zero to ten. Scale indicating the level of chronic graft-versus-host disease (GVHD) from zero to ten. Please rate the severity of this person's chronic GVHD on this scale 0;1;2;3;4;5;6;7;8;9;10 cGVHD symptoms are not at all severe;1;2;3;4;5;6;7;8;9;cGVHD symptoms are most severe possible Numeric Values Adult;Pediatric Proposed 1.00 2019-01-11 14:59:55.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGSEV2
C59046 Liver Function Test sample obtained date LFTSmplObtdDate Date when the liver function test sample was obtained Date when the liver function test sample was obtained Date LFT sample obtained: Date or Date & Time Adult;Pediatric Proposed 1.00 2019-01-10 13:07:16.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGLFTDT
C59092 GYN exam not performed indicate code GYNExNtPerfmdIndictCode Code indicating GYN was not performed. Code indicating GYN was not performed. Was a GYN performed 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-14 16:44:10.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) n/a
C17409 Visit date VisitDate Date of interview or visit (actually the date when data in the form were captured) Date of interview or visit Date of visit: Date or Date & Time Adult;Pediatric Proposed 3.00 2013-06-21 00:00:00.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

DeBaun Forms
C59047 Forced expiratory volume 1 second value ForcedExpVol1SecVal Value of %FEV1 from within one month of the assessment Value of %FEV1 from within one month of the assessment % FEV1 Numeric Values

PFT values from within one month of the assessment

Adult;Pediatric Proposed 1.00 2019-01-10 13:18:21.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

0 999 BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGFEV1
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 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event 4000

Free-Form Entry

DeBaun Forms
C59048 Forced expiratory volume 1 second date FrcdExpVol1SecDate Date of FEV1 from within one month of the assessment Date of FEV1 from within one month of the assessment Date of FEV1 Date or Date & Time

PFT values from within one month of the assessment

Adult;Pediatric Proposed 1.00 2019-01-10 13:25:26.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGFEVDT
C59031 Skin symptom score SkinSymptomScore Score indicating the amount of disease signs based on skin. Score indicating the amount of disease signs based on skin. Skin score 0;1;2;3 No symptoms;<18% BSA with disease signs but NO sclerotic features;19-50% BSA OR involvement with superficial sclerotic features not hidebound (able to pinch);>50% BSA OR deep sclerotic feats. hidebound OR impaired mobility, ulceration or severe pruritis Numeric Values Adult;Pediatric Proposed 1.00 2019-01-09 09:27:17.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGSKIN
C59049 Forced expiratory volume 1 second not done code FrcdExpVol1SecNtDnCode Code indicating whether FEV was done within one month of assessment. Code indicating whether FEV was done within one month of assessment. FEV not done Not done Not done Alphanumeric Adult;Pediatric Proposed 1.00 2019-01-10 13:37:15.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGFEVND
C59032 Mouth symptom score MouthSymptomScore Score indicating the level of mouth symptom related to chronic GVHD. Score indicating the level of mouth symptom related to chronic GVHD. Mouth Score 0;1;2;3 No symptoms;Mild symptoms with disease signs but not limiting oral intake significantly;Moderate symptoms with signs with partial limitation of oral intake;Severe symptoms with disease signs on examination with major limitation of oral intake Numeric Values Adult;Pediatric Proposed 1.00 2019-01-09 12:38:08.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGMOUTH
C59050 Diffusing capacity of the lung for carbon monoxide Value DLOcVal Value of % DLCOc from within one month of the assessment Value of % DLCOc from within one month of the assessment % DLCOc Numeric Values

PFT values from within one month of the assessment

Adult;Pediatric Proposed 1.00 2019-01-10 13:48:36.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

0 999 BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGDLCO
C59034 GI tract score GITractScore Score used to determine GI tract symptoms related to chronic GVHD Score used to determine GI tract symptoms related to chronic GVHD GI Tract Score 0;1;2;3 No symptoms;Symptoms: dysphagia, anorexia, nausea, vomiting, abdominal pain or diarrhea with weight loss (<5%);Symptoms associated with mild to moderate weight loss (5-15%);Symptoms with significant weight loss >15%, requires nutritional supplements OR esophageal dilation Numeric Values Adult;Pediatric Proposed 1.00 2019-01-09 12:47:43.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGGITRC
C59051 Diffusing capacity of the lung for carbon monoxide Date DLCOcDate Date of diffusing capacity of the lung for carbon monoxide Date of diffusing capacity of the lung for carbon monoxide Date of DLCOc Date or Date & Time

PFT values from within one month of the assessment

Adult;Pediatric Proposed 1.00 2019-01-10 13:53:00.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Free-Form Entry

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGDLCDT
C59036 Eye symptom score EyeSymptmScore Score indicating the severity of eye symptom as it relates to chronic GVHD. Score indicating the severity of eye symptom as it relates to chronic GVHD. Eye score 0;1;2;3 No symptoms;Mild dry eye not affecting ADL OR asymptomatic signs of kerato-conjunctivitis sicca;Moderate dry eye partially affecting ADL WITHOUT vision impairment;Severe dry eye symptoms significantly affecting ADL OR unable to work OR loss of vision Numeric Values Adult;Pediatric Proposed 1.00 2019-01-09 14:28:06.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGEYE
C59052 DLCOc not done code DLCOcNtDnCode Code indicating whether diffusing capacity of the lung adjusted for hemoglobin (DLCOc) was completed from within one month of the assessment Code indicating whether diffusing capacity of the lung adjusted for hemoglobin (DLCOc) was completed from within one month of the assessment DLCOc value not done Not done Not done Alphanumeric

PFT values from within one month of the assessment

Adult;Pediatric Proposed 1.00 2019-01-10 13:56:34.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGDLCND
C59037 Joint and Fascia Symptom Score JointAndFasciaSymtmScore Score indicating the severity of joint and fascia symptoms as it relates to chronic GVHD. Score indicating the severity of joint and fascia symptoms as it relates to chronic GVHD. Joint and Fascia Score 0;1;2;3 No symptoms;Mild tightness of arms or legs, normal or mild decreased range of motion (ROM) AND not affecting ADL;Tightness of arms or legs OR joint contractures, erythema due to fasciitis, moderate decrease in ROM;Contracture WITH significant decrease of ROM AND significant limitation of ADL Numeric Values Adult;Pediatric Proposed 1.00 2019-01-09 14:34:50.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PGCJOINT
C59053 Rash type present code RashTypPrsntCode Code indicating if an erythematous or maculopapular rash is present Code indicating if an erythematous or maculopapular rash is present Is an erythematous or maculopapular rash present? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-10 14:04:20.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGRASH
C59038 Genital tract symptom score GntlTrctSymptmScore Score indicating the severity of genital tract symptom(s) as it relates to chronic GVHD Score indicating the severity of genital tract symptom(s) as it relates to chronic GVHD Genital Tract Score 0;1;2;3 No symptoms;Symptomatic, mild distinct signs on exam and no effect on coitus, minimal discomfort with GYN exam;Symptomatic, distinct signs on exam and mild dyspareunia or discomfort with GYN exam;Symptomatic, advanced signs, severe pain with coitus or inability to insert vaginal spectrum Numeric Values Adult;Pediatric Proposed 1.00 2019-01-10 11:16:25.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGGNITL
C59054 Nausea vomiting diarrhea present code NsaVomDrhaPrsntCode Code indicating whether patient is presently experiencing nausea, vomiting, or diarrhea. Code indicating whether patient is presently experiencing nausea, vomiting, or diarrhea. Does the patient have nausea, vomiting or diarrhea? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed 1.00 2019-01-10 14:09:36.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGVOMIT
C59039 Lung symptom score LungSymptomScore Score indicating the severity of lung symptom as it relates to chronic GVHD Score indicating the severity of lung symptom as it relates to chronic GVHD Lung Score 0;1;2;3 No symptoms;Mild symptoms (shortness of breath after climbing one flight of steps);Moderate symptoms (shortness of breath after walking on flat ground);Severe symptoms (shortness of breath at rest requiring oxygen) Numeric Values Adult;Pediatric Proposed 1.00 2019-01-10 11:23:20.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGLUNG
C59076 Chronic GVHD severity 1 scale ChrncGVHDSev1Scl Scale used to determine severity of chronic graft-versus-host disease (GVHD). Scale used to determine severity of chronic graft-versus-host disease (GVHD). Please rate the severity of this person's chronic GVHD on this scale 1;2;3;4 None;mild;Moderate;severe Numeric Values Adult;Pediatric Proposed 1.00 2019-01-11 14:04:17.0 Chronic GVHD Provider Survey (PCG) Disease Related Events History of Disease Event

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Chronic GVHD Provider Survey (PCG) PCGSEV1
22 results.
CSV