CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Protocol Experience
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
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) Protocol Experience Study Management 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) Protocol Experience Study Management

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) Protocol Experience Study Management

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withdrawal code InvstglStdyDrgCnsntWdrlCode Code indicating whether patient's consent to investigational study drug was withdrawn Code indicating whether patient's consent to investigational study drug was withdrawn Did the patient withdraw consent to receive investigational study drug? 1;2;1;2 Yes;No;Yes;No Numeric Values Adult;Pediatric Proposed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) Protocol Experience Study Management

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) Protocol Experience Study Management

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) Protocol Experience Study Management

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) Protocol Experience Study Management

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) Protocol Experience Study Management

Single Pre-Defined Value Selected

BMTCTN 1507A Release 5.10 Withdrawal of Consent Form (WOC) WOCURSAM
8 results.
CSV