CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Assessments and Examinations
CRF: Immune Function Form
Sub-Domain: Assessments and Examinations
CRF: Immune Function Form
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C58397 | Laboratory procedure percent eosinophils value | LabProcedurePrctEosinophlsVal | Value of percent eosinophils. | Value of percent eosinophils. | Eosinophils: % | Numeric Values |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2018-01-22 11:03:02.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
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| C60052 | Systemic infection organism 3 code | SystemicInfectOrganism3Code | Code specifying the third organism pertaining to the subject/participant's systemic infection that was identified. | Code specifying the third organism pertaining to the subject/participant's systemic infection that was identified. | Systemic infection Third organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 78 | |||||||||||||||||||||||||
| C59988 | Lymphocyte CD3 measurement type | LymphocyteCD3MeasurementTyp | Type of measurement of CD3 lymphocytes (T cells) represented by the recorded value. | Type of measurement of CD3 lymphocytes (T cells) represented by the recorded value. | CD3 (T cells): % or value | Value;Percent of total lymphocytes | Value;Percent of total lymphocytes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:52:17.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 29 | ||||||||||||||||||||||||||
| C60020 | Lymphocyte function Candida antigen status | LymphcytFncCandidaAntgnStat | Status of Candida antigen lymphocyte function. | Status of Candida antigen lymphocyte function. | Candida antigen | Absent;Low;Normal;Not tested | < 10% of control;10-30% of control;> 30% of control;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:19:00.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 46 | |||||||||||||||||||||||||||
| C59967 | Transfusion red blood cell within 30 days test date status | TrnsfusRBCWin30DyTstDtStatus | Status indicating that the subject/participant received a transfusion of red blood cells (RBC) within 30 days of the pertinent test date. | Status indicating that the subject/participant received a transfusion of red blood cells (RBC) within 30 days of the pertinent test date. | Transfused RBC < 30 days from date of test | Transfused red blood cells < 30 days from date of test | Transfused red blood cells (RBC) < 30 days from date of test | Alphanumeric |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 14:15:25.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 14: transfused RBC | ||||||||||||||||||||||||||
| C60063 | Clinical features present type | ClinFeatrPresentTyp | Type(s) of clinical features the subject/participant presented with. | Type(s) of clinical features the subject/participant presented with. | Specify clinical features: Feature present? | Warts;Other features;Thrombocytopenia;Skin rash;Neutropenia;Microcephaly;Maternal T-cell engraftment;Lymphoproliferative disease;Hypoproteinemia;Hepatosplenomegaly;Growth retardation;Growth hormone deficiency;Failure to thrive;Eosinophilia;Edema;Bone abnormalities;Autoimmune hemolytic anemia | Warts;Other features, specify;Thrombocytopenia (< 100 x 10^9/L);Skin rash;Neutropenia;Microcephaly;Maternal T-cell engraftment;Lymphoproliferative disease;Hypoproteinemia;Hepatosplenomegaly;Growth retardation (height < 5th percentile);Growth hormone deficiency;Failure to thrive (weight < 5th percentile);Eosinophilia;Edema;Bone abnormalities;Autoimmune hemolytic anemia | Alphanumeric |
Select all clinical features that are presesnt. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 14:36:31.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Multiple Pre-Defined Values Selected |
CIBMTR | n/a | Form 2031 revision 2 | 89, 91, 93, 95, 97, 103, 105, 107, 109, 111, 113, 115, 117, 119, 121, 123, 125 | ||||||||||||||||||||||||||
| C59999 | Lymphocyte CD20 count unit of measure | LymphocyteCD20CountUOM | Unit of measure pertaining to the count of CD20 lymphocytes (B lymphocyte cells) being reported. | Unit of measure pertaining to the count of CD20 lymphocytes (B lymphocyte cells) being reported. | CD20 (B lymphocyte cells): Specify units | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:41:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 32. Specify units | ||||||||||||||||||||||||||
| C60031 | Meningitis encephalitis present indicator | MeningitsEncephalitsPresentInd | Indicator of whether meningitis or encephalitis is present in the subject/participant. | Indicator of whether meningitis or encephalitis is present in the subject/participant. | Meningitis / encephalitis Site of infection? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:38:10.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 57. Site of infection? | ||||||||||||||||||||||||||
| C60042 | Pneumonia prominent feature ID indicator | PneumoniaPromFeatIDInd | Indicator of whether pneumonia was a prominent feature of the subject/participant's ID. | Indicator of whether pneumonia was a prominent feature of the subject/participant's ID. | If pneumonia was present, was it a prominent feature of ID? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 14:22:19.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 68 | ||||||||||||||||||||||||||
| C59978 | Immunoglobulin A before treatment value | IgABeforeTxVal | Value of the subject/participant's immunoglobulin A (IgA) measurement prior to any disease treatment. | Value of the subject/participant's immunoglobulin A (IgA) measurement prior to any disease treatment. | IgA: | Numeric Values |
Specify the following quantitative immunoglobulins measured prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 15:47:39.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 20: Value | ||||||||||||||||||||||||||||
| C60074 | Lymphoproliferative disease prominent indicator | LymphoproliferativDzPromnntInd | Indicator of whether the lymphoproliferative disease the subject/participant presents with is a prominent clinical feature. | Indicator of whether the lymphoproliferative disease the subject/participant presents with is a prominent clinical feature. | If present, is lymphoproliferative disease prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 112 | |||||||||||||||||||||||||||
| C60010 | Antibody bacteriophage phi X-174 other neoantigen response status | AbdyBctphgPhiX174OthAgnRspStat | Status of the antibody response for bacteriophage phi X-174 or other neoantigen. | Status of the antibody response for bacteriophage phi X-174 or other neoantigen. | Bacteriophage phi X-174 or other neoantigen | Absent;Low;Normal;Not tested | Absent;Low;Normal;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 10:36:04.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 37 | |||||||||||||||||||||||||||
| C59957 | Complete blood count date | CompleteBloodCountDate | Date on which the complete blood count test was performed. | Date on which the complete blood count test was performed. | Date CBC tested: (testing done within 6 weeks of diagnosis) | Date or Date & Time |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:30:18.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 9 | ||||||||||||||||||||||||||||
| C60053 | Systemic infection organism code other text | SystemicInfectOrganismCodeOTH | The free-text field related to 'Systemic infection organism 1 code', 'Systemic infection organism 2 code', or 'Systemic infection organism 3 code', specifying other text. | The free-text field related to 'Systemic infection organism 1 code', 'Systemic infection organism 2 code', or 'Systemic infection organism 3 code', specifying other text. | Systemic infection Specify other organism | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 14:17:24.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers | 255 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 79 | |||||||||||||||||||||||||||
| C59989 | Lymphocyte CD3 measurement | LymphocyteCD3Measr | Measurement of CD3 lymphocytes (T cells). | Measurement of CD3 lymphocytes (T cells). | CD3 (T cells): % or value | Numeric Values |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:33:19.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 29 | ||||||||||||||||||||||||||||
| C60021 | Lymphocyte function concavalin A status | LymphcytFncConcavalinAStat | Status of concavalin A (ConA) lymphocyte function. | Status of concavalin A (ConA) lymphocyte function. | Concavalin A (ConA) | Absent;Low;Normal;Not tested | < 10% of control;10-30% of control;> 30% of control;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:19:00.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 47 | |||||||||||||||||||||||||||
| C60032 | Meningitis encephalitis infectious organism 1 code | MeningtsEncephltsInfctOrg1Code | Code specifying the first infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Code specifying the first infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Meningitis / encephalitis First organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 58 | |||||||||||||||||||||||||
| C59968 | Platelet count value | PlateletCountVal | Value of the count of platelets in the subject/participant's complete blood cell (CBC) sample. | Value of the count of platelets in the subject/participant's complete blood cell (CBC) sample. | Platelets | Numeric Values |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:36:15.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 15: Platelets | ||||||||||||||||||||||||||||
| C60064 | Clinical features present type other text | ClinFeatrPresentTypOTH | The free-text field related to 'Clinical features present type', specifying other text. | The free-text field related to 'Clinical features present type', specifying other text. | Specify other features: | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:32:45.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers | 255 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 | 127 | ||||||||||||||||||||||||||||
| C60000 | Lymphocyte CD56 measurement type | LymphocyteCD56MeasurementTyp | Type of measurement of CD56 lymphocytes (natural killer (NK) cells) represented by the recorded value. | Type of measurement of CD56 lymphocytes (natural killer (NK) cells) represented by the recorded value. | CD56 (natural killer (NK) cells): % or value | Value;Percent of total lymphocytes | Value;Percent of total lymphocytes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:52:17.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 33 | ||||||||||||||||||||||||||
| C60043 | Diarrhea severe protracted present indicator | DiarrheaSevrProtractPresentInd | Indicator of whether severe or protracted diarrhea is present in the subject/participant. | Indicator of whether severe or protracted diarrhea is present in the subject/participant. | Severe or protracted diarrhea Site of infection? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:38:10.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 69. Site of infection? | ||||||||||||||||||||||||||
| C59979 | Immunoglobulin A pre-defined unit of measure | IgAPreDefUOM | Unit of measurement specifying the pre-defined unit pertaining to the reported immunoglobulin A (IgA) value. | Unit of measurement specifying the pre-defined unit pertaining to the reported immunoglobulin A (IgA) value. | IgA: | grams per deciliter;grams per liter;milligrams per deciliter | grams per deciliter (g/dL);grams per liter (g/L);milligrams per deciliter (mg/dL) | Alphanumeric |
Specify the following quantitative immunoglobulins measured prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 15:51:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 20: Specify units | ||||||||||||||||||||||||||
| C60075 | Maternal T-cell engraftment prominent indicator | MtrnalTcellEngrftmntPromnntInd | Indicator of whether the maternal T-cell engraftment the subject/participant presents with is a prominent clinical feature. | Indicator of whether the maternal T-cell engraftment the subject/participant presents with is a prominent clinical feature. | If present, is maternal T-cell engraftment promient? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 114 | |||||||||||||||||||||||||||
| C60011 | Antibody diphtheria response status | AbdyDiphtheriaRspStat | Status of the antibody response for diphtheria. | Status of the antibody response for diphtheria. | Diphtheria | Absent;Low;Normal;Not tested | Absent;Low;Normal;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 10:36:04.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 38 | |||||||||||||||||||||||||||
| C59958 | White blood cell count | WhiteBloodCellCt | Count of white blood cells (WBC) in the subject/participant's complete blood cell (CBC) sample. | Count of white blood cells (WBC) in the subject/participant's complete blood cell (CBC) sample. | WBC: | Numeric Values |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:36:15.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 10. WBC: | ||||||||||||||||||||||||||||
| C60054 | Systemic infection prominent feature ID indicator | SystemicInfectionPromFeatIDInd | Indicator of whether systemic infection was a prominent feature of the subject/participant's ID. | Indicator of whether systemic infection was a prominent feature of the subject/participant's ID. | If systemic infection was present, was it a prominent feature of ID? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 14:22:19.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 80 | ||||||||||||||||||||||||||
| C59990 | Lymphocyte CD3 count unit of measure | LymphocyteCD3CountUOM | Unit of measure pertaining to the count of CD3 lymphocytes (T cells) being reported. | Unit of measure pertaining to the count of CD3 lymphocytes (T cells) being reported. | CD3 (T cells): specify units | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:41:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 29. Specify units | ||||||||||||||||||||||||||
| C60022 | Lymphocyte function phytohemagglutinin status | LymphcytFncPhyothmggltninStat | Status of phytohemagglutinin (PHA) lymphocyte function. | Status of phytohemagglutinin (PHA) lymphocyte function. | Phytohemagglutinin (PHA) | Absent;Low;Normal;Not tested | < 10% of control;10-30% of control;> 30% of control;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:19:00.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 48 | |||||||||||||||||||||||||||
| C60033 | Meningitis encephalitis infectious organism 2 code | MeningtsEncephltsInfctOrg2Code | Code specifying the second infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Code specifying the second infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Meningitis / encephalitis Second organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 59 | |||||||||||||||||||||||||
| C59969 | Platelet count pre-defined unit of measure | PlateletCtPreDefUOM | Unit of measure related to 'Platelet count value' specifying the pre-defined unit pertaining to the reported platelet count value. | Unit of measure related to 'Platelet count value' specifying the pre-defined unit pertaining to the reported platelet count value. | Platelets | x 10^6 platelets per liter;x 10^9 platelets per liter (x 10^3 platelets per cubic millimeter) | x 10^6 platelets per liter;x 10^9 platelets per liter (x 10^3 platelets per cubic millimeter) | Alphanumeric |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:44:36.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 15: Specify units | ||||||||||||||||||||||||||
| C60065 | Autoimmune hemolytic anemia prominent indicator | AutoimmunHmlytcAnmiaPromnntInd | Indicator of whether the autoimmune hemolytic anemia the subject/participant presents with is a prominent clinical feature. | Indicator of whether the autoimmune hemolytic anemia the subject/participant presents with is a prominent clinical feature. | If present, is autoimmune hemolytic anemia prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 90 | |||||||||||||||||||||||||||
| C60001 | Lymphocyte CD56 measurement | LymphocyteCD56Measr | Measurement of CD56 lymphocytes (natural killer (NK) cells). | Measurement of CD56 lymphocytes (natural killer (NK) cells). | CD56 (natural killer (NK) cells): % or value | Numeric Values |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:33:19.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 33 | ||||||||||||||||||||||||||||
| C60044 | Diarrhea severe protracted infectious organism 1 code | DiarheaSevrPrtrctInfctOrg1Code | Code specifying the first infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. | Code specifying the first infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. | Severe or protracted diarrhea First organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 70 | |||||||||||||||||||||||||
| C59980 | Immunoglobulin A not tested status | IgANotTestedStatus | Status indicating that the subject/participant's immunoglobulin A (IgA) was not tested. | Status indicating that the subject/participant's immunoglobulin A (IgA) was not tested. | IgA: | Not tested | Not tested | Alphanumeric |
Specify the following quantitative immunoglobulins measured prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:50:15.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 21: Not tested | ||||||||||||||||||||||||||
| C60076 | Microcephaly prominent indicator | MicrocephalyPromnntInd | Indicator of whether the microcephaly the subject/participant presents with is a prominent clinical feature. | Indicator of whether the microcephaly the subject/participant presents with is a prominent clinical feature. | If present, is microcephaly prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 116 | |||||||||||||||||||||||||||
| C60012 | Antibody isohemagglutinin anti-A response status | AbdyIshmgltninAntiARspStat | Status of the antibody response for isohemagglutinin anti-A. | Status of the antibody response for isohemagglutinin anti-A. | Isohemagglutinin anti-A | Absent;Low;Normal;Not tested | Absent;Low;Normal;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 10:36:04.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 39 | |||||||||||||||||||||||||||
| C59959 | White blood cell count pre-defined unit of measure | WBCPreDefUOM | Unit of measure related to 'White blood cell count' specifying the pre-defined unit pertaining to the reported white blood cell count (WBC). | Unit of measure related to 'White blood cell count' specifying the pre-defined unit pertaining to the reported white blood cell count (WBC). | WBC: | x 10^6 cells per liter;x 10^9 cells per liter (x 10^3 cells per cubic millimeter) | x 10^6 cells per liter;x 10^9 cells per liter (x 10^3 cells per cubic millimeter) | Alphanumeric |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:44:36.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 10: Specify units | ||||||||||||||||||||||||||
| C60055 | Other infection present indicator | OtherInfectionPresentInd | Indicator of whether another infection is present in the subject/participant. | Indicator of whether another infection is present in the subject/participant. | Other infection Site of infection? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:38:10.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 81. Site of infection? | ||||||||||||||||||||||||||
| C59991 | Lymphocyte CD4 measurement type | LymphocyteCD4MeasurementTyp | Type of measurement of CD4 lymphocytes (T helper cells) represented by the recorded value. | Type of measurement of CD4 lymphocytes (T helper cells) represented by the recorded value. | CD4 (T helper cells): % or value | Value;Percent of total lymphocytes | Value;Percent of total lymphocytes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:52:17.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 30 | ||||||||||||||||||||||||||
| C60023 | Lymphocyte function pokeweed mitogen status | LymphcytFncPkweedMitogenStat | Status of pokeweed mitogen (PWM) lymphocyte function. | Status of pokeweed mitogen (PWM) lymphocyte function. | Pokeweed mitogen (PWM) | Absent;Low;Normal;Not tested | < 10% of control;10-30% of control;> 30% of control;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:19:00.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 49 | |||||||||||||||||||||||||||
| C60034 | Meningitis encephalitis infectious organism 3 code | MeningtsEncephltsInfctOrg3Code | Code specifying the third infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Code specifying the third infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Meningitis / encephalitis Third organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 60 | |||||||||||||||||||||||||
| C59970 | Platelet count not tested status | PlateletCtNotTestedStatus | Status indicating that the subject/participant's platelet count was not tested. | Status indicating that the subject/participant's platelet count was not tested. | Platelets | Not tested | Not tested | Alphanumeric |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:50:15.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 15: Not tested | ||||||||||||||||||||||||||
| C60066 | Bone abnormality prominent indicator | BoneAbnormalityPromnntInd | Indicator of whether the bone abnormalities the subject/participant presents with are a prominent clinical feature. | Indicator of whether the bone abnormalities the subject/participant presents with are a prominent clinical feature. | If present, are bone abnormalities prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 92 | |||||||||||||||||||||||||||
| C60002 | Lymphocyte CD56 count unit of measure | LymphocyteCD56CountUOM | Unit of measure pertaining to the count of CD56 lymphocytes (natural killer (NK) cells) being reported. | Unit of measure pertaining to the count of CD56 lymphocytes (natural killer (NK) cells) being reported. | CD56 (natural killer (NK) cells): specify units | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:41:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 33. Specify units | ||||||||||||||||||||||||||
| C60045 | Diarrhea severe protracted infectious organism 2 code | DiarheaSevrPrtrctInfctOrg2Code | Code specifying the second infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. | Code specifying the second infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. | Severe or protracted diarrhea Second organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 71 | |||||||||||||||||||||||||
| C59981 | Immunoglobulin E before treatment measurement | IgEBeforeTxMeasr | Measurement in international units per milliliter (IU/mL) of the subject/participant's immunoglobulin E (IgE) prior to any disease treatment. | Measurement in international units per milliliter (IU/mL) of the subject/participant's immunoglobulin E (IgE) prior to any disease treatment. | IgE: IU/mL | Numeric Values |
Specify the following quantitative immunoglobulins measured prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 15:47:39.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
International units per milliliter (IU/mL) | CIBMTR | n/a | Form 2031 revision 2 | 22: Value | |||||||||||||||||||||||||||
| C60077 | Neutropenia prominent indicator | NeutropeniaPromnntInd | Indicator of whether the neutropenia the subject/participant presents with is a prominent clinical feature. | Indicator of whether the neutropenia the subject/participant presents with is a prominent clinical feature. | If present, is neutropenia prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 118 | |||||||||||||||||||||||||||
| C60013 | Antibody isohemagglutinin anti-B response status | AbdyIshmgltninAntiBRspStat | Status of the antibody response for isohemagglutinin anti-B. | Status of the antibody response for isohemagglutinin anti-B. | Isohemagglutinin anti-B | Absent;Low;Normal;Not tested | Absent;Low;Normal;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 10:36:04.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 40 | |||||||||||||||||||||||||||
| C59960 | White blood cell count not tested status | WBCCtNotTestedStatus | Status indicating that the subject/participant's white blood cell (WBC) count was not tested. | Status indicating that the subject/participant's white blood cell (WBC) count was not tested. | WBC: | Not tested | Not tested | Alphanumeric |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:50:15.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 10: Not tested | ||||||||||||||||||||||||||
| C60056 | Other infection organism 1 code | OtherInfectOrganism1Code | Code specifying the first organism pertaining to the subject/participant's other infection that was identified. | Code specifying the first organism pertaining to the subject/participant's other infection that was identified. | Other infection First organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 82 |