CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Assessments and Examinations
CRF: Immune Function Form

Displaying 1 - 50 of 128
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
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
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:
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
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 &copy; 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
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
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 &copy; 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
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
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
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
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 &copy; 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
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 &copy; 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
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 &copy; 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
C59992 Lymphocyte CD4 measurement LymphocyteCD4Measr Measurement of CD4 lymphocytes (T helper cells). Measurement of CD4 lymphocytes (T helper cells). CD4 (T helper 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 30
C60024 Lymphocyte function tetanus antigen status LymphcytFncTetanusAntigenStat Status of tetanus antigen lymphocyte function. Status of tetanus antigen lymphocyte function. Tetanus 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 50
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
C59971 Transfusion platelet within 7 days test date status TrnsfusPlatltWin7DyTstDtStatus Status indicating that the subject/participant received a transfusion of platelets within 7 days of the pertinent test date. Status indicating that the subject/participant received a transfusion of platelets within 7 days of the pertinent test date. Transfused platelets < 7 days from date of test Transfused platelets < 7 days from date of test Transfused platelets < 7 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 15: transfused platelets
C60067 Edema prominent indicator EdemaPromnntInd Indicator of whether the edema the subject/participant presents with is a prominent clinical feature. Indicator of whether the edema the subject/participant presents with is a prominent clinical feature. If present, is edema 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 94
C60003 Lymphocyte CD4 CD45RA measurement type LymphocyteCD4CD45RAMeasrTyp Type of measurement of CD4+/CD45RA+ lymphocytes (naive T cells) represented by the recorded value. Type of measurement of CD4+/CD45RA+ lymphocytes (naive T cells) represented by the recorded value. CD4+ / CD45RA+ (naive 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 34
C60035 Meningitis encephalitis infectious organism code other text MenngtsEncphltsInfctOrgCodeOTH The free-text field related to 'Meningitis encephalitis infectious organism 1 code', 'Meningitis encephalitis infectious organism 2 code', or 'Meningitis encephalitis infectious organism 3 code', specifying other text. The free-text field related to 'Meningitis encephalitis infectious organism 1 code', 'Meningitis encephalitis infectious organism 2 code', or 'Meningitis encephalitis infectious organism 3 code', specifying other text. Meningitis / encephalitis 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 61
C60046 Diarrhea severe protracted infectious organism 3 code DiarheaSevrPrtrctInfctOrg3Code Code specifying the third infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. Code specifying the third infectious organism pertaining to the subject/participant's severe or protracted diarrhea that was identified. Severe or protracted diarrhea 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 &copy; 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 72
C59982 Immunoglobulin E not tested status IgENotTestedStatus Status indicating that the subject/participant's immunoglobulin E (IgE) was not tested. Status indicating that the subject/participant's immunoglobulin E (IgE) was not tested. IgE: 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 23: Not tested
C60078 Skin rash prominent indicator SkinRashPromnntInd Indicator of whether the skin rash the subject/participant presents with is a prominent clinical feature. Indicator of whether the skin rash the subject/participant presents with is a prominent clinical feature. If present, is skin rash 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 2 120
C60014 Antibody protein conjugated HIB pneumococcal vaccine response status AbdyPtnCnjHIBPneuVaccRspStat Status of the antibody response for protein conjugated HIB or pneumococcal vaccine. Status of the antibody response for protein conjugated HIB or pneumococcal vaccine. Protein conjugated HIB or pneumococcal vaccine 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 41
C60057 Other infection organism 2 code OtherInfectOrganism2Code Code specifying the second organism pertaining to the subject/participant's other infection that was identified. Code specifying the second organism pertaining to the subject/participant's other infection that was identified. Other infection 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 &copy; 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 83
C59993 Lymphocyte CD4 count unit of measure LymphocyteCD4CountUOM Unit of measure pertaining to the count of CD4 lymphocytes (T helper cells) being reported. Unit of measure pertaining to the count of CD4 lymphocytes (T helper cells) being reported. CD4 (T helper 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 30. Specify units
C60025 Hepatitis present indicator HepatitisPresentInd Indicator of whether hepatitis is present in the subject/participant. Indicator of whether hepatitis is present in the subject/participant. Hepatitis 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 51. Site of infection?
C59961 Lymphocyte not tested status LymphocyteNotTestedStatus Status indicating that the subject/participant's lymphocytes were not tested. Status indicating that the subject/participant's lymphocytes were not tested. Lymphocytes 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 11: Not tested
C59972 Immunoglobulin G before treatment value IgGBeforeTxVal Value of the subject/participant's immunoglobulin G (IgG) measurement prior to any disease treatment. Value of the subject/participant's immunoglobulin G (IgG) measurement prior to any disease treatment. IgG: 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 16: Value
C60068 Eosinophilia prominent indicator EosinophiliaPromnntInd Indicator of whether the eosinophilia the subject/participant presents with is a prominent clinical feature. Indicator of whether the eosinophilia the subject/participant presents with is a prominent clinical feature. If present, is eosinophilia 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 96
C60004 Lymphocyte CD4 CD45RA measurement LymphocyteCD4CD45RAMeasr Measurement of CD4+/CD45RA+ lymphocytes (naive T cells). Measurement of CD4+/CD45RA+ lymphocytes (naive T cells). CD4+ / CD45RA+ (naive 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 34
C60036 Meningitis encephalitis prominent feature ID indicator MeningtsEncephltsPromFeatIDInd Indicator of whether meningitis or encephalitis was a prominent feature of the subject/participant's ID. Indicator of whether meningitis or encephalitis was a prominent feature of the subject/participant's ID. If meningitis / encephalitis 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 62
C60047 Diarrhea severe protracted infectious organism code other text DiarheaSvrPrtrctInfctOrg3CdOTH The free-text field related to 'Diarrhea severe protracted infectious organism 1 code', 'Diarrhea severe protracted infectious organism 2 code', or 'Diarrhea severe protracted infectious organism 3 code', specifying other text. The free-text field related to 'Diarrhea severe protracted infectious organism 1 code', 'Diarrhea severe protracted infectious organism 2 code', or 'Diarrhea severe protracted infectious organism 3 code', specifying other text. Severe or protracted diarrhea 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 73
C59983 Immunoglobulin supplemental intravenous prior ID first treatment indicator IGSupplIVPriorID1stTxInd Indicator of whether the subject/participant received supplemental intravenous immunoglobulins (IVIG) prior to any first treatment of (ID). Indicator of whether the subject/participant received supplemental intravenous immunoglobulins (IVIG) prior to any first treatment of (ID). Did the recipient receive supplemental intravenous immunoglobulins (IVIG) prior to any first treatment of ID? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2020-09-01 16:29:46.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Single Pre-Defined Value Selected

CIBMTR n/a Form 2031 revision 2 24.
C60079 Thrombocytopenia prominent indicator ThrombocytopeniaPromnntInd Indicator of whether the thrombocytopenia (< 100 x 10^9/liter) the subject/participant presents with is a prominent clinical feature. Indicator of whether the thrombocytopenia (< 100 x 10^9/liter) the subject/participant presents with is a prominent clinical feature. If present, is thrombocytopenia (< 100 x 10^9/L) 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 2 122
C60015 Antibody tetanus response status AbdyTetanusRspStat Status of the antibody response for tetanus. Status of the antibody response for tetanus. Tetanus 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 42
C60058 Other infection organism 3 code OtherInfectOrganism3Code Code specifying the third organism pertaining to the subject/participant's other infection that was identified. Code specifying the third organism pertaining to the subject/participant's other infection that was identified. Other 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 &copy; 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 84
C59994 Lymphocyte CD8 measurement type LymphocyteCD8MeasurementTyp Type of measurement of CD8 lymphocytes (cytotoxic T cells) represented by the recorded value. Type of measurement of CD8 lymphocytes (cytotoxic T cells) represented by the recorded value. CD8 (cytotoxic 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 31
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