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
C60028 Hepatitis infectious organism 3 code HepatitisInfectOrganism3Code Code specifying the third infectious organism pertaining to the subject/participant's hepatitis that was identified. Code specifying the third infectious organism pertaining to the subject/participant's hepatitis that was identified. Hepatitis 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 54
C59964 Polymorphonuclear leukocyte not tested status PMNLeukocyteNotTestedStatus Status indicating that the subject/participant's polymorphonuclear leukocytes (PMN) were not tested. Status indicating that the subject/participant's polymorphonuclear leukocytes (PMN) were not tested. Polymorphonuclear leukocytes 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 13: Not tested
C60060 Other infection anatomic site OtherInfectionAnatSite Anatomic site of the other infection found in the subject/participant. Anatomic site of the other infection found in the subject/participant. Specify other infection site: 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 2020-09-03 10:29:27.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers 255

Free-Form Entry

CIBMTR n/a Form 2031 revision 2 86
C59996 Lymphocyte CD8 count unit of measure LymphocyteCD8CountUOM Unit of measure pertaining to the count of CD8 lymphocytes (cytotoxic T cells) being reported. Unit of measure pertaining to the count of CD8 lymphocytes (cytotoxic T cells) being reported. CD8 (cytotoxic 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 31. Specify units
C60039 Pneumonia infectious organism 2 code PneumoniaInfectOrganism2Code Code specifying the second infectious organism pertaining to the subject/participant's pneumonia that was identified. Code specifying the second infectious organism pertaining to the subject/participant's pneumonia that was identified. Pneumonia 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 65
C59975 Immunoglobulin M before treatment value IgMBeforeTxVal Value of the subject/participant's immunoglobulin M (IgM) measurement prior to any disease treatment. Value of the subject/participant's immunoglobulin M (IgM) measurement prior to any disease treatment. IgM: 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 18: Value
C60071 Growth retardation prominent indicator GrwthRetardationPromnntInd Indicator of whether the growth retardation (height < 5th percentile) the subject/participant presents with is a prominent clinical feature. Indicator of whether the growth retardation (height < 5th percentile) the subject/participant presents with is a prominent clinical feature. If present, is growth retardation (height < 5th percentile) 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 2 106
C60007 Lymphocyte CD4 CD45RO measurement LymphocyteCD4CD45ROMeasr Measurement of CD4+/CD45RO+ lymphocytes (memory T cells). Measurement of CD4+/CD45RO+ lymphocytes (memory T cells). CD4+ / CD45RO+ (memory 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 35
C60018 Lymphocyte function assess date LymphcytFnctnAssessDate Date on which the subject/participant's lymphocyte function was assessed. Date on which the subject/participant's lymphocyte function was assessed. Date lymphocyte function was assessed: Date or Date & Time Adult;Pediatric Supplemental 1.00 2020-09-02 13:16:09.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Free-Form Entry

CIBMTR n/a Form 2031 revision 2 44
C14052 Hemoglobin measurement HemoglobMeasr The measurement for hemoglobin. The measurement for hemoglobin. Hemoglobin: Numeric Values

Report findings prior to any first treatment of the primary disease for which the HSCT is being performed.

Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Free-Form Entry

g/dL DeBaun Forms
C60050 Systemic infection organism 1 code SystemicInfectOrganism1Code Code specifying the first organism pertaining to the subject/participant's systemic infection that was identified. Code specifying the first organism pertaining to the subject/participant's systemic infection that was identified. Systemic 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 76
C59986 Lymphocyte test perform most recent date LymphcytTstMstRcntPrfrmDate Date of the subject/participant's most recent lymphocyte testing. Date of the subject/participant's most recent lymphocyte testing. Date of most recent testing performed: Date or Date & Time Adult;Pediatric Supplemental 1.00 2020-09-01 17:41:03.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Free-Form Entry

CIBMTR n/a Form 2031 revision 2 27
C60029 Hepatitis infectious organism code other text HepatitisInfectOrganismCodeOTH The free-text field related to 'Hepatitis infectious organism 1 code', 'Hepatitis infectious organism 2 code', or 'Hepatitis infectious organism 3 code', specifying other text. The free-text field related to 'Hepatitis infectious organism 1 code', 'Hepatitis infectious organism 2 code', or 'Hepatitis infectious organism 3 code', specifying other text. Hepatitis 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 55
C59965 Hemoglobin pre-defined unit of measure HemoglobinPreDefUOM Unit of measure related to 'Hemoglobin measurement'' specifying the pre-defined unit pertaining to the reported hemoglobin measurement value. Unit of measure related to 'Hemoglobin measurement'' specifying the pre-defined unit pertaining to the reported hemoglobin measurement value. Hemoglobin grams per deciliter;grams per liter;millimole per liter grams per deciliter (g/dL);grams per liter (g/L);millimole per liter (mmol/L) 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 14: Specify units
C60061 Other infection prominent feature ID indicator OtherInfectionPromFeatIDInd Indicator of whether the other infection was a prominent feature of the subject/participant's ID. Indicator of whether the other infection was a prominent feature of the subject/participant's ID. If other 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 87
C59997 Lymphocyte CD20 measurement type LymphocyteCD20MeasurementTyp Type of measurement of CD20 lymphocytes (B lymphocyte cells) represented by the recorded value. Type of measurement of CD20 lymphocytes (B lymphocyte cells) represented by the recorded value. CD20 (B lymphocyte 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 32
C60040 Pneumonia infectious organism 3 code PneumoniaInfectOrganism3Code Code specifying the third infectious organism pertaining to the subject/participant's pneumonia that was identified. Code specifying the third infectious organism pertaining to the subject/participant's pneumonia that was identified. Pneumonia 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 66
C59976 Immunoglobulin M pre-defined unit of measure IgMPreDefUOM Unit of measurement specifying the pre-defined unit pertaining to the reported immunoglobulin M (IgM) value. Unit of measurement specifying the pre-defined unit pertaining to the reported immunoglobulin M (IgM) value. IgM: 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 18: Specify units
C60072 Hepatosplenomegaly prominent indicator HepatosplenomegalyPromnntInd Indicator of whether the hepatosplenomegaly the subject/participant presents with is a prominent clinical feature. Indicator of whether the hepatosplenomegaly the subject/participant presents with is a prominent clinical feature. If present, is hepatosplenomegaly 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 2 108
C60008 Lymphocyte CD4 CD45RO count unit of measure LymphocyteCD4CD45ROCountUOM Unit of measure pertaining to the count of CD4+/CD45RO+ lymphocytes (memory T cells) being reported. Unit of measure pertaining to the count of CD4+/CD45RO+ lymphocytes (memory T cells) being reported. CD4+ / CD45RO+ (memory 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 35. Specify units
C60019 Lymphocyte function anti CD3 status LymphocyteFuncAntiCD3Status Status of anti-CD3 lymphocyte function. Status of anti-CD3 lymphocyte function. Anti-CD3 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 45
C57965 Laboratory procedure percent lymphocytes value LabProcedurePrctLymphocytesVal Value of percent lymphocytes. Value of percent lymphocytes. Lymphocytes: % 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

C60051 Systemic infection organism 2 code SystemicInfectOrganism2Code Code specifying the second organism pertaining to the subject/participant's systemic infection that was identified. Code specifying the second organism pertaining to the subject/participant's systemic infection that was identified. Systemic 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 77
C59987 Lymphocyte absolute count LymphocyteAbsoluteCt Absolute count of lymphocytes in cells per microliter (cells per cubic millimeter). Absolute count of lymphocytes in cells per microliter (cells per cubic millimeter). Absolute lymphocyte count: cells / uL (cells / mm^3) Numeric Values

Specify the following lymphocyte analyses performed prior to any disease treatment:

Adult;Pediatric Supplemental 1.00 2020-09-01 17:43:47.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Free-Form Entry

cells per microliter (cells/uL, cells/mm^3) CIBMTR n/a Form 2031 revision 2 28
C60030 Hepatitis prominent feature ID indicator HepatitisPromFeatIDInd Indicator of whether hepatitis was a prominent feature of the subject/participant's ID. Indicator of whether hepatitis was a prominent feature of the subject/participant's ID. If hepatitis 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 56
C59966 Hemoglobin not tested status HemoglobinNotTestedStatus Status indicating that the subject/participant's hemoglobin was not tested. Status indicating that the subject/participant's hemoglobin was not tested. Hemoglobin 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 14: Not tested
C60062 Clinical features any listed present indicator ClinFeatrAnyListedPresentInd Indicator of whether the subject/participant presented with any of the following clinical features between diagnosis and prior to the transplant preparative regimen: Autoimmune hemolytic anemia--Bone abnormalities--Edema--Eosinophilia--Failure to thrive--Growth hormone deficiency--Growth retardation--Hepatosplenomegaly--Hypoproteinemia--Lymphoproliferative disease--Maternal T-cell engraftment--Microcephaly--Neutropenia--Skin rash--Thrombocytopenia--Warts--Other features Indicator of whether the subject/participant presented with any of the specified clinical features between diagnosis and prior to the transplant preparative regimen. Did the recipient experience any of the following clinical features (between diagnosis and prior to the preparative regimen)?: Autoimmune hemolytic anemia--Bone abnormalities--Edema--Eosinophilia--Failure to thrive (weight < 5th percentile)--Growth hormone deficiency--Growth retardation (height < 5th percentile)--Hepatosplenomegaly--Hypoproteinemia--Lymphoproliferative disease--Maternal T-cell engraftment--Microcephaly--Neutropenia--Skin rash--Thrombocytopenia (< 100 x 10^9/L)--Warts--Other features No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2020-09-03 14:30:43.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

Single Pre-Defined Value Selected

CIBMTR n/a Form 2031 revision 2 88
C59998 Lymphocyte CD20 measurement LymphocyteCD20Measr Measurement of CD20 lymphocytes (B lymphocyte cells). Measurement of CD20 lymphocytes (B lymphocyte cells). CD20 (B lymphocyte 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

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CIBMTR n/a Form 2031 revision 2 32
C60041 Pneumonia infectious organism code other text PneumoniaInfectOrganismCodeOTH The free-text field related to 'Pneumonia infectious organism 1 code', 'Pneumonia infectious organism 2 code', or 'Pneumonia infectious organism 3 code', specifying other text. The free-text field related to 'Pneumonia infectious organism 1 code', 'Pneumonia infectious organism 2 code', or 'Pneumonia infectious organism 3 code', specifying other text. Pneumonia 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

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CIBMTR n/a Form 2031 revision 2 67
C59977 Immunoglobulin M not tested status IgMNotTestedStatus Status indicating that the subject/participant's immunoglobulin M (IgM) was not tested. Status indicating that the subject/participant's immunoglobulin M (IgM) was not tested. IgM: 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 19: Not tested
C60073 Hypoproteinemia prominent indicator HypoproteinemiaPromnntInd Indicator of whether the hypoproteinemia the subject/participant presents with is a prominent clinical feature. Indicator of whether the hypoproteinemia the subject/participant presents with is a prominent clinical feature. If present, is hypoproteinemia 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 2 110
C60009 Antibody response assessment date AntibodyResponseAssessDate Date on which the subject/participant's antibody responses were assessed. Date on which the subject/participant's antibody responses were assessed. Date antibody responses were assessed: (date closest to diagnosis, before any IVIG) Date or Date & Time Adult;Pediatric Supplemental 1.00 2020-09-02 10:32:15.0 Immune Function Form Assessments and Examinations Laboratory Tests and Biospecimens/Biomarkers

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CIBMTR n/a Form 2031 revision 2 36
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
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

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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 &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 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

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CIBMTR n/a Form 2031 revision 2 29
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?
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
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

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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

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CIBMTR n/a Form 2031 revision 2 37
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

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CIBMTR n/a Form 2031 revision 2 47
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

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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

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CIBMTR n/a Form 2031 revision 2 29
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 &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 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

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CIBMTR n/a Form 2031 revision 2 15: Platelets
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