CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Assessments and Examinations
CRF: Immune Function Form
Sub-Domain: Assessments and Examinations
CRF: Immune Function Form
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | Domain | CDASH Variable | CDASH Definition | CDASH Label | Controlled Terminology | Prompt | Essentiality | Question Text | CDASH imp guidance | SDTM IG target | csDSR | PhenX | Data Type | CRF Completion Inst | SDTMIG Target Var | SDTMIG Target Map | Codelist Name | PVs | Pre Pop Value | Query Display | List Style |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | ||||||||||||||||||||||||||
| 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 | |||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||
| 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 | |||||||||||||||||||||||||||
| 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 © 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 | |||||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||
| 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 © 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 | ||||||||||||||||||||||||||
| 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 © 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 | |||||||||||||||||||||||||||
| 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 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 32 | ||||||||||||||||||||||||||||
| 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 | |||||||||||||||||||||||||||
| 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 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 36 | |||||||||||||||||||||||||||||
| 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 |
Free-Form Entry |
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 | ||||||||||||||||||||||||||
| 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 |
Free-Form Entry |
||||||||||||||||||||||||||||||||
| C60052 | Systemic infection organism 3 code | SystemicInfectOrganism3Code | Code specifying the third organism pertaining to the subject/participant's systemic infection that was identified. | Code specifying the third organism pertaining to the subject/participant's systemic infection that was identified. | Systemic infection Third organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 78 | |||||||||||||||||||||||||
| C59988 | Lymphocyte CD3 measurement type | LymphocyteCD3MeasurementTyp | Type of measurement of CD3 lymphocytes (T cells) represented by the recorded value. | Type of measurement of CD3 lymphocytes (T cells) represented by the recorded value. | CD3 (T cells): % or value | Value;Percent of total lymphocytes | Value;Percent of total lymphocytes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:52:17.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 29 | ||||||||||||||||||||||||||
| C59999 | Lymphocyte CD20 count unit of measure | LymphocyteCD20CountUOM | Unit of measure pertaining to the count of CD20 lymphocytes (B lymphocyte cells) being reported. | Unit of measure pertaining to the count of CD20 lymphocytes (B lymphocyte cells) being reported. | CD20 (B lymphocyte cells): Specify units | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | x 10^9 cells per liter (x 10^3 cells per cubic millimeter);x 10^6 cells per liter;Not tested | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:41:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 32. Specify units | ||||||||||||||||||||||||||
| C60031 | Meningitis encephalitis present indicator | MeningitsEncephalitsPresentInd | Indicator of whether meningitis or encephalitis is present in the subject/participant. | Indicator of whether meningitis or encephalitis is present in the subject/participant. | Meningitis / encephalitis Site of infection? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:38:10.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 57. Site of infection? | ||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||
| C60074 | Lymphoproliferative disease prominent indicator | LymphoproliferativDzPromnntInd | Indicator of whether the lymphoproliferative disease the subject/participant presents with is a prominent clinical feature. | Indicator of whether the lymphoproliferative disease the subject/participant presents with is a prominent clinical feature. | If present, is lymphoproliferative disease prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 112 | |||||||||||||||||||||||||||
| C60010 | Antibody bacteriophage phi X-174 other neoantigen response status | AbdyBctphgPhiX174OthAgnRspStat | Status of the antibody response for bacteriophage phi X-174 or other neoantigen. | Status of the antibody response for bacteriophage phi X-174 or other neoantigen. | Bacteriophage phi X-174 or other neoantigen | Absent;Low;Normal;Not tested | Absent;Low;Normal;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 10:36:04.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 37 | |||||||||||||||||||||||||||
| 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 | ||||||||||||||||||||||||||||
| C59989 | Lymphocyte CD3 measurement | LymphocyteCD3Measr | Measurement of CD3 lymphocytes (T cells). | Measurement of CD3 lymphocytes (T cells). | CD3 (T cells): % or value | Numeric Values |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 09:33:19.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 29 | ||||||||||||||||||||||||||||
| C60021 | Lymphocyte function concavalin A status | LymphcytFncConcavalinAStat | Status of concavalin A (ConA) lymphocyte function. | Status of concavalin A (ConA) lymphocyte function. | Concavalin A (ConA) | Absent;Low;Normal;Not tested | < 10% of control;10-30% of control;> 30% of control;Not tested | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:19:00.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 47 | |||||||||||||||||||||||||||
| C59957 | Complete blood count date | CompleteBloodCountDate | Date on which the complete blood count test was performed. | Date on which the complete blood count test was performed. | Date CBC tested: (testing done within 6 weeks of diagnosis) | Date or Date & Time |
Report findings prior to any first treatment of the primary disease for which the HSCT is being performed. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 13:30:18.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 9 | ||||||||||||||||||||||||||||
| C60053 | Systemic infection organism code other text | SystemicInfectOrganismCodeOTH | The free-text field related to 'Systemic infection organism 1 code', 'Systemic infection organism 2 code', or 'Systemic infection organism 3 code', specifying other text. | The free-text field related to 'Systemic infection organism 1 code', 'Systemic infection organism 2 code', or 'Systemic infection organism 3 code', specifying other text. | Systemic infection Specify other organism | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 14:17:24.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers | 255 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 79 | |||||||||||||||||||||||||||
| C60000 | Lymphocyte CD56 measurement type | LymphocyteCD56MeasurementTyp | Type of measurement of CD56 lymphocytes (natural killer (NK) cells) represented by the recorded value. | Type of measurement of CD56 lymphocytes (natural killer (NK) cells) represented by the recorded value. | CD56 (natural killer (NK) cells): % or value | Value;Percent of total lymphocytes | Value;Percent of total lymphocytes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:52:17.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 33 | ||||||||||||||||||||||||||
| C60032 | Meningitis encephalitis infectious organism 1 code | MeningtsEncephltsInfctOrg1Code | Code specifying the first infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Code specifying the first infectious organism pertaining to the subject/participant's meningitis or encephalitis that was identified. | Meningitis / encephalitis First organism | 121;122;123;124;125;126;127;128;129;171;172;113;130;131;132;173;133;101;134;177;135;136;137;138;139;144;145;146;147;102;103;148;149;104;150;151;112;174;110;175;176;105;152;106;153;154;155;156;157;158;159;107;160;161;162;163;164;165;166;167;178;168;169;197;198;501;502;200;201;206;202;207;203;204;205;209;210;211;212;213;219;220;230;261;240;241;242;250;259;260;503;301;302;303;304;305;306;307;308;309;310;323;324;311;312;313;314;315;316;317;318;319;320;321;322;329;504;402;403;404;409;505;509 | Acinetobacter;Actinomyces;Bacillus;Bacteroides (gracillis, uniformis, vulgaris, other species);Bordetella pertussis (whooping cough);Borrelia (Lyme disease);Branhamella or Moraxella catarrhalis (other species);Campylobacter (all species);Capnocytophaga;Chlamydia pneumoniae;Other chlamydia, specify;Chlamydia, NOS;Citrobacter (freundii, other species);Clostridium (all species except difficile);Clostridium difficile;Corynebacterium jeikeium;Corynebacterium (all non-diptheria species);Coxiella;Enterobacter;Enterococcus, vancomycin resistant (VRE);Enterococcus (all species);Escherichia (also E. coli);Flavimonas oryzihabitans;Flavobacterium;Fusobacterium;Haemophilus (all species, including influenzae);Helicobacter pylori;Klebsiella;Lactobacillus (bulgaricus, acidophilus,other species);Legionella;Leptospira;Leptotrichia buccalis;Leuconostoc (all species);Listeria;Methylobacterium;Micrococcus, NOS;Mycobacterium avium– intracellulare (MAC, MAI);Mycobacterium species (cheloneae, fortuitum, haemophilum, kansasii,mucogenicum;Mycobacterium tuberculosis (tuberculosis, Koch bacillus);Other mycobacterium, specify;Mycobacterium, NOS;Mycoplasma;Neisseria (gonorrhoea, meningitidis, other species);Nocardia;Pasteurella multocida;Propionibacterium (acnes, avidum, granulosum, other species);Proteus;Pseudomonas (all species except cepacia & maltophilia);Pseudomonas or Burkholderia cepacia;Pseudomonas or Stenotrophomonas or Xanthomonas maltophilia;Rhodococcus;Rickettsia;Salmonella (all species);Serratia marcescens;Shigella;Staphylococcus, coagulase negative (not aureus);Staphylococcus aureus;Staphylococcus, NOS;Stomatococcus mucilaginosis;Streptococcus (all species except Enterococcus);Streptococcus pneumoniae;Treponema (syphilis);Vibrio (all species);Multiple bacteria at a single site, specify bacterial codes;Other bacteria, specify;Suspected atypical bacterial infection;Suspected bacterial infection;Candida, NOS;Candida albicans;Candida guillermondi;Candida krusei;Candida lusitaniae;Candida parapsilosis;Candida tropicalis;Candida (Torulopsis) glabrata;Other Candida, specify;Aspergillus, NOS;Aspergillus flavus;Aspergillus fumigatus;Aspergillus niger;Other Aspergillus, specify;Cryptococcus species;Fusarium species;Histoplasmosis;Zygomycetes, NOS;Mucormycosis;Rhizopus;Yeast, NOS;Other fungus, specify;Pneumocystis (PCP / PJP);Suspected fungal infection;Herpes simplex (HSV1, HSV2);Varicella (herpes zoster, chicken pox);Cytomegalovirus (CMV);Adenovirus;Enterovirus (coxsackie, echo, polio);Hepatitis A (HAV);Hepatitis B (HBV, Australian antigen);Hepatitis C (HCV);HIV-1 (HTLV-III);Influenza, NOS;Influenza A;Influenza B;Measles (rubeola);Mumps;Progressive multifocalleukoencephalopathy (PML);Respiratory syncytial virus (RSV);Rubella (German measles);Parainfluenza;Human herpesvirus-6 (HHV-6);Epstein-Barr virus (EBV);Polyoma virus (BK virus, JC virus);Rotavirus;Rhinovirus;Human papilloma virus (HPV);Other virus, specify;Suspected viral infection;Toxoplasma;Giardia;Cryptosporidium;Other parasite, specify;Suspected parasite infection;No organism identified | Numeric Values |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. Only report an organism once, even if it was identified at the same site in subsequent infections. |
CIBMTR Form 2031 revision 2 June 2009, Copyright © 2009 National Marrow Donor Program and The Medical College of Wisconsin, Inc. All rights reserved. | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:41:44.0 | Immune Function Form | Assessments and Examinations | Laboratory Tests and Biospecimens/Biomarkers |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 58 |