CDE Detailed Report
Disease:
Sub-Domain: Assessments and Examinations
CRF:
Sub-Domain: Assessments and Examinations
CRF:
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C60016 | Unconjugated pneumococcal polysaccharide serotype produce protective level count | UncnjPneumPlyscSrtypPrdPrtLvCt | Count of serotypes from unconjugated pneumococcal polysaccharide vaccine that have been assessed as producing a protective level in the subject/participant. | Count of serotypes from unconjugated pneumococcal polysaccharide vaccine that have been assessed as producing a protective level in the subject/participant. | Unconjugated pneumococcal polysaccharide: Number of serotypes producing a protective level | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:00:44.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 43: Number of serotypes | |||||||||||||||||||||||||||||
| C60048 | Diarrhea severe protracted prominent feature ID indicator | DiarrheaSvrPrtrctPromFeatIDInd | Indicator of whether severe or protracted diarrhea was a prominent feature of the subject/participant's ID. | Indicator of whether severe or protracted diarrhea was a prominent feature of the subject/participant's ID. | If diarrhea 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 74 | ||||||||||||||||||||||||||
| C59984 | Immunoglobulin supplemental intravenous therapy ongoing within one month immunoglobulin test indicator | IgSplIvThpyOngoWin1MoIgTstInd | Indicator of whether supplemental intravenous immunoglobulin (IVIG) therapy was ongoing within one month of immunoglobulin testing. | Indicator of whether supplemental intravenous immunoglobulin (IVIG) therapy was ongoing within one month of immunoglobulin testing. | Was therapy ongoing within one month of immunoglobulin testing? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:29:14.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 25 | |||||||||||||||||||||||||||
| C60080 | Warts prominent indicator | WartsPromnntInd | Indicator of whether the warts the subject/participant presents with are a prominent clinical feature. | Indicator of whether the warts the subject/participant presents with are a prominent clinical feature. | If present, are warts prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 124 | |||||||||||||||||||||||||||
| C60027 | Hepatitis infectious organism 2 code | HepatitisInfectOrganism2Code | Code specifying the second infectious organism pertaining to the subject/participant's hepatitis that was identified. | Code specifying the second infectious organism pertaining to the subject/participant's hepatitis that was identified. | Hepatitis 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 53 | |||||||||||||||||||||||||
| C59963 | Polymorphonuclear leukocyte value | PMNLeukocyteVal | Value (as a percentage of white blood cell (WBC) count) of the subject/participant's polymorphonuclear (PMN) leukocytes. | Value (as a percentage of white blood cell (WBC) count) of the subject/participant's polymorphonuclear (PMN) leukocytes. | Polymorphonuclear leukocytes (PMN): % | 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 13:58:31.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Free-Form Entry |
0 | 100 | percent of white blood cells | CIBMTR | n/a | Form 2031 revision 2 | 13: Polymorphonuclear leukocytes (PMN)x | |||||||||||||||||||||||||
| C60059 | Other infection organism code other text | OtherInfectOrganismCodeOTH | The free-text field related to 'Other infection organism 1 code', 'Other infection organism 2 code', or 'Other infection organism 3 code', specifying other text. | The free-text field related to 'Other infection organism 1 code', 'Other infection organism 2 code', or 'Other infection organism 3 code', specifying other text. | Other 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 | general-data-protection-regulation-gdpr | 255 |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 85 | |||||||||||||||||||||||||||
| C59995 | Lymphocyte CD8 measurement | LymphocyteCD8Measr | Measurement of CD8 lymphocytes (cytotoxic T cells). | Measurement of CD8 lymphocytes (cytotoxic T cells). | CD8 (cytotoxic 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 | general-data-protection-regulation-gdpr |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 31 | ||||||||||||||||||||||||||||
| C60006 | Lymphocyte CD4 CD45RO measurement type | LymphocyteCD4CD45ROMeasrTyp | Type of measurement of CD4+/CD45RO+ lymphocytes (memory T cells) represented by the recorded value. | Type of measurement of CD4+/CD45RO+ lymphocytes (memory T cells) represented by the recorded value. | CD4+ / CD45RO+ (memory 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 35 | ||||||||||||||||||||||||||
| C60038 | Pneumonia infectious organism 1 code | PneumoniaInfectOrganism1Code | Code specifying the first infectious organism pertaining to the subject/participant's pneumonia that was identified. | Code specifying the first infectious organism pertaining to the subject/participant's pneumonia that was identified. | Pneumonia 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 64 | |||||||||||||||||||||||||
| C59974 | Immunoglobulin G not tested status | IgGNotTestedStatus | Status indicating that the subject/participant's immunoglobulin G (IgG) was not tested. | Status indicating that the subject/participant's immunoglobulin G (IgG) was not tested. | IgG: | 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 17: Not tested | ||||||||||||||||||||||||||
| C60070 | Growth hormone deficiency prominent indicator | GrwthHrmoneDeficncyPromnntInd | Indicator of whether the growth hormone deficiency the subject/participant presents with is a prominent clinical feature. | Indicator of whether the growth hormone deficiency the subject/participant presents with is a prominent clinical feature. | If present, is growth hormone deficiency prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 104 | |||||||||||||||||||||||||||
| C60081 | Other features prominent indicator | OtherFeaturesPromnntInd | Indicator of whether the other specified feature(s) the subject/participant presents with is/are (a) prominent clinical feature(s). | Indicator of whether the other specified feature(s) the subject/participant presents with is/are (a) prominent clinical feature(s). | If present, are the other features prominent? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2020-09-03 15:35:46.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 126 | |||||||||||||||||||||||||||
| C60017 | Unconjugated pneumococcal polysaccharide serotype total test count | UncnjPneumPlyscSrtypTtlTstCt | Count of all serotypes from unconjugated pneumococcal polysaccharide vaccine that were tested. | Count of all serotypes from unconjugated pneumococcal polysaccharide vaccine that were tested. | Unconjugated pneumococcal polysaccharide: Total serotypes tested from vaccine | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:00:44.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Free-Form Entry |
CIBMTR | n/a | Form 2031 revision 2 | 43: Total serotypes teted | |||||||||||||||||||||||||||||
| C60049 | Systemic infection present indicator | SystemicInfectionPresentInd | Indicator of whether systemic infection is present in the subject/participant. | Indicator of whether systemic infection is present in the subject/participant. | Systemic infection Site of infection? | No;Yes | No;Yes | Alphanumeric |
Infections Identified between Diagnosis and the Start of the Preparative Regimen: Specify the presence of all clinically significant infections identified between diagnosis and the start of the preparative regimen. |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-02 13:38:10.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 75. Site of infection? | ||||||||||||||||||||||||||
| C59985 | Lymphocyte analysis perform prior disease treatment indicator | LymphcytAnlysPrfmPriorDzTxInd | Indicator of whether any lymphocyte analyses were performed prior to any disease treatment. | Indicator of whether any lymphocyte analyses were performed prior to any disease treatment. | Were lymphocyte analyses performed? | No;Yes | No;Yes | Alphanumeric |
Specify the following lymphocyte analyses performed prior to any disease treatment: |
Adult;Pediatric | Supplemental | 1.00 | 2020-09-01 17:38:02.0 | Immune Function Form | Assessments and Examinations | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 26 | ||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr | 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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 31. Specify units | ||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr | 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 32 | ||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 108 | |||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Free-Form Entry |
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| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 88 | |||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr | 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Single Pre-Defined Value Selected |
CIBMTR | n/a | Form 2031 revision 2 | 110 | |||||||||||||||||||||||||||
| 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 | general-data-protection-regulation-gdpr |
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 | general-data-protection-regulation-gdpr |
Free-Form Entry |