data dictionary codebook 08-04-2020 10:03 · % data dictionary codebook 08-04-2020 10:03 # variable...
TRANSCRIPT
08/04/2020, 10)04CAPACITY | REDCap
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% Data Dictionary Codebook 08-04-2020 10:03
# Variable / Field NameField LabelField Note
Field Attributes (Field Type, Validation, Choices,Calculations, etc.)
Instrument: ISARIC/CAPACITY - Participant Identification Number Pin (REQUIRED) (participant_identification_number_pin_required)
1 subjid Participant Identification Number (PIN):999-9999 (SiteNo-PIN)
text
2 studyid Please contact your local study coordinator for the STUDY ID. descriptive
3 participant_identification_number_pin_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC/CAPACITY - Inclusion Criteria (REQUIRED) (inclusion_criteria_required)
4 dsstdat Date of Enrollmentdd-mm-yyyy; definition: date of data entry
text (date_dmy), Required
5 sitename_nhr Site name dropdown
31 Admiraal de Ruyter Ziekenhuis
22 Albert Schweitzer Ziekenhuis
32 Alrijne ziekenhuis
11 Amphia Ziekenhuis
3 Amsterdam UMC, locatie AMC
4 Amsterdam UMC, locatie VU
33 Antonius Ziekenhuis, Sneek
34 Bernhoven Ziekenhuis
35 BovenIJ Ziekenhuis
36 Bravis Ziekenhuis
20 Canisius-Wilhelmina Ziekenhuis
250 Cardiologie Centra Nederland
12 Catharina Ziekenhuis
900 CHU CLU Namur - Site Godinne
37 De Tjongerschans Ziekenhuis
38 Deventer Ziekenhuis
39 Diakonessenhuis Utrecht
40a Dijklander Ziekenhuis, locatie Hoorn
40b Dijklander Ziekenhuis, locatie Purmerend
27 Elisabeth-TweeSteden Ziekenhuis
41 Elkerliek Ziekenhuis
9 Erasmus MC
42 Flevoziekenhuis
43 Franciscus Gasthuis en Vlietland
44 Gelderse Vallei Ziekenhuis
45 Gelre Ziekenhuizen, locatie Apeldoorn
CAPACITY
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46 Gelre Ziekenhuizen, locatie Zutphen
47 Groene Hart Ziekenhuis
25 Haaglanden Medisch Centrum
17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft
48 IJsselland Ziekenhuis
49 Ikazia Ziekenhuis
2a Isala Ziekenhuis (Meppel)
2b Isala Ziekenhuis (Zwolle)
21 Jeroen Bosch Ziekenhuis
50 Langeland Ziekenhuis
51 Laurentius Ziekenhuis
6 Leids Universitair Medisch Centrum
15 Maasstad Ziekenhuis
13 Maastricht UMC+
52 Maasziekenhuis Pantein
53 Martini Ziekenhuis
54 Máxima Medisch Centrum
74 MC Slotervaart
73 MC Zuiderzee
24 Meander Medisch Centrum
16 Medisch Centrum Leeuwarden
18 Medisch Spectrum Twente
55 Nij Smellinghe
14 Noordwest Ziekenhuisgroep
56 Ommelander Ziekenhuis Groningen
5 Onze Lieve Vrouwe Gasthuis
10 Radboudumc
57 Reinier de Graaf Gasthuis
19 Rijnstate Ziekenhuis
58 Rivas Zorggroep
59 Rivierenland Ziekenhuis
60 Rode Kruis Ziekenhuis
61 Ropcke Zweers Ziekenhuis
62 Slingeland Ziekenhuis
63a Spaarne Gasthuis, locatie Haarlem
63b Spaarne Gasthuis, locatie Hoofddorp
1000 Spijkenisse MC
64 St. Anna Ziekenhuis
8 St. Antonius Ziekenhuis Nieuwegein
65 St. Jans Gasthuis
66 St. Jansdal Ziekenhuis
67 Streekziekenhuis Koningin Beatrix
30 Tergooi
23 Treant Zorggroep
1 UMC Groningen
7 UMC Utrecht
201 UZ Antwerpen
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68 Van Weel-Bethesda Ziekenhuis
28 VieCuri Medisch Centrum
69 Wilhelmina Ziekenhuis, Assen
70 Zaans Medisch Centrum
71 Ziekenhuis Amstelland
72 Zorg Groep Twente
26 ZorgSaam Zorggroep Zeeuws-Vlaanderen
29 Zuyderland MC
6 country Country dropdown, Required
1 Afghanistan
2 Albania
3 Algeria
4 Andorra
5 Angola
6 Antigua & Deps
7 Argentina
8 Armenia
9 Australia
10 Austria
11 Azerbaijan
12 Bahamas
13 Bahrain
14 Bangladesh
15 Barbados
16 Belarus
17 Belgium
18 Belize
19 Benin
20 Bhutan
21 Bolivia
22 Bosnia Herzegovina
23 Botswana
24 Brazil
25 Brunei
26 Bulgaria
27 Burkina
28 Burundi
29 Cambodia
30 Cameroon
31 Canada
32 Cape Verde
33 Central African Rep
34 Chad
35 Chile
36 China
37 Colombia
38 Comoros
39 Congo
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40 Congo {Democratic Rep}
41 Costa Rica
42 Croatia
43 Cuba
44 Cyprus
45 Czech Republic
46 Denmark
47 Djibouti
48 Dominica
49 Dominican Republic
50 East Timor
51 Ecuador
52 Egypt
53 El Salvador
54 Equatorial Guinea
55 Eritrea
56 Estonia
57 Ethiopia
58 Fiji
59 Finland
60 France
61 Gabon
62 Gambia
63 Georgia
64 Germany
65 Ghana
66 Greece
67 Grenada
68 Guatemala
69 Guinea
70 Guinea-Bissau
71 Guyana
72 Haiti
73 Honduras
74 Hungary
75 Iceland
76 India
77 Indonesia
78 Iran
79 Iraq
80 Ireland {Republic}
81 Israel
82 Italy
83 Ivory Coast
84 Jamaica
85 Japan
86 Jordan
87 Kazakhstan
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88 Kenya
89 Kiribati
90 Korea North
91 Korea South
92 Kosovo
93 Kuwait
94 Kyrgyzstan
95 Laos
96 Latvia
97 Lebanon
98 Lesotho
99 Liberia
100 Libya
101 Liechtenstein
102 Lithuania
103 Luxembourg
104 Macedonia
105 Madagascar
106 Malawi
107 Malaysia
108 Maldives
109 Mali
110 Malta
111 Marshall Islands
112 Mauritania
113 Mauritius
114 Mexico
115 Micronesia
116 Moldova
117 Monaco
118 Mongolia
119 Montenegro
120 Morocco
121 Mozambique
122 Myanmar, {Burma}
123 Namibia
124 Nauru
125 Nepal
126 Netherlands
127 New Zealand
128 Nicaragua
129 Niger
130 Nigeria
131 Norway
132 Oman
133 Pakistan
134 Palau
135 Panama
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136 Papua New Guinea
137 Paraguay
138 Peru
139 Philippines
140 Poland
141 Portugal
142 Qatar
143 Romania
144 Russian Federation
145 Rwanda
146 St Kitts & Nevis
147 St Lucia
148 Saint Vincent & the Grenadines
149 Samoa
150 San Marino
151 Sao Tome & Principe
152 Saudi Arabia
153 Senegal
154 Serbia
155 Seychelles
156 Sierra Leone
157 Singapore
158 Slovakia
159 Slovenia
160 Solomon Islands
161 Somalia
162 South Africa
163 South Sudan
164 Spain
165 Sri Lanka
166 Sudan
167 Suriname
168 Swaziland
169 Sweden
170 Switzerland
171 Syria
172 Taiwan
173 Tajikistan
174 Tanzania
175 Thailand
176 Togo
177 Tonga
178 Trinidad & Tobago
179 Tunisia
180 Turkey
181 Turkmenistan
182 Tuvalu
183 Uganda
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184 Ukraine
185 United Arab Emirates
186 United Kingdom
187 United States
188 Uruguay
189 Uzbekistan
190 Vanuatu
191 Vatican City
192 Venezuela
193 Vietnam
194 Yemen
195 Zambia
196 Zimbabwe
197 Other
7 othcountry
Show the field ONLY if:[country] = 197
Other country text
8 corona_ieorres Section Header: INCLUSION CRITERIA
1. Suspected or proven acute novel Coronavirus (COVID-19)infection as main cause for admission:Including if an admission that was initially for a different reason was prolongeddue to COVID
yesno, Required
1 Yes
0 No
Custom alignment: RH
9 symptoms_epi_physical
Show the field ONLY if:[corona_ieorres] = '1'
Section Header: EPIDEMIOLOGICAL FACTORS - In the 14 days before onset ofillness had any of the following:
2. Close contact* with a confirmed or probable case of nCoVinfection, while that patient was symptomatic
radio (Matrix), Required
1 YES
2 NO
3 Unknown
Field Annotation: Including confirmed/probable casespresenting (with symptoms) simultaneously
10 symptoms_epi_healthfac
Show the field ONLY if:[corona_ieorres] = '1'
3. Presence in a healthcare facility where nCoV infections havebeen managed
radio (Matrix), Required
1 YES
2 NO
3 Unknown
11 symptoms_epi_lab
Show the field ONLY if:[corona_ieorres] = '1'
4. Presence in a laboratory handling suspected or confirmednCoV samples
radio (Matrix), Required
1 YES
2 NO
3 Unknown
12 contact
Show the field ONLY if:[corona_ieorres] = '1'
* Close contact' is defined as:- Health care associated exposure, including providing directcare for novel coronavirus patients, e.g. health care worker,working with health care workers infected with novelcoronavirus, visiting patients or staying in the same closeenvironment of a novel coronavirus patient, or direct exposureto body fluids or specimens including aerosols.- Working together in close proximity or sharing the sameclassroom environment with a novel coronavirus patient.- Traveling together with novel coronavirus patient in any kindof conveyance.- Living in the same household as a novel coronavirus patient.
descriptive
13 inclusion_criteria_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
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! CollapseInstrument: ISARIC/CAPACITY - Demographics (REQUIRED) (demographics_required)
14 sex Section Header: 1. DEMOGRAPHICS
1.1 Sex at Birth:
radio, Required, Identifier
1 Male
2 Female
-1 Not specified
15 age_estimateyears 1.2 Age/Estimated ageIf patient is a child less than one year age, include age in months
text (number, Max: 100), Required, Identifier
16 age_estimateyearsu Age/Estimated age Unit dropdown, Required
1 Months
2 Years
17 ethnic 1.3 Ethnic group (check all that apply) checkbox
1 ethnic___1 Arab
2 ethnic___2 Black
3 ethnic___3 East Asian
4 ethnic___4 South Asian
5 ethnic___5 West Asian
6 ethnic___6 Latin American
7 ethnic___7 White
8 ethnic___8 Aboriginal/First Nations
9 ethnic___9 Other
10 ethnic___10 N/A
18 other_ethnic
Show the field ONLY if:[ethnic(9)] = '1'
If Other: Specify text
19 healthwork_erterm 1.4 Employed as a healthcare worker? dropdown, Required
1 YES
2 NO
3 N/A
20 labwork_erterm 1.4 Employed in a microbiology laboratory? dropdown, Required
1 YES
2 NO
3 N/A
21 pregyn_rptestcd
Show the field ONLY if:[sex] = '2' and [age_estimateyears] > 12 and [age_estimateyears] < 55 and [age_estimateyearsu] = '2'
1.5 Pregnant ? radio, Required
1 Yes
0 No
998 Unknown
999 N/A
22 egestage_rptestcd
Show the field ONLY if:[pregyn_rptestcd] = '1'
If YES: Gestational weeks assessment:weeks
text (number_2dp, Min: 1, Max: 41)
23 postpart_rptestcd
Show the field ONLY if:[sex] = '2' and [age_estimateyears] >12 <55 and [age_estimateyearsu] = '2' and [pregyn_rptestcd] = '0' or [pregyn_rptestcd] = '998' or [pregyn_rptestcd] = '998'
1.6 Post Partum yesno, Required
1 Yes
0 No
24 pregout_rptestcd
Show the field ONLY if:[postpart_rptestcd] = '1'
1.6.1 Pregnancy Outcome radio, Required
1 Live birth
2 Still birth
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25 dlvrdtc_rptestcd
Show the field ONLY if:[postpart_rptestcd] = '1'
1.6.2 Delivery date text (date_dmy), Required
26 aplb_lbperf
Show the field ONLY if:[postpart_rptestcd] = '1' and [pregout_rptestcd] = '1'
1.6.3 Baby tested for mother's ARI infectionIf baby positive for COVID-19, complete a separate CRF for the baby
radio, Required
1 Yes
2 No
3 N/A
27 aplb_lborres
Show the field ONLY if:[aplb_lbperf] = '1'
If YES radio, Required
1 Positive
2 Negative
3 N/A
28 aplb_lbmethod
Show the field ONLY if:[aplb_lbperf] = '1'
1.6.4 Method radio, Required
1 PCR
2 Other
29 aplb_lbmethodoth
Show the field ONLY if:[aplb_lbmethod] = '2'
If OTHER method; Specify text, Required
30 apdm_age
Show the field ONLY if:[age_estimateyearsu] = '1'
1.7 INFANT - Less than 1 year old? yesno, Required
1 Yes
0 No
31 apvs_weight
Show the field ONLY if:[apdm_age] = '1'
1.7.1 Birth weight text (number_2dp, Max: 50), Required
32 apvs_weightu
Show the field ONLY if:[apdm_age] = '1'
Birth weight unit dropdown, Required
1 kg
2 lbs
33 apsc_gestout
Show the field ONLY if:[apdm_age] = '1'
1.7.2 Gestational outcome radio, Required
1 Term birth ( >= 37wk GA)
2 Preterm birth (< 37wk GA)
3 N/A
34 apsc_brfedind
Show the field ONLY if:[apdm_age] = '1'
1.7.3 Breastfed radio, Required
1 Yes
2 No
3 N/A
35 apsc_brfedindy
Show the field ONLY if:[apsc_brfedind] = '1'
If YES radio, Required
1 Currently breastfed
2 Breastfeeding discontinued
3 N/A
Field Annotation: weeks
36 apsc_brdisdat
Show the field ONLY if:[apsc_brfedindy] = '2'
Discontinued breastfeeding atweeks
text (number, Min: 0, Max: 300)
37 apsc_dvageind
Show the field ONLY if:[apdm_age] = '1'
1.7.4 Appropriate development for age? dropdown, Required
1 Yes
2 No
3 N/A
38 apsc_vcageind
Show the field ONLY if:
1.7.5 Vaccinations appropriate for age/country? dropdown, Required
1 Yes
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[apdm_age] = '1' 2 No
3 Unknown
4 N/A
39 demographics_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac baseline assessment (REQUIRED) (capacity_cardiac_baseline_assessment_required)
40 admission_sympt_date Section Header: Admission
Date of symptoms appearancedd-mm-yyyy; any symptom suspect for COVID
text (date_dmy)
41 admission_any_date Date of first admission to any facilitydd-mm-yyyy; trace back to very first admission related to COVID in anyhospital/facility
text (date_dmy)
42 admission_date Date of (first) admission at this facilitydd-mm-yyyy; may be the same as date first admission to any facility
text (date_dmy)
43 admis_complaints Complaints at admission checkbox
1 admis_complaints___1 Fever (Temperature>38°C or >100.4°F)
2 admis_complaints___2 Cough
3 admis_complaints___3 Sore throat
4 admis_complaints___4 Dyspnea
5 admis_complaints___5 Orthopnea
6 admis_complaints___6 Chest pain
7 admis_complaints___7 Peripheral edema
8 admis_complaints___8 Palpitations
9 admis_complaints___9 (Near) syncope
10 admis_complaints___10 Fatigue
11 admis_complaints___11 Gastrointestinalsymptoms
12 admis_complaints___12 Anosmia
99 admis_complaints___99 Other
-1 admis_complaints____1 Unknown
44 admis_compl_other
Show the field ONLY if:[admis_complaints(99)] = '1'
Specify complaints at admission text
45 susp_pe Was there also a suspicion of a pulmonary embolism atpresentation?
radio
1 Yes
2 No
-1 Unknown
46 admission_transfer Transfer from other facility? radio
1 Yes
0 No
-1 Unknown
47 admission_transf_facility
Show the field ONLY if:[admission_transfer] = '1'
Name of facility from which patient was transferred dropdown
31 Admiraal de Ruyter Ziekenhuis
22 Albert Schweitzer Ziekenhuis
32 Alrijne ziekenhuis
11 Amphia Ziekenhuis
3 Amsterdam UMC, locatie AMC
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4 Amsterdam UMC, locatie VU
33 Antonius Ziekenhuis, Sneek
34 Bernhoven Ziekenhuis
35 BovenIJ Ziekenhuis
36 Bravis Ziekenhuis
20 Canisius-Wilhelmina Ziekenhuis
250 Cardiologie Centra Nederland
12 Catharina Ziekenhuis
37 De Tjongerschans Ziekenhuis
38 Deventer Ziekenhuis
39 Diakonessenhuis Utrecht
40a Dijklander Ziekenhuis, locatie Hoorn
40b Dijklander Ziekenhuis, locatie Purmerend
27 Elisabeth-TweeSteden Ziekenhuis
41 Elkerliek Ziekenhuis
9 Erasmus MC
42 Flevoziekenhuis
43 Franciscus Gasthuis en Vlietland
44 Gelderse Vallei Ziekenhuis
45 Gelre Ziekenhuizen, locatie Apeldoorn
46 Gelre Ziekenhuizen, locatie Zutphen
47 Groene Hart Ziekenhuis
25 Haaglanden Medisch Centrum
17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft
48 IJsselland Ziekenhuis
49 Ikazia Ziekenhuis
2a Isala Ziekenhuis (Meppel)
2b Isala Ziekenhuis (Zwolle)
21 Jeroen Bosch Ziekenhuis
50 Langeland Ziekenhuis
51 Laurentius Ziekenhuis
6 Leids Universitair Medisch Centrum
15 Maasstad Ziekenhuis
13 Maastricht UMC+
52 Maasziekenhuis Pantein
53 Martini Ziekenhuis
54 Máxima Medisch Centrum
74 MC Slotervaart
73 MC Zuiderzee
24 Meander Medisch Centrum
16 Medisch Centrum Leeuwarden
18 Medisch Spectrum Twente
55 Nij Smellinghe
14 Noordwest Ziekenhuisgroep
56 Ommelander Ziekenhuis Groningen
5 Onze Lieve Vrouwe Gasthuis
10 Radboudumc
57 Reinier de Graaf Gasthuis
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19 Rijnstate Ziekenhuis
58 Rivas Zorggroep
59 Rivierenland Ziekenhuis
60 Rode Kruis Ziekenhuis
61 Ropcke Zweers Ziekenhuis
62 Slingeland Ziekenhuis
63a Spaarne Gasthuis, locatie Haarlem
63b Spaarne Gasthuis, locatie Hoofddorp
900 Spijkenisse MC
64 St. Anna Ziekenhuis
8 St. Antonius Ziekenhuis Nieuwegein
65 St. Jans Gasthuis
66 St. Jansdal Ziekenhuis
67 Streekziekenhuis Koningin Beatrix
30 Tergooi
23 Treant Zorggroep
1 UMC Groningen
7 UMC Utrecht
201 UZ Antwerpen
68 Van Weel-Bethesda Ziekenhuis
28 VieCuri Medisch Centrum
69 Wilhelmina Ziekenhuis, Assen
70 Zaans Medisch Centrum
71 Ziekenhuis Amstelland
72 Zorg Groep Twente
26 ZorgSaam Zorggroep Zeeuws-Vlaanderen
29 Zuyderland MC
-1 Other
48 capacity_covid_test Section Header: COVID-19 infection status
Suspected or proven acute COVID-19 infection
radio
1 Proven
2 Suspected
-1 Unknown
49 capacity_covid_date
Show the field ONLY if:[capacity_covid_test] = '1'
Date of proven COVID-19 infectiondd-mm-yyyy
text (date_dmy)
50 cvrisk_def Section Header: Cardiovascular risk factors prior to COVID-19 diagnosis
Definitions of cardiovascular risk factors Hypertension: Indicateif the patient has a current diagnosis of hypertension definedby any 1 of the following: History of hypertension diagnosedand treatment with medication, diet and/or exercise; Currentlyon pharmacological therapy for the treatment of hypertension. Diabetes Mellitus: History of diabetes diagnosed and/ortreated by a physician, as documented in the EPD. The currentWHO diagnostic criteria for diabetes are used: fasting plasmaglucose ≥ 7.0mmol/l (126mg/dl) or 2–h plasma glucose ≥11.1mmol/l (200mg/dl.2 Type 1 diabetes is characterized bydeficiency of insulin due to destruction of pancreatic beta-cells,progressing to absolute insulin deficiency. Type 2 diabetes ischaracterized by a combination of insulin resistance andbetacell failure, in association with obesity (typically with anabdominal distribution) and sedentary lifestyle—major riskfactors forT2DM. Dyslipidemia: Indicate if the patient has ahistory of dyslipidemia diagnosed and/or treated by aphysician. Cut-off values are defined as: Total cholesterol
descriptive
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greater than 200 mg/dl (5.18 mmol/l) Low-density lipoprotein(LDL) greater than or equal to 130 mg/dl (3.37 mmol/l) High-density lipoprotein (HDL) less than 40 mg/dl (1.04 mmol/l) inmen and less than 50 mg/dl (1.30 mmol/l) in women Currentlyon antilipidemic treatment Positive family history: Indicatewhether the family history in first degree familymembers (parents, siblings, children) was positive forcardiovascular disease (coronary artery disease,cardiomyopathy, stroke, etc.) before the age of 65. Chronickidney disease: Indicate if the patient has a history of chronickidney disease diagnosed and/or treated by a physician. Cut-off values are defined as: eGFR < 60 ml/min/1.73 m2 or urinealbumin-creatinin ratio ≥ 3 mg/mmol Chronic obstructivepulmonary disease (COPD): Indicate if the patient has a historyof chronic kidney disease diagnosed and/or treated by aphysician. Cut-off values are defined as: FEV1 / FVC < 5thpercentile of reference population (z-score < -1.64)
51 cvrisk_ht Hypertension radio
0 No
1 Yes
-1 Unknown
52 cvrisk_dm Diabetes Mellitus radio
0 No
1 Yes, type 1
2 Yes, type 2
-1 Unknown
53 cvrisk_lipid Dyslipidemia radio
0 No
1 Yes, treated
2 Yes, untreated
-1 Unknown
54 cvrisk_smoking Smoking radio
0 Never
1 Former smoker
2 Current smoker
-1 Unknown
55 cvrisk_smoking_py
Show the field ONLY if:[cvrisk_smoking] = '1' or [cvrisk_smoking] = '2'
Smoking: Pack yearsCalculation: (number of cigarettes smokedper day / 20) × years as a smokerpack years
text
56 cvrisk_famhist Family history positive for cardiovascular disease radio
0 No
1 Yes
-1 Unknown
57 cvrisk_inflammatory Known auto-immune or inflammatory disease radio
0 No
1 Yes
58 cvrisk_inflam_type
Show the field ONLY if:[cvrisk_inflammatory] = '1'
Type of auto-immune / inflammatory disease(s) checkbox
1 cvrisk_inflam_type___1 (Rheumatoid) arthritis
2 cvrisk_inflam_type___2 Gout
3 cvrisk_inflam_type___3 Ankylosingspondylitis(Bechterew disease)
4 cvrisk_inflam_type___4 Psoriasis
5 cvrisk_inflam_type___5 Crohn's disease
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6 cvrisk_inflam_type___6 Celiac disease
7 cvrisk_inflam_type___7 Systemic Lupuserythematosus
8 cvrisk_inflam_type___8 Sjögren syndrome
9 cvrisk_inflam_type___9 Vasculitis
99 cvrisk_inflam_type___99 Other
59 cvrisk_inflam_type_spec
Show the field ONLY if:[cvrisk_inflam_type(99)] = '1'
Type of auto-immune / inflammatory disease: Specify text
60 cvrisk_ckd Known chronic kidney disease radio
0 No
1 Yes
61 cvrisk_ckd_sev
Show the field ONLY if:[cvrisk_ckd] = '1'
Severity chronic kidney disease (at last evaluation)eGFR = estimated glomerular filtration speed (ml/min/1.73 m2), ACR = urinealbumin creatinineratio (mg/mmol)
radio
1 Mild (eGFR < 60 or ACR ≥ 3)
2 Moderate (eGFR 30-44 and ACR < 3, or eGFR 45-59 and ACR 3-30, or eGFR ≥ 60 and ACR > 30)
3 Severe (eGFR < 29, or eGFR 30-44 and ACR 3-30mg/mmol, or eGFR 45-59 and ACR >30mg/mmol)
-1 Unknown
62 cvrisk_copd Known chronic obstructive pulmonary disease (COPD) radio
0 No
1 Yes
63 cvrisk_copd_sev
Show the field ONLY if:[cvrisk_copd] = '1'
Severity chronic obstructive pulmonary disease (COPD, at lastevaluation)FEV1 % of predicted after bronchodilatation
radio
1 GOLD I (mild, FEV1 ≥ 80%)
2 GOLD II (moderate, FEV1 50-79%)
3 GOLD III (severe, FEV1 30-49%)
4 GOLD IV (very severe, FEV1 < 30%)
-1 Unknown
64 cvrisk_height_unit Section Header: Height & Weight
Height
radio
1 Meters
2 Inches
-1 Unknown
Custom alignment: RH
65 carhist_height_m
Show the field ONLY if:[cvrisk_height_unit] = '1'
Height (meters)meters
text (number_2dp, Min: 0.40, Max: 2.40)
66 cvrisk_height_inch
Show the field ONLY if:[cvrisk_height_unit] = '2'
Height (inches)inches
text
67 cvrisk_weight_unit Weight radio
1 Kilogram
2 Pounds
-1 Unknown
Custom alignment: RH
68 carhist_weight_kg
Show the field ONLY if:[cvrisk_weight_unit] = '1'
Weight (kilogram)kilogram
text (number, Min: 3, Max: 250)
69 cvrisk_weight_pound Weight (pounds) text
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Show the field ONLY if:[cvrisk_weight_unit] = '2'
pounds
70 carhist_bmi
Show the field ONLY if:[carhist_height_m] > 0 and [carhist_weight_kg] > 0
Body Mass Index (kg/m2) kg/m2
calcCalculation:round([carhist_weight_kg]/([carhist_height_m]*[carhist_height_m]),1)
71 cvrisk_bmi_inchpound
Show the field ONLY if:[cvrisk_height_inch] > 0 and [cvrisk_height_inch] > 0
Body Mass Index (pounds/inches2)pounds/inches2
calcCalculation: 703*([cvrisk_weight_pound]/([cvrisk_height_inch]*[cvrisk_height_inch]))
72 med_nsaid Section Header: Prior use of NSAIDs
Non-steroid anti-inflammatory drugs (NSAIDs)
checkbox
0 med_nsaid___0 None
1 med_nsaid___1 Ibuprofen
2 med_nsaid___2 Naproxen
3 med_nsaid___3 Diclofenac
-1 med_nsaid____1 Unknown
73 med_nsaid_use_chronic
Show the field ONLY if:[med_nsaid(1)] = '1' or [med_nsaid(2)] = '1' or [med_nsaid(3)] = '1'
NSAIDs: Use >1 month? radio
1 Yes
0 No
-1 Unknown
74 med_nsaid_usage
Show the field ONLY if:[med_nsaid(1)] = '1' or [med_nsaid(2)] = '1' or [med_nsaid(3)] = '1'
NSAIDs: Indication radio
1 Chronic use
2 Started due to recent onset of flu symptoms
3 Other
-1 Unknown
75 med_nsaid_use_indication
Show the field ONLY if:[med_nsaid_usage] = '3'
NSAID: Specify indication text
76 carmed_examples Section Header: Use of cardiovascular medication prior to COVID-19 diagnosis
Cardiovascular medication classification system (withexamples) Betablocker e.g. atenolol, bisoporolol, carvedilolAntiarrhythmic drugs e.g. Class 1 (quinidine, procainamide,flecainide), Class III (amiodarone, sotalol), Class IV (diltiazem,verapamil Diuretics e.g. furosemide, bumetanide,hydrochlorothiazide calcium channel blockers(dihypdropyridine) e.g. amlodipine, nifedipine, barnidipine ACEinhibitor e.g. captopril, enalapril, perindopril Angiontensin IIreceptor blocker e.g.candesartan, losartan, valsartanAldosterone antagonist e.g. spironolactone, eplerenonePhosphodieseterase inhibitor e.g. sildenafil, tadalafil Anti-platelet agents e.g. acetylsalicyd acid, clopidogrel, ticagrelorCoumarin e.g. acenocoumarol, fenprocoumon Direct oralanticoagulants e.g. apixaban, dabigatran, rivaroxaban Lipidlowering agents e.g. atorvastatin, rosuvastatin, ezetimib Oralantidiabetic agents e.g. gliclazide, metformin
descriptive
77 carmed Cardiovascular medications checkbox, Required
0 carmed___0 None
1 carmed___1 Betablocker
3 carmed___3 Antiarrhytmic drugs
4 carmed___4 Digoxine
5 carmed___5 Diuretics
6 carmed___6 Calcium channel blocker(dihydropyridine)
7 carmed___7 ACE inhibitor
8 carmed___8 Angiotensin II receptor blocker
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15 carmed___15 Aldosterone antagonist
16 carmed___16 Sacubitril/valsartan (Entresto)
17 carmed___17 Phosphodiesterase inhibitors
9 carmed___9 Anti-platelet agents
10 carmed___10 Coumarin
11 carmed___11 Direct oral anticoagulants(DOAC)
12 carmed___12 Lipid lowering agents
13 carmed___13 Insulin
14 carmed___14 Oral antidiabetic agents
99 carmed___99 Other cardiovascular medication
78 carmed_bb
Show the field ONLY if:[carmed(1)] = '1'
Betablockers checkbox
1 carmed_bb___1 Atenolol
2 carmed_bb___2 Bisoprolol (Emcor)
3 carmed_bb___3 Carvedilol
4 carmed_bb___4 Labetalol
5 carmed_bb___5 Metoprolol (Selokeen)
6 carmed_bb___6 Nebivolol (Nebilet)
7 carmed_bb___7 Propranolol
99 carmed_bb___99 Other
79 carmed_bb_spec
Show the field ONLY if:[carmed_bb(99)] = '1'
Specify betablocker text
80 carmed_antiarrh
Show the field ONLY if:[carmed(3)] = '1'
Antiarrhytmic drugs checkbox
1 carmed_antiarrh___1 Class I
3 carmed_antiarrh___3 Class III
4 carmed_antiarrh___4 Class IV
99 carmed_antiarrh___99 Other
81 carmed_arrhyth_class1
Show the field ONLY if:[carmed_antiarrh(1)] = '1'
Class I antiarrhytmic drugs checkbox
1 carmed_arrhyth_class1___1 1a - Quinidine
2 carmed_arrhyth_class1___2 1a - Disopyramide
3 carmed_arrhyth_class1___3 1a - Procainamide
4 carmed_arrhyth_class1___4 1b - Lidocaine
5 carmed_arrhyth_class1___5 1b - Phenytoin
6 carmed_arrhyth_class1___6 1b - Mexiletine
7 carmed_arrhyth_class1___7 1b - Tocainide
8 carmed_arrhyth_class1___8 1c - Flecainide
9 carmed_arrhyth_class1___9 1c - Propafenone
82 carmed_arrhyth_class3
Show the field ONLY if:[carmed_antiarrh(3)] = '1'
Class III antiarrhytmic drugs checkbox
1 carmed_arrhyth_class3___1 Amiodarone
2 carmed_arrhyth_class3___2 Sotalol
3 carmed_arrhyth_class3___3 Ibutilide
4 carmed_arrhyth_class3___4 Dofetilide
83 carmed_arrhyth_class4
Show the field ONLY if:[carmed_antiarrh(4)] = '1'
Class IV antiarrhytmic drugs: Calcium channel blockers radio
1 Diltiazem (Tildiem)
2 Verapamil (Isoptin)
84 carmed_antiarrh_spec
Show the field ONLY if:
Specify antiarrhythmic drug(s) text
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[carmed_antiarrh(99)] = '1'
85 carmed_diuretic
Show the field ONLY if:[carmed(5)] = '1'
Diuretics checkbox
1 carmed_diuretic___1 Bumetanide (Burinex)
2 carmed_diuretic___2 Chloortalidon
3 carmed_diuretic___3 Furosemide (Lasix)
4 carmed_diuretic___4 Hydrochlorothiazide
99 carmed_diuretic___99 Other
86 carmed_diuretic_spec
Show the field ONLY if:[carmed_diuretic(99)] = '1'
Specify diuretic text
87 carmed_cablock
Show the field ONLY if:[carmed(6)] = '1'
Calcium channel blocker (dihydropyridine) radio
1 Amlodipin (Norvasc)
2 Barnidipin (Cyress, Vasexten)
3 Nifedipin (Adalat)
99 Other
88 carmed_cablock_spec
Show the field ONLY if:[carmed_cablock] = '99'
Specify dihydropyridine calciumblocker text
89 carmed_acei
Show the field ONLY if:[carmed(7)] = '1'
ACE inhibitor radio
1 Captopril
2 Enalapril (Renitec)
3 Lisinopril (Zestril)
4 Perindopril (Coversyl)
99 Other
90 carmed_acei_spec
Show the field ONLY if:[carmed_acei] = '99'
Specify ACE inhibitor text
91 carmed_ace_dosage
Show the field ONLY if:[carmed(7)] = '1'
ACE inhibitor: Total dosage per day (mg/day)mg/day
text
92 carmed_acei_chronic
Show the field ONLY if:[carmed(7)] = '1'
ACE inhibitor: Use >1 month? radio
1 Yes
0 No
-1 Unknown
93 carmed_arb
Show the field ONLY if:[carmed(8)] = '1'
Angiotensin II receptor blocker radio
1 Candesartan (Atacand)
2 Irbesartan (Aprovel)
3 Losartan (Cozaar, Losanox)
4 Valsartan (Diovan, Vagrecor)
99 Other
94 carmed_arb_spec
Show the field ONLY if:[carmed_arb] = '99'
Specify angiotensin II receptor blocker text
95 carmed_arb_chronic
Show the field ONLY if:[carmed(8)] = '1'
Angiotensin II receptor blocker: Use >1 month? radio
1 Yes
0 No
-1 Unknown
96 carmed_arb_dosage
Show the field ONLY if:
Angiotensin II receptor blocker: Total dosage per day (mg/day)mg/day
text
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[carmed(8)] = '1'
97 carmed_mra
Show the field ONLY if:[carmed(15)] = '1'
Aldosterone antagonist radio
1 Spironolacton
2 Eplerenon
98 carmed_pde5
Show the field ONLY if:[carmed(17)]='1'
Phosphodiesterase inhibitors radio
1 Avanafil
2 Sildenafil
3 Tadalafil
4 Vardenaifl
99 carmed_antiplate
Show the field ONLY if:[carmed(9)] = '1'
Anti-platelet agents checkbox
1 carmed_antiplate___1 Acetylsalicylic acid
2 carmed_antiplate___2 Carbasalate calcium
3 carmed_antiplate___3 Clopidogrel (Plavix,Grepid, Iscover)
4 carmed_antiplate___4 Dipyridamole(Persantin)
5 carmed_antiplate___5 Prasugrel (Efient)
6 carmed_antiplate___6 Ticagrelor (Brilique)
99 carmed_antiplate___99 Other
100 carmed_antiplate_spec
Show the field ONLY if:[carmed_antiplate(99)] = '1'
Specify anti-platelet agent text
101 carmed_coum
Show the field ONLY if:[carmed(10)] = '1'
Coumarin radio
1 Acenocoumarol
2 Fenprocoumon (Marcoumar)
102 carmed_doac
Show the field ONLY if:[carmed(11)] = '1'
Direct oral anticoagulants (DOAC) radio
1 Apixaban (Eliquis)
2 Dabigatran (Pradaxa)
3 Edoxaban (Lixiana)
4 Rivaroxaban (Xarelto)
99 Other
103 carmed_doac_spec
Show the field ONLY if:[carmed_doac] = '99'
Specify DOAC text
104 carmed_lipid
Show the field ONLY if:[carmed(12)] = '1'
Lipid lowering agents checkbox
1 carmed_lipid___1 Atorvastatin (Lipitor)
2 carmed_lipid___2 Ciprofibrate (Modalim)
3 carmed_lipid___3 Evolocumab (Repatha)
4 carmed_lipid___4 Ezetimib (Ezetrol)
5 carmed_lipid___5 Gemfibrozil (Lopid)
6 carmed_lipid___6 Pravastatin (Selektine)
7 carmed_lipid___7 Rosuvastatin (Crestor)
8 carmed_lipid___8 Simvastatin (Zocor)
99 carmed_lipid___99 Other
105 carmed_lipid_spec
Show the field ONLY if:[carmed_lipid(99)] = '1'
Specify lipid lowering agent text
106 carmed_oraldm
Show the field ONLY if:[carmed(14)] = '1'
Oral antidiabetic agents checkbox
1 carmed_oraldm___1 Gliclazide (Diamicron)
2 carmed_oraldm___2 Glimepiride (Amaryl)
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3 carmed_oraldm___3 Metformin (Glucient)
4 carmed_oraldm___4 Sitagliptine (Januvia)
99 carmed_oraldm___99 Other
107 carmed_oraldm_spec
Show the field ONLY if:[carmed_oraldm(99)] = '1'
Specify oral antidiabetic agent text
108 carmed_other
Show the field ONLY if:[carmed(99)] = '1'
Other cardiovascular medication text
109 carcons Section Header: Reason for consultation cardiology (to be filled in bydepartment of cardiology)
Cardiology consulted during admission
radio
0 No
1 Yes
-1 Unknown
110 carcons_date
Show the field ONLY if:[carcons] = '1'
Date of first cardiac consultationdd-mm-yyyy
text (date_dmy)
111 carcons_reason
Show the field ONLY if:[carcons] = '1'
Reason for cardiac consultation checkbox
1 carcons_reason___1 Cardiac complaints
2 carcons_reason___2 Abnormal findings
3 carcons_reason___3 Preventive screening
112 carcons_carcompl
Show the field ONLY if:[carcons] = '1'
Cardiac complaints at 1st consultation checkbox
0 carcons_carcompl___0 None
1 carcons_carcompl___1 Dyspnea
2 carcons_carcompl___2 Orthopnea
3 carcons_carcompl___3 Peripheral edema
4 carcons_carcompl___4 Chest pain
5 carcons_carcompl___5 Palpitations
6 carcons_carcompl___6 (near) syncope
7 carcons_carcompl___7 Fatigue
99 carcons_carcompl___99 Other
-1 carcons_carcompl____1 Unknown
113 carcons_carcompl_other
Show the field ONLY if:[carcons_carcompl(99)] = '1'
Specify cardiac complaints text
114 carcons_abnfindings
Show the field ONLY if:[carcons_reason(2)] = '1'
Reason for consultation: Abnormal findings checkbox
1 carcons_abnfindings___1 Physicalexamination
2 carcons_abnfindings___2 ECG
3 carcons_abnfindings___3 Echocardiography
4 carcons_abnfindings___4 Laboratory analysis
5 carcons_abnfindings___5 CT Thorax
99 carcons_abnfindings___99 Other
115 carcons_carcons_abnfindings_other
Show the field ONLY if:[carcons_abnfindings(99)] = '1'
Specify abnormal finding text
116 carhist_yesno Section Header: Cardiac diagnosis prior to COVID-19 infection (to be filled inby department of cardiology)
Cardiac diagnosis prior to COVID-19 infection?
radio
1 Yes
0 No
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117 carhist
Show the field ONLY if:[carhist_yesno] = '1'
Cardiac diagnosis prior to COVID-19 infection checkbox
1 carhist___1 Arrhythmia / conduction disorder
5 carhist___5 Heart failure
3 carhist___3 Coronary artery disease
4 carhist___4 Valvular disease
6 carhist___6 Congenital heart disease
99 carhist___99 Other
118 carhist_arrhytmia
Show the field ONLY if:[carhist(1)] = '1'
Arrhythmia checkbox
1 carhist_arrhytmia___1 Supraventriculartachycardia
2 carhist_arrhytmia___2 Ventriculararrhythmias
3 carhist_arrhytmia___3 Sinus nodedysfunction
4 carhist_arrhytmia___4 Conduction disorders
99 carhist_arrhytmia___99 Other
119 carhist_arrhth_date
Show the field ONLY if:[carhist(1)] = '1'
Arrhythmia: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
120 carhist_arrhythmia_svt_def
Show the field ONLY if:[carhist_arrhytmia(1)] = '1'
Definitions of supraventricular tachycardias Atrial fibrillation: Acardiac arrhythmia arising from the atrium with an atrial rate>300 bpm and an irregularly irregular ventricular response inthe presence of conduction. * Paroxysmal: Self-terminating, inmost cases within 48 hours. Some AF paroxysms may continuefor up to 7 days. AF episodes that are cardioverted within 7days should be considered paroxysmal.* Persistent: AF thatlasts longer than 7 days, including episodes that areterminated by cardioversion, either with drugs or by directcurrent cardioversion, after 7 days or more.* Permanent: AFthat is accepted by the patient (and physician). Hence, rhythmcontrol interventions are, by definitions, not pursued inpatients with permanent AF. Atrial flutter: a reentranttachycardia following a counterclockwise (typical) or clockwise(reverse typical) rotation pattern around the tricuspid annulusresulting in a sawtooth pattern of atrial activation on inferiorECG leads. Atrial tachycardia: A usually regular cardiacarrhythmia arising from the atrium with a rate >100 bpm (cyclelength < 600 ms). AV nodal reentry tachycardia: A regular SVTwhich results from reentry within the AV node and/orperinodal atrial tissue AV reentry tachycardia: A reentrantarrhythmia whose circuit involves the atrium, the AV node, theventricles, and one or more accessory AV connections
descriptive
121 carhist_arrhythmia_svt
Show the field ONLY if:[carhist_arrhytmia(1)] = '1'
Supraventricular tachycardia checkbox
1 carhist_arrhythmia_svt___1 Paroxysmal atrialfibrillation
2 carhist_arrhythmia_svt___2 Persistent atrialfibrillation
3 carhist_arrhythmia_svt___3 Permanent atrialfibrillation
4 carhist_arrhythmia_svt___4 Atrial flutter
5 carhist_arrhythmia_svt___5 Atrial tachycardia
6 carhist_arrhythmia_svt___6 AV nodal reentrytachycardia
7 carhist_arrhythmia_svt___7 AV reentrytachycardia
-1 carhist_arrhythmia_svt____1 Not otherwisespecified
122 carhist_arrhythmia_vt_def
Show the field ONLY if:
Definitions of ventricular arrhythmias Non-sustainedventricular tachycardia: =>3 consecutive premature ventricular
descriptive
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[carhist_arrhytmia(2)] = '1' complexes with a rate >100/min, lasting < 30 seconds.Sustained ventricular tachycardia: Ventricular tachycardiawhich lasts 30 second or more, or les than 30 seconds whenterminated electrically or pharmacologically Ventricularfibrillation: Rapid, usually more than 300bpm (cycle length:180ms or less), grossly irregular ventricular rhythm withmarked variability in QRS cycle lenght, morphology, andamplitude.
123 carhist_arrhythmia_vt
Show the field ONLY if:[carhist_arrhytmia(2)] = '1'
Ventricular arrhythmia checkbox
1 carhist_arrhythmia_vt___1 Non-sustainedventriculartachycardia
2 carhist_arrhythmia_vt___2 Sustainedventriculartachycardia
3 carhist_arrhythmia_vt___3 Ventricularfibrillation
124 carhist_arrhyth_cond_def
Show the field ONLY if:[carhist_arrhytmia(4)] = '1'
Definitions of conduction disorders First degree AV block: PRinterval >200ms Second degree AV block: i) Mobitz I:progressive PR prolongation and shortening of RR interval untilP-wave is blocked. Pause after blocked P-wave is less thantwice the PP interval. PR following block is shorter than PRimmediately preceding block. ii) Mobitz II: Regualr sinus/atrialrhythm with intermittent non-conducted P-waves. Constand PRinterval in the conducted beat. Third degree AV block:Characterized by independent atrial and ventricular complexeswith atrial rate usually exceeding ventricular rate. Left bundlebranch block: QRS duration of 120ms or longer with: Delayedonset of intrinsicoid deflection in 1, V5 and V6 >60 ms. Broadand notched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB. Pre-exitation: An ECG pattern characterized by a short PR interval, awidened QRS complex, and a delta wave. A pre-exitationpattern on the ECG is evidence of the presence of ananomalous AV connection, which results in ventricularactivation prior to what would have occurred through thenormal His-Purkinje system. The PR interval is typically >120ms. Long QT syndrome: QTc =>480ms in repeated 12-leadECGs in the absence of secondary causes for QT prolongation.
descriptive
125 carhist_conduct
Show the field ONLY if:[carhist_arrhytmia(4)] = '1'
Conduction disorder checkbox
1 carhist_conduct___1 First degree AV block
2 carhist_conduct___2 Second degree AV block
3 carhist_conduct___3 Third degree AV block
4 carhist_conduct___4 Left bundle branch block
5 carhist_conduct___5 Right bundle branchblock
6 carhist_conduct___6 Nonspecificintraventricularconduction delay
7 carhist_conduct___7 Pre-excitation
8 carhist_conduct___8 Long QT syndrome
-1 carhist_conduct____1 Not otherwise specified
126 carhist_arrhythmia_other
Show the field ONLY if:[carhist_arrhytmia(99)] = '1'
Specify arrhythmia text
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127 carhist_hf_date
Show the field ONLY if:[carhist(5)] = '1'
Heart failure: date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
128 carhist_hf_nyha
Show the field ONLY if:[carhist(5)] = '1'
Heart failure: NYHA classificationHighest documented NYHA classification in the past year. If not available, select'Unknown'.
dropdown
1 NYHA I / IV
2 NYHA II / IV
3 NYHA III / IV
4 NYHA IV / IV
99 Unknown
129 carhist_cmp
Show the field ONLY if:[carhist(5)] = '1'
Heart failure: etiology checkbox
1 carhist_cmp___1 Dilated cardiomyopathy
2 carhist_cmp___2 Hypertrophic (obstructive)cardiomyopathy
3 carhist_cmp___3 Restrictive cardiomyopathy
4 carhist_cmp___4 Non-compactioncardiomyopathy
5 carhist_cmp___5 Arrhythmogeniccardiomyopathy
6 carhist_cmp___6 Impaired cardiac functiondue to ischemic heartdisease
7 carhist_cmp___7 Hypertensivecardiomyopathy
8 carhist_cmp___8 Valvular heart disease
9 carhist_cmp___9 Myocarditis
10 carhist_cmp___10 Toxic cardiomyopathy
99 carhist_cmp___99 Other
-1 carhist_cmp____1 Unknown
130 carhist_cmp_spec
Show the field ONLY if:[carhist_cmp(99)] = '1'
Specify etiology text
131 carhist_cad_date
Show the field ONLY if:[carhist(3)] = '1'
Coronary artery disease: date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
132 carhist_cad_diagn
Show the field ONLY if:[carhist(3)] = '1'
Coronary artery disease: Diagnosis checkbox
1 carhist_cad_diagn___1 Angina pectoris (stable)
2 carhist_cad_diagn___2 Angina pectoris(unstable)
3 carhist_cad_diagn___3 NSTEMI
4 carhist_cad_diagn___4 STEMI
133 carhist_cad_treat
Show the field ONLY if:[carhist(3)] = '1'
Coronary artery disease: treatment checkbox
1 carhist_cad_treat___1 Pharmacological
2 carhist_cad_treat___2 Percutaneous coronaryintervention (PCI)
3 carhist_cad_treat___3 Coronary artery bypassgrafting (CABG)
134 carhist_valve_def
Show the field ONLY if:[carhist(4)] = '1'
Valvular heart diseaseSelect the specific valve if the stenosis orregurgitation is classified as ≥ moderate. Mild valvular diseaseshould not be recorded. Classification according to:Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A,Griffin BP, Lung B, Otto CM, Pellikka PA, Quiñones M.Echocardiographic assessment of valve stenosis: EAE/ASErecommendations for clinical practice. J Am SocEchocardiogr 2009;22:1–23. Lancellotti P, Tribouilloy C,Hagendorff A, Moura L, Popescu BA, Agricola E, Monin J-L,
descriptive
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Pierard LA, Badano L, Zamorano JL, Sicari R, Vahanian A,Roelandt JRTC. European association of echocardiographyrecommendations for the assessment of valvular regurgitation.Part 1: Aortic and pulmonary regurgitation (native valvedisease). Eur J Echocardiogr 2010;11:223–244. Lancellotti P,Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C,Hagendorff A, Monin JL, Badano L, Zamorano JL, Sicari R,Vahanian A, Roelandt JRTC. European association ofechocardiography recommendations for the assessment ofvalvular regurgitation. Part 2: Mitral and tricuspid regurgitation(native valve disease). Eur J Echocardiogr 2010;11:307–332. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, KraftCD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA,Rakowski H, Stewart WJ, Waggoner A, Weissman NJ.Recommendations for Evaluation of the Severity ofNative Valvular Regurgitation with Two-dimensional andDoppler Echocardiography. J Am SocEchocardiogr 2003;16:777-802. Select the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.
135 carhist_valve
Show the field ONLY if:[carhist(4)] = '1'
Valvular heart disease, specifySelect the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.
checkbox
1 carhist_valve___1 Aortic valve stenosis
2 carhist_valve___2 Aortic valve regurgitation
3 carhist_valve___3 Mitral valve stenosis
4 carhist_valve___4 Mitral valve regurgitation
5 carhist_valve___5 Pulmonary valve stenosis
6 carhist_valve___6 Pulmonary valveregurgitation
7 carhist_valve___7 Tricuspid valve stenosis
8 carhist_valve___8 Tricuspid valve regurgitation
136 carhist_as_date
Show the field ONLY if:[carhist_valve(1)] = '1'
Aortic valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
137 carhist_ar_date
Show the field ONLY if:[carhist_valve(2)] = '1'
Aortic valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
138 carhist_ms_date
Show the field ONLY if:[carhist_valve(3)] = '1'
Mitral valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
139 carhist_mr_date
Show the field ONLY if:[carhist_valve(4)] = '1'
Mitral valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
140 carhist_ps_date
Show the field ONLY if:[carhist_valve(5)] = '1'
Pulmonary valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
141 carhist_pr_date
Show the field ONLY if:[carhist_valve(6)] = '1'
Pulmonary valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
142 carhist_ts_date
Show the field ONLY if:[carhist_valve(7)] = '1'
Tricuspid valve stenosis: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
143 carhist_tr_date
Show the field ONLY if:[carhist_valve(8)] = '1'
Tricuspid valve regurgitation: Date of diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
144 carhist_valve_treat
Show the field ONLY if:[carhist(4)] = '1'
Valvular heart disease: treatment radio
1 No intervention performed
2 Intervention performed
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3 Intervention planned
145 carhist_other
Show the field ONLY if:[carhist(99)] = '1'
Specify cardiac diagnosis notes
146 carhist_other_2
Show the field ONLY if:[carhist(99)] = '1'
Specify the date of cardiac diagnosisdd-mm-yyyy; Choose the date of the first event;
text (date_dmy)
147 capacity_cardiac_baseline_assessment_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Pre-admission medication (within 14 days of admission) (OPTIONAL) (isaric_preadmission_medication)
148 isaric_medication_inhste Inhaled steroids radio
1 Yes
0 No
-1 Unknown
149 isaric_medication_oraste Oral steroids radio
1 Yes
0 No
-1 Unknown
150 isaric_medication_antiv Antivirals radio
1 Yes
0 No
-1 Unknown
151 isaric_medication_antib Inhaled steroids radio
1 Yes
0 No
-1 Unknown
152 isaric_preadmission_medication_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Comorbidities (OPTIONAL) (isaric_comorbidities_optional)
153 chroniccard_mhyn Section Header: 4b. CO-MORBIDITIES & Risk Factors Charlson index will becalculated for each patient at analysis
4b.1. Chronic cardiac disease, including congenital heartdisease (not hypertension)
radio (Matrix), Required
1 YES
2 NO
3 N/A
154 chronicpul_mhyn 4b.2. Chronic pulmonary disease radio (Matrix), Required
1 YES
2 NO
3 N/A
155 asthma_mhyn 4b. 3. Asthma (physician diagnosed) radio (Matrix), Required
1 YES
2 NO
3 N/A
156 renal_mhyn 4b.4. Chronic kidney disease radio (Matrix), Required
1 YES
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2 NO
3 N/A
157 modliver_mhyn 4b.5. Moderate or severe liver disease radio (Matrix), Required
1 YES
2 NO
3 N/A
158 mildliv_mhyn 4b.6. Mild Liver disease radio (Matrix), Required
1 YES
2 NO
3 N/A
159 chronicneu_mhyn 4b.7. Chronic neurological disorder radio (Matrix), Required
1 YES
2 NO
3 N/A
160 malignantneo_mhyn 4b.8. Malignant neoplasm radio (Matrix), Required
1 YES
2 NO
3 N/A
161 chronhaemo_mhyn 4b.9. Chronic hematologic disease radio (Matrix), Required
1 YES
2 NO
3 N/A
162 aidshiv_mhyn 4b.10. AIDS/HIV radio (Matrix), Required
1 YES
2 NO
3 N/A
163 obesity_mhyn 4b.11. Obesity (as defined by clinical staff) radio (Matrix), Required
1 YES
2 NO
3 N/A
164 diabetiscomp_mhyn 4b.12. Diabetes with complications radio (Matrix), Required
1 YES
2 NO
3 N/A
165 diabetes_mhyn 4b.13. Diabetes without complications radio (Matrix), Required
1 YES
2 NO
3 N/A
166 rheumatology_mhyr 4b.14. Rheumatologic disorder radio (Matrix), Required
1 YES
2 NO
3 N/A
167 dementia_mhyn 4b.15. Dementia radio (Matrix), Required
1 YES
2 NO
3 N/A
168 malnutrition_mhyn 4b.16. Malnutrition radio (Matrix), Required
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1 YES
2 NO
3 N/A
169 other_mhyn 4b.17. Other relevant risk factors radio (Matrix), Required
1 YES
2 NO
3 N/A
170 smoking_mhyn 4b.18. Smoking radio, Required
1 Yes
2 Never Smoker
3 Former Smoker
4 Unknown
Custom alignment: RH
171 otherrisktext
Show the field ONLY if:[other_mhyn] = '1'
Other relevant risk factor; Specify text
172 isaric_comorbidities_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Onset And Admission (OPTIONAL) (isaric_onset_and_admission_optional)
173 cestdat Section Header: 2. ONSET and ADMISSION
2.1 Onset date of first/earliest symptomdd-mm-yyyy
text (date_dmy), Required
174 hostdat 2.2 Admission date at this facilitydd-mm-yyyy
text (date_dmy), Required
175 hosttim 2.3 Admission time at this facility(24-hr format)
text (time), Required
176 hooccur 2.4 Transfer from other facility? radio
1 Yes-facility is a study site
2 Yes-facility is not a study site
3 No
4 N/A
177 siteid_transfer
Show the field ONLY if:[hooccur] = '1' or [hooccur] = '2'
2.5.1 If YES: Name of transfer facility: dropdown
31 Admiraal de Ruyter Ziekenhuis
22 Albert Schweitzer Ziekenhuis
32 Alrijne ziekenhuis
11 Amphia Ziekenhuis
3 Amsterdam UMC, locatie AMC
4 Amsterdam UMC, locatie VU
33 Antonius Ziekenhuis, Sneek
34 Bernhoven Ziekenhuis
35 BovenIJ Ziekenhuis
36 Bravis Ziekenhuis
20 Canisius-Wilhelmina Ziekenhuis
250 Cardiologie Centra Nederland
12 Catharina Ziekenhuis
37 De Tjongerschans Ziekenhuis
38 Deventer Ziekenhuis
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39 Diakonessenhuis Utrecht
40a Dijklander Ziekenhuis, locatie Hoorn
40b Dijklander Ziekenhuis, locatie Purmerend
27 Elisabeth-TweeSteden Ziekenhuis
41 Elkerliek Ziekenhuis
9 Erasmus MC
42 Flevoziekenhuis
43 Franciscus Gasthuis en Vlietland
44 Gelderse Vallei Ziekenhuis
45 Gelre Ziekenhuizen, locatie Apeldoorn
46 Gelre Ziekenhuizen, locatie Zutphen
47 Groene Hart Ziekenhuis
25 Haaglanden Medisch Centrum
17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft
48 IJsselland Ziekenhuis
49 Ikazia Ziekenhuis
2a Isala Ziekenhuis (Meppel)
2b Isala Ziekenhuis (Zwolle)
21 Jeroen Bosch Ziekenhuis
50 Langeland Ziekenhuis
51 Laurentius Ziekenhuis
6 Leids Universitair Medisch Centrum
15 Maasstad Ziekenhuis
13 Maastricht UMC+
52 Maasziekenhuis Pantein
53 Martini Ziekenhuis
54 Máxima Medisch Centrum
74 MC Slotervaart
73 MC Zuiderzee
24 Meander Medisch Centrum
16 Medisch Centrum Leeuwarden
18 Medisch Spectrum Twente
55 Nij Smellinghe
14 Noordwest Ziekenhuisgroep
56 Ommelander Ziekenhuis Groningen
5 Onze Lieve Vrouwe Gasthuis
10 Radboudumc
57 Reinier de Graaf Gasthuis
19 Rijnstate Ziekenhuis
58 Rivas Zorggroep
59 Rivierenland Ziekenhuis
60 Rode Kruis Ziekenhuis
61 Ropcke Zweers Ziekenhuis
62 Slingeland Ziekenhuis
63a Spaarne Gasthuis, locatie Haarlem
63b Spaarne Gasthuis, locatie Hoofddorp
900 Spijkenisse MC
64 St. Anna Ziekenhuis
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8 St. Antonius Ziekenhuis Nieuwegein
65 St. Jans Gasthuis
66 St. Jansdal Ziekenhuis
67 Streekziekenhuis Koningin Beatrix
30 Tergooi
23 Treant Zorggroep
1 UMC Groningen
7 UMC Utrecht
201 UZ Antwerpen
68 Van Weel-Bethesda Ziekenhuis
28 VieCuri Medisch Centrum
69 Wilhelmina Ziekenhuis, Assen
70 Zaans Medisch Centrum
71 Ziekenhuis Amstelland
72 Zorg Groep Twente
26 ZorgSaam Zorggroep Zeeuws-Vlaanderen
29 Zuyderland MC
-1 Other
178 subjidcat_transfer
Show the field ONLY if:[hooccur] = '1'
2.5.3 If YES - Study Site: Participant ID # at transfer facility radio
1 Same as above
2 Different
3 N/A
179 hostdat_transfer
Show the field ONLY if:[hooccur] = '1' or [hooccur] = '2'
2.5.2 If YES: Admission date at transfer facilitydd-mm-yyyy
text (date_dmy)
180 subjid_transfer
Show the field ONLY if:[subjidcat_transfer] = '2'
If DIFFERENT; Participant number in CAPACITY in transferfacility
text
181 isaric_study_id If your centre is also participating in ISARIC through anotherdata collection environment (i.e. REDCap, CASTOR etc.) and theISARIC data collection forms are filled in another system,please indicate which study ID the patient has been assigned inISARIC:
text
182 admit_icu_trans Was the patient admitted to the ICU at the transfer facility? yesno
1 Yes
0 No
183 date_icu_transf Which date was the patient admitted to the ICU at the transferfacility?dd-mm-yyyy
text (date_dmy)
184 isaric_onset_and_admission_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Admission Signs And Symptoms (OPTIONAL) (isaric_admission_signs_and_symptoms_optional)
185 temp_vsyn Section Header: Admission Signs and Symptoms (first available data atpresentation/admission - within 24 hours)
Temperature on admission available?
yesno, Required
1 Yes
0 No
Custom alignment: RH
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186 temp_vsorres
Show the field ONLY if:[temp_vsyn] = '1'
Temperature text (number), Required
187 temp_vsorresu
Show the field ONLY if:[temp_vsyn] = '1'
Temperature Units radio, Required
1 °C
2 °F
Custom alignment: RH
188 hr_vsyn Heart rate on admission available? yesno, Required
1 Yes
0 No
Custom alignment: RH
189 hr_vsorres
Show the field ONLY if:[hr_vsyn] = '1'
Heart Ratebeats per minute
text (number), Required
190 rr_vsyn Respiratory rate on admission available? yesno, Required
1 Yes
0 No
Custom alignment: RH
191 rr_vsorres
Show the field ONLY if:[rr_vsyn] = '1'
Respiratory Ratebreaths per minute
text (number), RequiredCustom alignment: RH
192 sysbp_vsyn Systolic blood pressure on admission available? yesno, Required
1 Yes
0 No
Custom alignment: RH
193 sysbp_vsorres
Show the field ONLY if:[sysbp_vsyn] = '1'
Systolic blood pressuremmHg
text (number), RequiredCustom alignment: RH
194 diabp_vsyn Diastolic blood pressure on admission available? yesno, Required
1 Yes
0 No
Custom alignment: RH
195 admission_diabp_vsorres
Show the field ONLY if:[diabp_vsyn] = '1'
Diastolic blood pressuremmHg
text (number), RequiredCustom alignment: RH
196 dehydration_vsorres Severe dehydration: radio, Required
1 Yes
2 No
3 Unknown
Custom alignment: RH
197 stercap_vsyn Sternal capillary refill time on admission available? yesno, Required
1 Yes
0 No
Custom alignment: RH
198 stercap_vsorres
Show the field ONLY if:[stercap_vsyn] = '1'
Sternal capillary refill time >2 seconds ? radio, Required
1 Yes
2 No
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3 Unknown
Custom alignment: RH
199 oxy_vsyn Oxygen saturation on admission available: yesno, Required
1 Yes
0 No
Custom alignment: RH
200 oxy_vsorresu
Show the field ONLY if:[oxy_vsyn] = '1'
Oxygen saturation on: radio, Required
1 Room air
2 Oxygen therapy
3 N/A
Custom alignment: RH
201 oxy_vsorres
Show the field ONLY if:[oxy_vsyn] = '1'
Oxygen saturation%
text, RequiredCustom alignment: RH
202 fever_ceoccur_v2 Section Header: 4. Admission Signs and Symptoms (observed/reported atadmission and associated with this episode of acute illness)
4a.1. History of fever
radio (Matrix), Required
1 YES
2 NO
3 Unknown
203 cough_ceoccur_v2 4a.2. Cough radio (Matrix), Required
1 YES
2 NO
3 Unknown
204 coughsput_ceoccur_v2 4a.2.1 Cough: with sputum production radio (Matrix), Required
1 YES
2 NO
3 Unknown
205 coughhb_ceoccur_v2 4a.2.2 Cough: bloody sputum / haemoptysis radio (Matrix), Required
1 YES
2 NO
3 Unknown
206 sorethroat_ceoccur_v2 4a.3. Sore throat radio (Matrix), Required
1 YES
2 NO
3 Unknown
207 runnynose_ceoccur_v2 4a.4. Runny nose (Rhinorrhoea) radio (Matrix), Required
1 YES
2 NO
3 Unknown
208 earpain_ceoccur_v2 4a.5. Ear pain radio (Matrix), Required
1 YES
2 NO
3 Unknown
209 wheeze_ceoccur_v2 4a.6. Wheezing radio (Matrix), Required
1 YES
2 NO
3 Unknown
210 chestpain_ceoccur_v2 4a.7. Chest pain radio (Matrix), Required
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1 YES
2 NO
3 Unknown
211 myalgia_ceoccur_v2 4a.8. Muscle aches (Myalgia) radio (Matrix), Required
1 YES
2 NO
3 Unknown
212 jointpain_ceoccur_v2 4a.9. Joint pain (Arthralgia) radio (Matrix), Required
1 YES
2 NO
3 Unknown
213 fatigue_ceoccur_v2 4a.10. Fatigue / Malaise radio (Matrix), Required
1 YES
2 NO
3 Unknown
214 shortbreath_ceoccur_v2 4a.11. Shortness of breath (Dyspnea) radio (Matrix), Required
1 YES
2 NO
3 Unknown
215 lowerchest_ceoccur_v2 4a.12. Lower chest wall indrawing radio (Matrix), Required
1 YES
2 NO
3 Unknown
216 headache_ceoccur_v2 4a.13. Headache radio (Matrix), Required
1 YES
2 NO
3 Unknown
217 inabwalk_ceoccur_v2 Inability to walk radio (Matrix), Required
1 YES
2 NO
3 Unknown
218 confusion_ceoccur_v2 4a.14. Altered consciousness / confusion radio (Matrix), Required
1 YES
2 NO
3 Unknown
219 seizures_cecoccur_v2 4a.15. Seizures radio (Matrix), Required
1 YES
2 NO
3 Unknown
220 abdopain_ceoccur_v2 4a.16. Abdominal pain radio (Matrix), Required
1 YES
2 NO
3 Unknown
221 vomit_ceoccur_v2 4a.17. Vomiting / Nausea radio (Matrix), Required
1 YES
2 NO
3 Unknown
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222 diarrhoea_ceoccur_v2 4a.18. Diarrhoea radio (Matrix), Required
1 YES
2 NO
3 Unknown
223 conjunct_ceoccur_v2 4a.19. Conjunctivitis radio (Matrix), Required
1 YES
2 NO
3 Unknown
224 rash_ceoccur_v2 4a.19. Skin rash radio (Matrix), Required
1 YES
2 NO
3 Unknown
225 skinulcers_ceoccur_v2 4a.20. Skin ulcers radio (Matrix), Required
1 YES
2 NO
3 Unknown
226 lymp_ceoccur_v2 4a.21. Lymphadenopathy radio (Matrix), Required
1 YES
2 NO
3 Unknown
227 losssmell_ceoccur_v2 Loss of smell radio (Matrix), Required
1 YES
2 NO
3 Unknown
228 losstaste_ceoccur_v2 Loss of taste radio (Matrix), Required
1 YES
2 NO
3 Unknown
229 bleed_ceoccur_v2 4a.22. Bleeding (Haemorrhage) radio (Matrix), Required
1 YES
2 NO
3 Unknown
230 bleed_ceterm_v2 4a.23. If Bleeding (others) radio (Matrix), Required
1 YES
2 NO
3 Unknown
231 bleed_cetermy_v2
Show the field ONLY if:[bleed_ceoccur_v2] = '1'
If Yes, specify site(s) textCustom alignment: RH
232 isaric_admission_signs_and_symptoms_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Infectious Respiratory Disease Diagnosis (OPTIONAL) (isaric_infectious_respiratory_disease_diagnosis_op)
233 mbperf 5.1 Was pathogen testing done during this illness episode?5.2 is available as a repeating instrument in the next section
radio, Required
1 YES
2 NO
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3 N/A
234 influ_mbyn
Show the field ONLY if:[mbperf] = '1'
Section Header: Does the patient have:
5.3 Influenza:
radio, Required
2 YES - Confirmed
1 YES - Probable
0 NO
235 influ_mbcat
Show the field ONLY if:[influ_mbyn] = '2' or [influ_mbyn] = '1'
5.3.1 If Yes radio, Required
1 A/H3N2
2 A/H1N1pdm09
3 A/H7N9
4 A/H5N1
5 A - not typed
6 B
888 Other
236 influother_mborres
Show the field ONLY if:[influ_mbcat] = '888'
Other influenza, specify: text, Required
237 corna_mbcat
Show the field ONLY if:[mbperf] = '1'
5.3 Coronavirus: radio, Required
2 YES - Confirmed
1 YES - Probable
0 NO
238 corna_mbcaty
Show the field ONLY if:[corna_mbcat] = '2' or [corna_mbcat] = '1'
5.3.1 If Yes: radio, Required
1 Novel-CoV
2 MERS-CoV
888 Other CoV
239 coronaother_mborres
Show the field ONLY if:[corna_mbcaty] = '888'
IF Other coronavirus; Specify: text, Required
240 rsv_mbcat
Show the field ONLY if:[mbperf] = '1'
5.4 RSV radio, Required
2 YES - Confirmed
1 YES - Probable
0 NO
241 adeno_mbcat
Show the field ONLY if:[mbperf] = '1'
5.5 Adenovirus radio, Required
2 YES - Confirmed
1 YES - Probable
0 NO
242 bact_mborres
Show the field ONLY if:[mbperf] = '1'
5.6 Bacteria radio, Required
1 YES-Confirmed
2 NO
243 bact_mborres_2
Show the field ONLY if:[mbperf] = '1'
5.6 Bacteria radio, Required
1 YES-Confirmed
2 NO
244 other_mbyn
Show the field ONLY if:[mbperf] = '1'
5.7 Other Infectious Respiratory Diagnosis: radio, Required
2 YES - Confirmed
1 YES - Probable
0 NO
245 other_mborres
Show the field ONLY if:[other_mbyn] = '2' or [other_
If YES: Other infectious respiratory diagnosis, specify: text, Required
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mbyn] = '1'
246 otherpath_mbyn
Show the field ONLY if:[mbperf] = '1'
5.7 Other pathogen of Public Health interest detected: radio, Required
2 YES - Confirmed
1 YES - Probable
0 N/A
247 otherpath_mborres
Show the field ONLY if:[otherpath_mbyn] = '2' or [otherpath_mbyn] = '1'
If YES: specify HIV radio, Required
1 Positive
2 Negative
3 N/A
248 clinicalpneu_mborres
Show the field ONLY if:[mbperf] = '1'
5.8 Clinical pneumonia: dropdown, Required
1 YES
0 NO
2 Unknown
249 infectuk_mborres
Show the field ONLY if:[mbperf] = '1'
5.9 IF NONE OF THE ABOVE: Suspected Non-infective: dropdown
1 Yes
2 N/A
250 isaric_infectious_respiratory_disease_diagnosis_op_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Infectious Respiratory Disease Pathogen Testing (OPTIONAL)(isaric_infectious_respiratory_disease_pathogen_tes)
251 path_test_perf Section Header: 5.2 PATHOGEN TESTING: Details of pathogen testing andsample type done during admission
Pathogen testing done during admission
yesno
1 Yes
0 No
252 bio_spec_types
Show the field ONLY if:[path_test_perf] = '1'
Bio specimen type(s) checkbox
1 bio_spec_types___1 Nasal / NP swab
2 bio_spec_types___2 Throat swab
3 bio_spec_types___3 Combined nasal / NPswab
4 bio_spec_types___4 Sputum
5 bio_spec_types___5 Bronchoalveolar lavage(BAL)
6 bio_spec_types___6 Pleural fluid
7 bio_spec_types___7 Endotracheal aspirate(ETA)
8 bio_spec_types___8 Blood
9 bio_spec_types___9 Urine
10 bio_spec_types___10 Other
253 nasal_number
Show the field ONLY if:[bio_spec_types(1)] = '1'
Section Header: Nasal / NP swab (The results of maximal 5 swabs can bereported)
Number of nasal swabs
dropdown
1 1
2 2
3 3
4 4
5 5
6 >5
254 nasal_date_1
Show the field ONLY if:[nasal_number] >= '1'
Test 1: Collection date nasal / NP swabdd-mm-yyyy
text (date_dmy)
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255 lab_test_method_nasal_1
Show the field ONLY if:[nasal_number] >= '1'
Test 1: Laboratory test method nasal / NP swab checkbox
1 lab_test_method_nasal_1___1 PCR
2 lab_test_method_nasal_1___2 Other
256 pcr_nasal_1
Show the field ONLY if:[lab_test_method_nasal_1(1)] = '1'
Test 1: PCR checkbox
1 pcr_nasal_1___1 SARS-CoV-2
2 pcr_nasal_1___2 Adenovirus
3 pcr_nasal_1___3 Parainfluenzavirus
4 pcr_nasal_1___4 Rhinovirus/Enterovirus
5 pcr_nasal_1___5 RS-virus
6 pcr_nasal_1___6 Influenzavirus
7 pcr_nasal_1___7 Coronavirus (not SARS-CoV-2)
8 pcr_nasal_1___8 Human Metapneumovirus
9 pcr_nasal_1___9 Chlamydia pneumoniae
10 pcr_nasal_1___10 Chlamydophila psittaci
11 pcr_nasal_1___11 Coxiella burneti
12 pcr_nasal_1___12 Legionella pneumophila
13 pcr_nasal_1___13 Mycoplasma pneumoniae
14 pcr_nasal_1___14 Other, specify
257 pcr_nasal_other_1
Show the field ONLY if:[pcr_nasal_1(14)] = '1'
Test 1: If other please specify pathogen text
258 nasal_other_1
Show the field ONLY if:[lab_test_method_nasal_1(2)] = '1'
Test 1: If other, please specify laboratory test method nasal /NP swab + outcome
text
259 date_nasal_2
Show the field ONLY if:[nasal_number] > '1'
Test 2: Collection date nasal / NP swab 2dd-mm-yyyy
text (date_dmy)
260 lab_test_method_nasal_2
Show the field ONLY if:[nasal_number] > '1'
Test 2: Laboratory test method nasal / NP swab checkbox
1 lab_test_method_nasal_2___1 PCR
2 lab_test_method_nasal_2___2 Other
261 nasal_other_2
Show the field ONLY if:[lab_test_method_nasal_2(2)] = '1'
Test 2: If other, please specify laboratory test method nasal /NP swab + outcome
text
262 pcr_nasal_2
Show the field ONLY if:[lab_test_method_nasal_2(1)] = '1'
Test 2: PCR checkbox
1 pcr_nasal_2___1 SARS-CoV-2
2 pcr_nasal_2___2 Adenovirus
3 pcr_nasal_2___3 Parainfluenzavirus
4 pcr_nasal_2___4 Rhinovirus/Enterovirus
5 pcr_nasal_2___5 RS-virus
6 pcr_nasal_2___6 Influenzavirus
7 pcr_nasal_2___7 Coronavirus (not SARS-CoV-2)
8 pcr_nasal_2___8 Human Metapneumovirus
9 pcr_nasal_2___9 Chlamydia pneumoniae
10 pcr_nasal_2___10 Chlamydophila psittaci
11 pcr_nasal_2___11 Coxiella burneti
12 pcr_nasal_2___12 Legionella pneumophila
13 pcr_nasal_2___13 Mycoplasma pneumoniae
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14 pcr_nasal_2___14 Other, specify
263 pcr_nasal_other_2
Show the field ONLY if:[pcr_nasal_2(14)] = '1'
Test 2: If other please specify pathogen text
264 date_nasal_3
Show the field ONLY if:[nasal_number] > '2'
Test 3: Collection date nasal / NP swabdd-mm-yyyy
text (date_dmy)
265 lab_test_method_nasal_3
Show the field ONLY if:[nasal_number] > '2'
Test 3: Laboratory test method nasal / NP swab checkbox
1 lab_test_method_nasal_3___1 PCR
2 lab_test_method_nasal_3___2 Other
266 nasal_other_3
Show the field ONLY if:[lab_test_method_nasal_3(2)] = '1'
Test 3: If other, please specify laboratory test method nasal /NP swab + outcome
text
267 pcr_nasal_3
Show the field ONLY if:[lab_test_method_nasal_3(1)] = '1'
Test 3: PCR checkbox
1 pcr_nasal_3___1 SARS-CoV-2
2 pcr_nasal_3___2 Adenovirus
3 pcr_nasal_3___3 Parainfluenzavirus
4 pcr_nasal_3___4 Rhinovirus/Enterovirus
5 pcr_nasal_3___5 RS-virus
6 pcr_nasal_3___6 Influenzavirus
7 pcr_nasal_3___7 Coronavirus (not SARS-CoV-2)
8 pcr_nasal_3___8 Human Metapneumovirus
9 pcr_nasal_3___9 Chlamydia pneumoniae
10 pcr_nasal_3___10 Chlamydophila psittaci
11 pcr_nasal_3___11 Coxiella burneti
12 pcr_nasal_3___12 Legionella pneumophila
13 pcr_nasal_3___13 Mycoplasma pneumoniae
14 pcr_nasal_3___14 Other, specify
268 pcr_nasal_other_3
Show the field ONLY if:[pcr_nasal_3(14)] = '1'
Test 3: If other please specify pathogen text
269 date_nasal_4
Show the field ONLY if:[nasal_number] > '3'
Test 4: Collection date nasal / NP swabdd-mm-yyyy
text (date_dmy)
270 lab_test_method_nasal_4
Show the field ONLY if:[nasal_number] >'3'
Test 4: Laboratory test method nasal / NP swab checkbox
1 lab_test_method_nasal_4___1 PCR
2 lab_test_method_nasal_4___2 Other
271 nasal_other_4
Show the field ONLY if:[lab_test_method_nasal_4(2)] = '1'
Test 4: If other, please specify laboratory test method nasal /NP swab + outcome
text
272 pcr_nasal_4
Show the field ONLY if:[lab_test_method_nasal_4(1)] = '1'
Test 4: PCR checkbox
1 pcr_nasal_4___1 SARS-CoV-2
2 pcr_nasal_4___2 Adenovirus
3 pcr_nasal_4___3 Parainfluenzavirus
4 pcr_nasal_4___4 Rhinovirus/Enterovirus
5 pcr_nasal_4___5 RS-virus
6 pcr_nasal_4___6 Influenzavirus
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7 pcr_nasal_4___7 Coronavirus (not SARS-CoV-2)
8 pcr_nasal_4___8 Human Metapneumovirus
9 pcr_nasal_4___9 Chlamydia pneumoniae
10 pcr_nasal_4___10 Chlamydophila psittaci
11 pcr_nasal_4___11 Coxiella burneti
12 pcr_nasal_4___12 Legionella pneumophila
13 pcr_nasal_4___13 Mycoplasma pneumoniae
14 pcr_nasal_4___14 Other, specify
273 pcr_nasal_other_4
Show the field ONLY if:[pcr_nasal_4(14)] = '1'
Test 4: If other please specify pathogen text
274 date_nasal_5
Show the field ONLY if:[nasal_number] >'4'
Test 5: Collection date nasal / NP swabdd-mm-yyyy
text (date_dmy)
275 lab_test_method_nasal_5
Show the field ONLY if:[nasal_number] >'4'
Test 5: Laboratory test method nasal / NP swab checkbox
1 lab_test_method_nasal_5___1 PCR
2 lab_test_method_nasal_5___2 Other
276 nasal_other_5
Show the field ONLY if:[lab_test_method_nasal_5(2)] = '1'
Test 5: If other, please specify laboratory test method nasal /NP swab + outcome
text
277 pcr_nasal_5
Show the field ONLY if:[lab_test_method_nasal_5(1)] = '1'
Test 5: PCR checkbox
1 pcr_nasal_5___1 SARS-CoV-2
2 pcr_nasal_5___2 Adenovirus
3 pcr_nasal_5___3 Parainfluenzavirus
4 pcr_nasal_5___4 Rhinovirus/Enterovirus
5 pcr_nasal_5___5 RS-virus
6 pcr_nasal_5___6 Influenzavirus
7 pcr_nasal_5___7 Coronavirus (not SARS-CoV-2)
8 pcr_nasal_5___8 Human Metapneumovirus
9 pcr_nasal_5___9 Chlamydia pneumoniae
10 pcr_nasal_5___10 Chlamydophila psittaci
11 pcr_nasal_5___11 Coxiella burneti
12 pcr_nasal_5___12 Legionella pneumophila
13 pcr_nasal_5___13 Mycoplasma pneumoniae
14 pcr_nasal_5___14 Other, specify
278 pcr_nasal_other_5
Show the field ONLY if:[pcr_nasal_5(14)] = '1'
Test 5: If other please specify pathogen text
279 throat_number
Show the field ONLY if:[bio_spec_types(2)] = '1'
Section Header: Throat swab (the results of maximal 5 tests can be reported)
Number of throat swabs
dropdown
1 1
2 2
3 3
4 4
5 5
6 >5
280 throat_date_1
Show the field ONLY if:
Test 1: Collection date throat swabdd-mm-yyyy
text (date_dmy)
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[throat_number] >= '1'
281 throat_method_1
Show the field ONLY if:[throat_number] >= '1'
Test 1: Laboratory test method throat swab checkbox
1 throat_method_1___1 PCR
2 throat_method_1___2 Other
282 throat_method_other_1
Show the field ONLY if:[throat_method_1(2)] = '1'
Test 1: If other, please specify laboratory test method throatswab + outcome
text
283 throat_pcr_1
Show the field ONLY if:[throat_method_1(1)] = '1'
Test 1: PCR checkbox
1 throat_pcr_1___1 SARS-CoV-2
2 throat_pcr_1___2 Adenovirus
3 throat_pcr_1___3 Parainfluenzavirus
4 throat_pcr_1___4 Rhinovirus/Enterovirus
5 throat_pcr_1___5 RS-virus
6 throat_pcr_1___6 Influenzavirus
7 throat_pcr_1___7 Coronavirus (not SARS-CoV-2)
8 throat_pcr_1___8 Human Metapneumovirus
9 throat_pcr_1___9 Chlamydia pneumoniae
10 throat_pcr_1___10 Chlamydophila psittaci
11 throat_pcr_1___11 Coxiella burneti
12 throat_pcr_1___12 Legionella pneumophila
13 throat_pcr_1___13 Mycoplasma pneumoniae
14 throat_pcr_1___14 Other, specify
284 throat_pcr_other_1
Show the field ONLY if:[throat_pcr_1(14)] = '1'
Test 1: If other please specify pathogen text
285 throat_date_2
Show the field ONLY if:[throat_number] >= '2'
Test 2: Collection date throat swabdd-mm-yyyy
text (date_dmy)
286 throat_method_2
Show the field ONLY if:[throat_number] >= '2'
Test 2: Laboratory test method throat swab checkbox
1 throat_method_2___1 PCR
2 throat_method_2___2 Other
287 throat_method_other_2
Show the field ONLY if:[throat_method_2(2)] = '1'
Test 2: If other, please specify laboratory test method throatswab + outcome
text
288 throat_pcr_other_2
Show the field ONLY if:[throat_pcr_2(14)] = '1'
Test 2: If other please specify pathogen text
289 throat_pcr_2
Show the field ONLY if:[throat_method_2(1)] = '1'
Test 2: PCR checkbox
1 throat_pcr_2___1 SARS-CoV-2
2 throat_pcr_2___2 Adenovirus
3 throat_pcr_2___3 Parainfluenzavirus
4 throat_pcr_2___4 Rhinovirus/Enterovirus
5 throat_pcr_2___5 RS-virus
6 throat_pcr_2___6 Influenzavirus
7 throat_pcr_2___7 Coronavirus (not SARS-CoV-2)
8 throat_pcr_2___8 Human Metapneumovirus
9 throat_pcr_2___9 Chlamydia pneumoniae
10 throat_pcr_2___10 Chlamydophila psittaci
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11 throat_pcr_2___11 Coxiella burneti
12 throat_pcr_2___12 Legionella pneumophila
13 throat_pcr_2___13 Mycoplasma pneumoniae
14 throat_pcr_2___14 Other, specify
290 throat_date_3
Show the field ONLY if:[throat_number] >= '3'
Test 3: Collection date throat swabdd-mm-yyyy
text (date_dmy)
291 throat_method_3
Show the field ONLY if:[throat_number] >= '3'
Test 3: Laboratory test method throat swab checkbox
1 throat_method_3___1 PCR
2 throat_method_3___2 Other
292 throat_method_other_3
Show the field ONLY if:[throat_method_3(2)] = '1'
Test 3: If other, please specify laboratory test method throatswab + outcome
text
293 throat_pcr_3
Show the field ONLY if:[throat_method_3(1)] = '1'
Test 3: PCR checkbox
1 throat_pcr_3___1 SARS-CoV-2
2 throat_pcr_3___2 Adenovirus
3 throat_pcr_3___3 Parainfluenzavirus
4 throat_pcr_3___4 Rhinovirus/Enterovirus
5 throat_pcr_3___5 RS-virus
6 throat_pcr_3___6 Influenzavirus
7 throat_pcr_3___7 Coronavirus (not SARS-CoV-2)
8 throat_pcr_3___8 Human Metapneumovirus
9 throat_pcr_3___9 Chlamydia pneumoniae
10 throat_pcr_3___10 Chlamydophila psittaci
11 throat_pcr_3___11 Coxiella burneti
12 throat_pcr_3___12 Legionella pneumophila
13 throat_pcr_3___13 Mycoplasma pneumoniae
14 throat_pcr_3___14 Other, specify
294 throat_pcr_other_3
Show the field ONLY if:[throat_pcr_3(14)] = '1'
Test 3: If other please specify pathogen text
295 throat_date_4
Show the field ONLY if:[throat_number] >= '4'
Test 4: Collection date throat swabdd-mm-yyyy
text (date_dmy)
296 throat_method_4
Show the field ONLY if:[throat_number] >= '4'
Test 4: Laboratory test method throat swab checkbox
1 throat_method_4___1 PCR
2 throat_method_4___2 Other
297 throat_method_other_4
Show the field ONLY if:[throat_method_4(2)] = '1'
Test 4: If other, please specify laboratory test method throatswab + outcome
text
298 throat_pcr_4
Show the field ONLY if:[throat_method_4(1)] = '1'
Test 4: PCR checkbox
1 throat_pcr_4___1 SARS-CoV-2
2 throat_pcr_4___2 Adenovirus
3 throat_pcr_4___3 Parainfluenzavirus
4 throat_pcr_4___4 Rhinovirus/Enterovirus
5 throat_pcr_4___5 RS-virus
6 throat_pcr_4___6 Influenzavirus
7 throat_pcr_4___7 Coronavirus (not SARS-CoV-2)
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8 throat_pcr_4___8 Human Metapneumovirus
9 throat_pcr_4___9 Chlamydia pneumoniae
10 throat_pcr_4___10 Chlamydophila psittaci
11 throat_pcr_4___11 Coxiella burneti
12 throat_pcr_4___12 Legionella pneumophila
13 throat_pcr_4___13 Mycoplasma pneumoniae
14 throat_pcr_4___14 Other, specify
299 throat_pcr_other_4
Show the field ONLY if:[throat_pcr_4(14)] = '1'
Test 4: If other please specify pathogen text
300 throat_date_5
Show the field ONLY if:[throat_number] >= '5'
Test 5: Collection date throat swabdd-mm-yyyy
text (date_dmy)
301 throat_method_5
Show the field ONLY if:[throat_number] >= '5'
Test 5: Laboratory test method throat swab checkbox
1 throat_method_5___1 PCR
2 throat_method_5___2 Other
302 throat_method_other_5
Show the field ONLY if:[throat_method_5(2)] = '1'
Test 5: If other, please specify laboratory test method throatswab + outcome
text
303 throat_pcr_5
Show the field ONLY if:[throat_method_5(1)] = '1'
Test 5: PCR checkbox
1 throat_pcr_5___1 SARS-CoV-2
2 throat_pcr_5___2 Adenovirus
3 throat_pcr_5___3 Parainfluenzavirus
4 throat_pcr_5___4 Rhinovirus/Enterovirus
5 throat_pcr_5___5 RS-virus
6 throat_pcr_5___6 Influenzavirus
7 throat_pcr_5___7 Coronavirus (not SARS-CoV-2)
8 throat_pcr_5___8 Human Metapneumovirus
9 throat_pcr_5___9 Chlamydia pneumoniae
10 throat_pcr_5___10 Chlamydophila psittaci
11 throat_pcr_5___11 Coxiella burneti
12 throat_pcr_5___12 Legionella pneumophila
13 throat_pcr_5___13 Mycoplasma pneumoniae
14 throat_pcr_5___14 Other, specify
304 throat_pcr_other_5
Show the field ONLY if:[throat_pcr_5(14)] = '1'
Test 5: If other please specify pathogen text
305 comnpnasal_number
Show the field ONLY if:[bio_spec_types(3)] = '1'
Section Header: Combined nasal / NP swab
Number of combined nasal / NP swabs
dropdown
1 1
2 2
3 3
4 4
5 5
6 >5
306 comnpnasal_date_1
Show the field ONLY if:[comnpnasal_number] >= '1'
Test 1: Collection date combined nasal / NP swabdd-mm-yyyy
text (date_dmy)
307 comnpnasal_method_1 Test 1: Laboratory test method nasal / NP swab checkbox
1 comnpnasal_method_1___1 PCR
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Show the field ONLY if:[comnpnasal_number] >= '1'
2 comnpnasal_method_1___2 Other
308 comnpnasal_method_other_1
Show the field ONLY if:[comnpnasal_method_1(2)]='1'
Test 1: If other, please specify laboratory test methodcombined nasal / NP swab + outcome
text
309 comnpnasal_pcr_1
Show the field ONLY if:[comnpnasal_method_1(1)] = '1'
Test 1: PCR checkbox
1 comnpnasal_pcr_1___1 SARS-CoV-2
2 comnpnasal_pcr_1___2 Adenovirus
3 comnpnasal_pcr_1___3 Parainfluenzavirus
4 comnpnasal_pcr_1___4 Rhinovirus/Enterovirus
5 comnpnasal_pcr_1___5 RS-virus
6 comnpnasal_pcr_1___6 Influenzavirus
7 comnpnasal_pcr_1___7 Coronavirus (notSARS-CoV-2)
8 comnpnasal_pcr_1___8 HumanMetapneumovirus
9 comnpnasal_pcr_1___9 Chlamydiapneumoniae
10 comnpnasal_pcr_1___10 Chlamydophila psittaci
11 comnpnasal_pcr_1___11 Coxiella burneti
12 comnpnasal_pcr_1___12 Legionellapneumophila
13 comnpnasal_pcr_1___13 Mycoplasmapneumoniae
14 comnpnasal_pcr_1___14 Other, specify
310 comnpnasal_pcr_other_1
Show the field ONLY if:[comnpnasal_pcr_1(14)] = '1'
Test 1: If other please specify pathogen text
311 comnpnasal_date_2
Show the field ONLY if:[comnpnasal_number] >= '2'
Test 2: Collection date combined nasal / NP swabdd-mm-yyyy
text (date_dmy)
312 comnpnasal_method_2
Show the field ONLY if:[comnpnasal_number] >= '2'
Test 2: Laboratory test method nasal / NP swab checkbox
1 comnpnasal_method_2___1 PCR
2 comnpnasal_method_2___2 Other
313 comnpnasal_method_other_2
Show the field ONLY if:[comnpnasal_method_2(2)]='1'
Test 2: If other, please specify laboratory test methodcombined nasal / NP swab + outcome
text
314 comnpnasal_pcr_2
Show the field ONLY if:[comnpnasal_method_2(1)] = '1'
Test 2: PCR checkbox
1 comnpnasal_pcr_2___1 SARS-CoV-2
2 comnpnasal_pcr_2___2 Adenovirus
3 comnpnasal_pcr_2___3 Parainfluenzavirus
4 comnpnasal_pcr_2___4 Rhinovirus/Enterovirus
5 comnpnasal_pcr_2___5 RS-virus
6 comnpnasal_pcr_2___6 Influenzavirus
7 comnpnasal_pcr_2___7 Coronavirus (notSARS-CoV-2)
8 comnpnasal_pcr_2___8 HumanMetapneumovirus
9 comnpnasal_pcr_2___9 Chlamydiapneumoniae
10 comnpnasal_pcr_2___10 Chlamydophila psittaci
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11 comnpnasal_pcr_2___11 Coxiella burneti
12 comnpnasal_pcr_2___12 Legionellapneumophila
13 comnpnasal_pcr_2___13 Mycoplasmapneumoniae
14 comnpnasal_pcr_2___14 Other, specify
315 comnpnasal_pcr_other_2
Show the field ONLY if:[comnpnasal_pcr_2(14)] = '1'
Test 2: If other please specify pathogen text
316 comnpnasal_date_3
Show the field ONLY if:[comnpnasal_number] >= '3'
Test 3: Collection date combined nasal / NP swabdd-mm-yyyy
text (date_dmy)
317 comnpnasal_method_3
Show the field ONLY if:[comnpnasal_number] >= '3'
Test 3: Laboratory test method nasal / NP swab checkbox
1 comnpnasal_method_3___1 PCR
2 comnpnasal_method_3___2 Other
318 comnpnasal_method_other_3
Show the field ONLY if:[comnpnasal_method_3(2)]='1'
Test 3: If other, please specify laboratory test methodcombined nasal / NP swab + outcome
text
319 comnpnasal_pcr_3
Show the field ONLY if:[comnpnasal_method_3(1)] = '1'
Test 3: PCR checkbox
1 comnpnasal_pcr_3___1 SARS-CoV-2
2 comnpnasal_pcr_3___2 Adenovirus
3 comnpnasal_pcr_3___3 Parainfluenzavirus
4 comnpnasal_pcr_3___4 Rhinovirus/Enterovirus
5 comnpnasal_pcr_3___5 RS-virus
6 comnpnasal_pcr_3___6 Influenzavirus
7 comnpnasal_pcr_3___7 Coronavirus (notSARS-CoV-2)
8 comnpnasal_pcr_3___8 HumanMetapneumovirus
9 comnpnasal_pcr_3___9 Chlamydiapneumoniae
10 comnpnasal_pcr_3___10 Chlamydophila psittaci
11 comnpnasal_pcr_3___11 Coxiella burneti
12 comnpnasal_pcr_3___12 Legionellapneumophila
13 comnpnasal_pcr_3___13 Mycoplasmapneumoniae
14 comnpnasal_pcr_3___14 Other, specify
320 comnpnasal_pcr_other_3
Show the field ONLY if:[comnpnasal_pcr_3(14)] = '1'
Test 3: If other please specify pathogen text
321 comnpnasal_date_4
Show the field ONLY if:[comnpnasal_number] >= '4'
Test 4: Collection date combined nasal / NP swabdd-mm-yyyy
text (date_dmy)
322 comnpnasal_method_4
Show the field ONLY if:[comnpnasal_number] >= '4'
Test 4: Laboratory test method nasal / NP swab checkbox
1 comnpnasal_method_4___1 PCR
2 comnpnasal_method_4___2 Other
323 comnpnasal_method_other_4
Show the field ONLY if:[comnpnasal_method_4(2)]='1'
Test 4: If other, please specify laboratory test methodcombined nasal / NP swab + outcome
text
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324 comnpnasal_pcr_4
Show the field ONLY if:[comnpnasal_method_4(1)] = '1'
Test 4: PCR checkbox
1 comnpnasal_pcr_4___1 SARS-CoV-2
2 comnpnasal_pcr_4___2 Adenovirus
3 comnpnasal_pcr_4___3 Parainfluenzavirus
4 comnpnasal_pcr_4___4 Rhinovirus/Enterovirus
5 comnpnasal_pcr_4___5 RS-virus
6 comnpnasal_pcr_4___6 Influenzavirus
7 comnpnasal_pcr_4___7 Coronavirus (notSARS-CoV-2)
8 comnpnasal_pcr_4___8 HumanMetapneumovirus
9 comnpnasal_pcr_4___9 Chlamydiapneumoniae
10 comnpnasal_pcr_4___10 Chlamydophila psittaci
11 comnpnasal_pcr_4___11 Coxiella burneti
12 comnpnasal_pcr_4___12 Legionellapneumophila
13 comnpnasal_pcr_4___13 Mycoplasmapneumoniae
14 comnpnasal_pcr_4___14 Other, specify
325 comnpnasal_pcr_other_4
Show the field ONLY if:[comnpnasal_pcr_1(14)] = '1'
Test 4: If other please specify pathogen text
326 comnpnasal_date_5
Show the field ONLY if:[comnpnasal_number] >= '5'
Test 5: Collection date combined nasal / NP swabdd-mm-yyyy
text (date_dmy)
327 comnpnasal_method_5
Show the field ONLY if:[comnpnasal_number] >= '5'
Test 5: Laboratory test method nasal / NP swab checkbox
1 comnpnasal_method_5___1 PCR
2 comnpnasal_method_5___2 Other
328 comnpnasal_method_other_5
Show the field ONLY if:[comnpnasal_method_5(2)]='1'
Test 5: If other, please specify laboratory test methodcombined nasal / NP swab + outcome
text
329 comnpnasal_pcr_5
Show the field ONLY if:[comnpnasal_method_5(1)] = '1'
Test 5: PCR checkbox
1 comnpnasal_pcr_5___1 SARS-CoV-2
2 comnpnasal_pcr_5___2 Adenovirus
3 comnpnasal_pcr_5___3 Parainfluenzavirus
4 comnpnasal_pcr_5___4 Rhinovirus/Enterovirus
5 comnpnasal_pcr_5___5 RS-virus
6 comnpnasal_pcr_5___6 Influenzavirus
7 comnpnasal_pcr_5___7 Coronavirus (notSARS-CoV-2)
8 comnpnasal_pcr_5___8 HumanMetapneumovirus
9 comnpnasal_pcr_5___9 Chlamydiapneumoniae
10 comnpnasal_pcr_5___10 Chlamydophila psittaci
11 comnpnasal_pcr_5___11 Coxiella burneti
12 comnpnasal_pcr_5___12 Legionellapneumophila
13 comnpnasal_pcr_5___13 Mycoplasmapneumoniae
14 comnpnasal_pcr_5___14 Other, specify
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330 comnpnasal_pcr_other_5
Show the field ONLY if:[comnpnasal_pcr_1(14)] = '1'
Test 5: If other please specify pathogen text
331 sputum_number
Show the field ONLY if:[bio_spec_types(4)] = '1'
Section Header: Sputum
Number of sputum tests
dropdown
1 1
2 2
3 3
4 4
5 5
6 >5
332 sputum_date_1
Show the field ONLY if:[sputum_number] >= '1'
Test 1: Collection date sputumdd-mm-yyyy
text (date_dmy)
333 sputum_method_1
Show the field ONLY if:[sputum_number] >= '1'
Test 1: Laboratory test method sputum checkbox
1 sputum_method_1___1 PCR
2 sputum_method_1___2 Culture
3 sputum_method_1___3 Other
334 sputum_pcr_1
Show the field ONLY if:[sputum_method_1(1)]='1'
Test 1: PCR checkbox
1 sputum_pcr_1___1 SARS-CoV-2
2 sputum_pcr_1___2 Adenovirus
3 sputum_pcr_1___3 Parainfluenzavirus
4 sputum_pcr_1___4 Rhinovirus/Enterovirus
5 sputum_pcr_1___5 RS-virus
6 sputum_pcr_1___6 Influenzavirus
7 sputum_pcr_1___7 Coronavirus (not SARS-CoV-2)
8 sputum_pcr_1___8 HumanMetapneumovirus
9 sputum_pcr_1___9 Chlamydia pneumoniae
10 sputum_pcr_1___10 Chlamydophila psittaci
11 sputum_pcr_1___11 Coxiella burneti
12 sputum_pcr_1___12 Legionella pneumophila
13 sputum_pcr_1___13 Mycoplasma pneumoniae
14 sputum_pcr_1___14 Other, specify
335 sputum_pcr_other_1
Show the field ONLY if:[sputum_pcr_1(14)]='1'
Test 1: If other please specify pathogen text
336 sputum_culture_1
Show the field ONLY if:[sputum_method_1(2)]='1'
Test 1: Culture checkbox
1 sputum_culture_1___1 Acinetobacter spp
2 sputum_culture_1___2 Burkholderiapseudomallei
3 sputum_culture_1___3 Escherichia coli
4 sputum_culture_1___4 Haemophilusinfluenzae
5 sputum_culture_1___5 Klebsiella spp
6 sputum_culture_1___6 Moraxella catarrhalis
7 sputum_culture_1___7 Pseudomonasaeruginosa
8 sputum_culture_1___8 Staphylococcusaureus
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9 sputum_culture_1___9 Streptococcuspneumoniae
10 sputum_culture_1___10 Streptococcuspyogenes
11 sputum_culture_1___11 Streptococcusagalactiae
12 sputum_culture_1___12 Coagulase negativestaphylococci
13 sputum_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 sputum_culture_1___14 Other, specify
337 sputum_culture_other_1
Show the field ONLY if:[sputum_culture_1(14)]='1'
Test 1: If other please specify pathogen in culture text
338 sputum_method_other_1
Show the field ONLY if:[sputum_method_1(3)]='1'
Test 1: If other, please specify laboratory test method ofsputum + outcome
text
339 sputum_date_2
Show the field ONLY if:[sputum_number] >= '2'
Test 2: Collection date sputumdd-mm-yyyy
text (date_dmy)
340 sputum_method_2
Show the field ONLY if:[sputum_number] >= '2'
Test 2: Laboratory test method sputum checkbox
1 sputum_method_2___1 PCR
2 sputum_method_2___2 Culture
3 sputum_method_2___3 Other
341 sputum_pcr_2
Show the field ONLY if:[sputum_method_2(1)]='1'
Test 2: PCR checkbox
1 sputum_pcr_2___1 SARS-CoV-2
2 sputum_pcr_2___2 Adenovirus
3 sputum_pcr_2___3 Parainfluenzavirus
4 sputum_pcr_2___4 Rhinovirus/Enterovirus
5 sputum_pcr_2___5 RS-virus
6 sputum_pcr_2___6 Influenzavirus
7 sputum_pcr_2___7 Coronavirus (not SARS-CoV-2)
8 sputum_pcr_2___8 HumanMetapneumovirus
9 sputum_pcr_2___9 Chlamydia pneumoniae
10 sputum_pcr_2___10 Chlamydophila psittaci
11 sputum_pcr_2___11 Coxiella burneti
12 sputum_pcr_2___12 Legionella pneumophila
13 sputum_pcr_2___13 Mycoplasma pneumoniae
14 sputum_pcr_2___14 Other, specify
342 sputum_pcr_other_2
Show the field ONLY if:[sputum_pcr_2(14)]='1'
Test 2: If other please specify pathogen text
343 sputum_culture_2
Show the field ONLY if:[sputum_method_2(2)]='1'
Test 2: Culture checkbox
1 sputum_culture_2___1 Acinetobacter spp
2 sputum_culture_2___2 Burkholderiapseudomallei
3 sputum_culture_2___3 Escherichia coli
4 sputum_culture_2___4 Haemophilus
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influenzae
5 sputum_culture_2___5 Klebsiella spp
6 sputum_culture_2___6 Moraxella catarrhalis
7 sputum_culture_2___7 Pseudomonasaeruginosa
8 sputum_culture_2___8 Staphylococcusaureus
9 sputum_culture_2___9 Streptococcuspneumoniae
10 sputum_culture_2___10 Streptococcuspyogenes
11 sputum_culture_2___11 Streptococcusagalactiae
12 sputum_culture_2___12 Coagulase negativestaphylococci
13 sputum_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 sputum_culture_2___14 Other, specify
344 sputum_culture_other_2
Show the field ONLY if:[sputum_culture_2(14)]='1'
Test 2: If other please specify pathogen in culture text
345 sputum_method_other_2
Show the field ONLY if:[sputum_method_2(3)]='1'
Test 2: If other, please specify laboratory test method ofsputum + outcome
text
346 sputum_date_3
Show the field ONLY if:[sputum_number] >= '3'
Test 3: Collection date sputumdd-mm-yyyy
text (date_dmy)
347 sputum_method_3
Show the field ONLY if:[sputum_number] >= '3'
Test 3: Laboratory test method sputum checkbox
1 sputum_method_3___1 PCR
2 sputum_method_3___2 Culture
3 sputum_method_3___3 Other
348 sputum_pcr_3
Show the field ONLY if:[sputum_method_3(1)]='1'
Test 3: PCR checkbox
1 sputum_pcr_3___1 SARS-CoV-2
2 sputum_pcr_3___2 Adenovirus
3 sputum_pcr_3___3 Parainfluenzavirus
4 sputum_pcr_3___4 Rhinovirus/Enterovirus
5 sputum_pcr_3___5 RS-virus
6 sputum_pcr_3___6 Influenzavirus
7 sputum_pcr_3___7 Coronavirus (not SARS-CoV-2)
8 sputum_pcr_3___8 HumanMetapneumovirus
9 sputum_pcr_3___9 Chlamydia pneumoniae
10 sputum_pcr_3___10 Chlamydophila psittaci
11 sputum_pcr_3___11 Coxiella burneti
12 sputum_pcr_3___12 Legionella pneumophila
13 sputum_pcr_3___13 Mycoplasma pneumoniae
14 sputum_pcr_3___14 Other, specify
349 sputum_pcr_other_3
Show the field ONLY if:
Test 3: If other please specify pathogen text
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[sputum_pcr_3(14)]='1'
350 sputum_culture_3
Show the field ONLY if:[sputum_method_3(2)]='1'
Test 3: Culture checkbox
1 sputum_culture_3___1 Acinetobacter spp
2 sputum_culture_3___2 Burkholderiapseudomallei
3 sputum_culture_3___3 Escherichia coli
4 sputum_culture_3___4 Haemophilusinfluenzae
5 sputum_culture_3___5 Klebsiella spp
6 sputum_culture_3___6 Moraxella catarrhalis
7 sputum_culture_3___7 Pseudomonasaeruginosa
8 sputum_culture_3___8 Staphylococcusaureus
9 sputum_culture_3___9 Streptococcuspneumoniae
10 sputum_culture_3___10 Streptococcuspyogenes
11 sputum_culture_3___11 Streptococcusagalactiae
12 sputum_culture_3___12 Coagulase negativestaphylococci
13 sputum_culture_3___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 sputum_culture_3___14 Other, specify
351 sputum_culture_other_3
Show the field ONLY if:[sputum_culture_3(14)]='1'
Test 3: If other please specify pathogen in culture text
352 sputum_method_other_3
Show the field ONLY if:[sputum_method_3(3)]='1'
Test 3: If other, please specify laboratory test method ofsputum + outcome
text
353 sputum_date_4
Show the field ONLY if:[sputum_number] >= '4'
Test 4: Collection date sputumdd-mm-yyyy
text (date_dmy)
354 sputum_method_4
Show the field ONLY if:[sputum_number] >= '4'
Test 4: Laboratory test method sputum checkbox
1 sputum_method_4___1 PCR
2 sputum_method_4___2 Culture
3 sputum_method_4___3 Other
355 sputum_pcr_4
Show the field ONLY if:[sputum_method_4(1)]='1'
Test 4: PCR checkbox
1 sputum_pcr_4___1 SARS-CoV-2
2 sputum_pcr_4___2 Adenovirus
3 sputum_pcr_4___3 Parainfluenzavirus
4 sputum_pcr_4___4 Rhinovirus/Enterovirus
5 sputum_pcr_4___5 RS-virus
6 sputum_pcr_4___6 Influenzavirus
7 sputum_pcr_4___7 Coronavirus (not SARS-CoV-2)
8 sputum_pcr_4___8 HumanMetapneumovirus
9 sputum_pcr_4___9 Chlamydia pneumoniae
10 sputum_pcr_4___10 Chlamydophila psittaci
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11 sputum_pcr_4___11 Coxiella burneti
12 sputum_pcr_4___12 Legionella pneumophila
13 sputum_pcr_4___13 Mycoplasma pneumoniae
14 sputum_pcr_4___14 Other, specify
356 sputum_pcr_other_4
Show the field ONLY if:[sputum_pcr_4(14)]='1'
Test 4: If other please specify pathogen text
357 sputum_culture_4
Show the field ONLY if:[sputum_method_4(2)]='1'
Test 4: Culture checkbox
1 sputum_culture_4___1 Acinetobacter spp
2 sputum_culture_4___2 Burkholderiapseudomallei
3 sputum_culture_4___3 Escherichia coli
4 sputum_culture_4___4 Haemophilusinfluenzae
5 sputum_culture_4___5 Klebsiella spp
6 sputum_culture_4___6 Moraxella catarrhalis
7 sputum_culture_4___7 Pseudomonasaeruginosa
8 sputum_culture_4___8 Staphylococcusaureus
9 sputum_culture_4___9 Streptococcuspneumoniae
10 sputum_culture_4___10 Streptococcuspyogenes
11 sputum_culture_4___11 Streptococcusagalactiae
12 sputum_culture_4___12 Coagulase negativestaphylococci
13 sputum_culture_4___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 sputum_culture_4___14 Other, specify
358 sputum_culture_other_4
Show the field ONLY if:[sputum_culture_4(14)]='1'
Test 4: If other please specify pathogen in culture text
359 sputum_method_other_4
Show the field ONLY if:[sputum_method_4(3)]='1'
Test 4: If other, please specify laboratory test method ofsputum + outcome
text
360 sputum_date_5
Show the field ONLY if:[sputum_number] >= '5'
Test 5: Collection date sputumdd-mm-yyyy
text (date_dmy)
361 sputum_method_5
Show the field ONLY if:[sputum_number] >= '5'
Test 5: Laboratory test method sputum checkbox
1 sputum_method_5___1 PCR
2 sputum_method_5___2 Culture
3 sputum_method_5___3 Other
362 sputum_pcr_5
Show the field ONLY if:[sputum_method_5(1)]='1'
Test 5: PCR checkbox
1 sputum_pcr_5___1 SARS-CoV-2
2 sputum_pcr_5___2 Adenovirus
3 sputum_pcr_5___3 Parainfluenzavirus
4 sputum_pcr_5___4 Rhinovirus/Enterovirus
5 sputum_pcr_5___5 RS-virus
6 sputum_pcr_5___6 Influenzavirus
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7 sputum_pcr_5___7 Coronavirus (not SARS-CoV-2)
8 sputum_pcr_5___8 HumanMetapneumovirus
9 sputum_pcr_5___9 Chlamydia pneumoniae
10 sputum_pcr_5___10 Chlamydophila psittaci
11 sputum_pcr_5___11 Coxiella burneti
12 sputum_pcr_5___12 Legionella pneumophila
13 sputum_pcr_5___13 Mycoplasma pneumoniae
14 sputum_pcr_5___14 Other, specify
363 sputum_pcr_other_5
Show the field ONLY if:[sputum_pcr_5(14)]='1'
Test 5: If other please specify pathogen text
364 sputum_culture_5
Show the field ONLY if:[sputum_method_5(2)]='1'
Test 5: Culture checkbox
1 sputum_culture_5___1 Acinetobacter spp
2 sputum_culture_5___2 Burkholderiapseudomallei
3 sputum_culture_5___3 Escherichia coli
4 sputum_culture_5___4 Haemophilusinfluenzae
5 sputum_culture_5___5 Klebsiella spp
6 sputum_culture_5___6 Moraxella catarrhalis
7 sputum_culture_5___7 Pseudomonasaeruginosa
8 sputum_culture_5___8 Staphylococcusaureus
9 sputum_culture_5___9 Streptococcuspneumoniae
10 sputum_culture_5___10 Streptococcuspyogenes
11 sputum_culture_5___11 Streptococcusagalactiae
12 sputum_culture_5___12 Coagulase negativestaphylococci
13 sputum_culture_5___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 sputum_culture_5___14 Other, specify
365 sputum_culture_other_5
Show the field ONLY if:[sputum_culture_5(14)]='1'
Test 5: If other please specify pathogen in culture text
366 sputum_method_other_5
Show the field ONLY if:[sputum_method_5(3)]='1'
Test 5: If other, please specify laboratory test method ofsputum + outcome
text
367 bal_number
Show the field ONLY if:[bio_spec_types(5)] = '1'
Section Header: Bronchoalveolar lavage (BAL)
Number of bronchoalveolar lavages
dropdown
1 1
2 2
3 3
4 >3
368 bal_date_1
Show the field ONLY if:[bal_number] >= '1'
Test 1: Collection date bronchoalveolar lavage (BAL)dd-mm-yyyy
text (date_dmy)
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369 bal_method_1
Show the field ONLY if:[bal_number] >= '1'
Test 1: Laboratory test method bronchoalveolar lavage (BAL) checkbox
1 bal_method_1___1 PCR
2 bal_method_1___2 Culture
3 bal_method_1___3 Other
370 pcr_bal_1
Show the field ONLY if:[bal_method_1(1)]='1'
Test 1: PCR checkbox
1 pcr_bal_1___1 SARS-CoV-2
2 pcr_bal_1___2 Adenovirus
3 pcr_bal_1___3 Parainfluenzavirus
4 pcr_bal_1___4 Rhinovirus/Enterovirus
5 pcr_bal_1___5 RS-virus
6 pcr_bal_1___6 Influenzavirus
7 pcr_bal_1___7 Coronavirus (not SARS-CoV-2)
8 pcr_bal_1___8 Human Metapneumovirus
9 pcr_bal_1___9 Chlamydia pneumoniae
10 pcr_bal_1___10 Chlamydophila psittaci
11 pcr_bal_1___11 Coxiella burneti
12 pcr_bal_1___12 Legionella pneumophila
13 pcr_bal_1___13 Mycoplasma pneumoniae
14 pcr_bal_1___14 Other, specify
371 bal_pcr_other_1
Show the field ONLY if:[pcr_bal_1(14)]='1'
Test 1: If other please specify pathogen text
372 bal_culture_1
Show the field ONLY if:[bal_method_1(2)]='1'
Test 1: Culture checkbox
1 bal_culture_1___1 Acinetobacter spp
2 bal_culture_1___2 Burkholderia pseudomallei
3 bal_culture_1___3 Escherichia coli
4 bal_culture_1___4 Haemophilus influenzae
5 bal_culture_1___5 Klebsiella spp
6 bal_culture_1___6 Moraxella catarrhalis
7 bal_culture_1___7 Pseudomonas aeruginosa
8 bal_culture_1___8 Staphylococcus aureus
9 bal_culture_1___9 Streptococcuspneumoniae
10 bal_culture_1___10 Streptococcus pyogenes
11 bal_culture_1___11 Streptococcus agalactiae
12 bal_culture_1___12 Coagulase negativestaphylococci
13 bal_culture_1___13 Corynebacterium, bacillus,micrococcus,enterococcus,propionibacterium
14 bal_culture_1___14 Other, specify
373 bal_culture_other_1
Show the field ONLY if:[bal_culture_1(14)]='1'
Test 1: If other please specify pathogen in culture text
374 bal_method_other_1
Show the field ONLY if:[bal_method_1(3)]='1'
Test 1: If other, please specify laboratory test method of BAL +outcome
text
375 bal_date_2
Show the field ONLY if:[bal_number] >= '2'
Test 2: Collection date bronchoalveolar lavage (BAL)dd-mm-yyyy
text (date_dmy)
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376 bal_method_2
Show the field ONLY if:[bal_number] >= '2'
Test 2: Laboratory test method bronchoalveolar lavage (BAL) checkbox
1 bal_method_2___1 PCR
2 bal_method_2___2 Culture
3 bal_method_2___3 Other
377 pcr_bal_2
Show the field ONLY if:[bal_method_2(1)]='1'
Test 2: PCR checkbox
1 pcr_bal_2___1 SARS-CoV-2
2 pcr_bal_2___2 Adenovirus
3 pcr_bal_2___3 Parainfluenzavirus
4 pcr_bal_2___4 Rhinovirus/Enterovirus
5 pcr_bal_2___5 RS-virus
6 pcr_bal_2___6 Influenzavirus
7 pcr_bal_2___7 Coronavirus (not SARS-CoV-2)
8 pcr_bal_2___8 Human Metapneumovirus
9 pcr_bal_2___9 Chlamydia pneumoniae
10 pcr_bal_2___10 Chlamydophila psittaci
11 pcr_bal_2___11 Coxiella burneti
12 pcr_bal_2___12 Legionella pneumophila
13 pcr_bal_2___13 Mycoplasma pneumoniae
14 pcr_bal_2___14 Other, specify
378 bal_pcr_other_2
Show the field ONLY if:[pcr_bal_2(14)]='1'
Test 2: If other please specify pathogen text
379 bal_culture_2
Show the field ONLY if:[bal_method_2(2)]='1'
Test 2: Culture checkbox
1 bal_culture_2___1 Acinetobacter spp
2 bal_culture_2___2 Burkholderia pseudomallei
3 bal_culture_2___3 Escherichia coli
4 bal_culture_2___4 Haemophilus influenzae
5 bal_culture_2___5 Klebsiella spp
6 bal_culture_2___6 Moraxella catarrhalis
7 bal_culture_2___7 Pseudomonas aeruginosa
8 bal_culture_2___8 Staphylococcus aureus
9 bal_culture_2___9 Streptococcuspneumoniae
10 bal_culture_2___10 Streptococcus pyogenes
11 bal_culture_2___11 Streptococcus agalactiae
12 bal_culture_2___12 Coagulase negativestaphylococci
13 bal_culture_2___13 Corynebacterium, bacillus,micrococcus,enterococcus,propionibacterium
14 bal_culture_2___14 Other, specify
380 bal_culture_other_2
Show the field ONLY if:[bal_culture_2(14)]='1'
Test 2: If other please specify pathogen in culture text
381 bal_method_other_2
Show the field ONLY if:[bal_method_2(3)]='1'
Test 2: If other, please specify laboratory test method of BAL +outcome
text
382 bal_date_3
Show the field ONLY if:[bal_number] >= '3'
Test 3: Collection date bronchoalveolar lavage (BAL)dd-mm-yyyy
text (date_dmy)
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383 bal_method_3
Show the field ONLY if:[bal_number] >= '3'
Test 3: Laboratory test method bronchoalveolar lavage (BAL) checkbox
1 bal_method_3___1 PCR
2 bal_method_3___2 Culture
3 bal_method_3___3 Other
384 pcr_bal_3
Show the field ONLY if:[bal_method_3(1)]='1'
Test 3: PCR checkbox
1 pcr_bal_3___1 SARS-CoV-2
2 pcr_bal_3___2 Adenovirus
3 pcr_bal_3___3 Parainfluenzavirus
4 pcr_bal_3___4 Rhinovirus/Enterovirus
5 pcr_bal_3___5 RS-virus
6 pcr_bal_3___6 Influenzavirus
7 pcr_bal_3___7 Coronavirus (not SARS-CoV-2)
8 pcr_bal_3___8 Human Metapneumovirus
9 pcr_bal_3___9 Chlamydia pneumoniae
10 pcr_bal_3___10 Chlamydophila psittaci
11 pcr_bal_3___11 Coxiella burneti
12 pcr_bal_3___12 Legionella pneumophila
13 pcr_bal_3___13 Mycoplasma pneumoniae
14 pcr_bal_3___14 Other, specify
385 bal_pcr_other_3
Show the field ONLY if:[pcr_bal_3(14)]='1'
Test 3: If other please specify pathogen text
386 bal_culture_3
Show the field ONLY if:[bal_method_3(2)]='1'
Test 3: Culture checkbox
1 bal_culture_3___1 Acinetobacter spp
2 bal_culture_3___2 Burkholderia pseudomallei
3 bal_culture_3___3 Escherichia coli
4 bal_culture_3___4 Haemophilus influenzae
5 bal_culture_3___5 Klebsiella spp
6 bal_culture_3___6 Moraxella catarrhalis
7 bal_culture_3___7 Pseudomonas aeruginosa
8 bal_culture_3___8 Staphylococcus aureus
9 bal_culture_3___9 Streptococcuspneumoniae
10 bal_culture_3___10 Streptococcus pyogenes
11 bal_culture_3___11 Streptococcus agalactiae
12 bal_culture_3___12 Coagulase negativestaphylococci
13 bal_culture_3___13 Corynebacterium, bacillus,micrococcus,enterococcus,propionibacterium
14 bal_culture_3___14 Other, specify
387 bal_culture_other_3
Show the field ONLY if:[bal_culture_3(14)]='1'
Test 3: If other please specify pathogen in culture text
388 bal_method_other_3
Show the field ONLY if:[bal_method_3(3)]='1'
Test 3: If other, please specify laboratory test method of BAL +outcome
text
389 pleural_number
Show the field ONLY if:
Section Header: Pleural fluid
Number of pleural fluid tests
dropdown
1 1
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[bio_spec_types(6)] = '1' 2 2
3 >2
390 pleural_date_1
Show the field ONLY if:[pleural_number] >='1'
Test 1: Collection date pleural fluiddd-mm-yyyy
text (date_dmy)
391 pleural_method_1
Show the field ONLY if:[pleural_number] >='1'
Test 1: Laboratory test method pleural fluid checkbox
1 pleural_method_1___1 PCR
2 pleural_method_1___2 Culture
3 pleural_method_1___3 Other
392 pleural_pcr_1
Show the field ONLY if:[pleural_method_1(1)]='1'
Test 1: PCR checkbox
1 pleural_pcr_1___1 SARS-CoV-2
2 pleural_pcr_1___2 Adenovirus
3 pleural_pcr_1___3 Parainfluenzavirus
4 pleural_pcr_1___4 Rhinovirus/Enterovirus
5 pleural_pcr_1___5 RS-virus
6 pleural_pcr_1___6 Influenzavirus
7 pleural_pcr_1___7 Coronavirus (not SARS-CoV-2)
8 pleural_pcr_1___8 Human Metapneumovirus
9 pleural_pcr_1___9 Chlamydia pneumoniae
10 pleural_pcr_1___10 Chlamydophila psittaci
11 pleural_pcr_1___11 Coxiella burneti
12 pleural_pcr_1___12 Legionella pneumophila
13 pleural_pcr_1___13 Mycoplasma pneumoniae
14 pleural_pcr_1___14 Other, specify
393 pleural_pcr_other_1
Show the field ONLY if:[pleural_pcr_1(14)]='1'
Test 1: If other please specify pathogen text
394 pleural_culture_1
Show the field ONLY if:[pleural_method_1(2)]='1'
Test 1: Culture checkbox
1 pleural_culture_1___1 Acinetobacter spp
2 pleural_culture_1___2 Burkholderiapseudomallei
3 pleural_culture_1___3 Escherichia coli
4 pleural_culture_1___4 Haemophilusinfluenzae
5 pleural_culture_1___5 Klebsiella spp
6 pleural_culture_1___6 Moraxella catarrhalis
7 pleural_culture_1___7 Pseudomonasaeruginosa
8 pleural_culture_1___8 Staphylococcus aureus
9 pleural_culture_1___9 Streptococcuspneumoniae
10 pleural_culture_1___10 Streptococcuspyogenes
11 pleural_culture_1___11 Streptococcusagalactiae
12 pleural_culture_1___12 Coagulase negativestaphylococci
13 pleural_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
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14 pleural_culture_1___14 Other, specify
395 pleural_culture_other_1
Show the field ONLY if:[pleural_culture_1(14)]='1'
Test 1: If other please specify pathogen in pleural fluid text
396 pleural_method_other_1
Show the field ONLY if:[pleural_method_1(3)]='1'
Test 1: If other, please specify laboratory test method of pleuralfluid + outcome
text
397 pleural_date_2
Show the field ONLY if:[pleural_number] >='2'
Test 2: Collection date pleural fluiddd-mm-yyyy
text (date_dmy)
398 pleural_method_2
Show the field ONLY if:[pleural_number] >='2'
Test 2: Laboratory test method pleural fluid checkbox
1 pleural_method_2___1 PCR
2 pleural_method_2___2 Culture
3 pleural_method_2___3 Other
399 pleural_pcr_2
Show the field ONLY if:[pleural_method_2(1)]='1'
Test 2: PCR checkbox
1 pleural_pcr_2___1 SARS-CoV-2
2 pleural_pcr_2___2 Adenovirus
3 pleural_pcr_2___3 Parainfluenzavirus
4 pleural_pcr_2___4 Rhinovirus/Enterovirus
5 pleural_pcr_2___5 RS-virus
6 pleural_pcr_2___6 Influenzavirus
7 pleural_pcr_2___7 Coronavirus (not SARS-CoV-2)
8 pleural_pcr_2___8 Human Metapneumovirus
9 pleural_pcr_2___9 Chlamydia pneumoniae
10 pleural_pcr_2___10 Chlamydophila psittaci
11 pleural_pcr_2___11 Coxiella burneti
12 pleural_pcr_2___12 Legionella pneumophila
13 pleural_pcr_2___13 Mycoplasma pneumoniae
14 pleural_pcr_2___14 Other, specify
400 pleural_pcr_other_2
Show the field ONLY if:[pleural_pcr_2(14)]='1'
Test 2: If other please specify pathogen text
401 pleural_culture_2
Show the field ONLY if:[pleural_method_2(2)]='1'
Test 2: Culture checkbox
1 pleural_culture_2___1 Acinetobacter spp
2 pleural_culture_2___2 Burkholderiapseudomallei
3 pleural_culture_2___3 Escherichia coli
4 pleural_culture_2___4 Haemophilusinfluenzae
5 pleural_culture_2___5 Klebsiella spp
6 pleural_culture_2___6 Moraxella catarrhalis
7 pleural_culture_2___7 Pseudomonasaeruginosa
8 pleural_culture_2___8 Staphylococcus aureus
9 pleural_culture_2___9 Streptococcuspneumoniae
10 pleural_culture_2___10 Streptococcuspyogenes
11 pleural_culture_2___11 Streptococcusagalactiae
12 pleural_culture_2___12 Coagulase negative
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staphylococci
13 pleural_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 pleural_culture_2___14 Other, specify
402 pleural_culture_other_2
Show the field ONLY if:[pleural_culture_2(14)]='1'
Test 2: If other please specify pathogen in pleural fluid text
403 pleural_method_other_2
Show the field ONLY if:[pleural_method_2(3)]='1'
Test 2: If other, please specify laboratory test method of pleuralfluid + outcome
text
404 trach_number
Show the field ONLY if:[bio_spec_types(7)] = '1'
Section Header: Endotracheal aspirate
Number of endotracheal aspirate analyses
dropdown
1 1
2 2
3 >2
405 trach_date_1
Show the field ONLY if:[trach_number] >= '1'
Test 1: Collection date endotracheal aspirate (ETA)dd-mm-yyyy
text (date_dmy)
406 trach_method_1
Show the field ONLY if:[trach_number] >= '1'
Test 1: Laboratory test method endotracheal aspirate (ETA) checkbox
1 trach_method_1___1 PCR
2 trach_method_1___2 Culture
3 trach_method_1___3 Other
407 trach_pcr_1
Show the field ONLY if:[trach_method_1(1)]='1'
Test 1: PCR checkbox
1 trach_pcr_1___1 SARS-CoV-2
2 trach_pcr_1___2 Adenovirus
3 trach_pcr_1___3 Parainfluenzavirus
4 trach_pcr_1___4 Rhinovirus/Enterovirus
5 trach_pcr_1___5 RS-virus
6 trach_pcr_1___6 Influenzavirus
7 trach_pcr_1___7 Coronavirus (not SARS-CoV-2)
8 trach_pcr_1___8 Human Metapneumovirus
9 trach_pcr_1___9 Chlamydia pneumoniae
10 trach_pcr_1___10 Chlamydophila psittaci
11 trach_pcr_1___11 Coxiella burneti
12 trach_pcr_1___12 Legionella pneumophila
13 trach_pcr_1___13 Mycoplasma pneumoniae
14 trach_pcr_1___14 Other, specify
408 trach_pcr_other_1
Show the field ONLY if:[trach_pcr_1(14)]='1'
Test 1: If other please specify pathogen text
409 trach_culture_1
Show the field ONLY if:[trach_method_1(2)]='1'
Test 1: Culture checkbox
1 trach_culture_1___1 Acinetobacter spp
2 trach_culture_1___2 Burkholderiapseudomallei
3 trach_culture_1___3 Escherichia coli
4 trach_culture_1___4 Haemophilus influenzae
5 trach_culture_1___5 Klebsiella spp
6 trach_culture_1___6 Moraxella catarrhalis
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7 trach_culture_1___7 Pseudomonasaeruginosa
8 trach_culture_1___8 Staphylococcus aureus
9 trach_culture_1___9 Streptococcuspneumoniae
10 trach_culture_1___10 Streptococcus pyogenes
11 trach_culture_1___11 Streptococcus agalactiae
12 trach_culture_1___12 Coagulase negativestaphylococci
13 trach_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 trach_culture_1___14 Other, specify
410 trach_culture_other_1
Show the field ONLY if:[trach_culture_1(14)]='1'
Test 1: If other please specify pathogen in endotrachealaspirate
text
411 trach_method_other_1
Show the field ONLY if:[trach_method_1(3)]='1'
Test 1: If other, please specify laboratory test method of pleuralfluid + outcome
text
412 trach_date_2
Show the field ONLY if:[trach_number] >= '2'
Test 2: Collection date endotracheal aspirate (ETA)dd-mm-yyyy
text (date_dmy)
413 trach_method_2
Show the field ONLY if:[trach_number] >= '2'
Test 2: Laboratory test method endotracheal aspirate (ETA) checkbox
1 trach_method_2___1 PCR
2 trach_method_2___2 Culture
3 trach_method_2___3 Other
414 trach_pcr_2
Show the field ONLY if:[trach_method_2(1)]='1'
Test 2: PCR checkbox
1 trach_pcr_2___1 SARS-CoV-2
2 trach_pcr_2___2 Adenovirus
3 trach_pcr_2___3 Parainfluenzavirus
4 trach_pcr_2___4 Rhinovirus/Enterovirus
5 trach_pcr_2___5 RS-virus
6 trach_pcr_2___6 Influenzavirus
7 trach_pcr_2___7 Coronavirus (not SARS-CoV-2)
8 trach_pcr_2___8 Human Metapneumovirus
9 trach_pcr_2___9 Chlamydia pneumoniae
10 trach_pcr_2___10 Chlamydophila psittaci
11 trach_pcr_2___11 Coxiella burneti
12 trach_pcr_2___12 Legionella pneumophila
13 trach_pcr_2___13 Mycoplasma pneumoniae
14 trach_pcr_2___14 Other, specify
415 trach_pcr_other_2
Show the field ONLY if:[trach_pcr_2(14)]='1'
Test 2: If other please specify pathogen text
416 trach_culture_2
Show the field ONLY if:[trach_method_2(2)]='1'
Test 2: Culture checkbox
1 trach_culture_2___1 Acinetobacter spp
2 trach_culture_2___2 Burkholderiapseudomallei
3 trach_culture_2___3 Escherichia coli
4 trach_culture_2___4 Haemophilus influenzae
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5 trach_culture_2___5 Klebsiella spp
6 trach_culture_2___6 Moraxella catarrhalis
7 trach_culture_2___7 Pseudomonasaeruginosa
8 trach_culture_2___8 Staphylococcus aureus
9 trach_culture_2___9 Streptococcuspneumoniae
10 trach_culture_2___10 Streptococcus pyogenes
11 trach_culture_2___11 Streptococcus agalactiae
12 trach_culture_2___12 Coagulase negativestaphylococci
13 trach_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 trach_culture_2___14 Other, specify
417 trach_culture_other_2
Show the field ONLY if:[trach_culture_2(14)]='1'
Test 2: If other please specify pathogen in endotrachealaspirate
text
418 trach_method_other_2
Show the field ONLY if:[trach_method_2(3)]='1'
Test 2: If other, please specify laboratory test method of pleuralfluid + outcome
text
419 blood_number
Show the field ONLY if:[bio_spec_types(8)] = '1'
Section Header: Blood
Number of blood analyses
dropdown
1 1
2 2
3 >2
420 blood_date_1
Show the field ONLY if:[blood_number] >= '1'
Test 1: Collection date blooddd-mm-yyyy
text (date_dmy)
421 blood_method_1
Show the field ONLY if:[blood_number] >= '1'
Test 1: Laboratory test method blood checkbox
1 blood_method_1___1 PCR
2 blood_method_1___2 Culture
3 blood_method_1___3 Other
422 blood_pcr_1
Show the field ONLY if:[blood_method_1(1)]='1'
Test 1: PCR checkbox
1 blood_pcr_1___1 SARS-CoV-2
2 blood_pcr_1___2 Adenovirus
3 blood_pcr_1___3 Parainfluenzavirus
4 blood_pcr_1___4 Rhinovirus/Enterovirus
5 blood_pcr_1___5 RS-virus
6 blood_pcr_1___6 Influenzavirus
7 blood_pcr_1___7 Coronavirus (not SARS-CoV-2)
8 blood_pcr_1___8 Human Metapneumovirus
9 blood_pcr_1___9 Chlamydia pneumoniae
10 blood_pcr_1___10 Chlamydophila psittaci
11 blood_pcr_1___11 Coxiella burneti
12 blood_pcr_1___12 Legionella pneumophila
13 blood_pcr_1___13 Mycoplasma pneumoniae
14 blood_pcr_1___14 Other, specify
423 blood_pcr_other_1
Show the field ONLY if:
Test 1: If other please specify pathogen text
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[blood_pcr_1(14)]='1'
424 blood_culture_1
Show the field ONLY if:[blood_method_1(2)]='1'
Test 1: Culture checkbox
1 blood_culture_1___1 Acinetobacter spp
2 blood_culture_1___2 Burkholderiapseudomallei
3 blood_culture_1___3 Escherichia coli
4 blood_culture_1___4 Haemophilus influenzae
5 blood_culture_1___5 Klebsiella spp
6 blood_culture_1___6 Moraxella catarrhalis
7 blood_culture_1___7 Pseudomonasaeruginosa
8 blood_culture_1___8 Staphylococcus aureus
9 blood_culture_1___9 Streptococcuspneumoniae
10 blood_culture_1___10 Streptococcus pyogenes
11 blood_culture_1___11 Streptococcusagalactiae
12 blood_culture_1___12 Coagulase negativestaphylococci
13 blood_culture_1___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 blood_culture_1___14 Other, specify
425 blood_culture_other_1
Show the field ONLY if:[blood_culture_1(14)]='1'
Test 1: If other please specify pathogen in blood text
426 blood_method_other_1
Show the field ONLY if:[blood_method_1(3)]='1'
Test 1: If other, please specify laboratory test method of blood+ outcome
text
427 blood_date_2
Show the field ONLY if:[blood_number] >= '2'
Test 2: Collection date blooddd-mm-yyyy
text (date_dmy)
428 blood_method_2
Show the field ONLY if:[blood_number] >= '2'
Test 2: Laboratory test method blood checkbox
1 blood_method_2___1 PCR
2 blood_method_2___2 Culture
3 blood_method_2___3 Other
429 blood_pcr_2
Show the field ONLY if:[blood_method_2(1)]='1'
Test 2: PCR checkbox
1 blood_pcr_2___1 SARS-CoV-2
2 blood_pcr_2___2 Adenovirus
3 blood_pcr_2___3 Parainfluenzavirus
4 blood_pcr_2___4 Rhinovirus/Enterovirus
5 blood_pcr_2___5 RS-virus
6 blood_pcr_2___6 Influenzavirus
7 blood_pcr_2___7 Coronavirus (not SARS-CoV-2)
8 blood_pcr_2___8 Human Metapneumovirus
9 blood_pcr_2___9 Chlamydia pneumoniae
10 blood_pcr_2___10 Chlamydophila psittaci
11 blood_pcr_2___11 Coxiella burneti
12 blood_pcr_2___12 Legionella pneumophila
13 blood_pcr_2___13 Mycoplasma pneumoniae
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14 blood_pcr_2___14 Other, specify
430 blood_pcr_other_2
Show the field ONLY if:[blood_pcr_2(14)]='1'
Test 2: If other please specify pathogen text
431 blood_culture_2
Show the field ONLY if:[blood_method_2(2)]='1'
Test 2: Culture checkbox
1 blood_culture_2___1 Acinetobacter spp
2 blood_culture_2___2 Burkholderiapseudomallei
3 blood_culture_2___3 Escherichia coli
4 blood_culture_2___4 Haemophilus influenzae
5 blood_culture_2___5 Klebsiella spp
6 blood_culture_2___6 Moraxella catarrhalis
7 blood_culture_2___7 Pseudomonasaeruginosa
8 blood_culture_2___8 Staphylococcus aureus
9 blood_culture_2___9 Streptococcuspneumoniae
10 blood_culture_2___10 Streptococcus pyogenes
11 blood_culture_2___11 Streptococcusagalactiae
12 blood_culture_2___12 Coagulase negativestaphylococci
13 blood_culture_2___13 Corynebacterium,bacillus, micrococcus,enterococcus,propionibacterium
14 blood_culture_2___14 Other, specify
432 blood_culture_other_2
Show the field ONLY if:[blood_culture_2(14)]='1'
Test 2: If other please specify pathogen in blood text
433 blood_method_other_2
Show the field ONLY if:[blood_method_2(3)]='1'
Test 2: If other, please specify laboratory test method of blood+ outcome
text
434 urine_number
Show the field ONLY if:[bio_spec_types(9)] = '1'
Section Header: Urine
Number of urine analyses
dropdown
1 1
2 2
3 >2
435 urine_date_1
Show the field ONLY if:[urine_number]>='1'
Test 1: Collection date urinedd-mm-yyyy
text (date_dmy)
436 urine_antigen_test_1
Show the field ONLY if:[urine_number]>='1'
Test 1: Urine antigen test checkbox
1 urine_antigen_test_1___1 Streptococcuspneumoniae
2 urine_antigen_test_1___2 Legionellapneumophila
3 urine_antigen_test_1___3 Other, specify
437 urine_antigen_other_1
Show the field ONLY if:[urine_antigen_test_1(3)]='1'
Test 1: Specify urine antigen test text
438 urine_date_2
Show the field ONLY if:[urine_number]>='2'
Test 2: Collection date urinedd-mm-yyyy
text (date_dmy)
439 urine_antigen_test_2 Test 2: Urine antigen test checkbox
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! Collapse
Show the field ONLY if:[urine_number]>='2'
1 urine_antigen_test_2___1 Streptococcuspneumoniae
2 urine_antigen_test_2___2 Legionellapneumophila
3 urine_antigen_test_2___3 Other, specify
440 urine_antigen_other_2
Show the field ONLY if:[urine_antigen_test_2(3)]='1'
Test 2: Specify urine antigen test + outcome text
441 bio_spec_other
Show the field ONLY if:[bio_spec_types(10)] = '1'
Section Header: Other bio specimen
If other please specify biospecimen type + outcome
text
442 isaric_infectious_respiratory_disease_pathogen_tes_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Daily Form (OPTIONAL) (isaric_daily_form_optional)
443 daily_dsstdat DATE OF ASSESSMENTmay not be the date of completion
text (date_dmy), Required
444 daily_hoterm Section Header: 1. DAILY ASSESSMENT FORM, to be filled in at; - Firstadmission to the hospital - On admission to the ICU - Daily while on ICU (if >14days on ICU, do only fill in the first 14 days) - Discharge
1.1 Current admission to ICU/IMC/HDU
radio, Required
1 Yes
2 No
3 N/A
445 daily_fi02_lbyn Section Header: Record the worst value from 00:00-24:00 taken on day ofassessment (if Not Available write 'N/A')):
1.2 FiO2 available?
radio
1 Yes
2 No
446 daily_fio2_lborres
Show the field ONLY if:[daily_fi02_lbyn] = '1'
FiO2% (0.21-1.0)
text (number, Min: 0.2, Max: 1), Required
447 daily_sa02_lbyn 1.3 SaO2 available? radio
1 Yes
2 No
448 daily_sao2_lborres
Show the field ONLY if:[daily_sa02_lbyn] = '1'
SaO2%
text, Required
449 daily_pao2_lbyn 1.4 PaO2 available?at time of FiO2 above
yesno
1 Yes
0 No
450 daily_pao2_lborres
Show the field ONLY if:[daily_pao2_lbyn] = '1'
PaO2:at time of FiO2 specified above
text (number, Min: 0, Max: 500), Required
451 daily_pao2_lborresu
Show the field ONLY if:[daily_pao2_lbyn] = '1'
PaO2 unit: dropdown, Required
1 kPa
2 mmHg
452 daily_pao2_lbspec
Show the field ONLY if:[daily_pao2_lbyn] = '1'
PaO2 sample type dropdown, Required
1 Arterial
2 Venous
3 Capillary
4 N/A
453 daily_pco2_lbyn 1.5 PCO2 available?from same blood gas record as PaO2
radio
1 Yes
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2 No
454 daily_pco2_lborres
Show the field ONLY if:[daily_pco2_lbyn] = '1'
PCO2from same blood gas record as PaO2
text (number, Min: 0, Max: 200), Required
455 daily_pco2_lborresu
Show the field ONLY if:[daily_pco2_lbyn] = '1'
PCO2 Unit dropdown, Required
1 kPa
2 mmHg
456 daily_ph_lbyn 1.6 pH available yesno
1 Yes
0 No
457 daily_ph_lborres
Show the field ONLY if:[daily_ph_lbyn] = '1'
pH text (number_2dp), Required
458 daily_hco3_lbyn 1.7 HCO3- available yesno
1 Yes
0 No
459 daily_hco3_lborres
Show the field ONLY if:[daily_hco3_lbyn] = '1'
HCO3-mEq/L
text, Required
460 daily_baseex_lbyn 1.8 Base excess available yesno
1 Yes
0 No
461 daily_baseex_lborres
Show the field ONLY if:[daily_baseex_lbyn] = '1'
Base excessmmol/L
text, Required
462 avpu_vsorres 1.9 AVPU radio
1 Alert
2 Verbal
3 Pain
4 Unresponsive
463 rass_vsyn 1.10 Richmond Agitation-Sedation Scale (RASS) available yesno
1 Yes
0 No
464 rass_vsorres
Show the field ONLY if:[rass_vsyn] = '1'
Richmond Agitation-Sedation Scale (RASS) text, Required
465 sas_vsyn 1.11 Riker Sedation-Agitation Scale (SAS) available? yesno
1 Yes
0 No
466 sas_vsorres
Show the field ONLY if:[sas_vsyn] = '1'
Riker Sedation-Agitation Scale (SAS) text
467 daily_gcs_lbyn 1.12 Glasgow Coma Score available? radio
1 Yes
0 No
468 daily_gcs_vsorres
Show the field ONLY if:[daily_gcs_lbyn] = '1'
Glasgow Coma Score:out of 15
text (number, Min: 3, Max: 15), Required
469 systolic_vsyn 1.13 Systolic Blood Pressure available? yesno
1 Yes
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0 No
470 systolic_vsorres
Show the field ONLY if:[systolic_vsyn] = '1'
Systolic PressuremmHg
text, Required
471 diastolic_vsyn 1.14 Diastolic Blood Pressure available? yesno
1 Yes
0 No
472 diastolic_vsorres
Show the field ONLY if:[diastolic_vsyn] = '1'
Diastolic PressuremmHg
text, Required
473 daily_meanart_lbyn 1.15 Mean Arterial Pressure available? radio
1 Yes
0 No
474 daily_meanart_vsorres
Show the field ONLY if:[daily_meanart_lbyn] = '1'
Mean Arterial Pressure:mmHg
text (number, Min: 10, Max: 200), Required
475 daily_urine_lbyn 1.16 Urine flow rate available? radio
1 Yes
2 Estimated
0 No
476 daily_urine_lborres
Show the field ONLY if:[daily_urine_lbyn] = '1' or [daily_urine_lbyn] = '2'
Urine flow rate:mL/24 hours
text (number, Min: 0, Max: 15000), Required
477 daily_noninvasive_prtrt Section Header: Is the patient currently receiving, or has received (between00:00 to 24:00 on day of assessment) (apply to all questions in this section):
1.16 Non-invasive ventilation (e.g. BIPAP, CPAP)?
radio (Matrix)
1 YES
2 NO
3 N/A
478 daily_invasive_prtrt 1.17 Invasive ventilation? radio (Matrix)
1 YES
2 NO
3 N/A
479 daily_ecmo_prtrt 1.18 ECLS? radio (Matrix)
1 YES
2 NO
3 N/A
480 daily_nasaloxy_cmtrt 1.19 High-flow nasal canula oxygen therapy? radio (Matrix)
1 YES
2 NO
3 N/A
481 daily_rrt_cmtrt 1.20 Dialysis / Hemofiltration? radio (Matrix)
1 YES
2 NO
3 N/A
482 daily_inotrope_cmyn 1.21 Any vasopressor / inotropic support? radio (Matrix)
1 YES
2 NO
3 N/A
Field Annotation: If No; answer the next 3 questions
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'NO'
483 daily_dopless5_cmtrt
Show the field ONLY if:[daily_inotrope_cmyn] = '1'
1.22a Dopamine < 5 µg/min OR Dobutamine OR Milrinone ORLevosimendan:
radio (Matrix)
1 YES
2 NO
3 N/A
484 daily_dop5to15_cmtrt
Show the field ONLY if:[daily_inotrope_cmyn] = '1'
1.22b Dopamine 5-15 µg/min OR Epinephrine/Norepinephrine< 0.1 ?kg/min OR Vasopressin OR Phenylephrine:
radio (Matrix)
1 YES
2 NO
3 N/A
485 daily_dopgr15_cmtrt
Show the field ONLY if:[daily_inotrope_cmyn] = '1'
1.22c Dopamine > 15 µg/min OR Epinephrine/Norepinephrine> 0.1 ?kg/min:
radio (Matrix)
1 YES
2 NO
3 N/A
486 daily_neuro_cmtrt 1.23 Neuromuscular blocking agents? radio (Matrix)
1 YES
2 NO
3 N/A
487 daily_nitritc_cmtrt 1.24 Inhaled Nitric Oxide ? radio (Matrix)
1 YES
2 NO
3 N/A
488 daily_trach_prperf 1.25 Tracheostomy inserted? radio (Matrix)
1 YES
2 NO
3 N/A
489 daily_prone_cmtrt 1.26 Prone Positioning radio (Matrix)
1 YES
2 NO
3 N/A
490 daily_prperf 1.28 Other intervention or procedure? radio (Matrix)
1 YES
2 NO
3 N/A
491 daily_noninvasive_o2flow
Show the field ONLY if:[daily_noninvasive_prtrt] = '1'
If YES Non-invasive ventilation, specify O2 flow radio, Required
1 1-5 L/min
2 6-10 L/min
3 11-15 L/min
4 >15 L/min
-1 Unknown
492 daily_noninvasive_o2flow_2
Show the field ONLY if:[daily_ecmo_prtrt] = '1'
If YES extra corporeal life supports (ECLS), specify radio, Required
1 VV
2 AV
3 Central
4 N/A
493 daily_other_prtrt
Show the field ONLY if:[daily_prperf] = '1'
If YES other intervention, Specify, text, Required
494 daily_lbperf Section Header: 2. DAILY LABORATORY RESULTS (on admission, on anyadmission to ICU, then daily) Record the worst value from 00:00-24:00 taken on
yesno
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day of assessment (if Not Available write 'N/A')):
2.1 Results available for sample taken on the date in section 1above ?
1 Yes
0 No
495 daily_lbdat
Show the field ONLY if:[daily_lbperf] = '1'
Date of assessment text (date_dmy), Required
496 daily_hb_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.2 Haemoglobin available yesno
1 Yes
0 No
497 daily_hb_lborres
Show the field ONLY if:[daily_hb_lbyn] = '1'
Haemoglobin text (number, Min: 0, Max: 200), Required
498 daily_hb_lborresu
Show the field ONLY if:[daily_hb_lbyn] = '1'
Haemoglobin Unit dropdown, Required
1 g/L
2 g/dL
499 daily_wbc_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.3 WBC count available yesno
1 Yes
0 No
500 daily_wbc_lborres
Show the field ONLY if:[daily_wbc_lbyn] = '1'
WBC count text (number, Min: 0, Max: 200), Required
501 daily_wbc_lborresu
Show the field ONLY if:[daily_wbc_lbyn] = '1'
WBC Unit dropdown, Required
1 x 10^9 / L
2 x 10^3/µL
502 daily_lymp_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.4 Lymphocyte count available yesno
1 Yes
0 No
503 daily_lymp_lborres
Show the field ONLY if:[daily_lymp_lbyn] = '1'
Lymphocyte countcells/µL
text (number, Min: 0, Max: 200), Required
504 daily_neutro_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.5 Neutrophil count available yesno
1 Yes
0 No
505 daily_neutro_lborres
Show the field ONLY if:[daily_neutro_lbyn] = '1'
Neutrophil countcells/µL
text (number, Min: 0, Max: 200), Required
506 daily_haematocrit_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.6 Haematocrit available yesno
1 Yes
0 No
507 daily_haematocrit_lborres
Show the field ONLY if:[daily_haematocrit_lbyn] = '1'
Haematocrit%
text, Required
508 daily_plt_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.7 Platelets available yesno
1 Yes
0 No
509 daily_plt_lborres
Show the field ONLY if:[daily_plt_lbyn] = '1'
Platelet Count text (number, Min: 0, Max: 2000), Required
510 daily_plt_lborresu
Show the field ONLY if:
Platelets Unit dropdown, Required
1 x 10^9 / L
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[daily_plt_lbyn] = '1' 2 x 10^3/µL
511 daily_aptt_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.8 APTT/APTR available yesno
1 Yes
0 No
512 daily_aptt_lborres
Show the field ONLY if:[daily_aptt_lbyn] = '1'
APTT/APTR text (number, Min: 0, Max: 200), Required
513 daily_pt_inr_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.9 PT or INR available dropdown
1 PT done
2 INR done
3 PT or INR not done
514 daily_pt_lborres
Show the field ONLY if:[daily_pt_inr_lbyn] = '1'
PTseconds
text (number, Min: 0, Max: 100), Required
515 daily_inr_lborres
Show the field ONLY if:[daily_pt_inr_lbyn] = '2'
INR text (number, Min: 0, Max: 100), Required
516 daily_alt_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.10 ALT / SGPT available yesno
1 Yes
0 No
517 daily_alt_lborres
Show the field ONLY if:[daily_alt_lbyn] = '1'
ALT / SGPTU/L
text (number, Min: 0, Max: 8000), Required
518 daily_bil_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.11 Total Bilirubin available yesno
1 Yes
0 No
519 daily_bil_lborres
Show the field ONLY if:[daily_bil_lbyn] = '1'
Total Bilirubin text (number, Min: 0, Max: 700), Required
520 daily_bil_lborresu
Show the field ONLY if:[daily_bil_lbyn] = '1'
Total Bilirubin Unit dropdown, Required
1 µmol/L
2 mg/dL
521 daily_ast_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.12 AST/SGOT available yesno
1 Yes
0 No
522 daily_ast_lborres
Show the field ONLY if:[daily_ast_lbyn] = '1'
AST/SGOTU/L
text (number, Min: 0, Max: 8000), Required
523 daily_glucose_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.13 Glucose available yesno
1 Yes
0 No
524 daily_glucose_lborres
Show the field ONLY if:[daily_glucose_lbyn] = '1'
Glucose text (number, Min: 0, Max: 1000), Required
525 daily_glucose_lborresu
Show the field ONLY if:[daily_glucose_lbyn] = '1'
Glucose Unit dropdown, Required
1 mmol/L
2 mg/dL
526 daily_bun_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.14 Blood Urea Nitrogen (urea) available yesno
1 Yes
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0 No
527 daily_bun_lborres
Show the field ONLY if:[daily_bun_lbyn] = '1'
Blood Urea Nitrogen (urea) text (number, Min: 0, Max: 300), Required
528 daily_bun_lborresu
Show the field ONLY if:[daily_bun_lbyn] = '1'
Blood Urea Nitrogen (urea) dropdown, Required
1 mmol/L
2 mg/dL
529 daily_lactate_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.15 Lactate available yesno
1 Yes
0 No
530 daily_lactate_lborres
Show the field ONLY if:[daily_lactate_lbyn] = '1'
Lactate text (number, Min: 0, Max: 200), Required
531 daily_lactate_lborresu
Show the field ONLY if:[daily_lactate_lbyn] = '1'
Lactate Unit dropdown, Required
1 mmol/L
2 mg/dL
532 daily_creat_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.16 Creatinine available yesno
1 Yes
0 No
533 daily_creat_lborres
Show the field ONLY if:[daily_creat_lbyn] = '1'
Creatinine text (number, Min: 0, Max: 5000), Required
534 daily_creat_lborresu
Show the field ONLY if:[daily_creat_lbyn] = '1'
Creatinine Unit dropdown, Required
1 µmol/L
2 mg/dL
535 daily_sodium_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.17 Sodium available yesno
1 Yes
0 No
536 daily_sodium_lborres
Show the field ONLY if:[daily_sodium_lbyn] = '1'
Sodiummmol/L
text, Required
537 daily_potassium_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.18 Potassium available yesno
1 Yes
0 No
538 daily_potassium_lborres
Show the field ONLY if:[daily_potassium_lbyn] = '1'
Potassiummmol/L
text, Required
539 daily_procal_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.19 Procalcitonin available yesno
1 Yes
0 No
540 daily_procal_lborres
Show the field ONLY if:[daily_procal_lbyn] = '1'
Procalcitoninng/mL
text (number, Min: 0, Max: 2), Required
541 daily_crp_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.20 C-reactive protein (CRP) available yesno
1 Yes
0 No
542 daily_crp_lborres
Show the field ONLY if:[daily_crp_lbyn] = '1'
C-reactive protein (CRP)mg/L
text (number, Min: 0, Max: 500), Required
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543 daily_ldh_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.21 Lactodehydrogenase (LDH) yesno
1 Yes
0 No
544 daily_ldh_lborres
Show the field ONLY if:[daily_ldh_lbyn] = '1'
Lactodehydrogenase (LDH)U/L
text (number, Min: 0), Required
545 daily_esr_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.22 Erythrocyte Sedimentation Rate (ESR) available yesno
1 Yes
0 No
546 daily_esr_lborres
Show the field ONLY if:[daily_esr_lbyn] = '1'
Erythrocyte Sedimentation Rate (ESR)mm/hr
text (number, Min: 0, Max: 500), Required
547 daily_ddimer_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.23 D-dimer available yesno
1 Yes
0 No
548 daily_ddimer_lborres
Show the field ONLY if:[daily_ddimer_lbyn] = '1'
D-dimermg/L
text (number, Min: 0, Max: 500), Required
549 daily_ferritin_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.24 Ferritin available yesno
1 Yes
0 No
550 daily_crp_lborres_5
Show the field ONLY if:[daily_ferritin_lbyn] = '1'
Ferritinng/mL
text (number, Min: 0, Max: 500), Required
551 daily_il6_lbyn
Show the field ONLY if:[daily_lbperf] = '1'
2.25 Interleukin-6 (IL-6) available yesno
1 Yes
0 No
552 daily_il6_lborres
Show the field ONLY if:[daily_il6_lbyn] = '1'
Interleukin-6 (IL-6)mg/L
text (number, Min: 0, Max: 500), Required
553 isaric_daily_form_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac biomarkers (OPTIONAL) (capacity_cardiac_biomarkers_optional)
554 date_biomarker Date of examinationdd-mm-yyyy; only add if cardiac biomarkers were determined
text (date_dmy)
555 bio_trop Section Header: Troponin
Troponin
radio, Required
0 Not available
1 High sensitive Troponin I (hs-cTnI)
2 High sensitive Troponin T (hs-cTnT)
3 Troponin I
4 Troponin T
556 bio_trop_unit
Show the field ONLY if:[bio_trop] = '1' or [bio_trop] = '2' or [bio_trop] = '3' or [bio_trop] = '4'
Troponin: Unit radio
1 ng/L
2 µg/l
557 bio_trop_value
Show the field ONLY if:
Troponin: value text (number)
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[bio_trop] = '1' or [bio_trop] = '2' or [bio_trop] = '3' or [bio_trop] = '4'
558 bio_bnp Section Header: (NT-pro)BNP
(NT-pro)BNP
radio, Required
0 Not available
1 NT-proBNP
2 BNP
559 bio_bnp_unit
Show the field ONLY if:[bio_bnp] = '1' or [bio_bnp] = '2'
(NT-pro)BNP: Units radio
1 pg/mL
2 pmol/L
560 bio_bnp_value
Show the field ONLY if:[bio_bnp] = '1' or [bio_bnp] = '2'
(NT-pro)BNP: value text (number)
561 bio_ckmb Section Header: CK-MB
CK-MB
radio, Required
0 Not available
1 Available
562 bio_ckmb_unit
Show the field ONLY if:[bio_ckmb] = '1'
CK-MB: Units radio
1 U/L
2 µg/L
563 bio_ckmb_value
Show the field ONLY if:[bio_ckmb] = '1'
CK-MB: Value text (number)
564 bio_ck CK radio
0 Not available
1 Available
565 bio_ck_value CK: ValueU/L
text (number)
1 U/L
566 capacity_cardiac_biomarkers_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - ECG (OPTIONAL) (capacity_ecg_optional)
567 ecg_file If available, upload the ECG (make sure the file is anonymized). file
568 ecg_date Date of ECGdd-mm-yyyy; only add (i) baseline ecg, (ii) ecg with changes compared tobaseline or (iii) ecg with longest QTc after initiation of (hydro)chloroquinetreatment
text (date_dmy)
569 ecg_normal ECG normal? radio
1 Normal
2 Abnormal
570 ecg_hr
Show the field ONLY if:[ecg_normal] = '2'
Heart ratebpm
text (number, Min: 5, Max: 300)
571 ecg_rhythm
Show the field ONLY if:[ecg_normal] = '2'
Rhythm checkbox
1 ecg_rhythm___1 Sinus rhythm
2 ecg_rhythm___2 Atrial fibrillation
3 ecg_rhythm___3 Atrial flutter
4 ecg_rhythm___4 Premature ventricularcontraction
5 ecg_rhythm___5 Premature atrial contraction
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6 ecg_rhythm___6 Pacemaker rhythm
99 ecg_rhythm___99 Other
572 ecg_rhythm_spec
Show the field ONLY if:[ecg_rhythm(99)] = '1'
Specify Rhythm text
573 ecg_pq
Show the field ONLY if:[ecg_normal] = '2'
PQ intervalms
text (number, Min: 40, Max: 400)
574 ecg_qrs
Show the field ONLY if:[ecg_normal] = '2'
QRS duration text (number, Min: 40, Max: 260)
575 ecg_axis
Show the field ONLY if:[ecg_normal] = '2'
Heart axisDegree
text (number)
576 ecg_arrhyth_bbb_def
Show the field ONLY if:[ecg_qrs] >= 120
Definitions of bundle branch block Left bundle branch block:QRS duration of 120ms or longer with: Delayed onset ofintrinsicoid deflection in 1, V5 and V6 >60 ms. Broad andnotched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB.
descriptive
577 ecg_bbb
Show the field ONLY if:[ecg_qrs] >= 120
Bundle branch block dropdown
1 Left bundle branch block
2 Right bundle branch block
3 Nonspecific intraventricular conduction delay
578 ecg_qt
Show the field ONLY if:[ecg_normal] = '2'
QT durationms
text (number)
579 ecg_qtc
Show the field ONLY if:[ecg_qt] > 0
Corrected QT time (Bazett formula) calcCalculation: round([ecg_qt]/(sqrt (60 / [ecg_hr])))
580 ecg_abnormal_lvh_def
Show the field ONLY if:[ecg_normal] = '2'
Definition of pathological Q waves Any Q-wave in leads V2–V3≥ 0.02 s or QS complex in leads V2 and V3 Q-wave ≥ 0.03 s and> 0.1 mV deep or QS complex in leads I, II, aVL, aVF, or V4–V6 inany two leads of a contiguous lead grouping (I, aVL,V6; V4–V6;II, III, and aVF) R-wave ≥ 0.04 s in V1–V2 and R/S ≥ 1 with aconcordant positive T-wave in the absence of a conductiondefect Definition of left ventricular hypertrophy CornellVoltage: RaVL + SV3 >20 mm in women or 28 mm in males.Sokolow-Lyon Voltage: SV1 + RV5 or RV6 >35 mm (does notrequire gender or age adjustment), or R-wave in aVL ≥11mmCornell Product: Cornell voltage times the QRS duration >2,440ms (in women, 6 mm is added to their Cornell voltage).Romhilt-Estes Score: LVH is likely with 4 or more points. LVH ispresent with 5 or more points: Amplitude of R or S wave in limbleads >2.0 mV, or S wave in V1 or V2 >3.0 mV, or R wave inV5 or V6 >3.0 mV: 3 points. ST-segment changes with orwithout digitalis: 1 or 2 points, respectively. LA abnormality: 3points. Left-axis deviation -30° or more: 2 points. QRS duration:>90 ms: 1 point. Intrinsicoid deflection in V5 or V5: 0.05 to0.07s.
descriptive
581 ecg_abnormal
Show the field ONLY if:[ecg_normal] = '2'
AbnormalitiesCheck LVH if it fulfills any of the criteria listed above
checkbox
0 ecg_abnormal___0 None
1 ecg_abnormal___1 Pathological Qs
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2 ecg_abnormal___2 Left ventricular hypertrophy
3 ecg_abnormal___3 ST segments
4 ecg_abnormal___4 T-wave
582 ecg_lvh_crit
Show the field ONLY if:[ecg_abnormal(2)] = '1'
LVH criteria fulfilledDefinitions listed above
checkbox
1 ecg_lvh_crit___1 Cornell
2 ecg_lvh_crit___2 Sokolow-Lyon
3 ecg_lvh_crit___3 Romhilt-Estes
583 ecg_remarks
Show the field ONLY if:[ecg_normal] = '2'
Other remarks notes
584 capacity_ecg_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Echocardiography (OPTIONAL) (capacity_echocardiography_optional)
585 echo_date Date of examinationdd-mm-yyyy
text (date_dmy)
586 echo_type Type of examination dropdown
1 Transthoracic echocardiography
2 Transoesophageal echocardiography
3 Handheld ultrasound
587 tte_vendor
Show the field ONLY if:[echo_type] = '1' or [echo_type] = '2'
Vendor of echomachine dropdown
1 GE
2 Philips
3 Toshiba
588 echo_height_unit
Show the field ONLY if:[echo_type] = '1' or [echo_type] = '2'
Section Header: Height & Weight
Height
radio
1 Meters
2 Inches
Custom alignment: RH
589 echo_height_meter
Show the field ONLY if:[echo_height_unit] = '1'
Height (meters)meters
text (number, Min: 0.40, Max: 2.50)Custom alignment: RH
590 echo_height_inch
Show the field ONLY if:[echo_height_unit] = '2'
Height (inches)inches
text (number)Custom alignment: RH
591 tte_weight_unit
Show the field ONLY if:[echo_type] = '1' or [echo_type] = '2'
Weightkilogram
radio
1 Kilogram
2 Pounds
592 echo_weight_kg
Show the field ONLY if:[tte_weight_unit] = '1'
Weight (kilogram)kilogram
text (number)
593 echo_weight_pound
Show the field ONLY if:[tte_weight_unit] = '2'
Weight (pounds)pound
text
594 tte_bsa_kgm
Show the field ONLY if:[echo_height_meter] > 0 and [echo_weight_kg] > 0
Body surface aream2
calcCalculation: round(((([echo_weight_kg])^(0.425)) *(([echo_height_meter]*100)^(0.725)) * 0.007184),2)
595 tte_bsa_inchpoud Body surface area calc
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Show the field ONLY if:[echo_height_inch] > 0 and [echo_weight_pound] > 0
m2 Calculation:round(((([echo_weight_pound]*0.45359237)^(0.425))* (([echo_height_inch]*2.54)^(0.725)) * 0.007184),2)
596 tte_analysis
Show the field ONLY if:[echo_type] = '1'
Section Header: Transthoracic echocardiography
Transthoracic echocardiography protocol
checkbox, Required
1 tte_analysis___1 Dimensions
2 tte_analysis___2 Left ventricle: Ejection fraction(REQUIRED)
3 tte_analysis___3 Left ventricle: Strain analysis
4 tte_analysis___4 Left ventricle:Diastolic function
5 tte_analysis___5 Right ventricular function
6 tte_analysis___6 Valve analysis
7 tte_analysis___7 Pericardial effusion
Custom alignment: LV
597 tte_diml_dilate
Show the field ONLY if:[tte_analysis(1)] = '1'
Section Header: Dimensions
Left ventricular dilatationBased on 2D left ventricular end-diastolic diameter (♂ > 58mm; ♀ > 52mm)
radio
0 No
1 Yes
-1 Unknown
598 tte_lvh
Show the field ONLY if:[tte_analysis(1)] = '1'
Left ventricular hypertrophy (based on 2D images)Male: Septal wall thickness =>12mm or posterior wall thickness >10mm;Female: Septal wall thickness =>11mm or posterior wall thickness >10mm
radio
0 No
1 Yes concentric LVH
2 Yes asymmetrical LVH
-1 Unknown
599 tte_lavi
Show the field ONLY if:[tte_analysis(1)] = '1'
Left atrial volume indexml/m2; Unknown = NA
text (number, Min: 5, Max: 100)
600 tte_dim_other
Show the field ONLY if:[tte_analysis(1)] = '1'
Other abnormal dimensionsNo abnormalities = none; Unknown = NA;
notes
601 tte_lvef
Show the field ONLY if:[tte_analysis(2)] = '1'
Section Header: Left ventricle: Ejection fraction
Left ventricular ejection fraction:Type of measurement
checkbox
1 tte_lvef___1 3D
2 tte_lvef___2 2D biplane
3 tte_lvef___3 Estimated LVEF
-1 tte_lvef____1 Unknown
602 tte_lvef_3d
Show the field ONLY if:[tte_lvef(1)] = '1'
3D Left ventricular ejection fractionLVEF in %
text (number)
603 tte_lvef_3d_edv
Show the field ONLY if:[tte_lvef(1)] = '1'
3D Enddiastolic volumemL
text (number)
604 tte_lvef_3d_esv
Show the field ONLY if:[tte_lvef(1)] = '1'
3D Endsystolic volumemL
text (number)
605 tte_lvef_2d
Show the field ONLY if:[tte_lvef(2)] = '1'
2D (biplane) Left ventricular ejection fractionLVEF in %
text (number)
606 tte_lvef_2d_edv
Show the field ONLY if:[tte_lvef(2)] = '1'
2D Enddiastolic volumemL
text (number)
607 tte_lvef_2d_esv
Show the field ONLY if:
2D Endsystolic volumemL
text (number)
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[tte_lvef(2)] = '1'
608 tte_lvef_est
Show the field ONLY if:[tte_lvef(3)] = '1'
Estimated left ventricular ejection fractionLVEF in %
dropdown
1 Hyperdynamic (>70%)
2 Normal function (>53%)
3 Mild dysfunction (40-53%)
4 Moderate dysfunction (30-39%)
5 Severe dysfunction (< 30%)
609 tte_lvef_location
Show the field ONLY if:[tte_lvef_est] = '3' or [tte_lvef_est] = '4' or [tte_lvef_est] = '5' or ([tte_lvef_3d] < 53 and [tte_lvef_3d] > 0) or ([tte_lvef_2d] <53 and [tte_lvef_2d] > 0)
Localization of myocardial dysfunction radio
1 Global dysfunction
2 Regional dysfunction
610 tte_lvef_wms_figure
Show the field ONLY if:[tte_lvef_location] = '2'
descriptive
611 tte_lvef_wms
Show the field ONLY if:[tte_lvef_location] = '2'
Localization of wall abnormalities checkbox
1 tte_lvef_wms___1 1
2 tte_lvef_wms___2 2
3 tte_lvef_wms___3 3
4 tte_lvef_wms___4 4
5 tte_lvef_wms___5 5
6 tte_lvef_wms___6 6
7 tte_lvef_wms___7 7
8 tte_lvef_wms___8 8
9 tte_lvef_wms___9 9
10 tte_lvef_wms___10 10
11 tte_lvef_wms___11 11
12 tte_lvef_wms___12 12
13 tte_lvef_wms___13 13
14 tte_lvef_wms___14 14
15 tte_lvef_wms___15 15
16 tte_lvef_wms___16 16
17 tte_lvef_wms___17 17
612 tte_2ds_gls
Show the field ONLY if:[tte_analysis(3)] = '1'
Section Header: Strain analysis
Global longitudinal strain (average)%; Not available = NA
text
613 tte_2ds_plax
Show the field ONLY if:[tte_analysis(3)] = '1'
3-chamber longitudinal strain (average)%; Not available = NA
text
614 tte_2ds_4ch
Show the field ONLY if:[tte_analysis(3)] = '1'
4-chamber longitudinal strain (average)%; Not available = NA
text
615 tte_2ds_2ch
Show the field ONLY if:[tte_analysis(3)] = '1'
2-chamber longitudinal strain (average)%; Not available = NA
text
616 tte_2ds_comments
Show the field ONLY if:[tte_analysis(3)] = '1'
Strain analysis: Comments on measurements (quality,abnormalities)
notes
617 tte_dia_emax Section Header: Diastolic function text
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Show the field ONLY if:[tte_analysis(4)] = '1'
Mitral inflow: E maximal velocitycm/s; Unknown = NA;
618 tte_dia_amax
Show the field ONLY if:[tte_analysis(4)] = '1'
Mitral inflow: A maximal velocitycm/s; Unknown = NA;
text
619 tte_dia_earatio
Show the field ONLY if:[tte_analysis(4)] = '1'
Mitral inflow: E/A Ratio calcCalculation: round([tte_dia_emax] / [tte_dia_amax], 2)
620 tte_dia_dt
Show the field ONLY if:[tte_analysis(4)] = '1'
Mitral deceleration time (ms)ms; Unknown = NA
text
621 tte_dia_septale
Show the field ONLY if:[tte_analysis(4)] = '1'
TDI: Septal peak E' velocitycm/s; Unknown = NA;
text
622 tte_dia_laterale
Show the field ONLY if:[tte_analysis(4)] = '1'
TDI: Lateral peak E' velocitycm/s; Unknown = NA;
text
623 tte_dia_eeacc
Show the field ONLY if:[tte_analysis(4)] = '1'
E/E' calcCalculation: round([tte_dia_emax]/(([tte_dia_laterale]+[tte_dia_septale])/2),1)
624 tte_dia_trmax
Show the field ONLY if:[tte_analysis(4)] = '1'
Tricuspid regurgitation maximal velocitycm/s; No tricuspid regurgitation = none; Unknown = NA;
text
625 tte_rv_peaks
Show the field ONLY if:[tte_analysis(5)] = '1'
Section Header: Right ventricular function
TDI: RV peak systolic velocity of right ventricle tricuspid annuluscm/s; Unknown = NA;
text
626 tte_rv_tapse
Show the field ONLY if:[tte_analysis(5)] = '1'
Tricuspid annular plane systolic excursion (TAPSE)mm; unknown = NA
text
627 tte_valve_def
Show the field ONLY if:[tte_analysis(6)] = '1'
Section Header: Valves
Valvular heart diseaseSelect the specific valve if the stenosis orregurgitation is classified as ≥ moderate. Mild valvular diseaseshould not be recorded. Classification according to:Baumgartner H, Hung J, Bermejo J, Chambers JB, Evangelista A,Griffin BP, Lung B, Otto CM, Pellikka PA, Quiñones M.Echocardiographic assessment of valve stenosis: EAE/ASErecommendations for clinical practice. J Am SocEchocardiogr 2009;22:1–23. Lancellotti P, Tribouilloy C,Hagendorff A, Moura L, Popescu BA, Agricola E, Monin J-L,Pierard LA, Badano L, Zamorano JL, Sicari R, Vahanian A,Roelandt JRTC. European association of echocardiographyrecommendations for the assessment of valvular regurgitation.Part 1: Aortic and pulmonary regurgitation (native valvedisease). Eur J Echocardiogr 2010;11:223–244. Lancellotti P,Moura L, Pierard LA, Agricola E, Popescu BA, Tribouilloy C,Hagendorff A, Monin JL, Badano L, Zamorano JL, Sicari R,Vahanian A, Roelandt JRTC. European association ofechocardiography recommendations for the assessment ofvalvular regurgitation. Part 2: Mitral and tricuspid regurgitation(native valve disease). Eur J Echocardiogr 2010;11:307–332. Zoghbi WA, Enriquez-Sarano M, Foster E, Grayburn PA, KraftCD, Levine RA, Nihoyannopoulos P, Otto CM, Quinones MA,Rakowski H, Stewart WJ, Waggoner A, Weissman NJ.Recommendations for Evaluation of the Severity ofNative Valvular Regurgitation with Two-dimensional andDoppler Echocardiography. J Am SocEchocardiogr 2003;16:777-802. Select the specific valve if the stenosis or regurgitation is classified as≥moderate. Mild valvular disease should not be recorded.
descriptive
628 tte_valve_analysis Outcomes of valve analysis radio
1 There were abnormalities
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Show the field ONLY if:[tte_analysis(6)] = '1'
2 No abnormalities
629 tte_valve_abnormal
Show the field ONLY if:[tte_valve_analysis] = '1'
Which valves were abnormal? checkbox
1 tte_valve_abnormal___1 Aortic valve
2 tte_valve_abnormal___2 Mitral valve
3 tte_valve_abnormal___3 Pulmonary valve
4 tte_valve_abnormal___4 Tricuspid valve
630 tte_valve_aortic_s
Show the field ONLY if:[tte_valve_abnormal(1)] = '1'
Aortic valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
631 tte_valve_aortic_r
Show the field ONLY if:[tte_valve_abnormal(1)] = '1'
Aortic valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
632 tte_valve_aortic_veg
Show the field ONLY if:[tte_valve_abnormal(1)] = '1'
Aortic valve: vegetation? dropdown
0 No
1 Yes
633 tte_valve_mitral_s
Show the field ONLY if:[tte_valve_abnormal(2)] = '1'
Mitral valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
634 tte_valve_mitral_r
Show the field ONLY if:[tte_valve_abnormal(2)] = '1'
Mitral valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
635 tte_valve_mitral_veg
Show the field ONLY if:[tte_valve_abnormal(2)] = '1'
Mitral valve: vegetation dropdown
0 No
1 Yes
636 tte_valve_pulm_s
Show the field ONLY if:[tte_valve_abnormal(3)] = '1'
Pulmonary valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
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637 tte_valve_pulm_r
Show the field ONLY if:[tte_valve_abnormal(3)] = '1'
Pulmonary valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
638 tte_valve_pulm_veg
Show the field ONLY if:[tte_valve_abnormal(3)] = '1'
Pulmonary valve: vegetation? dropdown
0 No
1 Yes
639 tte_valve_tricus_s
Show the field ONLY if:[tte_valve_abnormal(4)] = '1'
Tricuspid valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
640 tte_valve_tricus_r
Show the field ONLY if:[tte_valve_abnormal(4)] = '1'
Tricuspid valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
641 tte_valve_tricus_veg
Show the field ONLY if:[tte_valve_abnormal(4)] = '1'
Tricuspid valve: vegetation? dropdown
0 No
1 Yes
642 tte_valve_intervention
Show the field ONLY if:[tte_valve_analysis] = '1'
Prior valve intervention text
643 tte_pe
Show the field ONLY if:[tte_analysis(7)] = '1'
Section Header: Pericardial effusion
Pericardial effusion
radio
0 None
1 Mild (< 10mm)
2 Moderate (10-20mm)
3 Large (>20mm)
4 Cardiac tamponade
-1 Unknown
644 tte_vscan
Show the field ONLY if:[echo_type] = '3'
Section Header: Handheld ultrasound
Handheld ultrasound: Abnormal findings
radio
1 Yes
0 No
Custom alignment: RH
645 tte_vscan_outcome
Show the field ONLY if:[echo_type] = '3'
Handheld ultrasound: Outcomes notes
646 toe_protocol
Show the field ONLY if:[echo_type] = '2'
Section Header: Transoesophageal echocardiography
Transoesophageal echocardiography protocol
checkbox
1 toe_protocol___1 Left ventricular function
2 toe_protocol___2 Right ventricular function
3 toe_protocol___3 Valve analysis
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Custom alignment: LV
647 toe_lvef_est
Show the field ONLY if:[toe_protocol(1)] = '1'
Estimated left ventricular ejection fractionLVEF in %
dropdown
1 Hyperdynamic (>70%)
2 Normal function (>53%)
3 Mild dysfunction (40-53%)
4 Moderate dysfunction (30-39%)
5 Severe dysfunction (< 30%)
648 toe_lvef_location
Show the field ONLY if:[toe_lvef_est] = '3' or [toe_lvef_est] = '4' or [toe_lvef_est] = '5'
Localization of myocardial dysfunction radio
1 Global dysfunction
2 Regional dysfunction
649 toe_lvef_wms_figure
Show the field ONLY if:[toe_lvef_location] = '2'
descriptive
650 toe_lvef_wms
Show the field ONLY if:[toe_lvef_location] = '2'
Localization of wall abnormalities checkbox
1 toe_lvef_wms___1 1
2 toe_lvef_wms___2 2
3 toe_lvef_wms___3 3
4 toe_lvef_wms___4 4
5 toe_lvef_wms___5 5
6 toe_lvef_wms___6 6
7 toe_lvef_wms___7 7
8 toe_lvef_wms___8 8
9 toe_lvef_wms___9 9
10 toe_lvef_wms___10 10
11 toe_lvef_wms___11 11
12 toe_lvef_wms___12 12
13 toe_lvef_wms___13 13
14 toe_lvef_wms___14 14
15 toe_lvef_wms___15 15
16 toe_lvef_wms___16 16
17 toe_lvef_wms___17 17
651 toe_rvef_est
Show the field ONLY if:[toe_protocol(2)] = '1'
Estimated right ventricular ejection fractionLVEF in %
dropdown
1 Hyperdynamic
2 Normal function
3 Mild dysfunction
4 Moderate dysfunction
5 Severe dysfunction
652 toe_valve_analysis
Show the field ONLY if:[toe_protocol(3)] = '1'
Outcomes of valve analysis radio
1 There were abnormalities
2 No abnormalities
653 toe_valve_abnormal
Show the field ONLY if:[toe_valve_analysis] = '1'
Which valves were abnormal? checkbox
1 toe_valve_abnormal___1 Aortic valve
2 toe_valve_abnormal___2 Mitral valve
3 toe_valve_abnormal___3 Pulmonary valve
4 toe_valve_abnormal___4 Tricuspid valve
654 toe_valve_aortic_s Aortic valve: stenosis dropdown
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Show the field ONLY if:[toe_valve_abnormal(1)] = '1'
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
655 toe_valve_aortic_r
Show the field ONLY if:[toe_valve_abnormal(1)] = '1'
Aortic valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
656 toe_valve_aortic_veg
Show the field ONLY if:[toe_valve_abnormal(1)] = '1'
Aortic valve: vegetation radio
0 No
1 Yes
657 toe_valve_mitral_r
Show the field ONLY if:[toe_valve_abnormal(2)] = '1'
Mitral valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
658 toe_valve_mitral_s
Show the field ONLY if:[toe_valve_abnormal(2)] = '1'
Mitral valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
659 toe_valve_mitral_veg
Show the field ONLY if:[toe_valve_abnormal(2)] = '1'
Mitral valve: vegetation? radio
0 No
1 Yes
660 toe_valve_pulm_r
Show the field ONLY if:[toe_valve_abnormal(3)] = '1'
Pulmonary valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
661 toe_valve_pulm_s
Show the field ONLY if:[toe_valve_abnormal(3)] = '1'
Pulmonary valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
662 toe_valve_pulm_veg Pulmonary valve: vegetation? radio
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Show the field ONLY if:[toe_valve_abnormal(3)] = '1'
0 No
1 Yes
663 toe_valve_tricus_r
Show the field ONLY if:[toe_valve_abnormal(4)] = '1'
Tricuspid valve: regurgitation dropdown
0 none
1 minimal
2 mild
3 moderate
4 severe
99 Unknown
664 toe_valve_tricus_s
Show the field ONLY if:[toe_valve_abnormal(4)] = '1'
Tricuspid valve: stenosis dropdown
0 none
1 sclerosis
2 mild
3 moderate
4 severe
99 Unknown
665 toe_valve_tricus_veg
Show the field ONLY if:[toe_valve_abnormal(4)] = '1'
Tricuspid valve: vegetation? radio
0 No
1 Yes
666 capacity_echocardiography_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac MRI (OPTIONAL) (capacity_cardiac_mri_optional)
667 cmr_date Date of cardiac MRIdd-mm-yyyy
text (date_dmy)
668 cmr_images Images availableAlso select no if only written report is available (e.g. from another center)
radio
1 Yes
0 No
Custom alignment: RH
669 cmr_height_unit Section Header: Height & Weight
Height
radio
1 Meters
2 Inch
Custom alignment: RH
670 cmr_height_meter
Show the field ONLY if:[cmr_height_unit] = '1'
Height (meters)meters
text (number, Min: 0.40, Max: 2.40)
671 cmr_height_inch
Show the field ONLY if:[cmr_height_unit] = '2'
Height (inch)inches
text (number)
672 cmr_weight_unit Weight radio
1 kilogram
2 pound
673 cmr_weight_kg
Show the field ONLY if:[cmr_weight_unit] = '1'
Weight (kilogram)kg
text (number)
674 cmr_weight_pound Weight (pound)lb
text (number)
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675 cmr_bsa_kgm
Show the field ONLY if:[cmr_height_meter] > 0 and [cmr_weight_kg] > 0
Body surface aream^2
calcCalculation: round(((([cmr_weight_kg])^(0.425)) *(([cmr_height_meter]*100)^(0.725)) * 0.007184),2)
676 cmr_bsa_inchpound
Show the field ONLY if:[cmr_height_inch] > 0 and [cmr_weight_pound] > 0
Body surface aream^2
calcCalculation:round(((([cmr_weight_pound]*0.45359237)^(0.425)) *(([cmr_height_inch]*2.54)^(0.725)) * 0.007184),2)
677 cmr_report ReportYou can copy-paste the report. Make sure the text is anonymized.
notes
678 cmr_tesla Strength of the magnetic field (Tesla)Unknown = NA
text (number)
679 cmr_protocol CMR protocol checkbox, Required
1 cmr_protocol___1 Left ventricular function(REQUIRED)
2 cmr_protocol___2 Right ventricular function
3 cmr_protocol___3 Late gadoliniumenhancement
4 cmr_protocol___4 Stress CMR
5 cmr_protocol___5 T1 mapping
6 cmr_protocol___6 T2 mapping
680 cmr_left_lvef
Show the field ONLY if:[cmr_protocol(1)] = '1'
Section Header: Left ventricular function
Left ventricle: Ejection fraction%
text (number)
681 cmr_left_edv
Show the field ONLY if:[cmr_protocol(1)] = '1'
Left ventricle: Enddiastolic volumemL
text (number)
682 cmr_left_esv
Show the field ONLY if:[cmr_protocol(1)] = '1'
Left ventricle: Endsystolic volumemL
text (number)
683 cmr_left_sv
Show the field ONLY if:[cmr_protocol(1)] = '1'
Left ventricle: Stroke volumemL
calcCalculation: round( [cmr_left_edv]-[cmr_left_esv])
684 cmr_right_lvef
Show the field ONLY if:[cmr_protocol(2)] = '1'
Section Header: Right ventricular function
Right ventricle: Ejection fraction%
text (number)
685 cmr_right_edv
Show the field ONLY if:[cmr_protocol(2)] = '1'
Right ventricle: Enddiastolic volumemL
text (number)
686 cmr_right_esv
Show the field ONLY if:[cmr_protocol(2)] = '1'
Right ventricle: Endsystolic volumemL
text (number)
687 cmr_right_sv
Show the field ONLY if:[cmr_protocol(2)] = '1'
Right ventricle: Stroke volumemL
calcCalculation: round( [cmr_right_edv]-[cmr_right_esv])
688 cmr_lge_figure
Show the field ONLY if:[cmr_protocol(3)] = '1'
Section Header: Additional investigations
Layer of late gadolinium enhancementHyperenhancementpatters that one may encounter in clinical practice.Adaptedfrom: Mahrholdt et al. (2005); doi: 10.1093/eurheartj/ehi258
descriptive
689 cmr_de_layer
Show the field ONLY if:[cmr_protocol(3)] = '1'
Layer of late gadolinium enhancement checkbox
0 cmr_de_layer___0 None
1 cmr_de_layer___1 Subendocardial
2 cmr_de_layer___2 Transmural
3 cmr_de_layer___3 Midmyocardial
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4 cmr_de_layer___4 Subepicardial
5 cmr_de_layer___5 Global endocardial
690 cmr_lge_loc_figure
Show the field ONLY if:[cmr_de_layer(1)] = '1' or [cmr_de_layer(2)] = '1' or [cmr_de_layer(3)] = '1' or [cmr_de_layer(4)] = '1'
Localization of late gadolinium enhancement descriptive
691 cmr_lge_localization
Show the field ONLY if:[cmr_de_layer(1)] = '1' or [cmr_de_layer(2)] = '1' or [cmr_de_layer(3)] = '1' or [cmr_de_layer(4)] = '1'
Localization of wall abnormalities checkbox
1 cmr_lge_localization___1 1
2 cmr_lge_localization___2 2
3 cmr_lge_localization___3 3
4 cmr_lge_localization___4 4
5 cmr_lge_localization___5 5
6 cmr_lge_localization___6 6
7 cmr_lge_localization___7 7
8 cmr_lge_localization___8 8
9 cmr_lge_localization___9 9
10 cmr_lge_localization___10 10
11 cmr_lge_localization___11 11
12 cmr_lge_localization___12 12
13 cmr_lge_localization___13 13
14 cmr_lge_localization___14 14
15 cmr_lge_localization___15 15
16 cmr_lge_localization___16 16
17 cmr_lge_localization___17 17
692 cmr_stress
Show the field ONLY if:[cmr_protocol(4)] = '1'
Stress CMR: Signs of ischemia? radio
0 No
1 Yes
99 Unknown
693 cmr_t1_native
Show the field ONLY if:[cmr_protocol(5)] = '1'
T1-mapping: Native T1 (Overall) text (number)
694 cmr_t1_ht
Show the field ONLY if:[cmr_protocol(5)] = '1'
Hematocrite on day of examination%; Not available = NA
text (number)
695 cmr_t1_ecv
Show the field ONLY if:[cmr_protocol(5)] = '1'
T1-mapping: Extracellular volume%; Not available = NA
text (number)
696 cmr_t1_remarks
Show the field ONLY if:[cmr_protocol(5)] = '1'
T1-mapping: Remarks text
697 cmr_t2_time
Show the field ONLY if:[cmr_protocol(6)] = '1'
T2-mapping: T2 time (overall)ms
text
698 cmr_other_cardiac Section Header: Other findings
Cardiac findings
notes
699 cmr_other_extracardiac Extracardiac findings notes
700 capacity_cardiac_mri_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
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2 Complete
Instrument: CAPACITY - CT (thorax/coronaries/PET/lung angiography) (OPTIONAL)(capacity_ct_thoraxcoronariespetlung_angiography_op)
701 ct_protocol CT protocol checkbox
1 ct_protocol___1 Thorax
2 ct_protocol___2 Coronary
3 ct_protocol___3 PET-CT
4 ct_protocol___4 Pulmonary angiography
702 ct_thorax_date
Show the field ONLY if:[ct_protocol(1)] = '1'
Section Header: CT-thorax
Date of CT-thoraxdd-mm-yyyy
text (date_dmy)
703 ct_thorax_report
Show the field ONLY if:[ct_protocol(1)] = '1'
CT-thorax: Copy of original report notes
704 ct_thorax_lunglesion
Show the field ONLY if:[ct_protocol(1)] = '1'
CT-thorax: Lesion(s) in lung(s) described? radio
1 Yes
0 No
-1 Unknown
705 ct_thorax_covid19
Show the field ONLY if:[ct_protocol(1)] = '1'
CT suspected for COVID-19 radio
1 Yes
0 No
-1 Unknown
706 ct_thorax_location
Show the field ONLY if:[ct_thorax_lunglesion] = '1'
Lung lesion(s): Location radio
1 Unilateral
2 Bilateral
-1 Unknown
707 ct_thorax_distribution
Show the field ONLY if:[ct_thorax_lunglesion] = '1'
Lung lesion(s): Distribution radio
1 Central
2 Peripheral
3 Both
-1 Unknown
708 ct_thorax_nrlesion
Show the field ONLY if:[ct_thorax_lunglesion] = '1'
Lesions involved radio
1 Single lesion
2 Multiple lesions
3 Diffuse
709 ct_thorax_lesion_feature
Show the field ONLY if:[ct_thorax_lunglesion] = '1'
Main features radio
1 Ground glass opacity
2 Consolidation
3 Linear opacity
4 Mixed type
-1 Unknown
710 ct_thorax_otherfeatures
Show the field ONLY if:[ct_protocol(1)] = '1'
Other features described in report checkbox
1 ct_thorax_otherfeatures___1 Interstitialchanges
2 ct_thorax_otherfeatures___2 (broncho)vascularthickening
3 ct_thorax_otherfeatures___3 nodules
4 ct_thorax_otherfeatures___4 pleural effusion
5 ct_thorax_otherfeatures___5 pleural thickening
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6 ct_thorax_otherfeatures___6 fibrosis
7 ct_thorax_otherfeatures___7 calcifications
8 ct_thorax_otherfeatures___8 lymphadenopathy
99 ct_thorax_otherfeatures___99 other
711 ct_thorax_features_spec
Show the field ONLY if:[ct_thorax_otherfeatures(99)] = '1'
Describe other features text
712 ct_thorax_heart
Show the field ONLY if:[ct_protocol(1)] = '1'
Cardiac abnormalities described? radio
1 Yes
2 No
-1 Unknown
713 ct_thorax_heart_abn
Show the field ONLY if:[ct_thorax_heart] = '1'
Cardiac abnormalities radio
1 Pericardial effusion
2 Thickening pericardium
99 Other
714 ct_thorax_heart_abn_spec
Show the field ONLY if:[ct_thorax_heart_abn] = '99'
Specify cardiac abnormalities text
715 ct_coro_date
Show the field ONLY if:[ct_protocol(2)] = '1'
Section Header: Coronary CT
Date of coronary CTdd-mm-yyyy
text (date_dmy)
716 ct_coro_contrast
Show the field ONLY if:[ct_protocol(2)] = '1'
Contrast used? radio
1 Yes
2 No
717 ct_coro_report
Show the field ONLY if:[ct_protocol(2)] = '1'
Coronary CT: Copy of original report notes
718 ct_coro_agatston
Show the field ONLY if:[ct_protocol(2)] = '1'
Calcium score (Agatston)1-10 is minimal; 11-100 is mild; 101-400 is moderate; >400 is severe
text (number)
719 ct_coro_cad
Show the field ONLY if:[ct_protocol(2)] = '1'
Coronary artery disease radio
0 None
1 Non-significant coronary artery lesions
2 Significant coronary artery lesions
-1 Unknown
720 petct_date
Show the field ONLY if:[ct_protocol(3)] = '1'
Section Header: PET-CT
Date of PET-CTdd-mm-yyyy
text (date_dmy)
721 petct_report
Show the field ONLY if:[ct_protocol(3)] = '1'
PET-CT: Copy of original report notes
722 petct_suppression
Show the field ONLY if:[ct_protocol(3)] = '1'
Adequate glucose metabolism suppression radio
1 Yes
0 No
-1 Unknown
723 petct_heart
Show the field ONLY if:[ct_protocol(3)] = '1'
PET-CT: Pathophysiological uptake in the heart radio
1 Yes
0 No
-1 Unknown
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724 petct_heart_abn
Show the field ONLY if:[petct_heart] = '1'
Pathophysiological uptake in the heart: Suspected for radio
1 Sarcoid
2 Myocarditis
99 Other
725 petct_heart_abn_spec
Show the field ONLY if:[petct_heart_abn] = '99'
Specify pathophysiological uptake in the heart (suspected for): text
726 petct_lungs
Show the field ONLY if:[ct_protocol(3)] = '1'
PET-CT: Pathophysiological uptake in the lungs radio
1 Yes
0 No
-1 Unknown
727 petct_lungs_abn
Show the field ONLY if:[petct_lungs] = '1'
Pathophysiological uptake in the lungs: Suspected for radio
1 Sarcoid
2 Pneumonia
99 Other
728 petct_lungs_abn_spec
Show the field ONLY if:[petct_lungs_abn] = '99'
Specify pathophysiological uptake in the lungs (suspected for): text
729 petct_uptake
Show the field ONLY if:[ct_protocol(3)] = '1'
Pathophysiological uptake in other regions radio
0 No
1 Yes
-1 Unknown
730 petct_uptake_oth
Show the field ONLY if:[petct_uptake] = '1'
Pathophysiological uptake in other regions checkbox
1 petct_uptake_oth___1 Head-neck
2 petct_uptake_oth___2 Abdomen
3 petct_uptake_oth___3 Skeleton
99 petct_uptake_oth___99 Other
731 petct_uptake_oth_spec
Show the field ONLY if:[petct_uptake_oth(99)] = '1'
Specify region of pathophysiological uptake text
732 ct_pulm_date
Show the field ONLY if:[ct_protocol(4)] = '1'
Section Header: CT pulmonary angiography
Date of CT pulmonary angiographydd-mm-yyyy
text (date_dmy)
733 ct_pulm_report
Show the field ONLY if:[ct_protocol(4)] = '1'
CT pulmonary angiography: Copy of original report notes
734 ct_pulm_pe
Show the field ONLY if:[ct_protocol(4)] = '1'
Pulmonary embolism(s)? radio
1 Yes
0 No
-1 Unknown
735 ct_pulm_pe_loc
Show the field ONLY if:[ct_pulm_pe] = '1'
Location of pulmonary embolism(s) radio
1 Central
2 Peripheral
-1 Unknown
736 capacity_ct_thoraxcoronariespetlung_angiography_op_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Invasive Cardiac Procedures (OPTIONAL) (capacity_invasive_cardiac_procedures_optional)
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737 invasive_cag Section Header: Coronary angiography
Coronary angiography
radio
1 Yes
0 No
Custom alignment: RH
738 invasive_cag_date
Show the field ONLY if:[invasive_cag] = '1'
Date of coronary angiographydd-mm-yyyy
text (date_dmy)Custom alignment: RH
739 invasive_cag_abn
Show the field ONLY if:[invasive_cag] = '1'
Coronary angiography: abnormalitiesSignificant CAD is defined by invasive coronary angiography as >50% stenosisof the left main stem, >70% stenosis in a major coronary vessel, or 30% to 70%stenosis with fractional flow reserve ≤0.8.
checkbox
0 invasive_cag_abn___0 No abnormalities
4 invasive_cag_abn___4 Non-significant coronaryartery disease
1 invasive_cag_abn___1 Significant coronaryartery disease
2 invasive_cag_abn___2 Thrombus
3 invasive_cag_abn___3 Dissection of coronaryartery
740 invasive_cag_segments
Show the field ONLY if:[invasive_cag_abn(1)] = '1' or [invasive_cag_abn(2)] = '1' or [invasive_cag_abn(3)] = '1'
Affected coronary artery segments (please see figure below forcorresponding numbers)
checkbox
1 invasive_cag_segments___1 1
2 invasive_cag_segments___2 2
3 invasive_cag_segments___3 3
4 invasive_cag_segments___4 4
5 invasive_cag_segments___5 5
6 invasive_cag_segments___6 6
7 invasive_cag_segments___7 7
8 invasive_cag_segments___8 8
9 invasive_cag_segments___9 9
10 invasive_cag_segments___10 10
11 invasive_cag_segments___11 11
12 invasive_cag_segments___12 12
13 invasive_cag_segments___13 13
14 invasive_cag_segments___14 14
15 invasive_cag_segments___15 15
741 invasive_cag_segmfigure
Show the field ONLY if:[invasive_cag_abn(1)] = '1' or [invasive_cag_abn(2)] = '1' or [invasive_cag_abn(3)] = '1'
Coronary artery segments descriptive
742 cag_intervention
Show the field ONLY if:[invasive_cag_abn(1)] = '1' or [invasive_cag_abn(2)] = '1' or [invasive_cag_abn(3)] = '1'
What treatment was initiated? checkbox
1 cag_intervention___1 Conservative
2 cag_intervention___2 PCI
3 cag_intervention___3 CABG
Custom alignment: RH
743 cag_int_pci
Show the field ONLY if:[cag_intervention(2)] = '1'
If PCI was performed, specify which artery or arteries checkbox
1 cag_int_pci___1 LAD
2 cag_int_pci___2 RCA
3 cag_int_pci___3 LCX
4 cag_int_pci___4 LM
744 invasive_biopsy Section Header: Myocardial biopsy
Myocardial biopsy
radio
1 Yes
0 No
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Custom alignment: RH
745 invasive_biopsy_date
Show the field ONLY if:[invasive_biopsy] = '1'
Date of myocardial biopsydd-mm-yyyy
text (date_dmy)
746 invasive_biopsy_abn
Show the field ONLY if:[invasive_biopsy] = '1'
Myocardial biopsy: Abnormalities radio
1 Yes
0 No
747 invasive_biopsy_abn_spec
Show the field ONLY if:[invasive_biopsy_abn] = '1'
Myocardial biopsy: Specifiy abnormalities notes
748 invasive_hemodynamic Section Header: Invasive hemodynamic measurements
Invasive hemodynamic measurements
radio
1 Yes
0 No
749 date_inv_hemo
Show the field ONLY if:[invasive_hemodynamic] = '1'
Date of invasive hemodynamic measurementsdd-mm-yyyy
text (date_dmy)
750 invasive_hd_outcome
Show the field ONLY if:[invasive_hemodynamic] = '1'
Invasive hemodynamic measurements: Outcome notes
751 capacity_invasive_cardiac_procedures_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac COVID-19 complications (REQUIRED) (capacity_cardiac_covid19_complications_required)
752 carcomp Cardiac complications after diagnosis of COVID-19 checkbox
0 carcomp___0 None
1 carcomp___1 Myocarditis
2 carcomp___2 Pericarditis
3 carcomp___3 Endocarditis
4 carcomp___4 Heart failure
5 carcomp___5 Cardiac ischemia
6 carcomp___6 Arrhythmia
7 carcomp___7 Pulmonary embolism
99 carcomp___99 Other
753 carcomp_myocarditis_def
Show the field ONLY if:[carcomp(1)] = '1'
Definition of myocarditis The gold standard for myocarditis isan endomyocardial biopsy. Clinically suspected myocarditis isdiagnosed if patient has an abnormal cardiac magneticresonance scan consistent with a diagnosis of myocarditis AND≥1 of the symptoms presented under clinical presentation AND≥1 diagnostic criteria listed below, in the absence ofangiographically detectable coronary artery disease (coronaryluminal narrowing ≥ 50%) and known pre-existingcardiovascular disease or extra-cardiac causes that couldexplain the syndrome (e.g. valve disease, congenital heartdisease, hyperthyroidism, etc.)Reference: Caforio et al (2013)doi: 10.1093/eurheartj/eht210yyyy-mm-dd;
descriptive
754 carcomp_myocarditis_date_sympt
Show the field ONLY if:[carcomp(1)] = '1'
Myocarditis: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
755 carcomp_myocarditis_date
Show the field ONLY if:
Myocarditis: date of diagnosisdd-mm-yyyy
text (date_dmy)
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[carcomp(1)] = '1'
756 carcomp_pericarditis_def
Show the field ONLY if:[carcomp(2)] = '1'
Definition of pericarditisReference: Adler et al (2015) doi:10.1093/eurheartj/ehv318yyyy-mm-dd;
descriptive
757 carcomp_pericarditis_date_symp
Show the field ONLY if:[carcomp(2)] = '1'
Pericarditis: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
758 carcomp_pericarditis_date
Show the field ONLY if:[carcomp(2)] = '1'
Pericarditis: date of diagnosisdd-mm-yyyy
text (date_dmy)
759 carcomp_endocarditis_def
Show the field ONLY if:[carcomp(3)] = '1'
Endocarditis Infective endocarditis is defined according to themodified Dukes criteria (See attachment). Reference: Habib etal (2015) doi: 10.1093/eurheartj/ehv319yyyy-mm-dd;
descriptive
760 carcomp_endocarditis_date_symp
Show the field ONLY if:[carcomp(3)] = '1'
Endocarditis: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
761 carcomp_endocarditis_date
Show the field ONLY if:[carcomp(3)] = '1'
Endocarditis: date of diagnosisdd-mm-yyyy
text (date_dmy)
762 carcomp_hf
Show the field ONLY if:[carcomp(4)] = '1'
Heart failure checkbox
1 carcomp_hf___1 Left-sided
2 carcomp_hf___2 Right-sided
763 carcomp_hf_date_symp
Show the field ONLY if:[carcomp(4)] = '1'
Heart failure: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
764 carcomp_hf_date
Show the field ONLY if:[carcomp(4)] = '1'
Heart failure: date of diagnosisdd-mm-yyyy
text (date_dmy)
765 carcomp_hf_provocation
Show the field ONLY if:[carcomp(4)] = '1'
Heart failure: provoked by? notes
766 carcomp_ischemia_def
Show the field ONLY if:[carcomp(5)] = '1'
Definitions of cardiac ischemia Acute coronary syndrome (typeI ischaemia): charachterized by artherosclerotic plaque rupture,ulceration, fissure, erosion or dissection with resultingintraluminal thrombus in one or more coronary arteriesleading to a decreased myocardial blood flow and/or distalembolization and subsequent myocardial necrosis. Type IIischaemia: defined as myocardial necrosis in which a conditionother than coronary plaque instability results in an imbalancebetween myocardial oxygen supply and demand.
descriptive
767 carcomp_ischemia
Show the field ONLY if:[carcomp(5)] = '1'
Cardiac ischemia radio
1 Acute coronary syndrome
2 Type II ischemia
768 carcomp_ischemia_date_symp
Show the field ONLY if:[carcomp(5)] = '1'
Cardiac ischemia: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
769 carcomp_ischemia_date
Show the field ONLY if:[carcomp(5)] = '1'
Cardiac ischemia: date of diagnosisdd-mm-yyyy
text (date_dmy)
770 carcomp_arrhythmia
Show the field ONLY if:[carcomp(6)] = '1'
Arrhythmia / Conduction disorder checkbox
1 carcomp_arrhythmia___1 Supraventriculartachycardia
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2 carcomp_arrhythmia___2 Ventriculararrhythmias
3 carcomp_arrhythmia___3 Sinus nodedysfunction
4 carcomp_arrhythmia___4 Conductiondisorders
99 carcomp_arrhythmia___99 Other
771 carcomp_arrhythmia_date_symp
Show the field ONLY if:[carcomp(6)] = '1'
Arrhythmia: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
772 carcomp_arrhythmia_date
Show the field ONLY if:[carcomp(6)] = '1'
Arrhythmia: date of diagnosisdd-mm-yyyy
text (date_dmy)
773 carcomp_arrhythmia_svt
Show the field ONLY if:[carcomp_arrhythmia(1)] = '1'
Supraventricular tachycardia checkbox
1 carcomp_arrhythmia_svt___1 Paroxysmalatrial fibrillation
2 carcomp_arrhythmia_svt___2 Persistent atrialfibrillation
3 carcomp_arrhythmia_svt___3 Permanentatrial fibrillation
4 carcomp_arrhythmia_svt___4 Atrial flutter
5 carcomp_arrhythmia_svt___5 Atrialtachycardia
6 carcomp_arrhythmia_svt___6 AV (nodal)reentrytachycardia
7 carcomp_arrhythmia_svt___7 Other
-1 carcomp_arrhythmia_svt____1 Not otherwisespecified
774 carcomp_arrhyth_svt_other
Show the field ONLY if:[carcomp_arrhythmia_svt(7)] = '1'
Define other supraventricular tachycardia text
775 carcomp_arrhyth_svt_def
Show the field ONLY if:[carcomp_arrhythmia(1)] = '1'
Definitions of supraventricular tachycardias Atrial fibrillation: Acardiac arrhythmia arising from the atrium with an atrial rate>300 bpm and an irregularly irregular ventricular response inthe presence of conduction. * Paroxysmal: Self-terminating, inmost cases within 48 hours. Some AF paroxysms may continuefor up to 7 days. AF episodes that are cardioverted within 7days should be considered paroxysmal.* Persistent: AF thatlasts longer than 7 days, including episodes that areterminated by cardioversion, either with drugs or by directcurrent cardioversion, after 7 days or more.* Permanent: AFthat is accepted by the patient (and physician). Hence, rhythmcontrol interventions are, by definitions, not pursued inpatients with permanent AF. Atrial flutter: a reentranttachycardia following a counterclockwise (typical) or clockwise(reverse typical) rotation pattern around the tricuspid annulusresulting in a sawtooth pattern of atrial activation on inferiorECG leads. Atrial tachycardia: A usually regular cardiacarrhythmia arising from the atrium with a rate >100 bpm (cyclelength < 600 ms). AV nodal reentry tachycardia: A regular SVTwhich results from reentry within the AV node and/orperinodal atrial tissue AV reentry tachycardia: A reentrantarrhythmia whose circuit involves the atrium, the AV node, theventricles, and one or more accessory AV connections
descriptive
776 carcomp_arrhythmia_vt
Show the field ONLY if:[carcomp_arrhythmia(2)] = '1'
Ventricular arrhythmia checkbox
1 carcomp_arrhythmia_vt___1 Non-sustainedventriculartachycardia
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2 carcomp_arrhythmia_vt___2 Sustainedventriculartachycardia
3 carcomp_arrhythmia_vt___3 Ventricularfibrillation
777 carcomp_arrhythmia_vt_def
Show the field ONLY if:[carcomp_arrhythmia(2)] = '1'
Definitions of ventricular arrhythmias Non-sustainedventricular tachycardia: =>3 consecutive premature ventricularcomplexes with a rate >100/min, lasting < 30 seconds.Sustained ventricular tachycardia: Ventricular tachycardiawhich lasts 30 second or more, or les than 30 seconds whenterminated electrically or pharmacologically Ventricularfibrillation: Rapid, usually more than 300bpm (cycle length:180ms or less), grossly irregular ventricular rhythm withmarked variability in QRS cycle lenght, morphology, andamplitude.
descriptive
778 carcomp_conduct
Show the field ONLY if:[carcomp_arrhythmia(4)] = '1'
Conduction disorder checkbox
1 carcomp_conduct___1 First degree AV block
2 carcomp_conduct___2 Second degree AVblock
3 carcomp_conduct___3 Third degree AV block
4 carcomp_conduct___4 Left bundle branchblock
5 carcomp_conduct___5 Right bundle branchblock
6 carcomp_conduct___6 Nonspecificintraventricularconduction delay
7 carcomp_conduct___7 Pre-excitation
8 carcomp_conduct___8 Long QT syndrome
-1 carcomp_conduct____1 Not otherwisespecified
779 carhist_arrhyth_cond_def_2
Show the field ONLY if:[carcomp_arrhythmia(4)] = '1'
Definitions of conduction disorders First degree AV block: PRinterval >200ms Second degree AV block: i) Mobitz I:progressive PR prolongation and shortening of RR interval untilP-wave is blocked. Pause after blocked P-wave is less thantwice the PP interval. PR following block is shorter than PRimmediately preceding block. ii) Mobitz II: Regualr sinus/atrialrhythm with intermittent non-conducted P-waves. Constand PRinterval in the conducted beat. Third degree AV block:Characterized by independent atrial and ventricular complexeswith atrial rate usually exceeding ventricular rate. Left bundlebranch block: QRS duration of 120ms or longer with: Delayedonset of intrinsicoid deflection in 1, V5 and V6 >60 ms. Broadand notched or slurred R waves in I, aVL, V5, and V6. rS or QScomplexes in right precordial leads. ST-segment and T-waves inopposite polarity to the major QRS deflection. Right bundlebranch block: QRS duration of 120ms or longer and: rsR' or rSR'complexes in V1 and V2. Delayed onset of intrinsicoiddeflection in V1 and V2 >50 ms. Broad, slurred S-wave in 1, V5and V6. Secondary ST-T-wave changes. Nonspecificintraventricular conduction delay: QRS duration of 110ms ormore with morphology different from LBBB or RBBB. Pre-exitation: An ECG pattern characterized by a short PR interval, awidened QRS complex, and a delta wave. A pre-exitationpattern on the ECG is evidence of the presence of ananomalous AV connection, which results in ventricularactivation prior to what would have occurred through thenormal His-Purkinje system. The PR interval is typically >120ms. Long QT syndrome: QTc =>480ms in repeated 12-leadECGs in the absence of secondary causes for QT prolongation.
descriptive
780 carcomp_arrhythmia_other
Show the field ONLY if:[carcomp_arrhythmia(99)] = '
Specify arrhythmia text
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1'
781 pulm_emb_date
Show the field ONLY if:[carcomp(7)] = '1'
Pulmonary embolism: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
782 pulm_emb_date_diag
Show the field ONLY if:[carcomp(7)] = '1'
Pulmonary embolism: date of diagnosisdd-mm-yyyy
text (date_dmy)
783 carcomp_other
Show the field ONLY if:[carcomp(99)] = '1'
Other cardiac complications notes
784 carcomp_other_date_symp
Show the field ONLY if:[carcomp(99)] = '1'
Other cardiac complications: date of onset of symptomsdd-mm-yyyy
text (date_dmy)
785 carcomp_other_date
Show the field ONLY if:[carcomp(99)] = '1'
Other cardiac complications: date of diagnosisdd-mm-yyyy
text (date_dmy)
786 capacity_cardiac_covid19_complications_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac outcome: 7 day follow-up (REQUIRED) (capacity_cardiac_outcome_7_day_followup_required)
787 fu7d_admission Is patient still hospitalized?Count from first day of first COVID-related admission in any hospital
radio
1 Yes
0 No
Custom alignment: LV
788 fu7d_cvcompl_cons
Show the field ONLY if:[fu7d_admission] = '1'
Was cardiology consulted within the first 7 days of admission(count days from the first presentation at the first hospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
789 fu7d_cvcompl
Show the field ONLY if:[fu7d_cvcompl_cons] = '1'
Did cardiovascular complications occur within the first 7 daysof admission (count days from the first presentation at the firsthospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
790 fu7d_cvcomp_note
Show the field ONLY if:[fu7d_cvcompl] = '1'
Please register the cardiovascular complications in the datacollection instrument 'CAPACITY - Cardiovascular COVID-19complications'
descriptive
791 fu7d_cvcompl_death
Show the field ONLY if:[fu7d_cvcompl] = '1'
Did cardiovascular complications cause cardiac death withinthe first 7 days of admission (count days from the firstpresentation at the first hospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
792 fu7d_cvcompl_hospadm
Show the field ONLY if:[fu7d_cvcompl] = '1' and [fu7d_cvcompl_death] <> '1'
Are the cardiovascular complications the reason / one of thereasons the patient is still hospitalized?
radio
1 Yes
2 No
-1 Unknown
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! Collapse
Custom alignment: RH
793 capacity_cardiac_outcome_7_day_followup_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Cardiac outcome: 30 day follow-up (REQUIRED) (capacity_cardiac_outcome_30_day_followup_required)
794 fu30d_admission Is patient still hospitalized?Count from first day of first COVID-related admission in any hospital
radio
1 Yes
0 No
Custom alignment: LV
795 fu30d_cvcompl_cons
Show the field ONLY if:[fu30d_admission] = '1'
Was cardiology consulted within the first 30 days of admission(count days from the first presentation at the first hospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
796 fu30d_cvcompl
Show the field ONLY if:[fu30d_cvcompl_cons] = '1'
Did cardiovascular complications occur within the first 30 daysof admission (count days from the first presentation at the firsthospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
797 fu30d_cvcomp_note
Show the field ONLY if:[fu30d_cvcompl] = '1'
Please register the cardiovascular complications in the datacollection instrument 'CAPACITY - Cardiovascular COVID-19complications'
descriptive
798 fu30d_cvcompl_death
Show the field ONLY if:[fu30d_cvcompl] = '1'
Did cardiovascular complications cause cardiac death withinthe first 30 days of admission (count days from the firstpresentation at the first hospital)?
radio
1 Yes
0 No
-1 Unknown
Custom alignment: LV
799 fu30d_cvcompl_hospadm
Show the field ONLY if:[fu30d_cvcompl] = '1' and [fu30d_cvcompl_death] <> '1'
Are the cardiovascular complications the reason / one of thereasons the patient is still hospitalized?
radio
1 Yes
2 No
-1 Unknown
Custom alignment: RH
800 capacity_cardiac_outcome_30_day_followup_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: CAPACITY - Discharge (REQUIRED) (capacity_discharge_required)
801 capdis_outcome Outcome dropdown, Required
1 Discharged alive
3 Transfer to other facility
4 Death
5 Palliative discharge
6 Unknown
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802 capdis_date Is the outcome date known radio, Required
1 Yes
2 No
803 capdis_outcomedate
Show the field ONLY if:[capdis_date] = '1'
Outcome datedd-mm-yyyy; if discharge: in case of readmissions, use date of last discharge
text (date_dmy), Required
804 capdis_death
Show the field ONLY if:[capdis_outcome] = '4'
Cause of death dropdown
1 Cardiac
2 Other
99 Unknown
805 capdis_death_obduct
Show the field ONLY if:[capdis_outcome] = '4'
Is or will autopsy be performed? radio
1 Yes
0 No
806 capdis_obduction_outcome
Show the field ONLY if:[capdis_death_obduct] = '1'
Outcomes of autopsy notes
807 capdis_transsitename
Show the field ONLY if:[capdis_outcome] = '3'
If Transferred: Facility name dropdown, Required
31 Admiraal de Ruyter Ziekenhuis
22 Albert Schweitzer Ziekenhuis
32 Alrijne ziekenhuis
11 Amphia Ziekenhuis
3 Amsterdam UMC, locatie AMC
4 Amsterdam UMC, locatie VU
33 Antonius Ziekenhuis, Sneek
34 Bernhoven Ziekenhuis
35 BovenIJ Ziekenhuis
36 Bravis Ziekenhuis
20 Canisius-Wilhelmina Ziekenhuis
250 Cardiologie Centra Nederland
12 Catharina Ziekenhuis
37 De Tjongerschans Ziekenhuis
38 Deventer Ziekenhuis
39 Diakonessenhuis Utrecht
40a Dijklander Ziekenhuis, locatie Hoorn
40b Dijklander Ziekenhuis, locatie Purmerend
27 Elisabeth-TweeSteden Ziekenhuis
41 Elkerliek Ziekenhuis
9 Erasmus MC
42 Flevoziekenhuis
43 Franciscus Gasthuis en Vlietland
44 Gelderse Vallei Ziekenhuis
45 Gelre Ziekenhuizen, locatie Apeldoorn
46 Gelre Ziekenhuizen, locatie Zutphen
47 Groene Hart Ziekenhuis
25 Haaglanden Medisch Centrum
17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft
48 IJsselland Ziekenhuis
49 Ikazia Ziekenhuis
2a Isala Ziekenhuis (Meppel)
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2b Isala Ziekenhuis (Zwolle)
21 Jeroen Bosch Ziekenhuis
50 Langeland Ziekenhuis
51 Laurentius Ziekenhuis
6 Leids Universitair Medisch Centrum
15 Maasstad Ziekenhuis
13 Maastricht UMC+
52 Maasziekenhuis Pantein
53 Martini Ziekenhuis
54 Máxima Medisch Centrum
74 MC Slotervaart
73 MC Zuiderzee
24 Meander Medisch Centrum
16 Medisch Centrum Leeuwarden
18 Medisch Spectrum Twente
55 Nij Smellinghe
14 Noordwest Ziekenhuisgroep
56 Ommelander Ziekenhuis Groningen
5 Onze Lieve Vrouwe Gasthuis
10 Radboudumc
57 Reinier de Graaf Gasthuis
19 Rijnstate Ziekenhuis
58 Rivas Zorggroep
59 Rivierenland Ziekenhuis
60 Rode Kruis Ziekenhuis
61 Ropcke Zweers Ziekenhuis
62 Slingeland Ziekenhuis
63a Spaarne Gasthuis, locatie Haarlem
63b Spaarne Gasthuis, locatie Hoofddorp
900 Spijkenisse MC
64 St. Anna Ziekenhuis
8 St. Antonius Ziekenhuis Nieuwegein
65 St. Jans Gasthuis
66 St. Jansdal Ziekenhuis
67 Streekziekenhuis Koningin Beatrix
30 Tergooi
23 Treant Zorggroep
1 UMC Groningen
7 UMC Utrecht
201 UZ Antwerpen
68 Van Weel-Bethesda Ziekenhuis
28 VieCuri Medisch Centrum
69 Wilhelmina Ziekenhuis, Assen
70 Zaans Medisch Centrum
71 Ziekenhuis Amstelland
72 Zorg Groep Twente
26 ZorgSaam Zorggroep Zeeuws-Vlaanderen
29 Zuyderland MC
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-1 Other
808 capdis_transsitestudy
Show the field ONLY if:[capdis_outcome] = '3'
If Transferred: Is the transfer facility a study site? dropdown
1 Yes
2 No
3 N/A
809 capdis_transsitepatientnr
Show the field ONLY if:[capdis_transsitestudy] = '1'
If a Study Site: Participant number at new facility dropdown
1 Same as the above
2 Different
810 transfer_subjid_v2
Show the field ONLY if:[capdis_transsitestudy] = '2'
If Different, Participant number at the new facility text, Required
811 capdis_selfcare
Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3' or [capdis_outcome] = '5'
Ability to self-care at discharge versus before illness dropdown, Required
1 Same as before illness
2 Worse
3 Better
4 N/A
812 capdis_department At any time during hospitalization, was patient admitted to oneof the following departments?
checkbox
1 capdis_department___1 Intensive care ormedium care (ICU,MCU)
2 capdis_department___2 Cardiac care unit (CCU)
3 capdis_department___3 General ward
813 capdis_department_icu
Show the field ONLY if:[capdis_department(1)] = '1'
Duration of ICU or MCU admission (days)days
text (number)
814 capdis_department_ccu
Show the field ONLY if:[capdis_department(2)] = '1'
Duration of CCU admission (days)days
text (number)
815 capdis_chloroquine At any time during hospitalization, was patient treated with(hydro)chloroquine
radio
0 No
1 Yes
-1 Unknown
816 capdis_chloroquine_inid
Show the field ONLY if:[capdis_chloroquine] = '1'
Date inititiation (hydro)chloroquine treatment text (date_dmy)
817 capdis_chloroquine_end
Show the field ONLY if:[capdis_chloroquine] = '1'
Was (hydro)chloroquine treatment ended/terminated duringadmission?
radio
0 No
1 Yes
-1 Unknown
818 capdis_chloroquine_endd
Show the field ONLY if:[capdis_chloroquine_end] = '1'
Date end/termination (hydro)chloroquine treatment text (date_dmy)
819 capdis_treat_mechvent
Show the field ONLY if:[capdis_department(1)] = '1'
Section Header: At any time during hospitalization, did the patient receive /undergo
Invasive ventilation
radio (Matrix)
1 Yes
2 No
NA Unknown
820 capdis_treat_niv
Show the field ONLY if:
Non-invasive ventilation radio (Matrix)
1 Yes
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[capdis_department(1)] = '1' or [capdis_department(2)] = '1'
2 No
NA Unknown
821 capdis_treat_ecmo
Show the field ONLY if:[capdis_department(1)] = '1'
Extracorporeal membrane oxygenation (ECMO) radio (Matrix)
1 Yes
2 No
NA Unknown
822 capdis_treat_iabp
Show the field ONLY if:[capdis_department(1)] = '1'
Intra-aortic balloon pump (IABP) / Impella radio (Matrix)
1 Yes
2 No
NA Unknown
823 capdis_treat_inotrop
Show the field ONLY if:[capdis_department(1)] = '1' or [capdis_department(2)] = '1'
Vasopressor or inotropic support radio (Matrix)
1 Yes
2 No
NA Unknown
824 capdis_treat_pde5
Show the field ONLY if:[capdis_department(1)] = '1' or [capdis_department(2)] = '1'
Phosphodiesterase inhibitor (e.g. milrinon, enoximon) radio (Matrix)
1 Yes
2 No
NA Unknown
825 capdis_post_oxygen
Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3'
Section Header: Post discharge treatment:
Oxygen therapy
radio (Matrix), Required
1 YES
2 NO
3 N/A
826 capdis_post_dialysis
Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3'
Dialysis / renal treatment? radio (Matrix), Required
1 YES
2 NO
3 N/A
827 capdis_post_other
Show the field ONLY if:[capdis_outcome] = '1' or [capdis_outcome] = '3'
Other intervention or procedure? radio (Matrix), Required
1 YES
2 NO
3 N/A
828 other_cmtrt_v2
Show the field ONLY if:[capdis_post_other]='1'
If YES: Specify (multiple permitted) text, Required
829 capdis_ai_echo Section Header: Have the following cardiac investigations been performedduring hospital admission?
Echocardiography (excluding handheld ultrasound)
radio (Matrix), Required
1 Yes
2 No
830 capdis_ai_cmr Cardiac MRI radio (Matrix), Required
1 Yes
2 No
831 capdis_ai_cag Coronary angiography radio (Matrix), Required
1 Yes
2 No
832 capdis_ai_biopsy Cardiac biopsy radio (Matrix), Required
1 Yes
2 No
833 capdis_ai_coronaryct Coronary CT radio (Matrix), Required
1 Yes
2 No
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834 capdis_ai_ctthorax CT Thorax radio (Matrix), Required
1 Yes
2 No
835 capdis_ai_petct PET-CT radio (Matrix), Required
1 Yes
2 No
836 capdis_ai_spect SPECT radio (Matrix), Required
1 Yes
2 No
837 capdis_ai_trop Troponin radio (Matrix), Required
1 Yes
2 No
838 capdis_ai_bnp (NT-pro)BNP radio (Matrix), Required
1 Yes
2 No
839 capdis_ai_ckmb CK-MB radio (Matrix), Required
1 Yes
2 No
840 capdis_compl_ards Section Header: Did the following complication(s) occur during admission?
Acute respiratory distress syndrome (ARDS)
radio (Matrix)
1 Yes
0 No
841 capdis_compl_aki Acute Kidney Injury (AKI) radio (Matrix)
1 Yes
0 No
842 capdis_compl_shock Shock radio (Matrix)
1 Yes
0 No
843 capdis_covid_test Section Header: COVID-19 infection status
Was SARS-CoV-2 infection proven preceding/during admission?
radio, Required
1 Yes
0 No
844 capdis_covid_swap
Show the field ONLY if:[capdis_covid_test] = '1'
Positive swab radio
1 Yes
0 No
Custom alignment: RH
845 capdis_covid_swap_date
Show the field ONLY if:[capdis_covid_test] = '1'
Swab datedd-mm-yyyy
text (date_dmy)
846 capdis_covid_ct
Show the field ONLY if:[capdis_covid_test] = '1'
Positive CT Thorax radio
1 Yes
0 No
Custom alignment: RH
847 capdis_covid_ct_date
Show the field ONLY if:[capdis_covid_ct] = '1'
Date positive CT Thoraxdd-mm-yyyy
text (date_dmy)Custom alignment: RH
848 capacity_discharge_required_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
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2 Complete
Instrument: ISARIC - Treatment (OPTIONAL) (isaric_treatment_optional)
849 icu_hoterm 6.1 ICU or High Dependency admission dropdown, Required
1 Yes
2 No
3 N/A
850 icu_hostdat
Show the field ONLY if:[icu_hoterm] = '1'
Date of ICU admissiondd-mm-yyyy
text (date_dmy), Required
851 hoendat
Show the field ONLY if:[icu_hoterm] = '1'
Date of ICU discharge:dd-mm-yyyy
text (date_dmy), Required
852 hodur
Show the field ONLY if:[icu_hoterm] = '1'
If YES, total duration (days) text (integer), Required
853 oxygen_cmoccur Section Header: At ANY time during hospitalisation, did the patientreceive/undergo
6.2. Oxygen therapy
radio (Matrix), Required
1 YES
2 NO
3 N/A
854 noninvasive_proccur 6.3. Non-invasive ventilation ? (e.g. BIPAP, CPAP) radio (Matrix), Required
1 YES
2 NO
3 N/A
855 invasive_proccur 6.4. Invasive ventilation (any) ? radio (Matrix), Required
1 YES
2 NO
3 N/A
856 pronevent_prtrt 6.4.1. Prone ventilation radio (Matrix), Required
1 YES
2 NO
3 N/A
857 inhalednit_cmtrt 6.4.2. Inhaled Nitric Oxide radio (Matrix), Required
1 YES
2 NO
3 N/A
858 tracheo_prtrt 6.4.3. Tracheostomy inserted radio (Matrix), Required
1 YES
2 NO
3 N/A
859 extracorp_prtrt 6.5. Extracorporeal support radio (Matrix), Required
1 YES
2 NO
3 N/A
860 rrt_prtrt 6.6. Renal replacement therapy (RRT) or dialysis radio (Matrix), Required
1 YES
2 NO
3 N/A
861 inotrop_cmtrt 6.7. Inotropes / vasopressors radio (Matrix), Required
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1 YES
2 NO
3 N/A
862 oxygen_prdur
Show the field ONLY if:[oxygen_cmoccur] = '1'
6.2a If yes oxygen therapy, total durationdays
text
863 noninvasive_prdur
Show the field ONLY if:[noninvasive_proccur] = '1'
6.3a If yes non-invasive ventilation, confirm durationdays
text
864 invasive_prdur
Show the field ONLY if:[invasive_proccur] = '1'
6.4a If yes invasive ventilation, confirm durationdays
text
865 extracorp_prdur
Show the field ONLY if:[extracorp_prtrt] = '1'
6.4a If yes extracorporeal support, confirm durationdays
text
866 inotrope_cmstdat
Show the field ONLY if:[inotrop_cmtrt] = '1'
If YES inotropes/vasopressors; First/Start Datedd-mm-yyyy
text (date_dmy), Required
867 inotrope_cmendat
Show the field ONLY if:[inotrop_cmtrt] = '1'
If YES inotropes/vasopressors; Last/End datedd-mm-yyyy
text (date_dmy), Required
868 other_cmyn 6.8 OTHER intervention or procedure radio, Required
1 Yes
2 No
3 N/A
869 other_cm
Show the field ONLY if:[other_cmyn] = '1'
IF YES OTHER intervention or procedure; SpecifyWrite 'N/A' for no additional procedure
text, Required
870 antiviral_cmyn Section Header: MEDICATION: While hospitalised or at discharge, were any ofthe following administered?
6.9 Antiviral agent?
radio (Matrix), Required
1 Yes
2 No
3 N/A
871 antibiotic_cmyn 6.10. Antibiotic ? radio (Matrix), Required
1 Yes
2 No
3 N/A
872 corticost_cmyn 6.11. Corticosteroid ? radio (Matrix), Required
1 Yes
2 No
3 N/A
873 antifung_cmyn 6.12. Antifungal agent ? radio (Matrix), Required
1 Yes
2 No
3 N/A
874 antiviral_cmtrt
Show the field ONLY if:[antiviral_cmyn] = '1'
IF YES to antiviral agent dropdown
1 Ribavirin
2 Lopinavir/Ritonvir
3 Interferon alpha
4 Interferon beta
5 Neuraminidase inhibitors
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6 Other
875 antiviral_cmtype
Show the field ONLY if:[antiviral_cmtrt] = '6'
If 'Other' antiviral agent; Specify type text
876 corticost_cmtrt
Show the field ONLY if:[corticost_cmyn] = '1'
If YES to Corticosteroid, specify type text, Required
877 corticost_cmdose
Show the field ONLY if:[corticost_cmyn] = '1'
If YES to Corticosteroid, specify dose text, Required
878 corticost_cmroute
Show the field ONLY if:[corticost_cmyn] = '1'
If YES to Corticosteroid, specify Route dropdown, Required
1 Oral
2 Intravenous
3 Inhaled
879 isaric_treatment_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Core Additional Information (OPTIONAL) (isaric_core_additional_information_optional)
880 core_addinfo Section Header: Detail any additional (relevant) information NOT captured inthe CASE REPORT FORM
Additional Information
notes
881 isaric_core_additional_information_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Outcome (OPTIONAL) (isaric_outcome_optional)
882 dsterm 7.1. Outcome: dropdown, Required
1 Discharged alive
2 Hospitalization
3 Transfer to other facility
4 Death
5 Palliative discharge
6 Unknown
883 dsstdtcyn Is the Outcome date known radio, Required
1 Yes
2 No
3 N/A
884 dsstdtc
Show the field ONLY if:[dsstdtcyn] = '1'
7.2. Outcome datedd-mm-yyyy
text (date_dmy), Required
885 suppds_qval
Show the field ONLY if:[dsterm] = '1'
Section Header: 7.3. IF Discharged alive:
7.3.1. If Discharged alive:Ability to self-care at discharge versus before illness
dropdown, Required
1 Same as before illness
2 Worse
3 Better
4 N/A
886 oxygen_proccur
Show the field ONLY if:
Section Header: Post discharge treatment:
7.3.2. Oxygen therapy
radio (Matrix), Required
1 YES
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[dsterm] = '1' 2 NO
3 N/A
887 renal_proccur
Show the field ONLY if:[dsterm] = '1'
7.3.3. Dialysis / renal treatment? radio (Matrix), Required
1 YES
2 NO
3 N/A
888 other_cmoccur
Show the field ONLY if:[dsterm] = '1'
7.3.4. Other intervention or procedure? radio (Matrix), Required
1 YES
2 NO
3 N/A
889 other_cmtrt
Show the field ONLY if:[other_cmoccur] = '1'
If YES: Specify (multiple permitted) text, Required
890 siteid
Show the field ONLY if:[dsterm] = '3'
Section Header: 7.4. IF Transferred:
7.4.1. If Transferred: Facility name
dropdown, Required
31 Admiraal de Ruyter Ziekenhuis
22 Albert Schweitzer Ziekenhuis
32 Alrijne ziekenhuis
11 Amphia Ziekenhuis
3 Amsterdam UMC, locatie AMC
4 Amsterdam UMC, locatie VU
33 Antonius Ziekenhuis, Sneek
34 Bernhoven Ziekenhuis
35 BovenIJ Ziekenhuis
36 Bravis Ziekenhuis
20 Canisius-Wilhelmina Ziekenhuis
250 Cardiologie Centra Nederland
12 Catharina Ziekenhuis
37 De Tjongerschans Ziekenhuis
38 Deventer Ziekenhuis
39 Diakonessenhuis Utrecht
40a Dijklander Ziekenhuis, locatie Hoorn
40b Dijklander Ziekenhuis, locatie Purmerend
27 Elisabeth-TweeSteden Ziekenhuis
41 Elkerliek Ziekenhuis
9 Erasmus MC
42 Flevoziekenhuis
43 Franciscus Gasthuis en Vlietland
44 Gelderse Vallei Ziekenhuis
45 Gelre Ziekenhuizen, locatie Apeldoorn
46 Gelre Ziekenhuizen, locatie Zutphen
47 Groene Hart Ziekenhuis
25 Haaglanden Medisch Centrum
17 Haga Ziekenhuis/Hartcentrum Den Haag-Delft
48 IJsselland Ziekenhuis
49 Ikazia Ziekenhuis
2a Isala Ziekenhuis (Meppel)
2b Isala Ziekenhuis (Zwolle)
21 Jeroen Bosch Ziekenhuis
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50 Langeland Ziekenhuis
51 Laurentius Ziekenhuis
6 Leids Universitair Medisch Centrum
15 Maasstad Ziekenhuis
13 Maastricht UMC+
52 Maasziekenhuis Pantein
53 Martini Ziekenhuis
54 Máxima Medisch Centrum
74 MC Slotervaart
73 MC Zuiderzee
24 Meander Medisch Centrum
16 Medisch Centrum Leeuwarden
18 Medisch Spectrum Twente
55 Nij Smellinghe
14 Noordwest Ziekenhuisgroep
56 Ommelander Ziekenhuis Groningen
5 Onze Lieve Vrouwe Gasthuis
10 Radboudumc
57 Reinier de Graaf Gasthuis
19 Rijnstate Ziekenhuis
58 Rivas Zorggroep
59 Rivierenland Ziekenhuis
60 Rode Kruis Ziekenhuis
61 Ropcke Zweers Ziekenhuis
62 Slingeland Ziekenhuis
63a Spaarne Gasthuis, locatie Haarlem
63b Spaarne Gasthuis, locatie Hoofddorp
900 Spijkenisse MC
64 St. Anna Ziekenhuis
8 St. Antonius Ziekenhuis Nieuwegein
65 St. Jans Gasthuis
66 St. Jansdal Ziekenhuis
67 Streekziekenhuis Koningin Beatrix
30 Tergooi
23 Treant Zorggroep
1 UMC Groningen
7 UMC Utrecht
201 UZ Antwerpen
68 Van Weel-Bethesda Ziekenhuis
28 VieCuri Medisch Centrum
69 Wilhelmina Ziekenhuis, Assen
70 Zaans Medisch Centrum
71 Ziekenhuis Amstelland
72 Zorg Groep Twente
26 ZorgSaam Zorggroep Zeeuws-Vlaanderen
29 Zuyderland MC
-1 Other
891 siteyn 7.4.2. If Transferred: Is the transfer facility a study site? dropdown, Required
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Show the field ONLY if:[dsterm] = '3'
1 Yes
2 No
3 N/A
892 subjidcat
Show the field ONLY if:[siteyn] = '1'
7.4.3. If a Study Site: Participant number at new facility dropdown, Required
1 Same as the above
2 Different
893 transfer_subjid
Show the field ONLY if:[subjidcat] = '2'
If Different, Participant number at the new facility text, Required
894 isaric_outcome_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete
Instrument: ISARIC - Complications (OPTIONAL) (isaric_complications_optional)
895 viralpneu_ceterm Section Header: 4c. COMPLICATIONS: At any time during hospitalisation didthe patient experience:
4c.1. Viral Pneumoniae/pneumonitis
radio (Matrix), Required
1 Yes
2 No
3 N/A
896 bactpneu_ceterm 4c.2. Bacterial pneumonia * must provide value radio (Matrix), Required
1 Yes
2 No
3 N/A
897 ards_ceterm 4c.3. Acute Respiratory Distress Syndrome radio (Matrix), Required
1 Yes
2 No
3 N/A
898 ardssev_ceterm
Show the field ONLY if:[ards_ceterm] = '1'
If YES, Acute Respiratory Distress Syndrome? radio, Required
1 Mild
2 Moderate
3 Severe
4 Unknown
Custom alignment: RH
899 pneumothorax_ceterm 4c.4. Pneumothorax radio (Matrix), Required
1 YES
2 NO
3 N/A
900 pleuraleff_ceterm 4c.5. Pleural effusion radio (Matrix), Required
1 YES
2 NO
3 N/A
901 cryptogenic_ceterm 4c.6 Cryptogenic organizing pneumonia (COP) radio (Matrix), Required
1 YES
2 NO
3 N/A
902 bronchio_ceterm 4c.7. Bronchiolitis radio (Matrix), Required
1 YES
2 NO
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3 N/A
903 meningitis_ceterm 4c.8. Meningitis / Encephalitis radio (Matrix), Required
1 YES
2 NO
3 N/A
904 seizure_ceterm 4c.9. Seizure radio (Matrix), Required
1 YES
2 NO
3 N/A
905 stroke_ceterm 4c.10. Stroke / Cerebrovascular accident radio (Matrix), Required
1 YES
2 NO
3 N/A
906 heartfailure_ceterm 4c.11. Congestive heart failure radio (Matrix), Required
1 YES
2 NO
3 N/A
907 carditis_aeterm 4c.12.Myocarditis / Pericarditis radio (Matrix), Required
1 YES
2 NO
3 N/A
908 arrhythmia_ceterm 4c.13. Cardiac arrhythmia radio (Matrix), Required
1 YES
2 NO
3 N/A
909 ischaemia_ceterm 4c.14. Cardiac ischemia radio (Matrix), Required
1 YES
2 NO
3 N/A
910 cardiacarrest_ceterm 4c.15. Cardiac arrest radio (Matrix), Required
1 YES
2 NO
3 N/A
911 bacteraemia_ceterm 4c.16. Bacteraemia radio (Matrix), Required
1 YES
2 NO
3 N/A
912 coagulo_ceterm 4c.17. Coagulation disorder / Disseminated intravascularcoagulation
radio (Matrix), Required
1 YES
2 NO
3 N/A
913 aneamia_ceterm 4c.18. Anaemia radio (Matrix), Required
1 YES
2 NO
3 N/A
914 rhabdomyolsis_ceterm 4c.19. Rhabdomyolysis / Myositis radio (Matrix), Required
1 YES
2 NO
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3 N/A
915 renalinjury_ceterm 4c.20. Acute renal injury / Acute renal failure radio (Matrix), Required
1 YES
2 NO
3 N/A
916 gastro_ceterm 4c.21. Gastrointestinal hemorrhage radio (Matrix), Required
1 YES
2 NO
3 N/A
917 pancreat_ceterm 4c.22. Pancreatitis radio (Matrix), Required
1 YES
2 NO
3 N/A
918 liverdysfunction_ceterm 4c.23. Liver dysfunction radio (Matrix), Required
1 YES
2 NO
3 N/A
919 hyperglycemia_aeterm 4c.24. Hyperglycaemia radio (Matrix), Required
1 YES
2 NO
3 N/A
920 hypoglycemia_ceterm 4c.25. Hypoglycaemia radio (Matrix), Required
1 YES
2 NO
3 N/A
921 other_ceoccur 4c.26. Other radio (Matrix)
1 YES
2 NO
3 N/A
922 other_ceterm
Show the field ONLY if:[other_ceoccur] = '1'
If "Other"; Specify text (alpha_only), Required
923 isaric_complications_optional_complete
Section Header: Form Status
Complete?
dropdown
0 Incomplete
1 Unverified
2 Complete