Form:	BRS-I Adverse Event Baseline v2.0

CDE ID	CDE Description
* 1063	Site Participant ID (Go To: 1097)
* 1899	Adverse Event onset date (MM/DD/YYYY): (Go To: 422)
* 422	EDRN Site ID (Go To: 423)
* 423	EDRN Protocol ID (Go To: 929)
* 929	EDRN Staff ID of the person who collected the data: (Go To: 4644)
* 4644	Age at date of visit, procedure, or data abstraction: (Go To: 1897)
* 1897	Adverse Event: (Go To: 1898)
* 1898	Is this a Serious AE? (Go To: 1901)
	Permissible Values (value): No (0)
	Yes (1)
	Unknown (99)
* 1901	Adverse Event Status: (Go To: 1902)
	Permissible Values (value): Ongoing (1)
	Ended (2) (Go To: 1900)
	Unknown (99)
* 1900	Adverse Event stop date (MM/DD/YYYY): (Go To: 1902)
* 1902	Adverse Event action(s) taken: Check all that apply. (Go To: 1904)
	Permissible Values (value): None (4)
	Administration Hold (6)
	Permanently Discontinued (7)
	Unknown (99)
* 1904	Adverse Event relationship to study treatment. (Go To: 1905)
	Permissible Values (value): Related (1)
	Not Related (2)
	Unknown (99)
* 1905	Adverse Event Grade: (Go To: 1097)
1097	Comments (do not include any participant identifiers) (Go To: End of Form)