| CDE ID | CDE Description | | * 421 | EDRN Participant ID (Go To: 1390) | 
| * 1390 | Follow-up visit missed:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          (Go To: 423) | 
|  | | Permissible  Values (value): | Y1V06                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                (20) | 
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| * 423 | EDRN Protocol ID (Go To: 422) | 
| * 422 | EDRN Site ID (Go To: 929) | 
| * 929 | EDRN Staff ID of the person who collected the data: (Go To: 1389) | 
| * 1389 | Reason for missed visit:                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         (Go To: 1097) | 
|  | | Permissible  Values (value): | Participant too ill (1) | 
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|  | |  | Participant temporarily away from area (2) | 
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|  | |  | Unable to contact participant (4) | 
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|  | |  | Other, specify:  (97)  (Go To: 2185) | 
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| * 2185 | Reason for missed visit (Other, specify): (Go To: 1097) | 
| 1097 | Comments (do not include any participant identifiers) (Go To: End of Form) |