Research Sample Collection (Stool)

*The timeline requirements for this form are as follows:
Assessment Time Frame:
• Pre-Conditioning Day -14 to -7
• Pre-Infusion Day -1/0
• Day 14 (+/- 1 Days)
• Day 21 (+/- 3 Days)
• Day 28 (+/- 3 Days)
• Day 56 (+/- 3 Days) – optional
• Day 100 (+/- 7 Days) – optional
• Day 180 (+/- 14 Days) – optional
• Day 365 (+/- 28 Days) – optional
Submission Time Frame: Within 5 business days of collection.

Was a stool sample collected for this timepoint?:
Report if a stool sample was collected at this timepoint as “Yes” or “No.”

Per protocol a Research Sample Collection (Stool) is required at Pre-Conditioning, Pre-Infusion, Day 14, Day 21, and Day 28. If this field is marked as “No” at these timepoints, a protocol deviation should be logged in the EDC.

If no, specify reason:
This field will only appear in the EDC if “Was a stool sample collected for this timepoint?” is answered No. Please describe the reason the stool sample was not collected in this free textbox (up to 200 characters).

CCG v1.0 | CRF v1.3

Copyright © 2004-2025 The Medical College of Wisconsin, Inc. and NMDP. All Rights Reserved.
CIBMTR® (Center for International Blood and Marrow Transplant Research) is a research collaboration between the Medical College of Wisconsin and NMDP.