CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Questionnaire for Verifying Stroke-Free Status (QVSFS)

9 results.
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type Source Form Set Form Field Domain CDASH Variable CDASH Definition CDASH Label Controlled Terminology Prompt Essentiality Question Text CDASH imp guidance SDTM IG target csDSR PhenX Data Type CRF Completion Inst SDTMIG Target Var SDTMIG Target Map Codelist Name PVs Pre Pop Value Query Display List Style
C13196 Questionnaire for Verifying Stroke Free Status (QVSFS) - painless vision loss status QVSFSPainlsVisnLossStatus Have you ever had sudden painless loss of vision in one or both eyes? Have you ever had sudden painless loss of vision in one or both eyes? Questionnaire for Verifying Stroke Free Status (QVSFS) Have you ever had sudden painless loss of vision in one or both eyes No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13197 Questionnaire for Verifying Stroke Free Status (QVSFS) - sudden vision loss status QVSFSSussVisnLossStatus Have you ever suddenly lost one half of your vision? Have you ever suddenly lost one half of your vision? Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status Have you ever suddenly lost one half of your vision No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13198 Questionnaire for Verifying Stroke Free Status (QVSFS) - understanding status QVSFSUndstandStatus Have you ever suddenly lost the ability to understand what people were saying? Have you ever suddenly lost the ability to understand what people were saying? Questionnaire for Verifying Stroke Free Status (QVSFS) Have you ever suddenly lost the ability to understand what people were saying No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13199 Questionnaire for Verifying Stroke Free Status (QVSFS) - verbal status QVSFSVerbalStatus Have you ever suddenly lost the ability to express yourself verbally or in writing? Have you ever suddenly lost the ability to express yourself verbally or in writing? Questionnaire for Verifying Stroke Free Status (QVSFS) Have you ever suddenly lost the ability to express yourself verbally or in writing No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13200 Questionnaire for Verifying Stroke Free Status (QVSFS) - stroke result QuestVerStrFrStatStrRes Whether patient is stroke free (all QVSFS items negative) or not stroke free (at least 1 QVSFS item positive) Whether patient is stroke free (all QVSFS items negative) or not stroke free (at least 1 QVSFS item positive), as part of Questionnaire for Verifying Stroke Free Status (QVSFS). Result Stroke free;Not stroke free Stroke free;Not stroke free Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13192 Questionnaire for Verifying Stroke Free Status (QVSFS) - stroke status QVSFSStrokeStatus Were you ever told by a physician that you had a stroke? Were you ever told by a physician that you had a stroke? Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status Were you ever told by a physician that you had a stroke No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13193 Questionnaire for Verifying Stroke Free Status (QVSFS) - TIA status QVSFSTIAStatus Were you ever told by a physician that you had a TIA, ministroke, or transient ischemic attack? Were you ever told by a physician that you had a TIA, ministroke, or transient ischemic attack? Questionnaire for Verifying Stroke Free Status (QVSFS) Were you ever told by a physician that you had a TIA, ministroke, or transient ischemic attack No;Yes No;Yes Alphanumeric

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Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C13194 Questionnaire for Verifying Stroke Free Status (QVSFS) - painless weakness status QVSFSPainlsWeaknsStatus Have you ever had sudden painless weakness on one side of your body? Have you ever had sudden painless weakness on one side of your body? Questionnaire for Verifying Stroke Free Status (QVSFS) Have you ever had sudden painless weakness on one side of your body No;Yes No;Yes Alphanumeric

Choose one

Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13195 Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status QVSFSNumbStatus Have you ever had sudden numbness or a dead feeling on one side of your body? Have you ever had sudden numbness or a dead feeling on one side of your body? Questionnaire for Verifying Stroke Free Status (QVSFS) Have you ever had sudden numbess or a dead feeling on one side of your body No;Yes No;Yes Alphanumeric

Choose one

Meschia JF, Lojacono MA, Miller MJ, Brott TG, Atkinson EJ, & O'Brien PC. (2004). Reliability of the Questionnaire for Verifying Stroke-Free Status. Cerebrovasc Dis, 17, 218-223. (DOI: 10.1159/000075794); Meschia JF, Brott TG, & Chukwudelunzu FE, et al.(2002). Verifying the stroke-free phenotype by structured telephone interview. Stroke, 31, 1076-1080; Jones WJ, Williams LS, & Meschia JF. (2001). Validating the Questionnaire for Verifying Stroke-Free Status (QVSFS) by Neurological History and Examination. Stroke, 32, 2232 - 2236 Adult Proposed 3.00 2013-06-21 00:00:00.0 Questionnaire for Verifying Stroke-Free Status (QVSFS) Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
9 results.
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