CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Intake Medical History

82 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
C19827 Seizure type NeuroSeizTyp Type of seizures had Type of seizures had What kind of seizure Grand Mal;Partial Complex;Absence;Ferbile;Don't know Grand Mal;Partial Complex;Absence;Ferbile;Don't know Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19763 Medical history cataracts diagnosis indicator MedHistCatrctsDiagInd Indicator of history of cataracts Indicator of history of cataracts Cataracts No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19806 Medical history endocrine diabetes indicator MedHistEndcrnDiabetInd Indicator of diabetes Indicator of diabetes Ever have diabetes? No;Yes No;Yes Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19838 Pain position text PainPosTxt The free-text field related to 'Pain Position indicator' Indicator of pain within a certain position of the body The free-text field related to 'Pain Position indicator' Indicator of pain within a certain position of the body If Yes, specify Alphanumeric

Only answered if Pain question #2 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other 255

Free-Form Entry

C19774 Medical history snoring presence indicator MedHistPlmnrySnorePresInd Indicator of snoring Indicator of snoring Any snoring? No;Yes No;Yes Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19817 Medical history musculoskeletal total broken bones mechanism type MedHistMusclBrknBonMechTyp Type of mechanism broken Type of mechanism broken If Yes, specify bones broken and mechanism broken: Alphanumeric

Answer for all applicable broken bones

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other 255

Free-Form Entry

C19785 Medical history pulmonary bilevel positive airway pressure start date MedHistLabPrPlBiPAPStrtDt Date of start of bilevel positive airway pressure Date of start of bilevel positive airway pressure If Yes, when started Date or Date & Time

The date should be recorded in the format YYYY/MM, and only answered if Pulmonary question #1 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19796 Medical history cardiovascular enlarged heart diagnosis method type MedHistCardioEnlHeDiagMetTyp Indicator of enlarged heart detection method Indicator of enlarged heart detection method If Yes, how detected: Chest X-ray;Echocardiogram Chest X-ray;Echocardiogram Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19828 Learning disability mental retardation indicator NeuroLearnDisabMentlRetrdnInd Indicator of mental retardation Indicator of mental retardation If Yes, is the learning disability characterized as mental retardation (IQ <70) either through formal IQ testing or exam? No;Yes;Unknown No;Yes;Unknown Alphanumeric

Only answered if question #3 under neurologic is answered Yes

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19764 Medical history retinal detachment diagnosis indicator MedHistRetnlDetachDiagInd Indicator of history of retinal detachment Indicator of history of retinal detachment Retinal detachment No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19807 Medical history abdominal difficulty eating indicator MedHistAbdmnlDfcltyEatingInd Indicator of history of difficulty eating Indicator of history of difficulty eating History of difficulty eating? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19839 Pain exersice indicator PainExrcseInd Indicator of pain while excercising Indicator of pain while excercising Pain with exercise? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19775 Medical history sleep pulmonary assessment indicator MedHistSleepPulAssessInd Indicator of sleep study completed Indicator of sleep study completed Any sleep study done? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19818 Medical history musculoskeletal total broken bones trauma type MedHistMusclBrknBonTraumaTyp Type of broken bone trauma Type of broken bone trauma If Yes, specify bones broken and mechanism broken: Major trauma;Minor trauma (slip and fall) Major trauma;Minor trauma (slip and fall) Alphanumeric

Answer for all applicable broken bones

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

C19786 Medical history pulmonary bilevel positive airway pressure hospitalization indicator MedHistPlmnryBiPAPHosptlInd Indicator of bilevel positive airway pressure hospitilization Indicator of bilevel positive airway pressure hospitilization BiPAP only with hospitalization or illness: No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19797 Medical history endocrine early puberty indicator MedHistEndcrnErlyPubrtyInd Indicator of history of early puberty Indicator of history of early puberty Any history of early puberty? No;Yes No;Yes Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19829 Behavioral issues indicator BehavrIssuesInd Indicator of behavioral issues Indicator of behavioral issues Behavioral issues? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19765 Medical history auditory deafness diagnosis indicator MedHistAudtryDeafDiagInd Indicator of any history of deafness Indicator of any history of deafness Any history of deafness? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19808 Medical history abdominal difficulty swallowing indicator MedHistAbdmnlDfclSwallInd Indicator of history of difficulty swallowing Indicator of history of difficulty swallowing History of difficulty swallowing? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19776 Medical history sleep pulmonary assessment date MedHistSleepPulAssessDate Date of sleep study completed Date of sleep study completed If Yes, date sleep study done Date or Date & Time

The date should be recorded in the format YYYY/MM.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19787 Medical history pulmonary ventilator use indicator MedHistPlmnryVentltrUseInd Indicator of ventilator used Indicator of ventilator used Ventilator: No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19819 Medical history musculoskeletal joint dislocation indicator MedHistMusclJointDislocInd Indicator of joint dislocation Indicator of joint dislocation Joint dislocation? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19798 Medical history endocrine male indicator MedHistEndcrnMaleInd Text of age of breast bud formation detected Text of age of breast bud formation detected If participant/subject is male, check N/A Alphanumeric

If pariticpant/subject is male, check N/A

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19830 Behavioral issues onset date BehavrIssuesOnstDate Date of onset of behavioral issues Date of onset of behavioral issues If Yes, date of onset Date or Date & Time

The date should be recorded in the format YYYY/MM, and only answered if Neurologic question #5 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19766 Medical history auditory deafness diagnosis date MedHistAudtryDeafDiagDate Date deafness first detected Date deafness first detected If Yes, date first detected: Date or Date & Time

The date should be recorded in the format YYYY/MM.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19809 Medical history abdominal constipation indicator MedHistAbdmnlConstptnInd Indicator of history of constipation Indicator of history of constipation History of constipation? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19777 Medical history wheezing pulmonary assessment indicator MedHistWheezPulAssessInd Indicator of wheezing Indicator of wheezing Wheezing? No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19788 Medical history pulmonary ventilator use frequency MedHistPlmnryVentltrUseFreq Frequency of use of ventilator Frequency of use of ventilator If Yes, how many hours a day? Numeric Values

The answer should be recorded as the number of hours per day.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19820 Medical history musculoskeletal total joint dislocations count MedHistMusclTtlJointDislocCt Number of total joints dislocated Number of total joints dislocated If Yes, total number of joint dislocations: Numeric Values

Only answered if Musculoskeletal question # 2 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19799 Medical history endocrine breast bud formation age value MedHistEndcrnBrBudFormAgeVal Text of age of breast bud formation detected Text of age of breast bud formation detected If female, at what age did you notice breast bud formation? Numeric Values

Only to be answered if participant/subject is female.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Free-Form Entry

C19831 Psychiatric anxiety indicator PsychAnxInd Indicator of anxiety Indicator of anxiety Anxiety: No;Yes;Unknown No;Yes;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C19767 Medical history pulmonary difficulty diagnosis indicator MedHistoryPlmnryDfltcyDiagInd Indicator of difficulty breathing Indicator of difficulty breathing Any difficulty breathing? Yes;No;Sometimes Yes;No;Sometimes Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Additional Proposed Instruments Other

Single Pre-Defined Value Selected

82 results.
CSV