CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Participant History and Family History
CRF: Intake Medical History

Displaying 1 - 50 of 82
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
C19778 Medical history wheezing pulmonary nebulizer use frequency MedHistWheezPulNebulUseFreq Frequency of nebulizer use in relation to wheezing Frequency of nebulizer use in relation to wheezing If Yes, how often do you use nebulizer? Numeric Values

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19810 Medical history abdominal kidney problem indicator MedHistAbdmnlKdnyProbInd Indicator of history of kidney problem Indicator of history of kidney problem Ever have a kidney problem? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

DeBaun Forms
C19789 Medical history pulmonary cough assist status MedHistPlmnryCghAstStatus Status of cough assist Status of cough assist Mechanical In/Ex-sufflation (cough assist): Daily;Only when ill;Don't use;Unknown Daily;Only when ill;Don't use;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19821 Medical history musculoskeletal joint dislocation type MedHistMusclskltlJointDislocTyp Type of joints dislcoated Type of joints dislcoated If Yes, specify joints dislocated and mechanism Elbow;Patella (knee cap);Wrist;Shoulder Elbow;Patella (knee cap);Wrist;Shoulder Alphanumeric

Choose all that apply

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Multiple Pre-Defined Values Selected

C19800 Medical history endocrine menarche indicator MedHistEndcrnMenarcheInd Indicator of start of menarche Indicator of start of menarche If female, start of her period (menarche)? No;Yes;Unknown No;Yes;Unknown Alphanumeric

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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19832 Psychiatric anxiety onset date PsychAnxOnstDate Date of onset of anxiety Date of onset of anxiety If Yes, date of onset Date or Date & Time

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

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19768 Medical history pulmonary difficulty ingestion relatedness indicator MedHistPlDfltcyIngesRltdnsInd Indicator of difficulty breathing relation to meal times Indicator of difficulty breathing relation to meal times If Yes, is difficulty breathing related to meal times? No;Yes;Unknown No;Yes;Unknown Alphanumeric

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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19779 Medical history asthma pulmonary assessment indicator MedHistAsthmaPulAssesInd Indicator of history of asthma Indicator of history of asthma History of asthma? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

DeBaun Forms
C19811 Medical history abdominal liver problem indicator MedHistAbdmnlLiverProbInd Indicator of history of liver problem Indicator of history of liver problem Ever have a liver problem? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

DeBaun Forms
C19790 Medical history pulmonary current intermittent positive pressure breathing use status MedHistPlCrntIPPBUseStatus Status of current Intermittent Positive Pressure Breathing (IPPB) use Status of current Intermittent Positive Pressure Breathing (IPPB) use Are you currently using IPPB?: Daily;Only when ill;Don't use;Unknown Daily;Only when ill;Don't use;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19822 Medical history musculoskeletal joint dislocation mechanism type MedHistMusclJointDislmechTyp Type of joints and mechanism dislocated Type of joints and mechanism dislocated If Yes, specify joints dislocated and mechanism Alphanumeric

Answer for all applicable joints dislocated

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C05460 Seizure indicator SeizInd Indicator of seizure activity Indicator of seizure activity Seizure Yes;No Yes;No Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 3.00 2013-07-20 10:21:25.65 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19769 Medical history pulmonary aspiration diagnosis indicator MedHistPlmnryAspirDiagInd Indicator of history of aspiration Indicator of history of aspiration History of aspiration? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19801 Medical history endocrine menarche onset date MedHistEndcrnMenarcheOnstDate Date of start of onset of menarche Date of start of onset of menarche If Yes, date of onset Date or Date & Time

The date should be recorded in the format YYYY/MM and only answered if Endocrine question #3 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19833 Psychiatric depression indicator PsychDepressInd Indicator of history of depression Indicator of history of depression Depression: 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19780 Medical history asthma pulmonary medication taken indicator MedHistAsthmaPulMedsTakenInd Indicator of steroid pills or liquid medication taken for asthma Indicator of steroid pills or liquid medication taken for asthma If Yes, steroid pills or liquid medication for asthma? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19812 Medical history abdominal liver problem enzyme elevation indicator MedHistAbdmnlLivProbEnzElInd Indicator of elevation in liver enzyme Indicator of elevation in liver enzyme If Yes, was this an elevation in the liver enzyme (AST/ALT) only? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19791 Medical history pulmonary antibiotics use frequency MedHistPlmnryAntibiotUseFreq Frequency of antibiotic use Frequency of antibiotic use How many times have you required antibiotics for a cold or pneumonia in the last year? None;Once;2 times;3 times;4 times;<5 times None;Once;2 times;3 times;4 times;<5 times Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19823 Medical history musculoskeletal joint dislocation trauma type MedHistMusclskltlJointDislocTaumaTyp Type of joint dislocation trauma Type of joint dislocation trauma If Yes, specify joints dislocated and mechanism Major trauma;Minor trauma (slip and fall) Major trauma;Minor trauma (slip and fall) Alphanumeric

Answer for all applicable joints dislocated

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C14116 Learning disability or attention deficit diagnosis indicator LearnDisableADHDDiagnosInd Whether the participant/subject was ever given formal diagnosis of any learning disability or diagnosed with ADD/ADHD (Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder) Whether the participant/subject was formally diagnosed with learning disability, attention deficit disorder, or attention deficit hyperactivity disorder. Is there a learning disability? Yes;No;Unknown Yes;No;Unknown Alphanumeric

No instructions available

No references available Adult;Pediatric Proposed 3.00 2013-08-28 16:08:00.453 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19770 Medical history pulmonary aspiration swallowing assessment indicator MedHistPlAspirSwallAssInd Indicator of swallowing studies completed Indicator of swallowing studies completed Any swallowing 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19802 Medical history endocrine Vitamin D deficiency indicator MedHistEndcrnVtmnDDefInd Indicator of history of vitamin D deficency Indicator of history of vitamin D deficency Any history of vitamin D deficiency? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19834 Psychiatric depression onset date PsychDepressOnstDate Date of onset of depression first Date of onset of depression first If Yes, date of onset Date or Date & Time

The date should be recorded in the format YYYY/MM, and only answered if Psychiatric question #2 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19781 Medical history asthma pulmonary inhalers use indicator MedHistAsthmaPlInhalUseInd Indicator of steroid inhalers used for asthma Indicator of steroid inhalers used for asthma If Yes, steroid inhalers (Qvar, Flovent)? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19813 Medical history genito-urinary urinary tract infections indicator MedHistGenitoUTIInd Indicator of history of urinary tract infections Indicator of history of urinary tract infections Frequent urinary tract infections? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19792 Medical history cardiovascular heart arrhythmia indicator MedHistCardioHeartArrhymInd Indicator of history of heart arrhythmia Indicator of history of heart arrhythmia Is there a history of heart arrhythmia? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19824 Medical history musculoskeletal scoliosis diagnosis indicator MedHistScolDiagnInd Indicator of scoliosis Indicator of scoliosis Scoliosis: 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19760 Medical history strabismus diagnosis indicator MedHistStrbsmsDiagInd Indicator of medical history of strabismus Indicator of medical history of strabismus Strabismus 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19771 Medical history pulmonary aspiration swallowing assessment completion date MedHistPlAspirSwallAssCompDt Date of swallowing study completed Date of swallowing study completed If Yes, date swallowing 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 Participant History and Family History General Health History

Free-Form Entry

C19803 Dual X-ray absorptiometry scanner performed indicator DEXAScanPerfInd Indicator of DEXA scan performed Indicator of DEXA scan performed Any DEXA scan performed? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19835 Pain indicator PainInd Indicator of pain present Indicator of pain present Pain? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19782 Medical history asthma pulmonary inhalers use frequency MedHistAsthmaPlInhalUseFreq Frequency of use of steroid inhalers used for asthma Frequency of use of steroid inhalers used for asthma If Yes, how often? Daily;Monthly;Yearly Daily;Monthly;Yearly Alphanumeric

Only answered if Pulmonary question #7 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19814 Medical history musculoskeletal broken bones indicator MedHistMusclskltlBrknBonesInd Indicator of broken bones Indicator of broken bones Broken bones? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19793 Medical history cardiovascular heart arrhythmia diagnosis date MedHistCardioHeArrhDiagDt Date of first detection of heart arrhythmia Date of first detection of heart arrhythmia If Yes, date first detected Date or Date & Time

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

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19825 Medical history musculoskeletal scoliosis diagnosis date MedHistMusclskltlScolDiagDt Date of first detection of scoliosis Date of first detection of scoliosis If Yes, date first detected Date or Date & Time

The date should be recorded in the format YYYY/MM, and only answered if Musculoskeletal question #3 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19761 Medical history glaucoma diagnosis indicator MedHistGlcmaDiagInd Indicator of history of Glaucoma Indicator of history of Glaucoma Glaucoma 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19772 Medical history pulmonary function test assessment indicator MedHistPFTAssessInd Indicator of pulmonary function tests completed Indicator of pulmonary function tests completed Any pulmonary function tests 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19804 Dual X-ray absorptiometry scanner performed date DEXAScanPerfDt Date of DEXA scan performed Date of DEXA scan performed If Yes, date performed Date or Date & Time

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

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19836 Pain anatomic site text PainAntmicSiteTxt Anatomic Site of body pain Anatomic Site of body pain If Yes, area of body: Alphanumeric

Only answered if Pain question #1 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19783 Medical history pulmonary bilevel positive airway pressure indicator MedHistPlmnryBiPAPInd Indicator of bilevel positive airway pressure Indicator of bilevel positive airway pressure BiPAP currently? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19815 Medical history musculoskeletal total broken bones count MedHistMusclTtlBrknBonesCt Number of toral bones broken Number of toral bones broken If Yes, total number of broken bones: Numeric Values

Only answered if Musculoskeletal question # 1 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19794 Medical history cardiovascular enlarged heart diagnosis indicator MedHistCardioEnlrgdHetDiagInd Indicator of history of enlarged heart Indicator of history of enlarged heart Is there a history of an enlarged heart? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19826 Seizure onset Date SeizOnstDate Date of onset of seizures Date of onset of seizures 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 #1 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

C19762 Medical history myopia diagnosis indicator MedHistMyopiaDiagInd Indicator of history of myopia Indicator of history of myopia Myopia 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19773 Medical history pulmonary function test assessment date MedHistPFTAssessDt Date of pulmonary function test completed Date of pulmonary function test completed If Yes, date 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 Participant History and Family History General Health History

Free-Form Entry

C19805 Medical history endocrine osteoporosis indicator MedHistEndcrnOstprsisInd Indicator of history of osteoporosis Indicator of history of osteoporosis Any history of osteoporosis? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

DeBaun Forms
C19837 Pain position indicator PainPostnInd Indicator of pain within a certain position of the body Indicator of pain within a certain position of the body Pain with certain position? 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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19784 Medical history pulmonary bilevel positive airway pressure frequency MedHistPlmnryBiPAPFreq Frequency of bilevel positive airway pressure Frequency of bilevel positive airway pressure If Yes, how many hours a day? 0-4 hours/day;5-16 hours/day;>16 hours/day 0-4 hours/day;5-16 hours/day;>16 hours/day Alphanumeric

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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

C19816 Medical history musculoskeletal total broken bones type MedHistMusclskltlBrknBonesTyp Type of bones broken Type of bones broken If Yes, specify bones broken and mechanism broken: Femur;Tibia/Fibia;Radius/Ulna;Vertebral body;Humerus;Carpal Femur;Tibia/Fibia;Radius/Ulna;Vertebral body;Humerus;Carpal Alphanumeric

Choose all that apply

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Multiple Pre-Defined Values Selected

C19795 Medical history cardiovascular enlarged heart diagnosis date MedHistCardioEnlrgdHeDiagDt Date of first detection of enlarged heart Date of first detection of enlarged heart If Yes, date first detected Date or Date & Time

The date should be recorded in the format YYYY/MM and only answered if Cardiovascular question #2 is answered Yes.

No references available Adult;Pediatric Proposed 1.00 2015-02-05 00:00:00.0 Intake Medical History Participant History and Family History General Health History

Free-Form Entry

Displaying 1 - 50 of 82
CSV