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

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

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

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

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

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

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

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

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

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

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

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

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

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History 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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

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 Participant History and Family History General Health History

Single Pre-Defined Value Selected

82 results.
CSV