CDE Detailed Report
Disease: cookie-policy
Sub-Domain: Additional Proposed Instruments
CRF:
Sub-Domain: Additional Proposed Instruments
CRF:
| 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 |
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| C13239 | National Institutes of Health Stroke Scale (NIHSS) - Motor leg score | NIHSSLvlConscMotLegScore | Motor ability of the leg (both left and right) assessed using the NIH Stroke Scale (NIHSS) | Motor ability of the leg (both left and right) assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;3;4;UN;0;1;2;3;4;UN | No drift: leg holds 30 degrees position for full 5 seconds.;Drift: leg falls by the end of the 5 second period but does not hit bed.;Some effort against gravity: leg falls to bed by 5 seconds, but has some effort against gravity.;No effort against gravity, leg falls to bed immediately.;No movement;Amputation or joint fusion, explain;No drift: leg holds 30 degrees position for full 5 seconds.;Drift: leg falls by the end of the 5 second period but does not hit bed.;Some effort against gravity: leg falls to bed by 5 seconds, but has some effort against gravity.;No effort against gravity, leg falls to bed immediately.;No movement;Amputation or joint fusion, explain | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C17503 | Hemoglobin electrophoresis type | HemoglbnElectrophoresisType | Type of hemoglobin that was identified by the electrophoresis test being reported | Type of hemoglobin that was identified by the electrophoresis test being reported | HbSS;HbSA;HBAA;HbFF;HbAF | HbSS;HbSA;HBAA;HbFF;HbAF | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56417 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale 2 T score sum value | WASIIIFullScale2TScoreSumVal | The sum of two of the subject's T scores (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The sum of two of the subject's T scores (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 11:40:41.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C10576 | Imaging in plane resolution axis 1 measurement | ImgInPlaneRsltnAxis1Measr | Axis 1 of in-plane spatial resolution used in imaging acquisition | Axis 1 of in-plane spatial resolution used in imaging acquisition | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
millimeter | |||||||||||||||||||||||||||||||||
| C14011 | Intracranial stenosis present indicator | IntracranStenosisPresentInd | Indicates presence of intracranial stenosis | Indicates presence of intracranial stenosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C21504 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest item score | WAISIVDSSSubtestItemScore | Item score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest | Item score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest | 0;1;2 | 0;1;2 | Numeric Values | Adult;Pediatric | Supplemental | 1.10 | 2018-07-30 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C00313 | Medical history condition SNOMED CT code | MedclHistCondSNOMEDCTCode | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
DeBaun Forms | ||||||||||||||||||||||||||||||||
| C13909 | Imaging plaque surface type | ImgPlaqSurfaceTyp | Indicates plaque surface type | Indicates plaque surface type | Irregular;Smooth | Irregular;Smooth | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C18715 | Imaging radio frequency coil other text | ImgRFCoilOTH | The free-text field related to 'Imaging radio frequency coil type' specifying other text. Type of radio frequency (RF) coil(s) used for the body part scanned | The free-text field related to 'Imaging radio frequency coil type' specifying other text. Type of radio frequency (RF) coil(s) used for the body part scanned | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C12491 | Imaging ventricle abnormality type | ImgVentrclAbnrmlyTyp | The type of abnormality in the ventricles on the image | The type of abnormality in the ventricles on the image | Dilation;Other, specify;Dilation;Other, specify | Dilation;Other, specify;Dilation;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C14443 | Muscle tone assessment anatomic site | MuscToneAssmtAntmicSite | Anatomic location of the muscle tone as part of the motor examination. | Anatomic location of the muscle tone as part of the motor examination. | Right upper extremity;Left upper extremity;Right lower extremity;Left lower extremity;Truncal tone | Right upper extremity (RUE);Left upper extremity (LUE);Right lower extremity (RLE);Left lower extremity (LLE);Truncal tone | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C55776 | Imaging ictal headache since onset duration | ImagIctHeadSinceOnsetDur | The duration of time since the onset of the subject's headache if it was ictal. | The duration of time since the onset of the subject's headache if it was ictal. | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-31 12:21:21.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C02301 | Adverse event end date and time | AdverseEvntEndDateTime | Date (and time, if applicable and known) on which the adverse event discontinued/stopped | Date (and time, if applicable and known) on which the adverse event discontinued/stopped | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
2189843 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C13941 | Imaging insonation plane type | ImgInsonPlaneTyp | Indicates insonation plane | Indicates insonation plane | Free;Coronal;Axial mesencephalic | Free;Coronal;Axial mesencephalic | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19805 | Medical history endocrine osteoporosis indicator | MedHistEndcrnOstprsisInd | Indicator of history of osteoporosis | Indicator of history of osteoporosis | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C21483 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest response text | WAISIVDSFRespnsTxt | Participant response, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest | Participant response, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 50 |
Free-Form Entry |
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| C13457 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - sensorimotor deficit type | PSOMSNESensDefTyp | The type of sensorimotor deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The type of sensorimotor deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | Global developmental delay;Global hypotonia or hypertonia;Hemiparesis;Hemifacial weakness;Dysarthria;Hemitaxia;Other motor deficit;Hemisensory deficit;Other sensory deficit;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Other describe | Global developmental delay;Global hypotonia or hypertonia;Hemiparesis;Hemifacial weakness;Dysarthria;Hemitaxia;Other motor deficit;Hemisensory deficit;Other sensory deficit;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Other describe | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13887 | Imaging vessel angiography symptomology type | ImgVesselAngioSympTyp | Indicates vessel imaging angiography symptomology | Indicates vessel imaging angiography symptomology | Symptomatic;Asymptomatic;Indeterminate | Symptomatic;Asymptomatic;Indeterminate | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C56428 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Verbal Comprehension confidence interval upper bound value | WASIIIVerbCompConfIntrvlUppVal | The upper bound of the subject's Verbal Comprehension confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The upper bound of the subject's Verbal Comprehension confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 12:55:22.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C12261 | Biopsy and autopsy inflammatory cell type | BpApInflamCellTyp | Type of inflammatory cells identified. | Type of inflammatory cells identified. | Lymphocytes;Neutrophils;Macrophages;Eosinophils;Microorganisms | Lymphocytes;Neutrophils;Macrophages;Eosinophils;Microorganisms | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C14023 | Sickle cell disease diagnosis result | SickleCellDiagnosReslt | Indicates sickle cell diagnosis result | Indicates sickle cell diagnosis result | Abnormal;Normal;Conditional;Abnormal;Normal;Conditional | Abnormal;Normal;Conditional;Abnormal;Normal;Conditional | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C54606 | Brief Test of Executive Function Second Edition (BRIEF 2) - Inhibit total raw scale score | BRIEF2InhbtTtlRwSclScore | Total score of the raw scale for the inhibit function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) | Total score of the raw scale for the inhibit function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-03-22 09:57:02.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C01521 | Heart rate | HeartRate | The participant/subject's pulse or number of contractions (heart beats) per minute | The participant/subject's pulse or number of contractions (heart beats) per minute | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 300 | beats per minute | 2767073 | DeBaun Forms | |||||||||||||||||||||||||||||
| C13920 | Imaging volume flow rate measurement | ImgVolFlowRateMeasr | Indicates volume flow rate | Indicates volume flow rate | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 999 | milliliter per minute | |||||||||||||||||||||||||||||||
| C18858 | Imaging pons abnormality other text | ImgPonsAbnrmlyOTH | The free-text field related to 'Imaging pons abnormality type' specifying other text. The type of abnormality in the pons on the image | The free-text field related to 'Imaging pons abnormality type' specifying other text. The type of abnormality in the pons on the image | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C12502 | Imaging anterior commissure type indicator | ImgAntCmsrTypInd | The condition of the anterior commissure | The condition of the anterior commissure | Involved;Spared | Involved;Spared | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14684 | Pediatric Migraine Disability Assessment (MIDAS) - total score | PedMIDASTotalScore | The total score as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. | The total score as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C56384 | Conners Continuous Performance Test 3rd Edition (CPT3) - Inattentiveness hit reaction time standard deviation value | ConnersCPT3InaHRTStDevVal | The standard deviation of the subject's response speed consistency, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | The standard deviation of the subject's response speed consistency, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-09 15:33:41.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C04802 | Death date and time | DeathDateTime | Date (and time, if known) of participant's/subject's death | Date (and time, if known) of participant's/subject's death | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
2004152 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C13952 | Consensus on Grading Intracranial Flow Obstruction (COGIF) - score | COGIFScore | The score related to the consensus on grading intracranial flow obstruction (COGIF) | The score related to the consensus on grading intracranial flow obstruction (COGIF) | No flow;Low flow/No diastolic flow;Low flow/diastolic flow;Established perfusion | No flow;Low flow/No diastolic flow;Low flow/diastolic flow;Established perfusion | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C08240 | Imaging flip angle measurement | ImgFlipAngleMeasr | Measurement of the angle, in degrees, over which the radio frequency changes proton spin angle | Measurement of the angle, in degrees, over which the radio frequency changes proton spin angle | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
degree | |||||||||||||||||||||||||||||||||
| C14001 | Extracranial stenosis type | ExtracranStenosisTyp | Indicates extracranial stenosis type | Indicates extracranial stenosis type | Collateral;Reduced upstroke;Reduced pulsatility index (Pi);VMR;Reduced velocity;Collateral;Reduced upstroke;Reduced pulsatility index (Pi);VMR;Reduced velocity | Collateral;Reduced upstroke;Reduced pulsatility index (Pi);VMR;Reduced velocity;Collateral;Reduced upstroke;Reduced pulsatility index (Pi);VMR;Reduced velocity | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C21494 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest trial number | WAISIVDSBTrialNum | Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest | Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest | 1;2 | Trial 1;Trial 2 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C13750 | Imaging study ID number | ImgStudyIDNum | Unique identification number assigned to the study or assessment session. | Unique identification number assigned to the study. | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
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| C13899 | Imaging probe type text | ImgProbeTypTxt | The text describing the type of imaging probe | Describes imaging probe type | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
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| C18027 | Comment text | CmmntTxt | Provide any additional information that pertains to the question. | Provide any additional information that pertains to the question. | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
DeBaun Forms | ||||||||||||||||||||||||||||||||
| C12481 | Imaging cortex lissencephaly (LIS type 1) indicator | ImgCortexLISInd | Indicator of whether cortex lissencephaly is found within the image studies | Indicator of whether cortex lissencephaly is found within the image studies | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14034 | Vasomotor response (VMR) vessel anatomic site | VMRVesselAntmicSite | Indicates vasomotor response (VMR) vessel type | Indicates vasomotor response (VMR) vessel type | M1;A1;P1;Siphon;Ophthalmic;Vert;Basilar;MCA;Other, specify | M1;A1;P1;Siphon;Ophthalmic;Vert;Basilar;Middle cerebral artery;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C54689 | PROMIS - Global Health physical health rate scale | PROMISGlbHlthPhysHlthRtScl | Scale related to an individual's rating of his/her physical health, as part of the PROMIS Global Health | Scale related to an individual's rating of his/her physical health, as part of the PROMIS Global Health | 1;2;3;4;5;1;2;3;4;5 | Poor;Fair;Good;Very Good;Excellent;Poor;Fair;Good;Very Good;Excellent | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-04-07 15:34:25.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C02004 | Study drug dispensed date and time | StdyDrugDispnsdDateTime | Date (and time, if applicable and known) on which a participant/subject was given or applied a therapeutic agent (drug, intervention therapy) used in a clinical trial protocol | Date (and time, if applicable and known) on which a participant/subject was given or applied a therapeutic agent (drug, intervention therapy) used in a clinical trial protocol | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
3163963 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C13931 | Intima media thickness (IMT) findings artery type | IMTFindArteryTyp | Indicates intima media thickness (IMT) artery used for mean and max measurements | Indicates intima media thickness (IMT) artery used for mean and max measurements | CCA - right;CCA - left;Bulb - right;Bulb - left;ICA - right;ICA - left;CCA - right;CCA - left;Bulb - right;Bulb - left;ICA - right;ICA - left | Common carotid artery - right;Common carotid artery - left;Bulb - right;Bulb - left;Internal Carotid Artery - right;Internal Carotid Artery - left;Common carotid artery - right;Common carotid artery - left;Bulb - right;Bulb - left;Internal Carotid Artery - right;Internal Carotid Artery - left | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C18942 | Cerebellar or coordination assessment abnormality present other text | CerbllCoordAssmtAbnrmlyPrsOTH | The free-text field related to 'Cerebellar or coordination assessment abnormality present status' specifying other text. Whether the cerebellar/coordination assessment found abnormalities | The free-text field related to 'Cerebellar or coordination assessment abnormality present status' specifying other text. Whether the cerebellar/coordination assessment found abnormalities | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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 | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C16187 | Vaccine type | VaccTyp | Vaccination received by pediatric patient | Vaccination received by pediatric patient | Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine | Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56439 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 2 percentile rank value | WASIIIFullScale2PrcntRankVal | The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The percentile rank the subject placed in with respect to Full Scale IQ for two subtests (Vocabulary and Matrix Reasoning), as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 13:04:39.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 100 | percent | |||||||||||||||||||||||||||||||
| C56406 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Block Design raw score | WASIIIBDRawScore | The raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . | The raw score that the subject received on the Block Design subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 11:23:35.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 71 | ||||||||||||||||||||||||||||||||
| C13240 | National Institutes of Health Stroke Scale (NIHSS) - Limb ataxia score | NIHSSLimbAtaxiaScore | Limb ataxia assessed using the NIH Stroke Scale (NIHSS) | Limb ataxia assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;UN;0;1;2;UN | Absent;Present in one limb;Present in two limbs;Amputation or joint fusion, explain;Absent;Present in one limb;Present in two limbs;Amputation or joint fusion, explain | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C17523 | Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex ankle jerk left score | FARSPNSNeuExDTenRAnkJLftScore | Score for left-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | Score for left-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | 0;1;2;3;4;0;1;2;3;4;0;1;2;3;4 | 0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56418 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Examinee visual hearing aid type | WASIIIExVisHearAidTyp | The type of visual or hearing aid or aids that the examinee needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The type of visual or hearing aid or aids that the examinee needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Glasses;Assisted Listening Device;Other;Prescription Lenses | Glasses;Assisted Listening Device;Other;Prescription Lenses | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 11:43:19.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C10609 | Hospitalization reason | HospitRsn | Reason why the participant/subject was hospitalized, excluding all surgeries | Reason why the participant/subject was hospitalized, excluding all surgeries | Pneumonia or Respiratory;Dehydration;Trauma;Fracture;Cardiomyopathy/Arrhythmia;Failure to Thrive;Other, specify;Infection other than pneumonia;Seizures;Cardiovascular | Pneumonia or Respiratory;Dehydration;Trauma;Fracture;Cardiomyopathy/Arrhythmia;Failure to Thrive;Other, specify;Infection other than pneumonia;Seizures;Cardiovascular | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms |