CDE Detailed Report
Disease: sites
Sub-Domain: Additional Proposed Instruments
CRF: scdc

Displaying 1 - 50 of 491
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
C14964 Sedation used indicator SedationUsedInd Whether the participant/subject was administered any sedation Whether the participant/subject was administered any sedation Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-14 19:48:50.273 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C08088 Age value unit of measure AgeValUoM Unit of measure used to initially record the age value Unit of measure used to initially record the age value Days;Weeks;Months;Years;Days;Weeks;Months;Years Days;Weeks;Months;Years;Days;Weeks;Months;Years Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21484 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest number series text WAISIVDSFNumTxt Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Series of numbers, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Numeric Values Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

50
C13462 Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - cognitive or behavioral deficit scale PSOMSNECogBehavDefScale The scale for cognitive or behavioral deficit based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). The scale for cognitive or behavioral deficit based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). 0;0.5;1;2;0;0.5;1;2;0;0.5;1;2 None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function;None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function;None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function Numeric values 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
C13955 Imaging transcranial color-coded sonography symptomatic indicator ImgTCCSSymptomaticInd Indicates symptomatic presentation by Transcranial Color-Coded Sonography (TCCS) Indicates symptomatic presentation by Transcranial Color-Coded Sonography (TCCS) 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

C56429 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Perceptual Reasoning IQ composite score WASIIIPercRsngIQCompScore The subject's Perceptual Reasoning IQ composite score, converted from his/her Perceptual Reasoning T score, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). The subject's Perceptual Reasoning IQ composite score, converted from his/her Perceptual Reasoning T score, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Numeric Values Adult;Pediatric Supplemental 1.00 2017-06-12 11:58:34.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Free-Form Entry

40 160
C12475 Imaging magnetic resonance imaging T1 T2 sequence name ImgMRIT1T2SeqName The name of the T1 or T2 sequences used for Magnetic Resonance Imaging (MRI) The name of the T1 or T2 sequences used for MRI Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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C13891 Thrombolysis in Cerebral Infarction (TICI) perfusion scale grade TICIPerfScaleGrade Indicates Thrombolysis in Cerebral Infarction (TICI) perfusion scale grade indicator Indicates Thrombolysis in Cerebral Infarction (TICI) perfusion scale grade indicator Grade 0;Grade 1;Grade 2;Grade 2b;Grade 3 No perfusion. No antegrade flow beyond the point of occlusion;Penetration with Minimal Perfusion. The contrast material passes beyond the area of obstruction but fails to opacify the entire cerebral bed distal to the obstruction for the duration of the angiographic run;Partial Perfusion. The contrast material passes beyond the obstruction and opacifies the arterial bed distal to the obstruction. However, the rate of entry of contrast into the vessel distal to the obstruction and/or its rate of clearance from the distal bed are perceptibly slower than its entry into and/or clearance from comparable areas not perfused by the previously occluded vessel, eg, the opposite cerebral artery or the arterial bed proximal to the obstruction. Grade 2a=Only partial filling (<2/3) of the entire vascular territory is visualized;Complete filling of all of the expected vascular territory is visualized, but the filling is slower than normal;Complete Perfusion. antegrade flow into the bed distal to the obstruction occurs as promptly as into the obstruction and clearance of contrast material from the involved bed is as rapid as from an uninvolved other bed of the same vessel or the opposite cerebral artery. 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

C54607 Brief Test of Executive Function Second Edition (BRIEF 2) - Self monitor total raw scale score BRIEF2SlfMntrTtlRwSclScore Total score of the raw scale for the self monitor function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) Total score of the raw scale for the self monitor 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

C56435 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 4 percentile rank value WASIIIFullScale4PrcntRankVal The percentile rank the subject placed in with respect to Full Scale IQ for all four subtests, 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 all four subtests, 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
C14026 Intracranial pressure imaging result ICPReslt Indicates intracranial pressure (ICP) imaging result Indicates vasospasm intracranial pressure (ICP) imaging result 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 millimeter of mercury
C01554 Oxygen saturation measurement O2SatMeasr Value, as a percent, of baseline O2 saturation (SPO2) in nocturnal oximetry, as part of Nocturnal Oximetry. Value, as a percent, of baseline O2 saturation (SPO2) in nocturnal oximetry, as part of Nocturnal Oximetry. Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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0 100 percent DeBaun Forms
C18859 Imaging cerebellum abnormality other text ImgCrblmAbnrmlyOTH The free-text field related to 'Imaging cerebellum abnormality type' specifying other text. The type of abnormality in the cerebellum on the image The free-text field related to 'Imaging cerebellum abnormality type' specifying other text. The type of abnormality in the cerebellum 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

C13138 Hague Side Effects Scale (HASES) - chronic side effects sub scale HASESChronSESubscale Hague Side Effects Scale (HASES)- Chronic Side Effects Subscale (6-24) HASES Chronic Side Effects Subscale (6-24) 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 24 DeBaun Forms
C13923 Imaging power doppler result ImgPowerDopplerReslt Indicates power doppler result Indicates power Doppler result Flow;No flow Flow;No flow 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

C56385 Conners Continuous Performance Test 3rd Edition (CPT3) - Inattentiveness variability value ConnersCPT3InaVarVal The variability of the subject's response speed consistency, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). The variability 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 15:36:25.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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C13934 Intima media thickness (IMT) max near-wall measurement IMTMaxNearWallMeasr Indicates max intima media thickness (IMT) near-wall measurement (mm) Indicates max intima media thickness (IMT) near-wall measurement (mm) Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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millimeter
C56407 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Vocabulary raw score WASIIIVocabRawScore The raw score that the subject received on the Vocabulary subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . The raw score that the subject received on the Vocabulary 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 59
C17397 Visit number VisitNum The numeric value associated with a particular assessment/examination of a participant/subject on a study The numeric value associated with a particular assessment/examination of a participant/subject on a study Numeric Values Adult;Pediatric Supplemental 1.00 2012-12-20 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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DeBaun Forms
C08254 Imaging visual analysis location performed type ImgVisAnlysisLocPerfTyp Location where visual analysis of the imaging data are performed Location where visual analysis of the imaging data are performed Central;Central read;Local - Site;Local read;Local report;Other, specify Central;Central read;Local - Site;Local read;Local report;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21495 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest trial score WAISIVDSBTrialScore Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest 0;1;0;1;0;1 0;1;0;1;0;1 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

C14004 Imaging brain death vessel anatomic site ImgBrainDeathVesseIAntmicSite Indicates brain death vessel(s) Indicates brain death vessel(s) ICA;Basilar;MCA;Other, specify;ACA;VA;PCA;Ophthalmic artery Internal carotid artery;Basilar;Middle cerebral artery;Other, specify;Anterior carotid artery;Vertebral artery;Posterior carotid artery;Ophthalmic artery 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

C00008 Age value AgeVal Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. 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 1800 month DeBaun Forms
C18492 Screening visit date and time ScreenVisitDateTime Date (and time, if applicable and known) the participant/subject was interviewed and screened for potential enrollment into the study Subject screened date and time 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

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DeBaun Forms
C12486 Imaging other cortical abnormality type ImgOthrCorticalAbnrmlyTyp The type of other cortical abnormality The type of other cortical abnormality Schizencephaly;Porencephaly;Other, specify Schizencephaly;Porencephaly;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

C13902 Imaging acute stroke study type ImgAcutStokStudTyp Indicates imaging acute stroke study type Indicates imaging acute stroke study type Initial;Follow-up 1;Follow-up 2 Initial;Follow-up 1;Follow-up 2 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

C54690 PROMIS - Global Health mental health rate scale PROMISGlbHlthMntlHlthRtScl Scale related to an individual's rating of his/her mental health, as part of the PROMIS Global Health Scale related to an individual's rating of his/her mental 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

C14037 Imaging power M mode left middle cerebral artery result ImgPowerMModeLeftMCARes Indicates power M mode for left middle cerebral artery (MCA) result Indicates power M mode for left middle cerebral artery (MCA) result Absent;High Resistance;Low Resistance;Absent;High Resistance;Low Resistance Absent;High Resistance;Low Resistance;Absent;High Resistance;Low Resistance 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

C02016 Medication prior or concomitant start date and time MedctnPriorConcomStrtDateTime The date (and time, if applicable and known) on which the prior/concomitant medication usage began. The date (and time, if applicable and known) on which the prior/concomitant medication usage began. Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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3162752 DeBaun Forms
C19015 Imaging angiography method other text ImgAngioMethdOTH The free-text field related to 'Imaging angiography method type' specifying other text. Type of angiography method performed The free-text field related to 'Imaging angiography method type' specifying other text. Type of angiography method performed Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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C13234 National Institutes of Health Stroke Scale (NIHSS) - Level of consciousness tertiary question score NIHSSLvlConscTertryQScore Level of consciousness (LOC) commands assessed using the NIH Stroke Scale (NIHSS) Level of consciousness (LOC) commands assessed using the NIH Stroke Scale (NIHSS) 0;1;2;0;1;2;0;1;2 Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly;Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly;Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly Numeric values 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
C19811 Medical history abdominal liver problem indicator MedHistAbdmnlLiverProbInd Indicator of history of liver problem Indicator of history of liver problem 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
C13245 National Institutes of Health Stroke Scale (NIHSS) - Severity total score NIHSSSevTotalScore The level of stroke severity as measured by the NIH Stroke Scale (NIHSS) scoring system (i.e., total of the subscale item scores). The level of stroke severity as measured by the NIH Stroke Scale (NIHSS) scoring system (i.e., total of the subscale item scores). 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 42
C13945 Imaging spectrum depth measurement ImgSpectrumDepthMeasr Indicates spectrum depth measurement (mm) Indicates spectrum depth measurement (mm) 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 millimeter
C56419 Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Examinee visual hearing aid other text WASIIIExVisHearAidOthrTxt Text describingg another visual or hearing aid the subject needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Text describingg another visual or hearing aid the subject needed during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). Alphanumeric Adult;Pediatric Supplemental 1.00 2017-06-12 11:51:49.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C17526 Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex biceps jerk right score FARSPNSNeuExDTenRefBicJRtScore Score for right-side biceps jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). Score for right-side biceps 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
C10931 Imaging quality of images technically satisfactory indicator ImgQualImgTechnSatisInd Indicator of whether the quality of the images were technically satisfactory. Indicator of whether the quality of the images were technically satisfactory. Yes;No;Unknown;Not applicable Yes;No;Unknown;Not applicable Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C21506 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest total raw score WAISIVDSSTtlScore Total raw score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Total raw score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest Numeric Values Adult;Pediatric Supplemental 1.00 2015-07-22 11:32:44.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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0 16
C14015 Microembolic signal count MicroembolSignalCt Numeric value counting the number of microembolic signals. Indicates microembolic signal number 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
C01013 Physical exam description text PhysExamDescripTxt Free text field to describe the abnormality in a specific body system or an explanation of why the body system was not examined Free text field to describe the abnormality in a specific body system or an explanation of why the body system was not examined Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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2201880 DeBaun Forms
C18718 Imaging scanner strength other text ImgScannerStrgthOTH The free-text field related to 'Imaging scanner strength value' specifying other text. Value, in Tesla (T), of the scanner's magnetic field strength used for the scan being reported The free-text field related to 'Imaging scanner strength value' specifying other text. Value, in Tesla (T), of the scanner's magnetic field strength used for the scan being reported Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 4000

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Tesla
C12497 Imaging cerebellum abnormality type ImgCrblmAbnrmlyTyp The type of abnormality in the cerebellum on the image The type of abnormality in the cerebellum on the image Other, specify;Cleft;Vermal hypoplasia;Hemispheric hypoplasia;Vermal dysplasia;Hemispheric dysplasia;Cysts Other, specify;Cleft;Vermal hypoplasia;Hemispheric hypoplasia;Vermal dysplasia;Hemispheric dysplasia;Cysts 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

C13913 Imaging plaque motion result ImgPlaqMotionReslt Indicates plaque motion Indicates plaque motion Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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C55778 Imaging inter peri ictal next headache start duration ImagInterPeriIctNextHeStartDur The duration of time until the start of the subject's next inter-ictal or peri-ictal headache. The duration of time until the start of the subject's next inter-ictal or peri-ictal headache. Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-31 12:23:34.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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C14559 EEG recording start date and time EEGRecordingStrtDateTime Date (and time, if applicable and known) the electroencephalogram (EEG) recording began Date the electroencephalogram (EEG) recording began Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

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DeBaun Forms
C02311 Adverse event MedDRA lower level term code AdvsEvntMedDRALowerLvlTermCode Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lower Level Term (LLT) for an adverse event Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lower Level Term (LLT) for an adverse event Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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3133353 DeBaun Forms
C15555 Imaging visual analysis performed indicator ImgVisAnlysisPerfrmInd Whether visual analysis was performed while blind to clinical data Whether visual analysis was performed while blind to clinical data Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

C08147 Data source DataSource Source of the data provided on the case report form Source of the data provided on the case report form Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-20 10:46:24.96 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

DeBaun Forms
C21485 Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest item number WAISIVDSFItemNum Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest 1;2;3;4;5;6;7;8 Item 1;Item 2;Item 3;Item 4;Item 5;Item 6;Item 7;Item 8 Numeric Values 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

C13463 Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - cognitive or behavioral deficit description text PSOMSNECogBehavDeficitDescTxt Description of the cognitive or behavioral deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Description of the cognitive or behavioral deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Miscellaneous Sickle Cell-related CDEs Additional Proposed Instruments Other 255

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DeBaun Forms
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