Sub-Domain: Additional Proposed Instruments
CRF: themes
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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C14035 | VMR response result | VMRResponseReslt | Indicates vasomotor response (VMR) response result | Indicates vasomotor response (VMR) response result | Abnormal;Normal;Abnormal;Normal | Abnormal;Normal;Abnormal;Normal | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C55775 | Imaging ictal pain intensity value | ImagIctPainIntensVal | The value related to the intensity of the subject's pain if the timing is ictal | The value related to the intensity of the subject's pain if the timing is ictal | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-31 12:19:15.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
0 | 10 | ||||||||||||||||||||||||||||||||
C12490 | Imaging ventricle abnormal indicator | ImgVentrclAbnrmlInd | Indicator of whether the ventricles appear normal or abnormal in the image studies | Indicator of whether the ventricles appear normal or abnormal in the image studies | Abnormal;Normal;Abnormal;Normal | Abnormal;Normal;Abnormal;Normal | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C13932 | Intima media thickness (IMT) mean near-wall measurement | IMTMeanNearWallMeasr | Indicates mean intima media thickness (IMT) near-wall measurement (mm) | Indicates mean 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 | sites |
Free-Form Entry |
millimeter | |||||||||||||||||||||||||||||||||
C19779 | Medical history asthma pulmonary assessment indicator | MedHistAsthmaPulAssesInd | Indicator of history of asthma | Indicator of history of asthma | 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 | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C02212 | Informed consent obtained date and time | InformConsntObtnDateTime | Date (and time, if applicable and known) on which the participant/subject (or the legal representative on behalf of the participant/subject) agrees to participate in a protocol, treatment, or other activity by signing an informed consent document. | Date (and time, if applicable and known) on which the participant/subject (or the legal representative on behalf of the participant/subject) agrees to participate in a protocol, treatment, or other activity by signing an informed consent document. | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
2435038,656 | DeBaun Forms | ||||||||||||||||||||||||||||||||
C16188 | Vaccine received indicator | VaccRcvdInd | Indicates whether participant/subject received the vaccine | Indicates whether participant/subject received the vaccine | Yes;No;Unknown;Not Asked | Yes;No;Unknown;Not Asked | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C56416 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale 4 T score sum value | WASIIIFullScale4TScoreSumVal | The sum of all four of the subject's T scores, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The sum of all four of the subject's T scores, 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 | sites |
Free-Form Entry |
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C13238 | National Institutes of Health Stroke Scale (NIHSS) - Motor arm score | NIHSSLvlConscMotArmScore | Motor ability of the arm (both left and right) assessed using the NIH Stroke Scale (NIHSS) | Motor ability of the arm (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: limb holds 90 (or 45) degrees for full 10 seconds;Drift: limb holds 90 (or 45) degrees, but drifts down before full 10 seconds, does not hit bed or other support;Some effort against gravity: limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.;No effort against gravity: limb falls;No movement;Amputation or joint fusion, explain;No drift: limb holds 90 (or 45) degrees for full 10 seconds;Drift: limb holds 90 (or 45) degrees, but drifts down before full 10 seconds, does not hit bed or other support;Some effort against gravity: limb cannot get to or maintain (if cued) 90 (or 45) degrees, drifts down to bed, but has some effort against gravity.;No effort against gravity: limb falls;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 | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C14002 | Extracranial stenosis collateral artery anatomic site | ExtracranStenCollArtAntmicSite | The site of parallel arteries having extracranial stenosis. | The site of parallel arteries having extracranial stenosis. | OA;ACA;VA | Ophthalmic artery;Anterior cerebral artery;Vertebral artery | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C21503 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span sequencing subtest trial score | WAISIVDSSTrialScore | Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest | Trial score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Sequencing subtest | 0;1;0;1;0;1 | 0;1;0;1;0;1 | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C10570 | Imaging contrast agent used indicator | ImgContrastAgentUsedInd | Indicator as to whether or not an imaging contrast agent was used for the scan as part of Diffusion Tensor Imaging (DTI). | Indicator as to whether or not an imaging contrast agent was used for the scan. | Yes;No;Unknown;Not applicable | Yes;No;Unknown;Not applicable | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C13900 | Imaging probe frequency | ImgProbeFreq | Indicates imaging probe frequency (Hz) | Indicates imaging probe frequency (Hz) | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
Hertz | |||||||||||||||||||||||||||||||||
C18714 | Imaging radio frequency coil channel other text | ImgRFCoilChannelOTH | The free-text field related to 'Imaging radio frequency coil channel count' specifying other text. Number of the coil channels in the radio frequency (RF) coil used for the imaging scan | The free-text field related to 'Imaging radio frequency coil channel count' specifying other text. Number of the coil channels in the radio frequency (RF) coil used for the imaging scan | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 4000 |
Free-Form Entry |
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C00312 | Body system category | BodySysCat | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. | Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
2002895 | DeBaun Forms | ||||||||||||||||||||||||||||||
C18857 | Imaging brainstem abnormality other text | ImgBrnstmAbnrmlyOTH | The free-text field related to 'Imaging brainstem abnormality type' specifying other text. The type of abnormality in the brainstem on the image | The free-text field related to 'Imaging brainstem abnormality type' specifying other text. The type of abnormality in the brainstem on the image | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 4000 |
Free-Form Entry |
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C01520 | Head circumference measurement | HeadCircumfMeasr | Circumferential measurement of the head at the widest point - the distance from above the eyebrows and ears and around the back of the head | Circumferential measurement of the head at the widest point - the distance from above the eyebrows and ears and around the back of the head | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
0 | 100 | centimeter | 3181613 | ||||||||||||||||||||||||||||||
C14462 | Reflex plantar right response result | RflxPlntrRtRespnsReslt | The results from reflex plantar response on the right side | The results from reflex plantar response on the right side | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2012-10-05 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C56382 | Conners Continuous Performance Test 3rd Edition (CPT3) - Inattentiveness hit reaction time value | ConnersCPT3InaHRTVal | The value representing the subject's response speed time, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | The value representing the subject's response speed time, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-09 15:32:03.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C12501 | Imaging internal capsule type indicator | ImgIntCpslTypInd | The condition of the internal capsule. | The condition of the internal capsule. | 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 | sites |
Single Pre-Defined Value Selected |
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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 | sites |
Free-Form Entry |
0 | 100 | percent | |||||||||||||||||||||||||||||||
C13943 | Imaging B-mode result | ImgBModReslt | Indicates B mode | Indicates B mode | Normal;Occlusion;Stenosis | Normal;Occlusion;Stenosis | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C21117 | Subject name | SubjectName | Name of subject/participant. | Name of subject/participant. | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-06-12 15:16:39.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 255 |
Free-Form Entry |
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C02496 | Imaging scanner manufacturer name | ImgScannerManufName | Name of manufacturer of imaging scanner | Imaging scanner manufacturer name | Agfa;Carestream;GE;Hitachi;Hologic;Konica Minolta;Philips;Siemens;Toshiba;Other, specify;Agfa;Carestream;GE;Hitachi;Hologic;Konica Minolta;Philips;Siemens;Toshiba;Other, specify | Agfa;Carestream;GE;Hitachi;Hologic;Konica Minolta;Philips;Siemens;Toshiba;Other, specify;Agfa;Carestream;GE;Hitachi;Hologic;Konica Minolta;Philips;Siemens;Toshiba;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C17524 | Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex ankle jerk right score | FARSPNSNeuExDTenRAnkJRtScore | Score for right-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 right-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 | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C56427 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Verbal Comprehension confidence interval lower bound value | WASIIIVerbCompConfIntrvlLowVal | The lower bound of the subject's Verbal Comprehension confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The lower 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 | sites |
Free-Form Entry |
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C13456 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - sensorimotor deficit scale | PSOMSNESensDefScale | The scale for sensorimotor deficit (any motor or sensory abnormality including cranial nerve deficits, visual, and hearing deficits) based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The scale for sensorimotor deficit (any motor or sensory abnormality including cranial nerve deficits, visual, and hearing deficits) 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 | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C14013 | Intracranial stenosis mean velocity criterion value | IntracranStenoMnVlctyCriterVal | Indicates intracranial stenosis mean velocity criterion | Indicates intracranial stenosis mean velocity criterion | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C54605 | Informant participant relationship duration unit of measure | InfrmntPrtcpntRltnshpDurUOM | Field related to 'Informant participant relationship duration' specifying the unit of measure of the duration for which the informant has known the participant | Field related to 'Informant participant relationship duration' specifying the unit of measure of the duration for which the informant has known the participant | Weeks;Months;Years | Weeks;Months;Years | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-03-22 09:46:35.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C11061 | Gait assessment result | GaitAssmtReslt | Result of the gait assessment | Result of the gait assessment | Normal;Abnormal;Cannot Assess;Other, specify | Normal;Abnormal;Cannot Assess;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C13911 | Imaging plaque texture text | ImgPlaqTextureTxt | Indicates plaque texture | Indicates plaque texture | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 255 |
Free-Form Entry |
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C12480 | Imaging cortex-pachygyria thickness measurement | ImgCortexPachygyriaThickMeasr | The measurement of cortex thickness, in , of the cortex | The measurement of cortex thickness, in , of the cortex | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C13922 | Imaging common carotid artery (CCA) externalization indicator | ImgCCAExternalizInd | Indicates common carotid artery (CCA) externalization | Indicates common carotid artery (CCA) externalization | 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 | sites |
Single Pre-Defined Value Selected |
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C18903 | Vasomotor response (VMR) vessel anatomic other text | VMRVesselAntmicOTH | The free-text field related to 'Vasomotor response (VMR) vessel anatomic site' specifying other text. Indicates vasomotor response (VMR) vessel type | The free-text field related to 'Vasomotor response (VMR) vessel anatomic site' specifying other text. Indicates vasomotor response (VMR) vessel type | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 4000 |
Free-Form Entry |
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C01705 | Lab test name | LabTestName | Name representing the lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. | Name representing the lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
2003746 | DeBaun Forms | LB | LBTEST |
Lab Test or Examination Name |
Laboratory Test Name |
What was the lab test name? |
LBTEST; LBTESTCD | Char | Record the name of the Lab measurement or finding, if not preprinted on the CRF. If collected on the CRF, the sponsor may provide additional instructions to ensure the data is entered as intended. | (LBTEST) |
[Select appropriate values from the LBTEST codelist] |
Prompt | Radio | ||||||||||||||||||||
C14686 | Pediatric Migraine Disability Assessment (MIDAS) - headache severity score | PedMIDASHeadSevScore | Score for headache severity, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. | Score for headache severity, 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 | sites |
Free-Form Entry |
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C56397 | Conners Continuous Performance Test 3rd Edition (CPT3) - Vigilance commission inter-stimulus interval change value | ConnersCPT3VigCommISIChngVal | The number of incorrect responses to non-targets by inter-stimulus interval (ISI), as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | The number of incorrect responses to non-targets by inter-stimulus interval (ISI), as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-09 15:48:46.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C13196 | Questionnaire for Verifying Stroke Free Status (QVSFS) - painless vision loss status | QVSFSPainlsVisnLossStatus | Have you ever had sudden painless loss of vision in one or both eyes? | Have you ever had sudden painless loss of vision in one or both eyes? Questionnaire for Verifying Stroke Free Status (QVSFS) | 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 | sites |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
C13954 | Consensus on Grading Intracranial Flow Obstruction (COGIF) - follow-up date and time | COGIFFollowupDateTime | The date and time for consensus on grading intracranial flow obstruction (COGIF) follow-up. | The date and time for consensus on grading intracranial flow obstruction (COGIF) follow-up. | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C21493 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest item number | WAISIVDSBItemNum | Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest | Item number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward 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 | sites |
Single Pre-Defined Value Selected |
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C08239 | Imaging echo duration | ImgEchoDur | Duration between the application of the 90 degree pulse and the peak of the echo signal, in milliseconds, during the spin echo and inversion recovery pulse sequences in imaging acquisition | Duration between the application of the 90° pulse and the peak of the echo signal, in milliseconds, during the spin echo and inversion recovery pulse sequences 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 | sites |
Free-Form Entry |
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C13889 | Thrombolysis In Myocardial Infarction (TIMI) scale - global score | TIMIScaleGlobalScore | Indicates TIMI perfusion scale global score | Indicates TIMI perfusion scale global score | 0;1;2;3;0;1;2;3;0;1;2;3 | No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches;No perfusion;Perfusion past the initial occlusion, but no distal branch filling;Perfusion with incomplete or slow distal branch filling;Full perfusion with filling of all distal branches | Numeric values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Single Pre-Defined Value Selected |
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C17972 | Medication prior concomitant dose frequency Clinical Data Interchange Standards Consortium Standard Data Tabulation Model code | MedPriConDoseFreqCDISCSDTMCode | Code that represents the frequency of the dosage of the prior or concomitant medication administered. Clinical Data Interchange Standards Consortium Standard Data Tabulation Model (CDISC SDTM) | Code that represents the frequency of the dosage of the prior or concomitant medication administered. Clinical Data Interchange Standards Consortium Standard Data Tabulation Model (CDISC SDTM) | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:36:20.083 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 255 |
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C13470 | Stroke Adjudication Worksheet - neuroimaging type | StrokeAdjudWksNeuroimagTyp | Type of neuro-imaging done for the stroke event | Type of neuro-imaging done for the stroke event | Single brain CT;Multiple brain CTs separated in time;MRI;DWI | Single brain CT;Multiple brain CTs separated in time;MRI;DWI | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Multiple Pre-Defined Values Selected |
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C14025 | Vasospasm Lindegaard ratio value | VasoLinegaardRatioVal | Indicates vasospasm Lindegaard ratio result | Indicates vasospasm Lindegaard ratio result | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
Free-Form Entry |
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C54688 | PROMIS - Global Health quality of life scale | PROMISGlbHlthQualOfLfScl | Scale related to an individual's rating of his/her quality of life, as part of the PROMIS Global Health | Scale related to an individual's rating of his/her quality of life, 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 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-04-07 15:34:25.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites |
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 | sites | 255 |
Free-Form Entry |
DeBaun Forms | ||||||||||||||||||||||||||||||||
C14036 | Breath-holding index result | BreathHoldingIndexReslt | Indicates breath-holding index (BHI) result | Indicates breath-holding index (BHI) result | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | sites | 255 |
Free-Form Entry |
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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 | sites |
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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 | sites |
Multiple Pre-Defined Values Selected |