CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Selected Debaun CDEs

Displaying 1 - 50 of 137
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
C13195 Questionnaire for Verifying Stroke Free Status (QVSFS) - numbness status QVSFSNumbStatus Have you ever had sudden numbness or a dead feeling on one side of your body? Have you ever had sudden numbness or a dead feeling on one side of your body? Questionnaire for Verifying Stroke Free Status (QVSFS) No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value 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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C02005 Study drug returned date and time StdyDrugRetrnDateTime Date (and time, if applicable and known) on which the study drug was returned Date (and time, if applicable and known) on which the study drug was returned Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

3164209 DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
C19904 Symptom disease lab data known disease other text SymptSignDisLabDataOTH Text of other symptoms, signs, known diseases, and lab data Text of other symptoms, signs, known diseases, and lab data Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-09 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other 255

Free-Form Entry

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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C02307 Adverse event verbatim term text AdvrsEvntVerbatimTermText Text that describes the adverse event word for word as described by the participant/subject Adverse event verbatim term text Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

2188132 DeBaun Forms
C08173 Ischemic hemorrhagic or vascular pathology indicator IschHemVasclPathInd Indicator of the presence of ischemic, hemorrhagic, or vascular pathology Indicator of the presence of ischemic, hemorrhagic, or vascular pathology Yes;No;Unknown;Not assessed Yes;No;Unknown;Not assessed Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C01522 Height measurement HgtMeasr Measurement of participant's/subject's height. Measurement of participant's/subject's height. Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

0 400 centimeter 649 DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14052 Hemoglobin measurement HemoglobMeasr The measurement for hemoglobin. The measurement for hemoglobin. Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

g/dL DeBaun Forms
C02006 Medication prior or concomitant dose MedctnPriorConcomDose Dose of prior/concomitant medication taken per administration. Dose of prior/concomitant medication taken per administration. Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

3162729 DeBaun Forms
C19151 Discontinuation date DiscontinuationDate The date of discontinuation The date of discontinuation Date or Date & Time Adult;Pediatric Supplemental 1.00 2014-05-29 11:10:46.0 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

DeBaun Forms
C20415 Serious adverse event report completed date SerAdvrsEvntRprtCompDt Date when the report on the adverse event was completed. Date when the report on the adverse event was completed. Alphanumeric Adult;Pediatric Supplemental 1.00 2015-03-24 11:55:24.0 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

DeBaun Forms
C13241 National Institutes of Health Stroke Scale (NIHSS) - Sensory score NIHSSSensoryScore Sensory abilities assessed using the NIH Stroke Scale (NIHSS) Sensory abilities assessed using the NIH Stroke Scale (NIHSS) 0;1;2;UN;0;1;2;UN Normal: no sensory loss.;Mild to moderate sensory loss: patient feels pinprick is less sharp or is dull on the affected side, or there is a loss of superficial pain with pinprick but patient is aware he/she is being touched.;Severe to total sensory loss: patient is not aware of being touched in the face, arm, and leg.;Unexaminable (intubated/paralyzed);Normal: no sensory loss.;Mild to moderate sensory loss: patient feels pinprick is less sharp or is dull on the affected side, or there is a loss of superficial pain with pinprick but patient is aware he/she is being touched.;Severe to total sensory loss: patient is not aware of being touched in the face, arm, and leg.;Unexaminable (intubated/paralyzed) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C00321 Medical history for body system indicator MedclHistBodySysInd Indicator of whether the participant/subject has a history of medical problems/conditions for the specific body system. Indicator of whether the participant/subject has a history of medical problems/conditions for the specific body system. Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C16679 Cambridge Brain Repair Center Sleep Questionnaire (BRC-Sleep) - intentionally nap day indicator BRCIntentNapDayInd The yes/no indicator for napping intentionally during the day from Cambridge Brain Repair Center Sleep Questionnaire (BRC-Sleep). The yes/no indicator for napping intentionally during the day from Cambridge Brain Repair Center Sleep Questionnaire (BRC-Sleep). No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-14 19:48:50.273 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C02308 Adverse event during study indicator AdvrsEvntDuringStudyInd Indicator of whether the participant/subject experienced any adverse events during the study Indicator of whether the participant/subject experienced any adverse events during the study Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2188132;3177812 DeBaun Forms
C08177 Hemorrhage indicator HemrrhgInd Indicator of the presence of cerebral hemorrhages, regardless of size in any region of the brain Indicator of the presence of cerebral hemorrhages, regardless of size in any region of the brain Yes;No;Unknown;Not assessed Yes;No;Unknown;Not assessed Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other 255

Free-Form Entry

DeBaun Forms
C01535 Respiratory rate RespRate Rate of the participant/subject's breathing (inhalation and exhalation). Rate of the participant/subject's breathing (inhalation and exhalation). Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

0 120 breaths per minute 2644399 DeBaun Forms
C17527 Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex brachioradialis jerk left score FARSPNSNeuExDTenRefBrJLftScore Score for left-side brachioradialis 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 brachioradialis 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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14127 Seizure generalized classification type SeizGenClassTyp The type of generalized epileptic seizures, considered to originate at some point within, and rapidly engage, bilaterally distributed networks and may include such bilateral networks as ortical and subcortical structures, but do not necessarily include the entire cortex, experienced by the participant/subject. The type of generalized epileptic seizures, considered to originate at some point within, and rapidly engage, bilaterally distributed networks, experienced by the participant/subject. Tonic clonic;Absence;Typical;Atypical;Myoclonic absence;Eyelid myoclonia;Myoclonic;Myoclonic atonic;Myoclonic tonic;Clonic;Tonic;Atonic;Epileptic spasms, focal or generalized Tonic clonic (in any combination);Absence;Absence-Typical;Absence-Atypical;Absence-Myoclonic absence;Absence-Eyelid myoclonia;Myoclonic;Myoclonic-Myoclonic atonic;Myoclonic-Myoclonic tonic;Clonic;Tonic;Atonic;Epileptic spasms, focal or generalized Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C02008 Medication prior or concomitant end date and time MedctnPriorConcomEndDateTime The date (and time, if applicable and known) the administration of the prior/concomitant medication ended. The date (and time, if applicable and known) the administration of the prior/concomitant medication ended. Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

3162753 DeBaun Forms
C19166 Special care unit admittance indicator SCUAddmittanceInd Indicator for the admittance of participant to special care unit, including any Intensive Care or Step-Down Unit Indicator for the admittance of participant to special care unit, including any Intensive Care or Step-Down Unit No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-29 13:03:57.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C20416 National Institutes of Health Stroke Scale (NIHSS) - Motor arm amputation text NIHSSMotArmAmpTxt The text field for explaining the amputation or joint fusion for question related to motor ability of the arm (both left and right) assessed using the NIH Stroke Scale (NIHSS). The text field for explaining the amputation or joint fusion for question related to motor ability of the arm (both left and right) assessed using the NIH Stroke Scale (NIHSS). Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
C13242 National Institutes of Health Stroke Scale (NIHSS) - Best language score NIHSSBestLangScore Language ability assessed using the NIH Stroke Scale (NIHSS) Language ability assessed using the NIH Stroke Scale (NIHSS) 0;1;2;3;UN;0;1;2;3;UN No aphasia, normal;Mild to moderate aphasia: some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided material difficult or impossible. For example in conversation about provided materials examiner can identify picture or naming card from patient's response.;Severe aphasia: all communication is through fragmentary expression, great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited: listener carries burden of communication. Examiner cannot identify materials provided from patient response.;Mute, global aphasia: no usable speech or auditory comprehension.;Unexaminable (intubated/paralyzed);No aphasia, normal;Mild to moderate aphasia: some obvious loss of fluency or facility of comprehension, without significant limitation on ideas expressed or form of expression. Reduction of speech and/or comprehension, however, makes conversation about provided material difficult or impossible. For example in conversation about provided materials examiner can identify picture or naming card from patient's response.;Severe aphasia: all communication is through fragmentary expression, great need for inference, questioning, and guessing by the listener. Range of information that can be exchanged is limited: listener carries burden of communication. Examiner cannot identify materials provided from patient response.;Mute, global aphasia: no usable speech or auditory comprehension.;Unexaminable (intubated/paralyzed) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C00322 Medical history condition text MedclHistCondTxt Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

2003874 DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

DeBaun Forms
C02309 Serious adverse event indicator SeriousAdvrsEvntInd The indicator of whether the adverse event is serious. The indicator of whether the adverse event is serious. Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

2199908 DeBaun Forms
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 Selected Debaun CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

DeBaun Forms
C13464 Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - total score PSOMSNETotalScore The total score on the Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). The total score on the Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). Numeric Values Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

0 10 DeBaun Forms
C01539 Temperature measurement TempMeasr Measurement of the participant's/subject's body temperature. Measurement of the participant's/subject's body temperature. Numeric Values Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

0 50 degree Celsius 2644401 DeBaun Forms
C17528 Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex brachioradialis jerk right score FARSPNSNeuExDTenRefBrJRtScore Score for right-side brachioradialis 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 brachioradialis 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 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13198 Questionnaire for Verifying Stroke Free Status (QVSFS) - understanding status QVSFSUndstandStatus Have you ever suddenly lost the ability to understand what people were saying? Have you ever suddenly lost the ability to understand what people were saying? Questionnaire for Verifying Stroke Free Status (QVSFS) No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C14424 Epilepsy etiology specific classification type EpilepsyEtioSpecClassTyp The specific etiologies preceeding the development of epilepsy in the participant/subject, as described by the International League Against Epilepsy (ILAE). The specific etiologies preceding the development of epilepsy in the participant/subject. Viral, bacterial and parasitic infections;Traumatic brain injury;Stroke;Intraventricular hemorrhage;Hypoxic-ischemic encephalopathy;Other metabolic or toxic insults;Neurocutaneous syndromes;Inborn errors of metabolism;Genetic and chromosomal development encephalopathies;Malformations of cortical or other brain development with or without known genetic determinants;Neoplasia;Dementia;Other degenerative neurologic diseases;Genetic or presumed genetic;Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging;Other, specify;Developmental encephalopathy of unknown cause;Mesial Temporal Sclerosis Viral, bacterial and parasitic infections;Traumatic brain injury;Stroke;Intraventricular hemorrhage;Hypoxic-ischemic encephalopathy;Other metabolic or toxic insults;Neurocutaneous syndromes;Inborn errors of metabolism;Genetic and chromosomal development encephalopathies;Malformations of cortical or other brain development with or without known genetic determinants;Neoplasia;Dementia;Other degenerative neurologic diseases;Genetic or presumed genetic;Epilepsy of unknown cause, without relevant abnormalities on examination, cognition, history, or imaging;Other, specify;Developmental encephalopathy of unknown cause as evidenced by the presence of mental retardation, cerebral palsy, or autism with no evidence of a specific insult or disorder to which cause can be attributed preceding the onset of epilepsy;Mesial Temporal Sclerosis Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C02014 Medication prior or concomitant name MedctnPriorConcomName Name of the prior/concomitant agent or drug administered. Name of the prior/concomitant agent or drug administered. Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

3162728 DeBaun Forms
C19167 Special care unit type SCUTyp Type of special care unit Type of special care unit Intensive Care Unit;Step-Down Unit Intensive Care Unit (ICU);Step-Down Unit (SDU) Alphanumeric Adult;Pediatric Supplemental 1.00 2014-05-29 14:04:21.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C20419 National Institutes of Health Stroke Scale (NIHSS) - Limb ataxia amputation text NIHSSLimbAtaxiaAmputTxt The text field for explaining the amputation or joint fusion for question related to Limb ataxia assessed using the NIH Stroke Scale (NIHSS). The text field for explaining the amputation or joint fusion for question related to Limb ataxia assessed using the NIH Stroke Scale (NIHSS). Alphanumeric Adult;Pediatric Supplemental 4.00 2015-04-27 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other 4000

Free-Form Entry

DeBaun Forms
C13243 National Institutes of Health Stroke Scale (NIHSS) - Dysarthria score NIHSSDysarthriaScore Dysarthria assessed using the NIH Stroke Scale (NIHSS) Dysarthria assessed using the NIH Stroke Scale (NIHSS) 0;1;2;UN;0;1;2;UN Normal;Mild to moderate: patient slurs at least some words and, at worst, can be understood with some difficulty.;Severe: patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.;Intubated or other physical barrier, explain;Normal;Mild to moderate: patient slurs at least some words and, at worst, can be understood with some difficulty.;Severe: patient's speech is so slurred as to be unintelligible in the absence of or out of proportion to any dysphasia, or is mute/anarthric.;Intubated or other physical barrier, explain Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C00720 Family history medical condition type FamHistMedclCondTyp Type of medical condition or health related event for which the family history is taken Type of medical condition or health related event for which the family history is taken Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Selected Debaun CDEs Additional Proposed Instruments Other

Multiple Pre-Defined Values Selected

3165585 DeBaun Forms
C17409 Visit date VisitDate Date of interview or visit (actually the date when data in the form were captured) Date of interview or visit Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Free-Form Entry

DeBaun Forms LB VISDAT

Visit Date

Visit Date

What [is/was] the date of the visit?

N/A Char Record the [date/start date] of the visit using DD-MON-YYYY format. Prompt
C02310 Adverse event CTCAE low level term name AdvrsEvntCTCAELowLvlTermName Text that represents the Common Terminology Criteria for Adverse Events (CTCAE) low level term name for an adverse event. Text that represents the Common Terminology Criteria for Adverse Events (CTCAE) low level term name for an adverse event. Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other 255

Free-Form Entry

3125302 DeBaun Forms
C11026 Neuromuscular Exam Muscle weakness indicator NeuromuExmCranlMuscleWeaknInd Indicator whether there is muscle weakness in the muscle or muscle group examined Whether there is muscle weakness in the muscle or muscle group examined Yes;No;Not assessed;Unknown Yes;No;Not assessed;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-08-28 16:08:00.453 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
C13468 Stroke Adjudication Worksheet - symptom duration StrokeAdjudWksSymDur How long the symptom(s) experienced around the time of the stroke event lasted How long the symptom(s) experienced around the time of the stroke event lasted Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed;Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed;Confirmed to be greater than or equal to 24 hours;Confirmed to be less than 24 hours;Duration of symptoms could not be confirmed Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Selected Debaun CDEs Additional Proposed Instruments Other

Single Pre-Defined Value Selected

DeBaun Forms
Displaying 1 - 50 of 137
CSV