CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Intake Medical History
Sub-Domain: Additional Proposed Instruments
CRF: Intake Medical History
82 results.
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Additional Notes (Question Text) | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guideline) | Sub Domain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | Source | Form Set | Form | Field | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C19764 | Medical history retinal detachment diagnosis indicator | MedHistRetnlDetachDiagInd | Indicator of history of retinal detachment | Indicator of history of retinal detachment | Retinal detachment | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19807 | Medical history abdominal difficulty eating indicator | MedHistAbdmnlDfcltyEatingInd | Indicator of history of difficulty eating | Indicator of history of difficulty eating | History of difficulty eating? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19839 | Pain exersice indicator | PainExrcseInd | Indicator of pain while excercising | Indicator of pain while excercising | Pain with exercise? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19775 | Medical history sleep pulmonary assessment indicator | MedHistSleepPulAssessInd | Indicator of sleep study completed | Indicator of sleep study completed | Any sleep study done? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19786 | Medical history pulmonary bilevel positive airway pressure hospitalization indicator | MedHistPlmnryBiPAPHosptlInd | Indicator of bilevel positive airway pressure hospitilization | Indicator of bilevel positive airway pressure hospitilization | BiPAP only with hospitalization or illness: | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19818 | Medical history musculoskeletal total broken bones trauma type | MedHistMusclBrknBonTraumaTyp | Type of broken bone trauma | Type of broken bone trauma | If Yes, specify bones broken and mechanism broken: | Major trauma;Minor trauma (slip and fall) | Major trauma;Minor trauma (slip and fall) | Alphanumeric |
Answer for all applicable broken bones |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C19797 | Medical history endocrine early puberty indicator | MedHistEndcrnErlyPubrtyInd | Indicator of history of early puberty | Indicator of history of early puberty | Any history of early puberty? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19829 | Behavioral issues indicator | BehavrIssuesInd | Indicator of behavioral issues | Indicator of behavioral issues | Behavioral issues? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19765 | Medical history auditory deafness diagnosis indicator | MedHistAudtryDeafDiagInd | Indicator of any history of deafness | Indicator of any history of deafness | Any history of deafness? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19808 | Medical history abdominal difficulty swallowing indicator | MedHistAbdmnlDfclSwallInd | Indicator of history of difficulty swallowing | Indicator of history of difficulty swallowing | History of difficulty swallowing? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19776 | Medical history sleep pulmonary assessment date | MedHistSleepPulAssessDate | Date of sleep study completed | Date of sleep study completed | If Yes, date sleep study done | Date or Date & Time |
The date should be recorded in the format YYYY/MM. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19787 | Medical history pulmonary ventilator use indicator | MedHistPlmnryVentltrUseInd | Indicator of ventilator used | Indicator of ventilator used | Ventilator: | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19819 | Medical history musculoskeletal joint dislocation indicator | MedHistMusclJointDislocInd | Indicator of joint dislocation | Indicator of joint dislocation | Joint dislocation? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19798 | Medical history endocrine male indicator | MedHistEndcrnMaleInd | Text of age of breast bud formation detected | Text of age of breast bud formation detected | If participant/subject is male, check N/A | Alphanumeric |
If pariticpant/subject is male, check N/A |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19830 | Behavioral issues onset date | BehavrIssuesOnstDate | Date of onset of behavioral issues | Date of onset of behavioral issues | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Neurologic question #5 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19766 | Medical history auditory deafness diagnosis date | MedHistAudtryDeafDiagDate | Date deafness first detected | Date deafness first detected | If Yes, date first detected: | Date or Date & Time |
The date should be recorded in the format YYYY/MM. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19809 | Medical history abdominal constipation indicator | MedHistAbdmnlConstptnInd | Indicator of history of constipation | Indicator of history of constipation | History of constipation? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19777 | Medical history wheezing pulmonary assessment indicator | MedHistWheezPulAssessInd | Indicator of wheezing | Indicator of wheezing | Wheezing? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19788 | Medical history pulmonary ventilator use frequency | MedHistPlmnryVentltrUseFreq | Frequency of use of ventilator | Frequency of use of ventilator | If Yes, how many hours a day? | Numeric Values |
The answer should be recorded as the number of hours per day. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19820 | Medical history musculoskeletal total joint dislocations count | MedHistMusclTtlJointDislocCt | Number of total joints dislocated | Number of total joints dislocated | If Yes, total number of joint dislocations: | Numeric Values |
Only answered if Musculoskeletal question # 2 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19799 | Medical history endocrine breast bud formation age value | MedHistEndcrnBrBudFormAgeVal | Text of age of breast bud formation detected | Text of age of breast bud formation detected | If female, at what age did you notice breast bud formation? | Numeric Values |
Only to be answered if participant/subject is female. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19831 | Psychiatric anxiety indicator | PsychAnxInd | Indicator of anxiety | Indicator of anxiety | Anxiety: | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19767 | Medical history pulmonary difficulty diagnosis indicator | MedHistoryPlmnryDfltcyDiagInd | Indicator of difficulty breathing | Indicator of difficulty breathing | Any difficulty breathing? | Yes;No;Sometimes | Yes;No;Sometimes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19778 | Medical history wheezing pulmonary nebulizer use frequency | MedHistWheezPulNebulUseFreq | Frequency of nebulizer use in relation to wheezing | Frequency of nebulizer use in relation to wheezing | If Yes, how often do you use nebulizer? | Numeric Values |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19810 | Medical history abdominal kidney problem indicator | MedHistAbdmnlKdnyProbInd | Indicator of history of kidney problem | Indicator of history of kidney problem | Ever have a kidney problem? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | ||||||||||||||||||||||||||||
| C19789 | Medical history pulmonary cough assist status | MedHistPlmnryCghAstStatus | Status of cough assist | Status of cough assist | Mechanical In/Ex-sufflation (cough assist): | Daily;Only when ill;Don't use;Unknown | Daily;Only when ill;Don't use;Unknown | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19821 | Medical history musculoskeletal joint dislocation type | MedHistMusclskltlJointDislocTyp | Type of joints dislcoated | Type of joints dislcoated | If Yes, specify joints dislocated and mechanism | Elbow;Patella (knee cap);Wrist;Shoulder | Elbow;Patella (knee cap);Wrist;Shoulder | Alphanumeric |
Choose all that apply |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C19800 | Medical history endocrine menarche indicator | MedHistEndcrnMenarcheInd | Indicator of start of menarche | Indicator of start of menarche | If female, start of her period (menarche)? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Only to be answered if participant/subject is female. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19832 | Psychiatric anxiety onset date | PsychAnxOnstDate | Date of onset of anxiety | Date of onset of anxiety | If Yes, date of onset | Date or Date & Time |
The date should be recorded in the format YYYY/MM, and only answered if Psychiatric question #1 is answered Yes. |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C19768 | Medical history pulmonary difficulty ingestion relatedness indicator | MedHistPlDfltcyIngesRltdnsInd | Indicator of difficulty breathing relation to meal times | Indicator of difficulty breathing relation to meal times | If Yes, is difficulty breathing related to meal times? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric |
Only answered if Pulmonary question #1 is answered Yes |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19779 | Medical history asthma pulmonary assessment indicator | MedHistAsthmaPulAssesInd | Indicator of history of asthma | Indicator of history of asthma | History of asthma? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | 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 | Ever have a liver problem? | No;Yes | No;Yes | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Proposed | 1.00 | 2015-02-05 00:00:00.0 | Intake Medical History | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms |
82 results.