CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric
Sub-Domain: Additional Proposed Instruments
CRF: PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric
40 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C59390 | Child problem strength coordination result stroke describe text | ChdPrbStgCrdRstStrkDscTxt | Text field for describing other problems with strength or coordination exhibited by the respondent's child as a result of his or her stroke | Text field for describing other problems with strength or coordination exhibited by the respondent's child as a result of his or her stroke | Other problems with strength or coordination; describe: | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-02 15:50:09.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A.2 Describe | |||||||||||||||||||||||||||
| C59423 | Child stroke rehabilitation treatment current type other text | ChldStrokRehabTxCurrTypOthTxt | Text describing the type of stroke rehabilitation treatment not otherwise specified that the respondent's child is currently receiving | Text describing the type of stroke rehabilitation treatment not otherwise specified that the respondent's child is currently receiving | Other (describe): | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-04 11:10:44.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q7.Describe | |||||||||||||||||||||||||||
| C59401 | Child stroke any subsequent clot indicator | ChldStrokAnySbsqntClotInd | Indicator of whether the respondent's child has had any blood clot at any anatomic site since his or her initial stroke | Indicator of whether the respondent's child has had any blood clot at any anatomic site since his or her initial stroke | Since the first stroke, has your child had another Stroke or Transient Ischemic Attack (TIA) or blood clot in any other blood vessel (e.g. in the leg, lung, heart, other location) ? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:54:17.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3 | ||||||||||||||||||||||||||
| C59412 | Child stroke treatment initial type other text | ChldStrokTxInitlTypOthTxt | Text describing the type of treatment for stroke not otherwise specified that the respondent's child was being given at the beginning of the stroke or clotting episode subsequent to his or her initial stroke | Text describing the type of treatment for stroke not otherwise specified that the respondent's child was being given at the beginning of the stroke or clotting episode subsequent to his or her initial stroke | Other (describe) | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:46:06.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 100 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.Treatment.Describe | |||||||||||||||||||||||||||
| C59391 | Child stroke problem strength coordination sensation affect daily activity indicator | ChStPrStgCrdSnsAffDlyActInd | Indicator of whether the problems with strength, coordination, or sensation including vision or hearing exhibited by the respondent's child as a result of his or her stroke, affect his or her daily activities | Indicator of whether the problems with strength, coordination, or sensation including vision or hearing exhibited by the respondent's child as a result of his or her stroke, affect his or her daily activities | Does the problem affect your child's day-to-day activities? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-02 15:17:35.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A.3 | ||||||||||||||||||||||||||
| C59424 | Death reason | DeathRsn | Reason or cause of death | Reason or cause of death | Cause of death: | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-04 11:26:59.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q8.Cause | |||||||||||||||||||||||||||
| C59402 | Child stroke any subsequent clot type | ChldStrokAnySbsqntClotTyp | Type of the respondent's child's blood clot at any anatomic site, if any, since his or her initial stroke | Type of the respondent's child's blood clot at any anatomic site, if any, since his or her initial stroke | Which type? | Unknown;Stroke in a brain artery;Stroke in a brain vein;Other blood clot;Transient Ischemic Attack (TIA) | Unknown;Stroke in a brain artery (usual form of 'stroke');Stroke in a brain vein ('sinus thrombosis');Other blood clot;Transient Ischemic Attack (TIA) | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:54:17.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.Type | ||||||||||||||||||||||||||
| C59413 | Child headache seizure since discharge after stroke indicator | ChHdchSeizSncDschgAfStrkInd | Indicator of whether the respondent's child experiences headaches or seizures since his or her discharge from hospital after a stroke | Indicator of whether the respondent's child experiences headaches or seizures since his or her discharge from hospital after a stroke | Does your child suffer from headaches or seizures since being discharged after the stroke(s)? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:55:37.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q4 | ||||||||||||||||||||||||||
| C59392 | Child stroke problem strength coordination right side face body code | ChStrProStgCrdRtSdFcBdyCode | Code for the score of the respondent's child's problems with strength or coordination of the right side of the face or body as a result of his or her stroke. | Code for the score of the respondent's child's problems with strength or coordination of the right side of the face or body as a result of his or her stroke. | Right side face or body | n/t;0;0.5;1;2 | Not Done;None;Mild but no impact on function;Moderate with some limitations with daily functions;Severe or profound with missing function | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:28:55.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A.Right side | ||||||||||||||||||||||||||
| C59403 | Child stroke subsequent clot anatomic site | ChldStrokSbsqntClotAnatSite | Anatomic site of the respondent's child's blood clot, if any, since his or her initial stroke | Anatomic site of the respondent's child's blood clot, if any, since his or her initial stroke | State location of blood clot | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:54:17.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 100 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.Type.location | |||||||||||||||||||||||||||
| C59414 | Child headache since discharge after stroke indicator | ChHdchSncDschgAfStrkInd | Indicator of whether the respondent's child experiences headaches since his or her discharge from hospital after a stroke | Indicator of whether the respondent's child experiences headaches since his or her discharge from hospital after a stroke | Headache: | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:55:37.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q4.Headache | ||||||||||||||||||||||||||
| C59393 | Child stroke problem strength coordination left side face body code | ChStrProStgCrdLfSdFcBdyCode | Code for the score of the respondent's child's problems with strength or coordination of the left side of the face or body as a result of his or her stroke. | Code for the score of the respondent's child's problems with strength or coordination of the left side of the face or body as a result of his or her stroke. | Left side face or body | n/t;0;0.5;1;2 | Not Done;None;Mild but no impact on function;Moderate with some limitations with daily functions;Severe or profound with missing function | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:28:55.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A.Left side | ||||||||||||||||||||||||||
| C59404 | Child stroke subsequent clot occur date | ChldStrokSbsqntClotOcurDate | Date of the respondent's child's subsequent blood clot, if any, since his or her initial stroke | Date of the respondent's child's subsequent blood clot, if any, since his or her initial stroke | When was the recurrence (if unknown, please estimate)? | Date or Date & Time | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:54:17.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.When | ||||||||||||||||||||||||||||
| C59415 | Child seizure since discharge after stroke indicator | ChSeizSncDschgAfStrkInd | Indicator of whether the respondent's child experiences seizures since his or her discharge from hospital after a stroke | Indicator of whether the respondent's child experiences seizures since his or her discharge from hospital after a stroke | Seizures | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:55:37.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q4.Seizure | ||||||||||||||||||||||||||
| C59394 | Child stroke problem verbal expression score code | ChdStrokProbVrblExprsnScorCode | Code for the score of the respondent's child's problem with verbal expression as a result of his or her stroke | Code for the score of the respondent's child's problem with verbal expression as a result of his or her stroke | Does your child have difficulty expressing him/herself verbally? (Exclude dysarthrias or pronunciation problems) | n/t;0;0.5;1;2 | Not Done;None;Mild but no impact on function;Moderate with some limitations with daily functions;Severe or profound with missing function | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1B | ||||||||||||||||||||||||||
| C59405 | Child stroke subsequent clot CT MRI indicator | ChldStrokSbsqntClotCTMRIInd | Indicator of whether the respondent's child had a CT or MRI scan at the time of the subsequent blood clot, if any, since his or her initial stroke | Indicator of whether the respondent's child had a CT or MRI scan at the time of the subsequent blood clot, if any, since his or her initial stroke | Did your child have a CT / MRI at the time of the recurrence? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:54:17.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.CTMRI | ||||||||||||||||||||||||||
| 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). | Total Parental PSOM Score | Numeric Values | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 3.00 | 2013-06-21 00:00:00.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Free-Form Entry |
0 | 10 | DeBaun Forms | |||||||||||||||||||||||||||||
| C59416 | Child seizure medication indicator | ChSeizMdctnInd | Indicator of whether the respondent's child takes a seizure medication | Indicator of whether the respondent's child takes a seizure medication | Is he/she on a seizure medicine now? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:55:37.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q4.SeizureMed | ||||||||||||||||||||||||||
| C59395 | Child stroke problem verbal expression describe text | ChdStrokProbVrblExprsnDscrTxt | Text description of the respondent's child's problem with verbal expression as a result of his or her stroke | Text description of the respondent's child's problem with verbal expression as a result of his or her stroke | Please describe | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1B.Describe | |||||||||||||||||||||||||||
| C59406 | Imaging CT MRI new stroke indicator | ImgCTMRINewStrokeInd | Indicator of whether a CT or MRI scan showed a new stroke | Indicator of whether a CT or MRI scan showed a new stroke | Did the CT/MRI show a new stroke? | No;Yes;Unknown | No;Yes;Unknown | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 12:49:52.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.CTMRI.New | ||||||||||||||||||||||||||
| C22354 | Imaging diagnostic method type | ImgDiagMethodType | The type of imaging method utilized for diagnosis. | The type of imaging method utilized for diagnosis. | Which test was done? | MRI;CT;Unknown | MRI;CT;Unknown | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2016-06-09 14:44:44.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
||||||||||||||||||||||||||||||
| C59418 | Health problem procedure result from stroke or treatment indicator | HthPrbPrcdrRstFrStrOrTxInd | Indicator of whether health problems or procedures resulted from the stroke or stroke treatment | Indicator of whether health problems or procedures resulted from the stroke or stroke treatment | Have there been any other major health problems or procedures resulting from the stroke(s) or the stroke(s) treatment? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-04 10:55:58.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q5 | ||||||||||||||||||||||||||
| C59396 | Child stroke problem verbal comprehension score code | ChdStrokProbVrblCmphnsScorCode | Code for the score of the respondent's child's problem with verbal comprehension as a result of his or her stroke | Code for the score of the respondent's child's problem with verbal comprehension as a result of his or her stroke | Does your child have difficulty understanding what is said to her/him? | n/t;0;0.5;1;2 | Not Done;None;Mild but no impact on function;Moderate with some limitations with daily functions;Severe or profound with missing function | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1C | ||||||||||||||||||||||||||
| C59407 | Child stroke subsequent clot clinical symptom new type | ChdStrSubCltClnSympNewTyp | Type of new symptom presented by the respondent's child at the time of the clot subsequent to his or her initial stroke | Type of new symptom presented by the respondent's child at the time of the clot subsequent to his or her initial stroke | Describe the new clinical symptoms at the time of the recurrence: | Difficulty walking;Difficulty with drinking, chewing, or swallowing;Difficulty with vision;Difficulty speaking;Difficulty using hands;Other, describe | Difficulty walking;Difficulty with drinking, chewing, or swallowing;Difficulty with vision;Difficulty speaking;Difficulty using hands;Other, describe | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 12:55:50.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Multiple Pre-Defined Values Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.NewSymptom | ||||||||||||||||||||||||||
| C58800 | Death date | DeathDate | Date on which the subject/participant died | Date on which the subject/participant died | If your child is deceased, please specify: Date of death: | Date or Date & Time | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2018-12-12 12:24:18.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Free-Form Entry |
BMTCTN | 1507A Release 5.10 | Follow Up Status Form - 1507 (F23) | F23DTHDT | ||||||||||||||||||||||||||||
| C59419 | Health problem procedure result from stroke or treatment describe text | HthPrbPrcdrRstFrStrOrTxDscrTxt | Text describing health problems or procedures that resulted from the stroke or stroke treatment | Text describing health problems or procedures that resulted from the stroke or stroke treatment | If yes, describe: | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-04 10:55:58.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q5.Describe | |||||||||||||||||||||||||||
| C59397 | Child stroke problem verbal comprehension describe text | ChdStrokProbVrblCmprhnDscrTxt | Text description of the respondent's child's problem with verbal comprehension as a result of his or her stroke | Text description of the respondent's child's problem with verbal comprehension as a result of his or her stroke | Please describe | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1C.Describe | |||||||||||||||||||||||||||
| C59408 | Child stroke subsequent clot clinical symptom new other text | ChdStrSubCltClnSympNewOthTxt | Text description of type of new symptom not otherwise specified presented by the respondent's child at the time of the clot subsequent to his or her initial stroke | Text description of type of new symptom not otherwise specified presented by the respondent's child at the time of the clot subsequent to his or her initial stroke | Other, describe | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 12:55:50.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.NewSymptom.Describe | |||||||||||||||||||||||||||
| C59387 | Child recover stroke completely indicator | ChldRcvrStrkCmpltInd | Indicator of whether the respondent's child has recovered completely from his or her stroke | Indicator of whether the respondent's child has recovered completely from his or her stroke | Has your child recovered completely from the stroke? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-02 15:12:55.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q1 | ||||||||||||||||||||||||||
| C59420 | Child stroke treatment current type | ChldStrokTxCurrTyp | Type of treatment for stroke that the respondent's child is currently taking | Type of treatment for stroke that the respondent's child is currently taking | What medications are being used right now for stroke treatment? | None;Aspirin;Other, describe;Low molecular weight Heparin;Coumadin | None;Aspirin;Other, describe;Low molecular weight Heparin (Enoxaparin, Loxaprin, injections under the skin);Coumadin (blood thinning pill) | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:46:06.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Multiple Pre-Defined Values Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q6 | ||||||||||||||||||||||||||
| C59398 | Child stroke problem thinking behavior score code | ChdStrokProbThnkBhvrScorCode | Code for the score of the respondent's child's problem with thinking or behavior as a result of his or her stroke | Code for the score of the respondent's child's problem with thinking or behavior as a result of his or her stroke | Does your child have difficulty with his/her thinking or behavior? | n/t;0;0.5;1;2 | Not Done;None;Mild but no impact on function;Moderate with some limitations with daily functions;Severe or profound with missing function | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1D | ||||||||||||||||||||||||||
| C59409 | Child stroke subsequent clot clinical symptom new duration range | ChdStrSubCltClnSympNewDurRng | Range of duration of new symptoms presented by the respondent's child at the time of his or her most recent stroke or other clot. | Range of duration of new symptoms presented by the respondent's child at the time of his or her most recent stroke or other clot. | Describe how long the symptoms lasted with the most recent attack: | Less than 6 hrs;6-24 hours;More than 24 hours | Less than 6 hrs;6-24 hours;More than 24 hours | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 12:55:50.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.HowLong | ||||||||||||||||||||||||||
| C59388 | Child stroke problem strength coordination sensation indicator | ChldStrkPrblmStgthCoordSensInd | Indicator of whether the respondent's child has any problems with strength, coordination, or sensation including vision or hearing as a result of his or her stroke | Indicator of whether the respondent's child has any problems with strength, coordination, or sensation including vision or hearing as a result of his or her stroke | Does your child have any problems with strength, coordination, or sensation including vision or hearing, as a result of the stroke? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-02 15:17:35.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A | ||||||||||||||||||||||||||
| C59421 | Child stroke treatment current type other text | ChldStrokTxCurrTypOthTxt | Text describing the type of treatment for stroke not otherwise specified that the respondent's child is currently on | Text describing the type of treatment for stroke not otherwise specified that the respondent's child is currently on | Other (describe) | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:46:06.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 100 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q6.Other | |||||||||||||||||||||||||||
| C59399 | Child stroke problem thinking behavior describe text | ChdStrokProbThnkngBhvrDscrTxt | Text description of the respondent's child's problem with thinking or behavior as a result of his or her stroke | Text description of the respondent's child's problem with thinking or behavior as a result of his or her stroke | Please describe | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 10:42:49.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X | 255 |
Free-Form Entry |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1D.Describe | |||||||||||||||||||||||||||
| C59410 | Child stroke episode count | ChildStrokeEpisodeCt | Count of episodes of stroke or internal clotting experienced by the respondent's child since his or her initial stroke | Count of episodes of stroke or internal clotting experienced by the respondent's child since his or her initial stroke | If there was more than one episode, how many episodes occurred? | Numeric Values | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:33:42.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Free-Form Entry |
0 | 100 | PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.HowManyEpisodes | ||||||||||||||||||||||||||
| C59389 | Child stroke problem strength coordination sensation type | ChldStkPrblmStgthCoordSensTyp | Type of problems with strength, coordination, or sensation including vision or hearing exhibited by the respondent's child as a result of his or her stroke | Type of problems with strength, coordination, or sensation including vision or hearing exhibited by the respondent's child as a result of his or her stroke | Please choose which of the following are present in your child: | Developmental delay;Abnormal tone;Weakness on one side of the body;Weakness on one side of the face;Unsteadiness on one side of the body;Difficulty with hearing;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Difficulty with speaking clearly;Loss of sensation on one side of the body;Other sensory problems;Other problems with strength or coordination | Developmental delay;Abnormal tone;Weakness on one side of the body;Weakness on one side of the face;Unsteadiness on one side of the body;Difficulty with hearing;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Difficulty with speaking clearly (problem with pronouncing words);Loss of sensation on one side of the body;Other sensory problems;Other problems with strength or coordination | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-02 15:17:35.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Multiple Pre-Defined Values Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | 1A.2 | ||||||||||||||||||||||||||
| C59422 | Child stroke rehabilitation treatment current type | ChldStrokRehabTxCurrTyp | Type of stroke rehabilitation treatment the respondent's child is currently receiving | Type of stroke rehabilitation treatment the respondent's child is currently receiving | What rehabilitation treatments is your child receiving now? | None;Occupational therapy;Physical therapy;Speech therapy;Other, describe;Special education services | None;Occupational therapy;Physical therapy;Speech therapy;Other, describe;Special education services | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-04 11:10:44.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Multiple Pre-Defined Values Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q7 | ||||||||||||||||||||||||||
| C59400 | Child need help daily activity compare peer indicator | ChdNedHlpDlyActCmprPeerInd | Indicator of whether the respondent's child needs help with daily activities compared to his or her peers | Indicator of whether the respondent's child needs help with daily activities compared to his or her peers | Does your child need extra help with day-to-day activities compared with other children of the same age? | No;Yes | No;Yes | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 11:50:59.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Single Pre-Defined Value Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q2 | ||||||||||||||||||||||||||
| C59411 | Child stroke treatment initial type | ChldStrokTxInitlTyp | Type of treatment for stroke that the respondent's child was being given at the beginning of the stroke or clotting episode subsequent to his or her initial stroke | Type of treatment for stroke that the respondent's child was being given at the beginning of the stroke or clotting episode subsequent to his or her initial stroke | What stroke treatment was he/she on at the beginning of the episode? | None;Aspirin;Other, describe;Low molecular weight Heparin;Coumadin | None;Aspirin;Other, describe;Low molecular weight Heparin (Enoxaparin, Loxaprin, injections under the skin);Coumadin (blood thinning pill) | Alphanumeric | PhenX Protocol: Recovery and Recurrence Questionnaire (RRQ) - Pediatrics (#820702) | Pediatric | Proposed | 1.00 | 2019-04-03 15:46:06.0 | PhenX Toolkit: Neurology, QOL Health Services Recovery and Recurrence Questionnaire - Pediatric | Additional Proposed Instruments | Phen-X |
Multiple Pre-Defined Values Selected |
PhenX | Neurology, Quality of Life, and Health Services Specialty Collection | Recovery and Recurrence Questionnaire - Pediatric | Q3.Treatment |
40 results.