CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Miscellaneous Sickle Cell-related CDEs
Sub-Domain: Additional Proposed Instruments
CRF: Miscellaneous Sickle Cell-related CDEs
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C18493 | Screening visit eligibility status | ScreenVisitEligibilityStatus | The status determined from screening criteria that indicates whether a participant/subject may be eligible for a study. | Screening visit eligibility status | Eligible;Eligible but declined;Not eligible;Other, specify;Eligible;Eligible but declined;Not eligible;Other, specify | Eligible;Eligible but declined;Not eligible;Other, specify;Eligible;Eligible but declined;Not eligible;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C08088 | Age value unit of measure | AgeValUoM | Unit of measure used to initially record the age value | Unit of measure used to initially record the age value | Days;Weeks;Months;Years;Days;Weeks;Months;Years | Days;Weeks;Months;Years;Days;Weeks;Months;Years | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14022 | Sickle cell disease criterion result text | SickleCellCriterResltTxt | Indicates sickle cell criterion result | Indicates sickle cell criterion result | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
DeBaun Forms | ||||||||||||||||||||||||||||||||
| C54691 | PROMIS - Global Health social satisfaction rate scale | PROMISGlbHlthSocSatisRtScl | Scale related to an individual's rating of his/her satisfaction with his/her social activities, as part of the PROMIS Global Health | Scale related to an individual's rating of his/her satisfaction with his/her social activities, as part of the PROMIS Global Health | 1;2;3;4;5;1;2;3;4;5 | Excellent;Very good;Good;Fair;Poor;Excellent;Very good;Good;Fair;Poor | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-04-07 15:34:25.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C13462 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - cognitive or behavioral deficit scale | PSOMSNECogBehavDefScale | The scale for cognitive or behavioral deficit based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The scale for cognitive or behavioral deficit based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | 0;0.5;1;2;0;0.5;1;2;0;0.5;1;2 | None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function;None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function;None;Mild but no impact on function;Moderate with some impact on function;Severe or profound with missing function | Numeric values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13919 | Imaging percent stenosis criterion type | ImgPercentStenosisCriterionTyp | The criteria used to find indicate stenosis. | The criteria used to find indicate stenosis. | PSV;PSV/EDV;Other, specify | Peak systolic velocity;Peak systolic velocity/end diastolic velocity;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19059 | Informant participant relationship other text | InformantPartcpntRelateOTH | The free-text field related to 'Informant participant relationship type' specifying other text. The relationship of the informant to participant/subject | The free-text field related to 'Informant participant relationship type' specifying other text. The relationship of the informant to participant/subject | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-30 17:06:52.8 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C12475 | Imaging magnetic resonance imaging T1 T2 sequence name | ImgMRIT1T2SeqName | The name of the T1 or T2 sequences used for Magnetic Resonance Imaging (MRI) | The name of the T1 or T2 sequences used for MRI | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C14683 | Pediatric Migraine Disability Assessment (MIDAS) - headache decrease other activity function day count | PedMIDASHeadDecOActFuncDayCt | Count the days you participate in these activities, but functioned at less than half your ability, as part of migraine disability assessment (MIDAS) questionnaire-pediatric form. | Count the days you participate in these activities, but functioned at less than half your ability, 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 | Other |
Free-Form Entry |
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| C56408 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Matrix Reasoning raw score | WASIIIMRRawScore | The raw score that the subject received on the Matrix Reasoning subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) . | The raw score that the subject received on the Matrix Reasoning subtest of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 11:23:35.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 30 | ||||||||||||||||||||||||||||||||
| C01554 | Oxygen saturation measurement | O2SatMeasr | Value, as a percent, of baseline O2 saturation (SPO2) in nocturnal oximetry, as part of Nocturnal Oximetry. | Value, as a percent, of baseline O2 saturation (SPO2) in nocturnal oximetry, as part of Nocturnal Oximetry. | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 100 | percent | DeBaun Forms | ||||||||||||||||||||||||||||||
| C13951 | Imaging spectrum end diastolic ratio value | ImgSpectrumEndDiastlRatioVal | Indicates spectrum end diastolic ratio result | Indicates spectrum end diastolic ratio result | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C21496 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span backward subtest item score | WAISIVDSBItemScore | Item score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest | Item score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Backward subtest | 0;1;2 | 0;1;2 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C13138 | Hague Side Effects Scale (HASES) - chronic side effects sub scale | HASESChronSESubscale | Hague Side Effects Scale (HASES)- Chronic Side Effects Subscale (6-24) | HASES Chronic Side Effects Subscale (6-24) | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 24 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C13886 | Imaging vessel angiography cause type | ImgVesselAngioCauseTyp | Indicates vessel imaging angiography cause | Indicates vessel imaging angiography cause | Atherosclerotic;Embolic;Other;Unknown;Vasospasm | Atherosclerotic;Embolic;Other;Unknown;Vasospasm | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C13898 | Imaging vessel angiography collateral grade | ImgVesselAngioCollateralGrad | Indicates vessel angiography collateral grade | Indicates vessel angiography collateral grade | Grade 0;Grade 1;Grade 2;Grade 3;Grade 4 | No collaterals visible to the ischemic site;Slow collaterals to the periphery of the ischemic site with persistence of some of the defect;Rapid collaterals to the periphery of ischemic site with persistence of some of the defect and to only a portion of the ischemic territory;Collaterals with slow but complete angiographic blood flow of the ischemic bed by the late venous phase;Complete and rapid collateral blood flow to the vascular bed in the entire ischemic territory by retrograde perfusion. | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C18719 | Imaging slice orientation other text | ImgSliceOrientOTH | The free-text field related to 'Imaging slice orientation type' specifying other text. The slice orientation used in imaging acquisition | The free-text field related to 'Imaging slice orientation type' specifying other text. The slice orientation used in imaging acquisition | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C56444 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Full Scale IQ 4 expected score | WASIIIFullScaleIQ4ExpScore | The Full Scale IQ score for all four subtests that the subject was expected to receive, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The Full Scale IQ score for all four subtests that the subject was expected to receive, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 13:20:27.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C08254 | Imaging visual analysis location performed type | ImgVisAnlysisLocPerfTyp | Location where visual analysis of the imaging data are performed | Location where visual analysis of the imaging data are performed | Central;Central read;Local - Site;Local read;Local report;Other, specify | Central;Central read;Local - Site;Local read;Local report;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14033 | Vasospasm vessel anatomic site | VasospasmVesselAntmicSite | Indicates vasospasm vessel(s) | Indicates vasospasm vessel(s) | ICA;Basilar;MCA;Other, specify;ACA;VA | Internal carotid artery;Basilar;Middle cerebral artery;Other, specify;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 | Other |
Multiple Pre-Defined Values Selected |
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| C55779 | Imaging automated evaluation vascular MRI data indicator | ImagAutoEvalVasMRIDataInd | The indicator relating to whether or not an automated evaluation of vascular magnetic resonance imaging (MRI) data has been given. | The indicator relating to whether or not an automated evaluation of vascular magnetic resonance imaging (MRI) data has been given. | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-31 12:26:23.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C00008 | Age value | AgeVal | Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. | Value for participant/subject's age, calculated as elapsed time since the birth of the participant/subject. | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 1800 | month | DeBaun Forms | ||||||||||||||||||||||||||||||
| C13930 | Intima media thickness (IMT) timing type | IMTTimingTyp | Indicates intima media thickness (IMT) timing type | Indicates intima media thickness (IMT) timing type | ECG Gating;End Diastolic;Peak Systolic;ECG Gating;End Diastolic;Peak Systolic | ECG Gating;End Diastolic;Peak Systolic;ECG Gating;End Diastolic;Peak Systolic | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C19840 | Medical history medication change since last visit indicator | MedHistMedctnChngeSLVInd | Indicator of medication changes since last study visit | Indicator of medication changes since last study visit | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-06 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C12486 | Imaging other cortical abnormality type | ImgOthrCorticalAbnrmlyTyp | The type of other cortical abnormality | The type of other cortical abnormality | Schizencephaly;Porencephaly;Other, specify | Schizencephaly;Porencephaly;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C16100 | Symptoms new or worsening neurologic indicator | SymptmNewWrseNeuroInd | Indicates whether the participant/subject has new neurologic symptoms or an acute worsening of preexisting neurologic symptoms | Indicates whether the participant/subject has new neurologic symptoms or an acute worsening of preexisting neurologic symptoms | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56420 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Examinee visual hearing aid glasses used indicator | WASIIIExVisHearAidGlassUsedInd | The indicator relating to whether the examine used his/her glasses during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The indicator relating to whether the examine used his/her glasses during testing, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | Used;Not used | Used;Not used | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-06-12 11:53:18.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C02016 | Medication prior or concomitant start date and time | MedctnPriorConcomStrtDateTime | The date (and time, if applicable and known) on which the prior/concomitant medication usage began. | The date (and time, if applicable and known) on which the prior/concomitant medication usage began. | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
3162752 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C14000 | Extracranial stenosis present indicator | ExtracranStenPresInd | Indicates presence of extracranial stenosis | Indicates presence of extracranial stenosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C21507 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span subtest total raw score | WAISIVDSTtlScore | Total score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span subtest | Total score, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span subtest | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 48 | ||||||||||||||||||||||||||||||||
| C13234 | National Institutes of Health Stroke Scale (NIHSS) - Level of consciousness tertiary question score | NIHSSLvlConscTertryQScore | Level of consciousness (LOC) commands assessed using the NIH Stroke Scale (NIHSS) | Level of consciousness (LOC) commands assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;0;1;2;0;1;2 | Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly;Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly;Performs both tasks correctly.;Performs one task correctly;Performs neither task correctly | Numeric values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C14011 | Intracranial stenosis present indicator | IntracranStenosisPresentInd | Indicates presence of intracranial stenosis | Indicates presence of intracranial stenosis | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C54609 | Brief Test of Executive Function Second Edition (BRIEF 2) - Emotional control total raw scale score | BRIEF2EmtnlCntrlTtlRwSclScore | Total score of the raw scale for the emotional control function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) | Total score of the raw scale for the emotional control function, as part of the Brief Test of Executive Function Second Edition (BRIEF 2) | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-03-22 09:57:02.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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| C13245 | National Institutes of Health Stroke Scale (NIHSS) - Severity total score | NIHSSSevTotalScore | The level of stroke severity as measured by the NIH Stroke Scale (NIHSS) scoring system (i.e., total of the subscale item scores). | The level of stroke severity as measured by the NIH Stroke Scale (NIHSS) scoring system (i.e., total of the subscale item scores). | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 42 | ||||||||||||||||||||||||||||||||
| C13909 | Imaging plaque surface type | ImgPlaqSurfaceTyp | Indicates plaque surface type | Indicates plaque surface type | Irregular;Smooth | Irregular;Smooth | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C18888 | Imaging acquisition reason other text | ImgAcquisitionRsnOTH | The free-text field related to 'Imaging acquisition reason' specifying other text. Describes why the imaging study was performed | The free-text field related to 'Imaging acquisition reason' specifying other text. Describes why the imaging study was performed | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
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| C10931 | Imaging quality of images technically satisfactory indicator | ImgQualImgTechnSatisInd | Indicator of whether the quality of the images were technically satisfactory. | Indicator of whether the quality of the images were technically satisfactory. | Yes;No;Unknown;Not applicable | Yes;No;Unknown;Not applicable | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C14443 | Muscle tone assessment anatomic site | MuscToneAssmtAntmicSite | Anatomic location of the muscle tone as part of the motor examination. | Anatomic location of the muscle tone as part of the motor examination. | Right upper extremity;Left upper extremity;Right lower extremity;Left lower extremity;Truncal tone | Right upper extremity (RUE);Left upper extremity (LUE);Right lower extremity (RLE);Left lower extremity (LLE);Truncal tone | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56388 | Conners Continuous Performance Test 3rd Edition (CPT3) - Impulsivity commission count | ConnersCPT3ImpCommCt | The number of incorrect responses to non-targets, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | The number of incorrect responses to non-targets, as part of the Conners Continuous Performance Test 3rd Edition (CPT3). | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-06-09 15:38:27.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | |||||||||||||||||||||||||||||||||
| C01013 | Physical exam description text | PhysExamDescripTxt | Free text field to describe the abnormality in a specific body system or an explanation of why the body system was not examined | Free text field to describe the abnormality in a specific body system or an explanation of why the body system was not examined | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
2201880 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C13941 | Imaging insonation plane type | ImgInsonPlaneTyp | Indicates insonation plane | Indicates insonation plane | Free;Coronal;Axial mesencephalic | Free;Coronal;Axial mesencephalic | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C21486 | Wechsler Adult Intelligence Scale IV (WAIS IV) - Digit span forward subtest trial number | WAISIVDSFTrialNum | Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest | Trial number, as part of Wechsler Adult Intelligence Scale IV (WAIS IV) Digit Span Forward subtest | 1;2 | Trial 1;Trial 2 | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2015-07-22 11:32:44.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C12497 | Imaging cerebellum abnormality type | ImgCrblmAbnrmlyTyp | The type of abnormality in the cerebellum on the image | The type of abnormality in the cerebellum on the image | Other, specify;Cleft;Vermal hypoplasia;Hemispheric hypoplasia;Vermal dysplasia;Hemispheric dysplasia;Cysts | Other, specify;Cleft;Vermal hypoplasia;Hemispheric hypoplasia;Vermal dysplasia;Hemispheric dysplasia;Cysts | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:38:01.2 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
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| C17503 | Hemoglobin electrophoresis type | HemoglbnElectrophoresisType | Type of hemoglobin that was identified by the electrophoresis test being reported | Type of hemoglobin that was identified by the electrophoresis test being reported | HbSS;HbSA;HBAA;HbFF;HbAF | HbSS;HbSA;HBAA;HbFF;HbAF | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C56431 | Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II) - Perceptual Reasoning confidence interval lower bound value | WASIIIPercRsngConfIntrvlLowVal | The lower bound of the subject's Perceptual Reasoning confidence interval, as part of the Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II). | The lower bound of the subject's Perceptual Reasoning 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 | Other |
Free-Form Entry |
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| C02311 | Adverse event MedDRA lower level term code | AdvsEvntMedDRALowerLvlTermCode | Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lower Level Term (LLT) for an adverse event | Code that corresponds to the Medical Dictionary for Regulatory Activities (MedDRA) Lower Level Term (LLT) for an adverse event | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-18 16:35:19.49 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
3133353 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C18610 | Imaging in plane resolution axis 2 measurement | ImgInPlaneRsltnAxis2Measr | Axis 2 of in-plane spatial resolution used in imaging acquisition | Axis 2 of in-plane spatial resolution used in imaging acquisition | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2013-09-12 00:00:00.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
millimeter | |||||||||||||||||||||||||||||||||
| C08147 | Data source | DataSource | Source of the data provided on the case report form | Source of the data provided on the case report form | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse | Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:46:24.96 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| 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 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C54692 | PROMIS - Global Health carry out social role scale | PROMISGlbHlthCrryOutSocRlScl | Scale related to an individual's rating of his/her ability to carry out usual social activities and roles, as part of the PROMIS Global Health | Scale related to an individual's rating of his/her ability to carry out usual social activities and roles, as part of the PROMIS Global Health | 1;2;3;4;5;1;2;3;4;5 | Excellent;Very good;Good;Fair;Poor;Excellent;Very good;Good;Fair;Poor | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-04-07 15:34:25.0 | Miscellaneous Sickle Cell-related CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |