CDE Detailed Report
Disease: Sickle Cell Disease
Sub-Domain: Additional Proposed Instruments
CRF: Selected Debaun CDEs
Sub-Domain: Additional Proposed Instruments
CRF: Selected Debaun 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C00007 | Birth date | BirthDate | Date (and time, if applicable and known) the participant/subject was born | Date (and time, if applicable and known) the participant/subject was born | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
793 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C14462 | Reflex plantar right response result | RflxPlntrRtRespnsReslt | The results from reflex plantar response on the right side | The results from reflex plantar response on the right side | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2012-10-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C02203 | Off study reason | OffStdyRsn | Primary reason participant/ subject is no longer participating in study (i.e., is not being followed and will not receive intervention/treatment). | Primary reason participant/ subject is no longer participating in study (i.e., is not being followed and will not receive intervention/treatment). | Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died;Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died | Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died;Completed study;Refused further participation (or withdrew consent);Lost to follow-up (or cannot be located);Died | 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 |
2979313 | DeBaun Forms | ||||||||||||||||||||||||||||||
| C19779 | Medical history asthma pulmonary assessment indicator | MedHistAsthmaPulAssesInd | Indicator of history of asthma | Indicator of history of asthma | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13233 | National Institutes of Health Stroke Scale (NIHSS) - Level of consciousness secondary question score | NIHSSLvlConscSecdryQScore | Level of consciousness (LOC) questions assessed using the NIH Stroke Scale (NIHSS) | Level of consciousness (LOC) questions assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;0;1;2;0;1;2 | Answers both questions correctly;Answers one question correctly;Answers neither question correctly;Answers both questions correctly;Answers one question correctly;Answers neither question correctly;Answers both questions correctly;Answers one question correctly;Answers neither question correctly | 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 | |||||||||||||||||||||||||||||||
| C13457 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - sensorimotor deficit type | PSOMSNESensDefTyp | The type of sensorimotor deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The type of sensorimotor deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | Global developmental delay;Global hypotonia or hypertonia;Hemiparesis;Hemifacial weakness;Dysarthria;Hemitaxia;Other motor deficit;Hemisensory deficit;Other sensory deficit;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Other describe | Global developmental delay;Global hypotonia or hypertonia;Hemiparesis;Hemifacial weakness;Dysarthria;Hemitaxia;Other motor deficit;Hemisensory deficit;Other sensory deficit;Difficulty with vision;Difficulty with drinking, chewing, or swallowing;Other describe | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
2201880 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C17495 | Delay motor milestone indicator | DelayMotorMilestoneInd | Indicator as to whether the participant/subject has or had delayed motor milestones, as diagnosed by a pediatrician or neurologist | Indicator as to whether the participant/subject has or had delayed motor milestones, as diagnosed by a pediatrician or neurologist | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | 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 | |||||||||||||||||||||||||||||||
| C04804 | Hospital discharge date and time | HospitDischgDateTime | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Date (and time, if applicable and known) the participant/subject was discharged from the hospital | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||||
| C14007 | Imaging Transcranial Doppler (TCD) findings result type | ImgTCDFindResltTyp | Indicates Transcranial Doppler (TCD) findings | Indicates Transcranial Doppler (TCD) findings | Reversed Diastolic Flow;Systolic spike;No signals;Reduced upstroke/Pulsatility Index (PI) | Reversed Diastolic Flow;Systolic spike;No signals;Reduced upstroke/Pulsatility Index (PI) | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C01701 | Lab specimen collection date and time | LabSpecmnCollDateTime | Date (and time if applicable and known) when the specimen was collected | Date (and time if applicable and known) when the specimen was collected | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
2004004 | DeBaun Forms | LB | LBDTC |
Specimen Collection Date |
Collection Date |
What was the date of the lab specimen collection? |
LBDTC | Char | Record the date when specimen collection was done using this format (DD-MON-YYYY). | Prompt | |||||||||||||||||||||||
| C18492 | Screening visit date and time | ScreenVisitDateTime | Date (and time, if applicable and known) the participant/subject was interviewed and screened for potential enrollment into the study | Subject screened date and time | 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 |
DeBaun Forms | |||||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 24 | DeBaun Forms | |||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 1800 | month | DeBaun Forms | ||||||||||||||||||||||||||||||
| C14463 | Reflex plantar left response result | RflxPlntrLftRespnsReslt | The results from reflex plantar response on the left side | The results from reflex plantar response on the left side | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Flexor;Extensor;Equivocal;Cannot Assess;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2012-10-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Multiple Pre-Defined Values Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C02209 | Informed consent obtained indicator | InfConsntObtInd | Indicator of whether informed consent was obtained for the participant/subject to participate in the clinical research study. | Indicator of whether informed consent was obtained for the participant/subject to participate in the clinical research 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 |
2186028 | DeBaun Forms | ||||||||||||||||||||||||||||||
| C19805 | Medical history endocrine osteoporosis indicator | MedHistEndcrnOstprsisInd | Indicator of history of osteoporosis | Indicator of history of osteoporosis | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13458 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - language deficit-production scale | PSOMSNELangDefProdScale | The scale for language deficit - production (including dysarthria) based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The scale for language deficit - production (including dysarthria) 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 | |||||||||||||||||||||||||||||||
| C01041 | Alteration consciousness indicator | AOCInd | The indicator of whether the participant/subject experienced any period of alteration of consciousness (AOC). | The indicator of whether the participant/subject experienced any period of alteration of consciousness (AOC). | Yes;No;Suspected;Unknown | Yes;No;Suspected;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C04808 | RETIRED Death cause ICD-9-CM code | DeathCauseICD9CMCode | REDIRECTED to C21665 – Death cause ICD-10-CM code | ICD-9-CM code that describes the cause of participant/subject's death | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
3178386 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C14019 | Sickle cell disease present indicator | SickleCellPresInd | Indicates presence of sickle cell | Indicates presence of sickle cell | Yes;No;Unknown | Yes;No;Unknown | 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 | |||||||||||||||||||||||||||||||
| C01702 | Pregnancy test date and time | PregTestDateTime | The date (and time if applicable and known) when the pregnancy test was performed | The date (and time if applicable and known) when the pregnancy test was performed | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13147 | Stroke Specific Quality of Life Scale (SS-QOL) - trouble phone language scale | SSQOLTroubPhonScale | The scale for trouble speaking on phone based on Stroke Specific Quality of Life Scale (SS-QOL). | The scale for trouble speaking on phone based on Stroke Specific Quality of Life Scale (SS-QOL). | 1;2;3;4;5;1;2;3;4;5 | Total help - Couldn't do it at all - Strongly agree;A lot of help - A lot of trouble - Moderately agree;Some help - Some trouble - Neither agree nor disagree;A little help - A little trouble - Moderately disagree;No help needed - No trouble at all - Strongly disagree;Total help - Couldn't do it at all - Strongly agree;A lot of help - A lot of trouble - Moderately agree;Some help - Some trouble - Neither agree nor disagree;A little help - A little trouble - Moderately disagree;No help needed - No trouble at all - Strongly disagree | 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 | |||||||||||||||||||||||||||||||
| C00023 | Hand preference type | HandPrefTyp | Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. | Hand which the participant/subject uses predominantly, not necessarily the hand he/she writes with exclusively. | Left hand;Right hand;Both hands;Unknown;Forced right | Left hand;Right hand;Both hands;Unknown;Forced right | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
2180147 | DeBaun Forms | ||||||||||||||||||||||||||||||
| C14559 | EEG recording start date and time | EEGRecordingStrtDateTime | Date (and time, if applicable and known) the electroencephalogram (EEG) recording began | Date the electroencephalogram (EEG) recording began | 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 |
DeBaun Forms | |||||||||||||||||||||||||||||||||
| C02212 | Informed consent obtained date and time | InformConsntObtnDateTime | Date (and time, if applicable and known) on which the participant/subject (or the legal representative on behalf of the participant/subject) agrees to participate in a protocol, treatment, or other activity by signing an informed consent document. | Date (and time, if applicable and known) on which the participant/subject (or the legal representative on behalf of the participant/subject) agrees to participate in a protocol, treatment, or other activity by signing an informed consent document. | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
2435038,656 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C19810 | Medical history abdominal kidney problem indicator | MedHistAbdmnlKdnyProbInd | Indicator of history of kidney problem | Indicator of history of kidney problem | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13235 | National Institutes of Health Stroke Scale (NIHSS) - Best gaze score | NIHSSLvlConscBestGazeScore | Best gaze assessed using the NIH Stroke Scale (NIHSS) | Best gaze assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;0;1;2 | Normal;Partial gaze palsy. This score is given when gaze is abnormal in one or both eyes, but where forced deviation or total gaze paresis are not present;Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver;Normal;Partial gaze palsy. This score is given when gaze is abnormal in one or both eyes, but where forced deviation or total gaze paresis are not present;Forced deviation, or total gaze paresis not overcome by the oculocephalic maneuver | 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 | |||||||||||||||||||||||||||||||
| C13459 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - language deficit-production description text | PSOMSNELangDefProdDescTxt | Description of the language production deficits observed in the participant/subject based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | Description of the language production 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 | ||||||||||||||||||||||||||||||||
| C01052 | Loss of consciousness indicator | LOCInd | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC). | Yes;No;Suspected;Unknown | Yes;No;Suspected;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C17523 | Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex ankle jerk left score | FARSPNSNeuExDTenRAnkJLftScore | Score for left-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | Score for left-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | 0;1;2;3;4;0;1;2;3;4;0;1;2;3;4 | 0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C05408 | Hospital admission date and time | HospitlAdmissDateTime | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
DeBaun Forms | |||||||||||||||||||||||||||||||||
| C14021 | Sickle cell disease velocity measurement | SickleCellVelMeasr | The velocity measurement of sickle cell. | The velocity measurement of sickle cell. | 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 | 999 | centimeter per second | DeBaun Forms | ||||||||||||||||||||||||||||||
| C01705 | Lab test name | LabTestName | Name representing the lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. | Name representing the lab test performed on body fluid(s) and tissues. Test names are typically comprised of the analyte name, properties (%, Ratio, etc.), the type of body fluid tested, and any special instructions. | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
2003746 | DeBaun Forms | LB | LBTEST |
Lab Test or Examination Name |
Laboratory Test Name |
What was the lab test name? |
LBTEST; LBTESTCD | Char | Record the name of the Lab measurement or finding, if not preprinted on the CRF. If collected on the CRF, the sponsor may provide additional instructions to ensure the data is entered as intended. | (LBTEST) |
[Select appropriate values from the LBTEST codelist] |
Prompt | Radio | ||||||||||||||||||||
| C18666 | Body system other text | BodySysOTH | The free-text field related to 'Body system category' specifying other text. Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured | Free-text category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems. | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2014-05-27 13:34:46.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other | 4000 |
Free-Form Entry |
2002895 | DeBaun Forms | |||||||||||||||||||||||||||||||
| C13192 | Questionnaire for Verifying Stroke Free Status (QVSFS) - stroke status | QVSFSStrokeStatus | Were you ever told by a physician that you had a stroke? | Were you ever told by a physician that you had a stroke? 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 | |||||||||||||||||||||||||||||||
| C00035 | Gender Type | GenderTyp | Self-reported gender of the participant/subject. Gender is the socially constructed identity of sex. Gender is equated with phenotypic sex. Gender may differ from the sex of an individual determined genetically. | Self-reported gender of the participant/subject. Gender is the socially constructed identity of sex. | Female;Male;Unknown;Unspecified;Not reported | Female;Male;Unknown;Undifferentiated/Indeterminant/Intersex;Not reported | 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 |
2200604 | DeBaun Forms | ||||||||||||||||||||||||||||||
| 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 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C02301 | Adverse event end date and time | AdverseEvntEndDateTime | Date (and time, if applicable and known) on which the adverse event discontinued/stopped | Date (and time, if applicable and known) on which the adverse event discontinued/stopped | 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 |
2189843 | DeBaun Forms | ||||||||||||||||||||||||||||||||
| C19811 | Medical history abdominal liver problem indicator | MedHistAbdmnlLiverProbInd | Indicator of history of liver problem | Indicator of history of liver problem | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2015-02-05 00:00:00.0 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
DeBaun Forms | |||||||||||||||||||||||||||||||
| C13236 | National Institutes of Health Stroke Scale (NIHSS) - Visual field score | NIHSSLvlConscVisuFldScore | Visual fields assessed using the NIH Stroke Scale (NIHSS) | Visual fields assessed using the NIH Stroke Scale (NIHSS) | 0;1;2;3;UN;0;1;2;3;UN | No visual loss;Partial hemianopia;Complete hemianopia;Bilateral hemianopia (blind including cortical blindness);Unexaminable (intubated/paralyzed);No visual loss;Partial hemianopia;Complete hemianopia;Bilateral hemianopia (blind including cortical blindness);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 |
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| C13460 | Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003) - language deficit-comprehension scale | PSOMSNELangDefCompScale | The scale for language deficit - comprehension based on Pediatric Stroke Outcomes Measure-Neuro Exam (PSOM-SNEVOct2003). | The scale for language deficit - comprehension 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 |
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| C01507 | Blood pressure diastolic measurement | BldPressrDiastlMeasr | Measurement of pressure of the participant's/subject's blood against the artery walls during diastole (the relaxation phase) in millimeters of mercury (mmHg) | Measurement of pressure of the participant's/subject's blood against the artery walls during diastole (the relaxation phase) in millimeters of mercury (mmHg) | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
0 | 300 | millimeter of mercury | 2004291 | DeBaun Forms | |||||||||||||||||||||||||||||
| C17524 | Friedreich's Ataxia Rating Scale (FARS) - neurological exam peripheral deep tendon reflex ankle jerk right score | FARSPNSNeuExDTenRAnkJRtScore | Score for right-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | Score for right-side ankle jerk in the peripheral nervous system section of the neurological exam, as part of the Friedreich's Ataxia Rating Scale (FARS). | 0;1;2;3;4;0;1;2;3;4;0;1;2;3;4 | 0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia;0 - absent;1 - hyporeflexia;2 - normal;3 - hyperreflexia;4 - pathologic hyperreflexia | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-15 16:08:48.687 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Single Pre-Defined Value Selected |
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| C06421 | SCI Classification light touch single side score | SCIClssLghtTchSnglSdScore | Score of sensation of light touch for the specific side of the body. | Score of sensation of light touch for the specific side of the body. | Numeric Values | Adult;Pediatric | Supplemental | 3.00 | 2013-07-17 09:26:36.973 | Selected Debaun CDEs | Additional Proposed Instruments | Other |
Free-Form Entry |
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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 | Selected Debaun CDEs | Additional Proposed Instruments | Other | 255 |
Free-Form Entry |
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| C02004 | Study drug dispensed date and time | StdyDrugDispnsdDateTime | Date (and time, if applicable and known) on which a participant/subject was given or applied a therapeutic agent (drug, intervention therapy) used in a clinical trial protocol | Date (and time, if applicable and known) on which a participant/subject was given or applied a therapeutic agent (drug, intervention therapy) used in a clinical trial protocol | 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 |
3163963 | DeBaun Forms |