CDE Detailed Report
Subdomain Name: History of Disease/Injury Event
CRF: Post-traumatic Headache (PTH) Mild TBI Questionnaire
Displaying 51 - 63 of 63
CDE ID | CDE Name | Variable Name | Definition | Short Description | 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 / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
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C59637 | Headache additional symptom type | HdchAddtnlSymptmTyp | Type of additional symptoms the participant/subject experienced with headache | Type of additional symptoms the participant/subject experienced with headache | Headache Symptom | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Miosis (i.e., excessive constriction of the pupil of the eye);Aural fullness (i.e., stuffy ears or fluid in the ears);Conjunctival Injection (i.e., white of eye gets red);Tearing;Nasal congestion;Eyelid swelling;Eyelid drooping;Facial sweating | Alphanumeric |
Choose all that apply |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:13:24.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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C16208 | Family history medical condition second-degree relative type | FamHistMedclCondScndDegReltTyp | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of the second-degree family member or ancestor with the medical condition or health related event to the participant/subject | Relationship of second-degree relative(s) to participant/subject | 11;12;13;14;15;16;17;18;19;20;21;22;23;24 | Half-Sibling Male;Half-Sibling Female;Maternal Grandmother;Maternal Grandfather;Paternal Grandmother;Paternal Grandfather;Maternal Aunt;Maternal Uncle;Paternal Aunt;Paternal Uncle;Grandchild Male;Grandchild Female;Nephew;Niece | Numeric Values |
Separate multiple codes with comma |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-16 14:01:43.01 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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C59616 | Headache day since onset count | HdchDaySinceOnsetCt | Count of days passed since participant's/subject's onset of post traumatic headache | Count of days passed since participant's/subject's onset of post traumatic headache | Number of days passed since onset of PTH: | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
Indicate number of days (b) For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio, (a/b) x100, where a = number of days with a headache of any duration (minutes or hours) of any kind of severity (mild, moderate or severe), and b = Number of days passed since onset of post traumatic headache |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:49:21.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C59648 | Neck pain stiffness without headache frequency category | NeckPnStffnessWthoutHdchFrqCat | Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject | Category that describes how frequently the headache associated symptom of neck pain/stiffness affects the participant/subject | Neck Pain/Stiffness | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:34:31.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C59627 | Month code | MonthCode | Ordinal month code identifying the month within a specified count of months | Ordinal month code identifying the month within a specified count of months | For patients with greater than one month to 6 months of PTH | Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 | Month 1;Month 2;Month 3;Month 4;Month 5;Month 6 | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:56:16.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C19035 | Headache aura symptom other text | HdchAurasSymOTH | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | The free-text field related to 'Headache aura symptom type' specifying other text. Type of aura (warning) that a headache was going to start | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2023-08-14 20:18:00.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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C59638 | Headache additional symptom type present indicator | HdchAddtnlSympTypPresentInd | Indicator of whether the participant's/subject's headache symptom is present | Indicator of whether the participant's/subject's headache symptom is present | Is Symptom Present? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:15:53.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C59617 | Headache less than 30 day ratio value | HdchLessThan30DayRatVal | Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days | Value which represents the headache ratio calculation. Value calculated by dividing the response from Q (a) by Q (b) and multiplying by 100. Applies only to patients that have had post traumatic headache for less than 30 days | Headache Ratio calculation (a/b) x100 | Numeric Values |
For patients who have had post traumatic headache for fewer than 30 days, calculate headache ratio as follows: |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:27:07.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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C59649 | Dizziness vertigo without headache frequency category | DizznessVertgoWthoutHdchFrqCat | Category that describes how frequently the headache associated symptom of dizziness and/or vertigo affects the participant/subject | Category that describes how frequently the headache associated symptom of dizziness and/or vertigo affects the participant/subject | Dizziness and/or vertigo | Never;Almost Never;Sometimes;Often;Almost always | Never;Almost Never;Sometimes;Often;Almost always | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.10 | 2023-10-12 10:13:55.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C59628 | Headache days per month count | HdchDaysPerMnthCt | Count of the number of days the participant/subject experienced headaches in a month | Count of the number of days the participant/subject experienced headaches in a month | Headache days per month | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | 0;1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;17;18;19;20;21;22;23;24;25;26;27;28;29;30 | Numeric Values |
For patients with greater than one month to 6 months of post traumatic headache indicate number of headache days per month (30 days) |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 20:59:05.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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C05400 | Injury date time | InjDateTime | Date (and time, if applicable and known) of injury | Date (and time, if applicable and known) of injury | Date of TBI that led to current PTH | Date or Date & Time | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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C59607 | Headache traumatic brain injury previous count | HdchTBIPreviousCt | Count of previous traumatic brain injuries not including the current event experienced by the participant/subject that led to the current post traumatic headache | Count of previous traumatic brain injuries not including the current event experienced by the participant/subject that led to the current post traumatic headache | Number of previous TBIs (concussions) (not including the TBI (concussion) that led to current post-traumatic headache) | Numeric Values |
Example: 0= no prior TBIs; 1= one prior TBI |
Adult;Pediatric | Supplemental | 1.10 | 2023-08-14 18:44:36.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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C59639 | Headache additional symptom laterality type | HdchAddtnlSympLateralTyp | Laterality type of the participant's/subject's headache symptom | Laterality type of the participant's/subject's headache symptom | If 'Yes', is Symptom Unilateral or Bilateral? | Unilateral;Bilateral | Unilateral;Bilateral | Alphanumeric |
Choose one |
Adult;Pediatric | Supplemental | 1.00 | 2023-08-14 21:17:24.0 | Post-traumatic Headache (PTH) Mild TBI Questionnaire | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |