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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Epilepsy
Sub-Domain: Assessing Comorbidities
CRF: Migraine Headaches Questionnaire 21-Item
Item count: 155 (31 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C13485
Household member total count
HouseMembTotCt
The total number of members in the participant's household.
   
Numeric Values
Write in number
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q1
 
Free-Form Entry
0
20
     
C13486
Headache Screening Survey (HSS) - household members suffering severe headache count
HSSHouseMembSufSevHdacheCt
The total number of members of participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
   
Numeric Values
Write in number
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q2
 
Free-Form Entry
0
20
     
C13487
Headache Screening Survey (HSS) - household member suffering severe headache identifier number
HSSHouseMembSufSevHdacheIdNum
The numeric identifier for each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Household Member
1;2;3;
1;2;3;
Numeric Values
Please have each member of your household who suffers from severe headaches complete the rest of this card and the following card.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q3
 
Single Pre-Defined Value Selected
       
C13488
Headache Screening Survey (HSS) - household members age value
HSSHouseMembAgeVal
The age of each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Age
  
Numeric Values
Write in age in years. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q3a
 
Free-Form Entry
0
99
year
    
C13489
Headache Screening Survey (HSS) - household member sex type
HSSHouseMembSexTyp
The sex of each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
 
Male;Female;
Male;Female;
Alphanumeric
Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q3b
 
Single Pre-Defined Value Selected
       
C13490
Headache Screening Survey (HSS) - household member headache symptom type
HSSHouseMembHdacheSympTyp
The types of headache symptoms experience by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
When you have a severe headache, do you experience any of the following?
Nausea;Vomiting;Pain on one side of head only;Pulsating/throbbing headaches;Pain-free intervals of days or weeks between severe headache attacks;Sensitivity to light;Sensitivity to noise;Blurring of vision;Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts;Numbness of lips, tongue, fingers, or legs before the headache starts;
Nausea;Vomiting;Pain on one side of head only;Pulsating/throbbing headaches;Pain-free intervals of days or weeks between severe headache attacks;Sensitivity to light;Sensitivity to noise;Blurring of vision;Seeing shimmering lights, circles, other shapes, or colors before the eyes, before the headache starts;Numbness of lips, tongue, fingers, or legs before the headache starts;
Alphanumeric
Choose all that apply. Completed by and answered for each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q4
 
Multiple Pre-Defined Values Selected
       
C13491
Headache Screening Survey (HSS) - household member headache occurrence week frequency
HSSHouseMembHdacheOccWkFreq
The number headaches experienced by each members of a participant's household who suffer from severe headaches in a week from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
About how often do your severe headaches occur? number in a week
  
Numeric Values
Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q5a
 
Free-Form Entry
0
7
day
    
C13492
Headache Screening Survey (HSS) - household member headache occurrence month frequency
HSSHouseMembHdacheOccMnthFreq
The number headaches experienced by each members of a participant's household who suffer from severe headaches in a month.
About how often do your severe headaches occur? number in a month
  
Numeric Values
Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q5b
 
Free-Form Entry
0
31
day
    
C13494
Headache Screening Survey (HSS) - household member headache pain scale
HSSHouseMembHdachePainScale
The scale to rate the pain caused by a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Which statement best describes the pain of your severe headaches?
Extremely severe pain;Severe pain;Moderately severe pain;Mild pain;
Extremely severe pain;Severe pain;Moderately severe pain;Mild pain;
Alphanumeric
Choose only one. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q6
 
Single Pre-Defined Value Selected
       
C13495
Headache Screening Survey (HSS) - household members headache affect scale
HSSHouseMembHdacheAffScale
The scale to rate the affect caused by a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Which best describes how your are usually affected by severe headaches?
Able to work/function normally;Working ability or activity impaired to some degree;Working ability or activity severely impaired;Bed rest required;
Able to work/function normally;Working ability or activity impaired to some degree;Working ability or activity severely impaired;Bed rest required;
Alphanumeric
Choose only one. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q7
 
Single Pre-Defined Value Selected
       
C13496
Headache Screening Survey (HSS) - household member headache unable to work scale
HSSHouseMembHdacheUnabWrkScale
The scale to rate the ability to function as a result of a headache experienced by each members of a participant's household who suffer from severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Each time you have a severe headache, how long are you unable to work or undertake normal activities?
0 days;Less than 1 day;1-2 days;3-5 days;6 or more days;
0 days (no activity restriction);Less than 1 day;1-2 days;3-5 days;6 or more days;
Alphanumeric
Choose only one. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q8
 
Single Pre-Defined Value Selected
       
C13497
Headache Screening Survey (HSS) - household member headache last 3 month days count
HSSHouseMembHdacheL3MnthDCt
The number of days a headache was experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
On how many days in the last 3 months did you have a headache?
  
Numeric Values
If headache lasted more than 1 day, count each day. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q9
 
Free-Form Entry
0
93
day
    
C13498
Headache Screening Survey (HSS) - household member headache last three month miss work school day count
HSSHouMemHdacL3MthMisWrkSchDCt
The number of missed work or schools days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Because of your headaches on how many days in the last 3 months did you miss work or school?
  
Numeric Values
Write in number of days. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q10a
 
Free-Form Entry
0
93
day
    
C13499
Headache Screening Survey (HSS) - household member headache last three month productivity reduced day count
HSSHoMemHdaL3MthPrdRdDCt
The number of reduced productivity days as a result of a headache experienced by each members of a participant's household who suffer from severe headaches in the last three months from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Because of your headaches on how many days in the last 3 months was your productivity at work/school reduced by half or more?
  
Numeric Values
Write in number of days. Do not include days missed in question 10a. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q10b
 
Free-Form Entry
0
93
day
    
C13503
Headache Screening Survey (HSS) - severe headache began age value
HSSSevereHeadacheBeginAgeVal
The age value of when person began to have severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
At what age did you BEGIN having severe headaches?
  
Numeric Values
Write in age. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q11
 
Free-Form Entry
0
99
     
C13504
Headache Screening Survey (HSS) - severe headache emergency care indicator
HSSSevereHdacheEmergCarInd
Indicator for having gone to hospital emergency room or to an urgent care clinic because of severe headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Have you ever gone to the hospital emergency room or to an urgent care clinic because of your severe headaches?
Yes;No;
Yes;No;
Alphanumeric
Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q12
 
Single Pre-Defined Value Selected
       
C13505
Headache Screening Survey (HSS) - severe headaches treatment type
HSSSevereHdacheTreatTyp
The types of ways that usually treat severe headache from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Which best describes the way you usually treat severe headaches?
Take non-prescription medications;Take prescription medications;Take both prescription and non-prescription medications;Take no medications;
Take non-prescription medications;Take prescription medications;Take both prescription and non-prescription medications;Take no medications;
Alphanumeric
Choose only one. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q13
 
Single Pre-Defined Value Selected
       
C13506
Headache Screening Survey (HSS) - severe headache previous medication indicator
HSSSevereHdachePrevMedInd
The indicator for having taken prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Have you ever taken prescription medication for headache on a DAILY basis, whether or not you have a headache, to help prevent a severe headache from happening in the first place?
Yes;No;
Yes;No;
Alphanumeric
Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q14
 
Single Pre-Defined Value Selected
       
C13507
Headache Screening Survey (HSS) - other current daily medication type
HSSOtherCurrentDlyMedTyp
The indicator for currently taking prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Are you currently taking any other medication on a DAILY basis?
Water pill or prescription diuretic| or high blood pressure;Prescription medicine (other than water pill) for high blood pressure;Prescription medicine for seizures, epilepsy or fits;Prescription medicine for diabetes;Prescription medicine for cholesterol;Prescription medicine for depression or anxiety;
Water pill or prescription diuretic| or high blood pressure;Prescription medicine (other than water pill) for high blood pressure;Prescription medicine for seizures, epilepsy or fits;Prescription medicine for diabetes;Prescription medicine for cholesterol;Prescription medicine for depression or anxiety;
Alphanumeric
Choose all that apply. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q15
 
Multiple Pre-Defined Values Selected
       
C13508
Headache Screening Survey (HSS) - other current daily medication occurrence
HSSOtherCurrentDlyMedOccur
The occurrence of the last time that person took prescription medication for headache on a daily basis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
When did you last take prescription medication for headache on a DAILY basis to help prevent a severe headache from happening in the first place?
Currently taking;Last took within the past 3 months;Last took 3 to 12 months ago;Last took more than 12 months ago;Never took;
Currently taking;Last took within the past 3 months;Last took 3 to 12 months ago;Last took more than 12 months ago;Never took;
Alphanumeric
Choose only one. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q16
 
Single Pre-Defined Value Selected
       
C13509
Headache Screening Survey (HSS) - severe headache considered migraine indicator
HSSSevereHdacheConsMigraineInd
The indicator that person considers severe headache to be migraine from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Do you consider your severe headaches to be migraines?
Yes;No;
Yes;No;
Alphanumeric
Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q17
 
Single Pre-Defined Value Selected
       
C13510
Headache Screening Survey (HSS) - headache diagnosis type
HSSHeadacheDiagTyp
The type as related to headache diagnosis from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Have you ever been diagnosed by a physician or other health professional as suffering from headaches?
Tension headaches;Sinus headaches;Cluster headaches;Stress headaches;"Sick" headaches;Migraine headaches;
Tension headaches;Sinus headaches;Cluster headaches;Stress headaches;"Sick" headaches;Migraine headaches;
Alphanumeric
Choose all that apply. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q18
 
Multiple Pre-Defined Values Selected
       
C13511
Headache Screening Survey (HSS) - migraine diagnosis age value
HSSMigraineDiagAgeVal
The age value of being diagnosed with migraines from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
If diagnosed with migraines, at what age were you FIRST DIAGNOSED with migraines?
  
Numeric Values
Write in age. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q19
 
Free-Form Entry
0
99
     
C13512
Headache Screening Survey (HSS) - migraine household total count
HSSMigraineHousehldTtlCt
How many household members (including yourself) suffer from MIGRAINE headaches?
How many household members (including yourself) suffer from MIGRAINE headaches? number who suffer migrain headaches:
  
Numeric Values
Write in number.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
1.0
10/5/2012
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q22
 
Free-Form Entry
0
20
     
C13493
Headache Screening Survey (HSS) - household member headache occurrence year frequency
HSSHouseMembHdacheOccYrFreq
The number headaches experienced by each members of a participant's household who suffer from severe headaches in a year from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
About how often do your severe headaches occur? number in a year
  
Numeric Values
Answer for headache days per week OR per month OR in a year. Completed by and answered for each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q5c
 
Free-Form Entry
0
366
day
    
C13500
Headache Screening Survey (HSS) - no household work day count
HSSNotHouseholdWorkDayCt
The number of days in the last 3 months that person could not do household work because of headaches from Headache Screening Survey (HSS) which is a questionnaire that screens for alcohol dependency without it appearing to be the main focus of the instrument.
Because of your headaches on how many days in the last 3 months did you not do household work?
  
Numeric Values
Write in number of days. Completed by each member of your household who suffers from severe headaches.
Lipton RL, et al. Prevalence and burden of Migraine in the United States: Data from the American Migraine Study II. Headache. 2001; 41: 646-657.
Adult
Supplemental
3.0
8/28/2013
Aliases for variable name not defined
Migraine Headaches Questionnaire 21-Item
Assessing Comorbidities
Outcomes and End Points
Headache Screening Survey Q10c
 
Free-Form Entry
0
93
day
    
05-26-2017
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