CDE Detailed Report
Subdomain Name: General Health History
CRF: Medical History
Displaying 1 - 19 of 19
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C59686 | COVID-19 status reason | COVID19StatRsn | Reason related to the status of whether the participant/subject thinks that they have or have had coronavirus disease 2019 (COVID-19) | Reason related to the status of whether the participant/subject thinks that they have or have had coronavirus disease 2019 (COVID-19) | Do you think that you have or have had COVID-19? | Yes, confirmed by a positive test;Yes, suspected by a doctor but not tested;Yes, my own suspicions;No | Yes, confirmed by a positive test;Yes, suspected by a doctor but not tested;Yes, my own suspicions;No | Alphanumeric |
Intended respondent for the COVID-19 questions is the participant/subject. |
COVID-19 Related Health Questions, https://www.phenxtoolkit.org/protocols/view/940101 | Adult;Pediatric | Supplemental | 1.00 | 2023-11-03 10:19:46.0 | Medical History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
||||||||
| C59687 | COVID-19 first date | COVID19FirstDate | Date the participant/subject was first told or first thought that they had coronavirus disease 2019 (COVID-19) | Date the participant/subject was first told or first thought that they had coronavirus disease 2019 (COVID-19) | If YES, when were you told/when did you think you first had COVID-19? | Date or Date & Time |
Intended respondent for the COVID-19 questions is the participant/subject. |
COVID-19 Related Health Questions, https://www.phenxtoolkit.org/protocols/view/940101 | Adult;Pediatric | Supplemental | 1.00 | 2023-11-03 10:21:16.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
||||||||||
| C59688 | COVID-19 first date not applicable status | COVID19FirstDateNAStat | Status denoting that the date the participant/subject was first told or first thought that they had coronavirus disease 2019 (COVID-19) is not applicable | Status denoting that the date the participant/subject was first told or first thought that they had coronavirus disease 2019 (COVID-19) is not applicable | When were you told/when did you think you first had COVID-19? | N/A | Not applicable | Alphanumeric |
Intended respondent for the COVID-19 questions is the participant/subject. |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2023-11-03 10:22:20.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C59689 | COVID-19 vaccine or clinical vaccine trial status | COVID19VacOrClinVacTrialStat | Status related to whether the participant/subject has ever been given a coronavirus disease 2019 (COVID-19) vaccine or has enrolled in COVID-19 vaccine clinical trials | Status related to whether the participant/subject has ever been given a coronavirus disease 2019 (COVID-19) vaccine or has enrolled in COVID-19 vaccine clinical trials | Have you ever been given a vaccine for COVID-19 or enrolled in the COVID-19 clinical vaccine trials? | Don't know;Yes;No;Refuse to answer | Don't know;Yes;No;Refuse to answer | Alphanumeric |
Intended respondent for the COVID-19 questions is the participant/subject. |
COVID-19 Vaccination - Adult, https://www.phenxtoolkit.org/protocols/view/940401 | Adult;Pediatric | Supplemental | 1.00 | 2023-11-03 10:25:06.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C59019 | Birth weight measurement | BirthWeightMeasr | Measurement in kilograms of the weight of a neonate at birth | Measurement in kilograms of the weight of a neonate at birth | Birth Weight | Numeric Values |
Recorded value of participant's/subject's measured weight at birth. This element is intended for pediatric clinical studies. |
No references available | Pediatric | Supplemental | 1.10 | 2022-08-01 10:17:22.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 9000 | kilograms | 3201400;2179689 | ||||||
| C00313 | Medical history condition SNOMED CT code | MedclHistCondSNOMEDCTCode | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Systematized Nomenclature Of Medicine Clinical Terms (SNOMED CT) code for medical condition/disease reported by the participant/subject | Medical History Term | Alphanumeric |
Code each of the medical history conditions using SNOMED CT. |
SNOMED CT Codes (https://www.nlm.nih.gov/healthit/snomedct/index.html) | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
|||||||||
| C00314 | Medical history taken date and time | MedclHistTakenDateTime | Date (and time, if applicable and known) the participant's medical history was taken | Date (and time, if applicable and known) the participant 's medical history was taken | Date Medical History Taken | Date or Date & Time |
Record the date (and time) the medical history was taken. The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.) and in the format acceptable to the study database. |
No references available | Adult;Pediatric | Supplemental | 3.20 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2179659 | |||||||||
| C00315 | Medical history global assessment indicator | MedclHistGlobalAssmtInd | Indicator of whether the participant has a history of any medical problems/conditions | Indicator of whether the participant has a history of any medical problems/conditions | Does the participant subject have a history of any medical problems conditions in the following body systems? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one. If this question is answered NO then the rest of the form is blank. If the question is answered YES then the medical history for at least one body system should be recorded. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:39.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3145578 | |||||||
| C00316 | Medical history condition end date and time | MedclHistCondEndDateTime | Date (and time, if applicable and known) for the end of an event in the participant's medical history | Date (and time, if applicable and known) for the end of an event in the participant's medical history | End Date | Date or Date & Time |
If the condition is not ongoing, record the date (and time) the medical condition/disease stopped. The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.) and in the format acceptable to the study database. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
3145557 | |||||||||
| C00317 | Medical history condition start date and time | MedclHistCondStrtDateTime | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Date (and time, if applicable and known) for the start of an event in the participant's medical history | Start Date | Date or Date & Time |
Record the date the medical condition/disease started. The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.) and in the format acceptable to the study database. |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:42:43.0 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
2543596 | |||||||||
| C00319 | Medical history condition ongoing indicator | MedclHistCondOngoingInd | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Indicator of whether a medical condition/disease experienced by the participant is ongoing | Ongoing? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Check Yes or No to indicate if the medical condition/disease is still present. |
No references available | Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:44.0 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2736881 | |||||||
| C00322 | Medical history condition text | MedclHistCondTxt | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Verbatim text for the medical condition/disease reported by the participant/subject or documented in the medical record as part of medical history | Medical History Term | Alphanumeric |
Record one Medical History term per line. |
SNOMED CT Codes (https://www.nlm.nih.gov/healthit/snomedct/index.html) | Adult;Pediatric | Core | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
2003874 | ||||||||
| C00001 | Gestational age value | GestatnlAgeVal | Time elapsed in weeks between the first day of the last normal menstrual period and the day of delivery of the participant/subject | Time elapsed in weeks between the first day of the last normal menstrual period and the day of delivery of the participant/subjec | Gestational Age | Numeric Values |
Record the gestational age of the participant/subject in weeks and days. This element is intended for pediatric clinical studies. |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 52 | week | 3192017 | ||||||
| C00723 | APGAR ten minute score | APGARTenMinuteScore | Score of a newborn recorded at ten minutes from the time of birth and expressed as a number quantifying the overall physical condition, which includes heart rate, muscle tone, respiratory effort, color, and reflex responsiveness | Score of a newborn recorded at ten minutes from the time of birth and expressed as a number quantifying the overall physical condition, which includes heart rate, muscle tone, respiratory effort, color, and reflex responsivenes | 10 minute APGAR score | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
Record the APGAR score (0 - 10 points, inclusive) assessed at 10 minutes |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3181701 | |||||||
| C00002 | Post conceptional age value | PostConceptnAgeVal | Gestational age plus postnatal age of the participant/subject | Gestational age plus postnatal age of the participant/subject | Post Conceptional Age (PCA) | Numeric Values |
Record the post conceptional age of the participant/subject in weeks and days. This element is intended for pediatric clinical studies. This field is not needed if Gestational Age and Post Natal Age are captured since it can be derived from those data. |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
day | 3182713 | ||||||||
| C00724 | APGAR five minute score | APGARFiveMinuteScore | Score of a newborn recorded at five minutes from the time of birth and expressed as a number quantifying the overall physical condition, which includes heart rate, muscle tone, respiratory effort, color, and reflex responsiveness | Score of a newborn recorded at five minutes from the time of birth and expressed as a number quantifying the overall physical condition, which includes heart rate, muscle tone, respiratory effort, color, and reflex responsivenes | 5 minute APGAR score | 0;1;2;3;4;5;6;7;8;9;10 | 0;1;2;3;4;5;6;7;8;9;10 | Numeric Values |
Record the APGAR score (0 - 10 points, inclusive) assessed at 5 minutes |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2738533 | |||||||
| C00003 | Postnatal age value | PostnatalAgeVal | Time elapsed after birth of the participant/subject | Time elapsed after birth of the participant/subject | Post Natal Age (PNA) | Numeric Values |
Record the post natal age of the participant/subject in weeks and days. This element is intended for pediatric clinical studies. |
No references available | Pediatric | Supplemental | 3.00 | 2013-07-24 11:36:20.083 | Medical History | General Health History | Participant History and Family History |
Free-Form Entry |
day | 3182608 | ||||||||
| C18666 | Body system category other text | BodySysCatOTH | 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 | 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 | Other, specify | Alphanumeric |
Record the appropriate body system for each line of medical history. |
Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf | Adult;Pediatric | Supplemental | 1.10 | 2023-11-07 08:40:35.0 | Medical History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
2002895 | ||||||||
| C00312 | Body system category | BodySysCat | 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 | 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 system | Body System | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify: | Alphanumeric |
Record the appropriate body system for each line of medical history. |
Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/eval-mgmt-serv-guide-icn006764.pdf | Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Medical History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
2002895 |
