CDE Detailed Report

Disease: Amyotrophic Lateral Sclerosis
Sub-Domain: Quality of Life/Patient Reported Outcomes
CRF: Quality of Life in Swallowing Disorders (SWAL-QOL)

Displaying 1 - 50 of 66
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 External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C10289 Quality of Life in Swallowing Disorders (SWAL-QOL) - excess saliva phlegm problem indicator SWALQOLExcsSalvPhlgmProbInd Scale assessing how true the following statement has been for the participant during the last month: Having excess saliva or phlegm. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences having excess saliva or phlegm, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Having excess saliva or phlegm 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10321 Quality of Life in Swallowing Disorders (SWAL-QOL) - consistency liquid indicator SWALQOLConsstncyLiqInd Category of consistency or texture of the liquids participant has been drinking most often in the last week. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates consistency of the liquid subject has been drinking in the last week, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Please circle the letter of the one description below that best describes the consistency of liquids you have been drinking most often in the last week. A;B;C;D;E A;B;C;D;E Alphanumeric

Choose only one

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19500 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10300 Quality of Life in Swallowing Disorders (SWAL-QOL) - fear choke food problem indicator SWALQOLFrChokFdProbInd Scale assessing how true the following statement has been for the participant during the last month: I fear I may start choking when I eat food. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject feels fear of choking on food again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I fear I amy start choking when I eat food. 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18100 Quality of Life in Swallowing Disorders (SWAL-QOL) - age value SWALQOLAgVal Age of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Age of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) What is your age today? Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

C10279 Quality of Life in Swallowing Disorders (SWAL-QOL) - rare realization hunger indicator SWALQOLRarRealztnHugrInd Scale assessing how true the following statement has been for the participant during the last month: I'm rarely hungry anymore, as part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how rarely subject feels hungry, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I'm rarely hungry anymore. 1;2;3;4;5 Very much true;Quite a bit true;Somewhat true;A little true;Not at all true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10311 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem changed activities indicator SWALQOLSwllwngProbChngdActInd Scale assessing how true the following statement has been for the participant during the last month: My usual work or leisure activities have changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates subject's work or leisure activities have changed because of swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) My usual work or leisure activities have changed because of my swallowing problem. 1;2;3;4;5 Strongly agree;Agree;Uncertain;Disagree;Strongly disagree Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10290 Quality of Life in Swallowing Disorders (SWAL-QOL) - clear throat problem indicator SWALQOLClrThrtProbInd Scale assessing how true the following statement has been for the participant during the last month: Having to clear your throat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences having to clear throat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Having to clear your throat 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10322 Quality of Life in Swallowing Disorders (SWAL-QOL) - general health indicator SWALQOLGenrlHlthInd Scale assessing the general health of the participant. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates the subject's general health condition, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) In general, would you say your health is 1;2;3;4;5 Poor;Fair;Good;Very Good;Excellent Numeric Values

Circle one

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10301 Quality of Life in Swallowing Disorders (SWAL-QOL) - worry pneumonia problem indicator SWALQOLWryPnemnProbInd Scale assessing how true the following statement has been for the participant during the last month: I worry about getting pneumonia. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject fear of getting pneumonia, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I worry about getting pneumonia. 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18101 Quality of Life in Swallowing Disorders (SWAL-QOL) - gender indicator SWALQOLGendrInd Gender of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Gender of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Are you 1;2 1;2 Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10280 Quality of Life in Swallowing Disorders (SWAL-QOL) - long eating period indicator SWALQOLLngEatngPerdInd Scale assessing how true the following statement has been for the participant during the last month: It takes me forever to eat a meal. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much longer subject to eat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) It takes me forever to eat a meal. 1;2;3;4;5 Very much true;Quite a bit true;Somewhat true;A little true;Not at all true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10312 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem enjoyable social indicator SWALQOLSwllwngProbEnjblSoclInd Scale assessing how true the following statement has been for the participant during the last month: Social gatherings (like holidays or get-togethers) are not enjoyable because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates subject no longer enjoys social gatherings because of swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Social gatherings (like holidays or get-togethers) are not enjoyable because of my swallowing problem. 1;2;3;4;5 Strongly agree;Agree;Uncertain;Disagree;Strongly disagree Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10291 Quality of Life in Swallowing Disorders (SWAL-QOL) - food sticking throat problem indicator SWALQOLFdStckngThrtProbInd Scale assessing how true the following statement has been for the participant during the last month: Food sticking in your throat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences food sticking to throat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Food sticking in your throat 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17833 Quality of Life in Swallowing Disorders (SWAL-QOL) - questionnaire help indicator SWALQOLQuestHelpInd Indicator of whether the subject/participant received help filling out the Quality of Life in Swallowing Disorders (SWAL-QOL) questionnaire. Indicator of whether the subject/participant received help filling out the Quality of Life in Swallowing Disorders (SWAL-QOL) - questionnaire. Did anybody help you complete this questionnaire? 1;2 No, I did it myself;Yes, someone helped me fill it out Numeric Values

circle one

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10302 Quality of Life in Swallowing Disorders (SWAL-QOL) - fear choke liquid problem indicator SWALQOLFrChokLiqProbInd Scale assessing how true the following statement has been for the participant during the last month: I am afraid of choking when I drink liquids. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject fears choking on liquid again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I am afraid of choking when I drink liquids. 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18102 Quality of Life in Swallowing Disorders (SWAL-QOL) - race indicator SWALQOLRcInd Racial group of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Racial group of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) What is your main racial or ethnic group? 1;2;3;4;5 1;2;3;4;5 Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10281 Quality of Life in Swallowing Disorders (SWAL-QOL) - eating enjoyment indicator SWALQOLEatngEnjmntInd Scale assessing how true the following statement has been for the participant during the last month: I don't enjoy eating anymore. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much subject does not enjoy eating, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I don't enjoy eating anymore. 1;2;3;4;5 Very much true;Quite a bit true;Somewhat true;A little true;Not at all true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10313 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem changed family friends role indicator SWALQOLSwllwngProbChngdRolInd Scale assessing how true the following statement has been for the participant during the last month: My role with family and friends has changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Scale assessing how true the following statement has been for the participant during the last month: My role with family and friends has changed because of my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). My role with family and friends has changed because of my swallowing problem. 1;2;3;4;5 Strongly agree;Agree;Uncertain;Disagree;Strongly disagree Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10292 Quality of Life in Swallowing Disorders (SWAL-QOL) - food sticking mouth problem indicator SWALQOLFdStckngMthProbInd Scale assessing how true the following statement has been for the participant during the last month: Food sticking in your mouth. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences food sticking to mouth, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Food sticking in your mouth 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17834 Quality of Life in Swallowing Disorders (SWAL-QOL) - age number SWALQOLAgeNum Age of subject/participant. Age of subject/participant. What is your age today? Numeric Values No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

C10303 Quality of Life in Swallowing Disorders (SWAL-QOL) - unsure when choke problem indicator SWALQOLUnsrWhnChokProbInd Scale assessing how true the following statement has been for the participant during the last month: I never know when I am going to choke. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject fears of not knowing when subject will choking again, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I never know when I am going to choke. 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18103 Quality of Life in Swallowing Disorders (SWAL-QOL) - education scale SWALQOLEduInd Education level of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Education level of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) What is the highest year of school or collge you have ever completed? 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+ 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+ Alphanumeric No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10282 Quality of Life in Swallowing Disorders (SWAL-QOL) - coughing problem indicator SWALQOLCoughngProbInd Scale assessing how true the following statement has been for the participant during the last month: Coughing. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences the coughing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Coughing 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10314 Quality of Life in Swallowing Disorders (SWAL-QOL) - feeling weak indicator SWALQOLFeelngWkInd Scale assessing how true the following statement has been for the participant during the last month: Feel weak? As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject feels weak, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Feel weak? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10293 Quality of Life in Swallowing Disorders (SWAL-QOL) - food liquid dribble out problem indicator SWALQOLFdLiqDrblOtProbInd Scale assessing how true the following statement has been for the participant during the last month: Food or liquid dribbling out of your mouth. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences food or liquid dribbling out of mouth, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Food or liquid dribbling out of your mouth 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17836 Quality of Life in Swallowing Disorders (SWAL-QOL) - education level status SWALQOLEduLevelStatus Participant's highest education level. Participant's highest education level. What is the highest year of school or college you have ever completed? 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+;Grade School;High School;College;Post Graduate 1;2;3;4;5;6;7;8;9;10;11;12;13;14;15;16;16+;Grade School;High School;College;Post Graduate Alphanumeric

circle one number

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10304 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem depress indicator SWALQOLSwllwngProbDeprsInd Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem depresses me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much swallowing problem depresses the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) My swallowing problem depresses me. 1;2;3;4;5 Always true;Often true;Sometimes true;Hardly ever true;Never true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18104 Quality of Life in Swallowing Disorders (SWAL-QOL) - current marital status SWALQOLCurntMartlStatus Current marital status of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Current marital status of the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) What is your current marital status/ 1;2 1;2 Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10283 Quality of Life in Swallowing Disorders (SWAL-QOL) - choking food problem indicator SWALQOLChokngFdProbInd Scale assessing how true the following statement has been for the participant during the last month: Choking when you eat food. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject chokes on food when eating food, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Choking when you eat food 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10315 Quality of Life in Swallowing Disorders (SWAL-QOL) - troubling falling asleep indicator SWALQOLTrblngFllngAslpInd Scale assessing how true the following statement has been for the participant during the last month: Have trouble falling asleep? As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject has trouble falling asleep, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Have trouble falling asleep? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10294 Quality of Life in Swallowing Disorders (SWAL-QOL) - food liquid fall out nose problem indicator SWALQOLFdLiqFllOtNsProbInd Scale assessing how true the following statement has been for the participant during the last month: Food or liquid coming out of your nose. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences food or liquid fall out of nose, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Food or liquid coming out of your nose 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17838 Quality of Life in Swallowing Disorders (SWAL-QOL) - gender type SWALQOLGenderTyp Self-reported gender of the subject/participant. Self-reported gender of the subject/participant. Are you 1;2 Male;Female Numeric Values

circle one

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10305 Quality of Life in Swallowing Disorders (SWAL-QOL) - careful diet annoy problem indicator SWALQOLCarflAnnyProbInd Scale assessing how true the following statement has been for the participant during the last month: Having to be so careful when I eat or drink annoys me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much having to be careful when eating or drinking annoys the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Having to be so careful when I eat or drink annoys me. 1;2;3;4;5 Always true;Often true;Sometimes true;Hardly ever true;Never true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18105 Quality of Life in Swallowing Disorders (SWAL-QOL) - help questionnaire indicator SWALQOLHlpQuestnnrInd Indicator of whether subject received help to complete this questionnaire or not, Indicator of whether subject received help to complete this questionnaire or not, Did anybody help you complete this questionnaire? 1;2 1;2 Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10284 Quality of Life in Swallowing Disorders (SWAL-QOL) - choking liquid problem indicator SWALQOLChockngLiqProbInd Scale assessing how true the following statement has been for the participant during the last month: Choking when you take liquids. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject chokes on liquid when drinking, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Choking when you take liquids 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10316 Quality of Life in Swallowing Disorders (SWAL-QOL) - feeling tired indicator SWALQOLFlngTrdInd Scale assessing how true the following statement has been for the participant during the last month: Feel tired? As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject feels tired, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Feel tired? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10295 Quality of Life in Swallowing Disorders (SWAL-QOL) - coughing stuck food liquid out mouth problem indicator SWALQOLCghStkFdLiqOtMthProbInd Scale assessing how true the following statement has been for the participant during the last month: Coughing food or liquid out of your mouth when it gets stuck. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject feels the need to cough food or liquid out of mouth when it's stuck, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Coughing food or liquid out of your mouth when it gets stuck 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17839 Quality of Life in Swallowing Disorders (SWAL-QOL) - help method type SWALQOLHelpMethdTyp Type of help the subject/participant received filling out the questionnaire. Type of help the subject/participant received filling out the questionnaire. If someone helped you fill out this questionnaire, how did that person help you? 1;2;3 Read you the questions and/or wrote down the answers you gave;Answered the questions for you;Helped in some other way Numeric Values

circle one

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10306 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem discourage indicator SWALQOLSwllwngProbDiscrgInd Scale assessing how true the following statement has been for the participant during the last month: I've been discouraged by my swallowing problem. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much subject gets discouraged with swallowing problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) I've been discouraged by my swallowing problem. 1;2;3;4;5 Always true;Often true;Sometimes true;Hardly ever true;Never true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18106 Quality of Life in Swallowing Disorders (SWAL-QOL) - help method indicator SWALQOLHlpMethdInd If received help, what type of help did the subject receive, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) If received help, what type of help did the subject receive, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) If someone helped you fill out this questionnaire, how did that person help you? 1;2;3 1;2;3 Numeric Values No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10285 Quality of Life in Swallowing Disorders (SWAL-QOL) - thick saliva phlegm problem indicator SWALQOLThicSalvPhlgmProbInd Scale assessing how true the following statement has been for the participant during the last month: Having thick saliva or phlegm. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences having thick saliva or phlegm, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Having thick saliva or phlegm 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10317 Quality of Life in Swallowing Disorders (SWAL-QOL) - trouble staying asleep indicator SWALQOLTrblStyngAslpInd Scale assessing how true the following statement has been for the participant during the last month: Having trouble staying asleep? As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject has trouble staying asleep, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Having trouble staying asleep? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10296 Quality of Life in Swallowing Disorders (SWAL-QOL) - figuring out eating problem indicator SWALQOLFigrngOtEatngProbInd Scale assessing how true the following statement has been for the participant during the last month: Figuring out what I can and can't eat is a problem for me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates subject feels figuring out what to eat/not to eat, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Figuring out what I can and can't eat is a problem for me 1;2;3;4;5 Strongly agree;Agree;Uncertain;Disagree;Strongly disagree Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C17840 Quality of Life in Swallowing Disorders (SWAL-QOL) - marital status SWALQOLMaritalStatus Status of whether the participant is married, divorced, separated, widowed, or never married. Status of whether the participant is married, divorced, separated, widowed, or never married. What is your current marital status 1;2;3;4;5 Never married;Married;Divorced;Separated;Widowed Numeric Values

circle one

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10275 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem indicator SWALQOLSwllwProbInd Scale assessing how true the following statement has been for the participant during the last month: Dealing with my swallowing problem is very difficult, as part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how difficult dealing with swallowing problem is, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Dealing with my swallowing problem is very difficult. 1;2;3;4;5 Very much true;Quite a bit true;Somewhat true;A little true;Not at all true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10307 Quality of Life in Swallowing Disorders (SWAL-QOL) - swallowing problem frustrating indicator SWALQOLSwllwngProbFrstrngInd Scale assessing how true the following statement has been for the participant during the last month: My swallowing problem frustrates me. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how much swallowing problem frustrates the subject, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) My swallowing problem frustrates me. 1;2;3;4;5 Always true;Often true;Sometimes true;Hardly ever true;Never true Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C18107 Quality of Life in Swallowing Disorders (SWAL-QOL) - completion date SWALQOLCompltDate Date the subject completed this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Date the subject completed this questionnaire, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Please write today's date here Date or Date & Time No references available Adult Supplemental 3.00 2013-07-18 09:11:50.26 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Free-Form Entry

C10286 Quality of Life in Swallowing Disorders (SWAL-QOL) - gagging problem indicator SWALQOLGagngProbInd Scale assessing how true the following statement has been for the participant during the last month: Gagging. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject experiences gagging problem, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Gagging 1;2;3;4;5 Almost always;Often;Sometimes;Hardly ever;Never Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10318 Quality of Life in Swallowing Disorders (SWAL-QOL) - feeling exhausted indicator SWALQOLFlngExhstdInd Scale assessing how true the following statement has been for the participant during the last month: Feel exhausted? As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates how often subject feels exhausted, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) Feel exhausted? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

C10297 Quality of Life in Swallowing Disorders (SWAL-QOL) - difficult find food indicator SWALQOLDifcltFndFdInd Scale assessing how true the following statement has been for the participant during the last month: It is difficult to find foods that I both like and can eat. As part of Quality of Life in Swallowing Disorders (SWAL-QOL). Indicates subject feels finding food that subject both like and can eat is difficult, as part of the Quality of Life in Swallowing Disorders (SWAL-QOL) It is difficult to find foods that I both like and can eat. 1;2;3;4;5 Strongly agree;Agree;Uncertain;Disagree;Strongly disagree Numeric Values

Circle one number on each line

Colleen A. McHorney, PhD, US Outcomes Research, Merck & Co., Inc., 351 North Sumneytown Pike, UG2MW-05, North Wales, PA 19454 Adult Supplemental 3.00 2013-07-22 16:57:17.79 Quality of Life in Swallowing Disorders (SWAL-QOL) Quality of Life/Patient Reported Outcomes Outcomes and End Points

Single Pre-Defined Value Selected

CSV