CDE Detailed Report
Disease: Multiple Sclerosis
Subdomain Name: General Health History
CRF: Pediatric Developmental History
Displaying 1 - 21 of 21
Subdomain Name: General Health History
CRF: Pediatric Developmental History
Displaying 1 - 21 of 21
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C16187 | Vaccine type | VaccTyp | Vaccination received by pediatric patient | Vaccination received by pediatric patient | Vaccine | Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine | Routine: measles, mumps, rubella;Routine: tetanus, pertussis, diptheria, polio;Hepatitis B;Hemophilus Influenza Type B;Chicken pox vaccine | Alphanumeric |
For each vaccine type record whether the participant/subject received it and if he/she was hospitalized following the vaccination |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C00018 | Education service type | EduSrvcTyp | Type of educational services received | Type of educational services received | Type of educational services received | Special Education;Regular Education;None;Unknown;Early Intervention | Special Education;Regular Education;None;Unknown;Early Intervention | Alphanumeric |
Choose one. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16188 | Vaccine received indicator | VaccRcvdInd | Indicates whether participant/subject received the vaccine | Indicates whether participant/subject received the vaccine | Did patient receive this vaccine | Yes;No;Unknown;Not Asked | Yes;No;Unknown;Not Asked | Alphanumeric |
Answer, choosing one, for all vaccination types, except vaccination within one month of 1st demyselinating attack. Record from vaccination record where possible. For vaccines which require more than one immunization, yes refers to completion of all immunizations required for participant/subject's current age. |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C08076 | Breastfed indicator | BreastfedInd | Indicator of whether the participant/subject was breastfed by his/her mother | Indicator of whether the participant/subject was breastfed by his/her mother | Breast fed | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one response |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 09:34:41.527 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16189 | Vaccine hospitalization indicator | VaccineHosznpInd | Indicates whether participant/subject was hospitalized due to serious complications from vaccine | Indicates whether participant/subject was hospitalized due to serious complications from vaccine | Hospitalized | Yes;No | Yes;No | Alphanumeric |
Answer for each vaccination type. Choose one |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C14117 | School repeat grade indicator | SchoolRepeatGradeInd | Whether the participant/subject ever repeated a grade in school | Whether the participant/subject ever repeated a grade in school | Has the participant/subject ever repeated a grade in school | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
No additional instructions |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-08-28 16:08:00.453 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16191 | Chicken pox infection age value | ChickenPoxInfctAgeVal | The age value of participant/subject when they experienced a natural infection of chicken pox | The age value of participant/subject when they experienced a natural infection of chicken po | If participant/subject experienced a natural infection of chicken pox, specify age at which natural infection occurred | Numeric Values |
Record age in years |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Free-Form Entry |
year | |||||||||
| C16170 | Menstrual period occurrence indicator | MenstrualPrdOcurInd | Indicates whether participant has ever had a menstrual period | Indicates whether participant has ever had a menstrual period | Has participant/subject ever had a menstrual period | Yes;No;N/A - male | Yes;No;N/A - male | Alphanumeric |
Choose one. If participant/subject is male, select "N/A - male". |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-02 08:23:32.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16192 | Vaccination within one month of demyelinating attack indicator | VaccOneMoDemyltsAttckInd | Whether or not the participant/subject received a vaccination within one month of his/her first demyelinating attack | Whether or not the participant/subject received a vaccination within one month of his/her first demyelinating attack | Vaccination within one month of 1st demyelinating attack | Yes;No;Unknown;Not Asked | Yes;No;Unknown;Not Asked | Alphanumeric |
Choose one. If yes, specify type of vaccine. |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16171 | Menstrual period first occurrence age value | MenstrualPrd1stOcurAgeVal | Youngest age the participant had a menstrual period, otherwise known as the age of menarche | Youngest age the participant had a menstrual period, otherwise known as the age of menarche | Youngest age the female participant/subject had a menstrual period | Numeric Values |
If YES is answered for having received a menstrual period, record the age first received in years |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-02 08:26:11.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 100 | year | |||||||
| C17441 | Clinical event or milestone cognitive learning disability indicator | ClinEvntMilstneCogLearDisInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of having a cognitive/learning disability which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of having a cognitive/learning disability which is pertinent to the disease or disorde | Have a cognitive/learning disability | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16181 | Breast fed duration value | BreastFedDurationVal | The duration of time the participant/subject was breast fed | The duration of time the participant/subject was breast fed | Indicate duration | Numeric Values |
Only answer if "Yes" is answered for "Breast fed?" Record answer in months |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Free-Form Entry |
month | |||||||||
| C17442 | Clinical event or milestone day care indicator | ClincEvntMilestDayCareInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of attending a day care group (with > 5 other children) which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of attending a day care group (with > 5 other children) which is pertinent to the disease or disorde | Attend a day care group (with > 5 other children) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16182 | Formula fed indicator | FormulaFedInd | Indicates whether participant/subject was formula fed | Indicates whether participant/subject was formula fed | Formula fed | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
No additional instructions |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17443 | Clinical event or milestone 1 year speech indicator | ClincEvntMilest1YrSpechInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking his/her first words by 12 months which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking his/her first words by 12 months which is pertinent to the disease or disorde | Speak his/her first words by 12 months (Clinical event or milestone 1 year speach indicator) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16183 | Formula fed duration value | FormulaFedDurationVal | The duration of time the participant/subject was formula fed | The duration of time the participant/subject was formula fed | Indicate duration | Numeric Values |
Only answer if "Yes" is answered for "Formula fed?" Record answer in months |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Free-Form Entry |
month | |||||||||
| C17444 | Clinical event or milestone 2 year word combination indicator | ClincEvntMilest2YrWrdCombInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking in two word combinations by 2 years which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking in two word combinations by 2 years which is pertinent to the disease or disorde | Speak in two word combinations by 2 years (Clinical event or milestone 2 year word combination indicator) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16184 | Formula fed to infant name | FormulaFedInfantNme | The name of the formula fed to participant/subject | The name of the formula fed to participant/subject | Formula type | Alphanumeric |
Only answered if "Yes" is answered for "Formula fed?" |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17445 | Clinical event or milestone 3 year sentence indicator | ClincEvntMilest3YrSentncInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking in complete sentences by 3 years which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of speaking in complete sentences by 3 years which is pertinent to the disease or disorde | Speak in complete sentences by 3 years (Clinical event or milestone 3 year sentence indicator) | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16186 | Education performance status | EduPerfStatus | Participant/subject's cognitive status with regards to education | Participant/subject's cognitive status with regards to education | Indicate patient's cognitive status with regards to education: | Above average (receives mostly As in school);Normal (functions well in school, receives mostly Bs, Cs);Minimal difficulty (struggling but obtains passing grades);Moderate difficulty (needs assistance with school work such as an Educational Assistant);Special needs class setting, actively participating in learning;Severe (unable to function in regular classroom even in special class setting, not an active participant in learning activities);Limited cognition (unrelated to demyelination or predates demyelination);N/A (patient is too young for school);Unknown | Above average (receives mostly As in school);Normal (functions well in school, receives mostly Bs, Cs);Minimal difficulty (struggling but obtains passing grades);Moderate difficulty (needs assistance with school work such as an Educational Assistant);Special needs class setting, actively participating in learning;Severe (unable to function in regular classroom even in special class setting, not an active participant in learning activities);Limited cognition (unrelated to demyelination or predates demyelination);N/A (patient is too young for school);Unknown | Alphanumeric |
Complete according to last year in education and utilize grades reported on report cards from the past year. Choose one |
No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C17446 | Clinical event or milestone walk indicator | ClincEvntMilestWalkInd | Whether the participant/subject achieved or experienced the specific clinical event or milestone of walking by 17 months old which is pertinent to the disease or disorder | Whether the participant/subject achieved or experienced the specific clinical event or milestone of walking by 17 months old which is pertinent to the disease or disorde | Walk by 17 months old | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Pediatric Developmental History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
