CDE Detailed Report

Disease: Chiari I Malformation
Sub-Domain: Epidemiology/Environmental History
CRF: Allergy

Displaying 1 - 12 of 12
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
C21678 Allergy food reaction type AllergyFoodRnTyp Type of reaction caused by food allergy Type of reaction caused by food allergy Food Allergy Reaction Type Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 12:07:02.0 Allergy Epidemiology/Environmental History Participant History and Family History

Multiple Pre-Defined Values Selected

C21679 Allergy reaction plastic tape indicator AllergyReactPlTpInd Indicator related to allergic reaction to plastic tape. Indicator related to allergic reaction to plastic tape. Plastic tape No;Yes No;Yes Alphanumeric Adult;Pediatric Exploratory 1.00 2016-05-25 13:16:58.0 Allergy Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C21680 Allergy reaction latex indicator AllergyReacLatxInd Indicator related to allergic reaction to latex. Indicator related to allergic reaction to latex. Latex No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 13:26:49.0 Allergy Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C21681 Allergy reaction acrylic indicator AllergyReacAcylInd Indicator related to allergic reaction to acrylic. Indicator related to allergic reaction to acrylic. Acrylic No;Yes No;Yes Alphanumeric Adult;Pediatric Exploratory 1.00 2016-05-25 13:30:30.0 Allergy Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C21682 Allergy reaction other source text AllergyReacOtherSrcTxt Free-text field to specify other source of allergy. Free-text field to specify other source of allergy. Specify Alphanumeric

If yes, specify

Adult;Pediatric Exploratory 1.00 2016-05-25 13:33:10.0 Allergy Epidemiology/Environmental History Participant History and Family History 500

Free-Form Entry

C06005 Data collected date and time DataCollDateTime Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Allergy Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C21683 Allergy reaction other source indicator AllergyRnOthSrcInd Indicator related to other source of allergic reaction Indicator related to other source of allergic reaction Other No;Yes No;Yes Alphanumeric Adult;Pediatric Exploratory 1.00 2016-05-25 13:30:30.0 Allergy Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C21673 Allergy medication antibiotic reaction type AllergyMedAntiRTyp Type related to allergic reaction to antibiotic medication Type related to allergic reaction to antibiotic medication Antibiotic Allergy Reaction Type Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 11:11:15.0 Allergy Epidemiology/Environmental History Participant History and Family History

Multiple Pre-Defined Values Selected

C21674 Allergy medication antibiotic name AllergyMedAntiNam Name to indicate the antibiotic causing the allergy Name to indicate the antibiotic causing the allergy Antibiotic name/type Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 11:28:24.0 Allergy Epidemiology/Environmental History Participant History and Family History 4000

Free-Form Entry

C21675 Allergy medication name AllergyMedNam Name related to the medication causing allergic reaction Name related to the medication causing allergic reaction Medication name Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 11:34:09.0 Allergy Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C21676 Allergy medication reaction type AllergyMedReactTyp Type of allergic reaction to medication Type of allergic reaction to medication Medication Allergy Reaction type Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Anaphylaxis;Rash;Itching;Hives;Swelling;Difficulty breathing Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 11:39:52.0 Allergy Epidemiology/Environmental History Participant History and Family History

Multiple Pre-Defined Values Selected

C21677 Allergy food type text AllergyFoodTypTxt Free-text field to specify the type of food causing an allergic reaction Free-text field to specify the type of food causing an allergic reaction Food type Alphanumeric Adult;Pediatric Supplemental 1.00 2016-05-25 12:03:49.0 Allergy Epidemiology/Environmental History Participant History and Family History 500

Free-Form Entry

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