CDE Detailed Report

Disease: Chiari I Malformation
Sub-Domain: General Health History
CRF: Past History (on intake)

Displaying 1 - 30 of 30
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
C21887 Injury whiplash indicator InjWhiInd The indicator relating to injury in the form of whiplash. The indicator relating to injury in the form of whiplash. Whiplash injury? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:11:25.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18793 Medical history condition other text MedHistCondOTH The free-text field related to 'Medical history condition type' specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant/subject or found documented in the medical record. The free-text field related to 'Medical history condition type' specifying other text. Pre-specified medical condition/disease asked about when collecting the medical history from the participant/subject or found documented in the medical record. Other, specify: Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Past History (on intake) General Health History Participant History and Family History 4000

Free-Form Entry

C21875 Surgical history cardiac bypass stent indicator SurgHistCarBypSteInd The indicator related to surgical history of cardiac bypass/stent. The indicator related to surgical history of cardiac bypass/stent. Cardiac Bypass/Stent No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:57:14.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21888 Injury fall head neck indicator InjFallHeadNeckInd The indicator relating to injury in the form of the patient falling on their head or neck. The indicator relating to injury in the form of the patient falling on their head or neck. Fall on head/back? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:12:33.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C19500 Assessment performed date AssessmentPerformedDate The date of assessment of the examination being performed. The date of assessment of the examination being performed. Date of Intake Date or Date & Time Adult;Pediatric Supplemental 1.00 2014-06-18 08:10:12.0 Past History (on intake) General Health History Participant History and Family History

Free-Form Entry

C21876 Surgical history pacemaker indicator SurgHistPacId The indicator related to surgical history of a pacemaker. The indicator related to surgical history of a pacemaker. Pacemaker No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:58:13.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21889 Medical history claustrophobic indicator MedHistClaInd The indicator relating to personal medical history of claustrophobia. The indicator relating to personal medical history of claustrophobia. Are you claustrophobic? No;Yes No;Yes Alphanumeric Adult;Pediatric Exploratory 1.00 2016-06-06 11:13:45.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C19761 Medical history glaucoma diagnosis indicator MedHistGlcmaDiagInd Indicator of history of Glaucoma Indicator of history of Glaucoma Glaucoma No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21877 Surgical history defibrillator indicator SurgHistDefInd The indicator related to surgical history of using a defibrillator. The indicator related to surgical history of using a defibrillator. Defibrillator No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:59:27.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21890 Medical history test sedation require indicator MedHistTestSedReqInd The indicator relating to the requirement of sedation for testing. The indicator relating to the requirement of sedation for testing. Do you require sedation for testing? No;Yes No;Yes Alphanumeric Adult;Pediatric Exploratory 1.00 2016-06-06 11:15:21.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C19779 Medical history asthma pulmonary assessment indicator MedHistAsthmaPulAssesInd Indicator of history of asthma Indicator of history of asthma Asthma No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21879 Surgical history prosthetic implantation indicator SurgHistProsImpInd The indicator related to surgical history of prosthetic implantation. The indicator related to surgical history of prosthetic implantation. Prosthetic Implantation No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 11:00:30.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C19806 Medical history endocrine diabetes indicator MedHistEndcrnDiabetInd Indicator of diabetes Indicator of diabetes Diabetes No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-05 00:00:00.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21880 Surgical history valve replacement indicator SurgHistValRepInd The indicator related to surgical history of valve replacement The indicator related to surgical history of valve replacement Valve Replacement No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 11:02:18.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21869 Medical history coronary artery disease indicator MedHistCorArtDisInd The indicator related to personal medical history of coronary artery disease. The indicator related to personal medical history of coronary artery disease. Coronary Artery Disease No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:48:12.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21882 Surgical history cataract removal indicator SurgHistCatRemInd The indicator related to surgical history of cataract removal. The indicator related to surgical history of cataract removal. Cataract Removal No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:04:34.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C05454 Hypertension indicator HypertensInd Indicator of hypertension. In adults, hypertension is defined as a systolic pressure >= 140 and a diastolic >= 90. In children, it is defined as systolic blood pressure >95th percentile for age. Indicator of hypertension. Hypertension Yes;No;Unknown;Suspected Yes;No;Unknown;Suspected Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21870 Medical history Lyme disease indicator MedHistLymDisInd The indicator related to personal medical history of Lyme disease. The indicator related to personal medical history of Lyme disease. Lyme Disease No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:50:40.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21883 Surgical history other text SurgHistOthrTxt The free-text field related to other past surgery. The free-text field related to other past surgery. Other, specify: Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 11:06:15.0 Past History (on intake) General Health History Participant History and Family History 4000

Free-Form Entry

C12875 Echocardiogram mitral valve prolapse indicator EchcrdgrmMitrlValvProlapseInd Assessment with echocardiography of the absence or presence of prolapse of the mitral valve, often with regurgitation, associated with myxomatous proliferation of the leaflets of the mitral valve. Assessment with echocardiography of the absence or presence of prolapse of the mitral valve, often with regurgitation, associated with myxomatous proliferation of the leaflets of the mitral valve. Mitral Valve Prolapse Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21871 Medical history chronic obstructive pulmonary disease indicator MedHistChrObstPulDisInd The indicator related to personal medical history of chronic obstructive pulmonary disease (COPD). The indicator related to personal medical history of chronic obstructive pulmonary disease (COPD). COPD No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2016-06-06 10:52:17.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21884 Pain lower back indicator PainLowrBackInd The indicator relating to lower back pain. The indicator relating to lower back pain. Lower back pain? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:07:41.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C13758 Imaging diagnosis stroke transient ischemic attack indicator ImgDiagStrokeTIAInd Indicator of the diagnosis of stroke/transient ischemic attack (TIA) for imaging positive Indicator of the diagnosis of stroke/transient ischemic attack (TIA) for imaging positive Stroke/TIA Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-06-21 00:00:00.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21872 Medical history visual impairment indicator MedHistVisImpairmntInd The indicator related to personal medical history of visual impairment or legally blind. The indicator related to personal medical history of visual impairment or legally blind. Visual Impairment/Legally Blind No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 10:53:36.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21885 Pain general leg indicator PainGenLegInd The indicator relating to general leg pain. The indicator relating to general leg pain. Leg pain, in general? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:08:50.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17460 Cancer history indicator CancerHistInd Indicator as to whether the participant/subject has or had cancer Indicator as to whether the participant/subject has or had cancer. Cancer Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21873 Medical history hearing deficit indicator MedHistHeaDefInd The indicator related to personal medical history of hearing deficit or use of hearing aid. The indicator related to personal medical history of hearing deficit or use of hearing aid. Hearing deficit/use of hearing aid No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 10:55:07.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21886 Injury Head Indicator InjHeadInd The indicator relating to traumatic head injury. The indicator relating to traumatic head injury. Head injury? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 11:10:17.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18150 Thyroid disease indicator ThyrdDiseasInd Indicator for thyroid disease Indicator for thyroid disease Thyroid Disease No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-17 09:26:36.973 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

C21874 Medical history paraplegia quadriplegia indicator MedHistParQuadInd The indicator related to personal medical history of paraplegia/quadriplegia. The indicator related to personal medical history of paraplegia/quadriplegia. Paraplegia/Quadriplegia No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2016-06-06 10:56:04.0 Past History (on intake) General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV