CDE Detailed Report

Disease: Cerebral Palsy
Sub-Domain: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Residential History

Displaying 1 - 10 of 10
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
C08662 Risk Factor Questionnaire (RFQ) - residential history age 0 17 first residence city text RFQResHxAg0171stResdnceCityTxt Text specifying the participant's/subject's first city or town of residence Text specifying the participant's/subject's first city or town of residence City/Town Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History 255

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C08663 Risk Factor Questionnaire (RFQ) - residential history age 0 17 first residence state text RFQResHxAge0171stRsdncStateTxt Text specifying the participant's/subject's first state of residence Text specifying the participant's/subject's first state of residence State Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History 255

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C08664 Risk Factor Questionnaire (RFQ) - residential history age 0 17 first residence zip code number RFQResHxAge0171stRsdncZpCdNum Number specifying the participant's/subject's first zip code of residence Number specifying the participant's/subject's first zip code of residence Zip Code Numeric Values Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

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C08665 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence country text RFQBrthAg17ResHxFstResCntryTxt Text specifying the participant's/subject's first country of residence Text specifying the participant's/subject's first country of residence Country Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History 255

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C08666 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence location type RFQBrthAg17ResHxFstResLocTyp Type describing the participant's/subject's first location of residence Type describing the participant's/subject's first location of residence At the time you lived there, was the residence located in a Large City (>250,000 people);Midsized city (100,000-250,000 people);Small town (2,500-24,999 people);Rural, non-farm;Suburb of a large city;Rural, farm;Large town (25,000-99,999 people) Large City (>250,000 people);Midsized city (100,000-250,000 people);Small town (2,500-24,999 people);Rural, non-farm;Suburb of a large city;Rural, farm;Large town (25,000-99,999 people) Alphanumeric

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Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08667 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence well water indicator RFQBrthAg17ResHxFstResWlWtrInd Indicator as to whether the participant's/subject's source of drinking water was a private well at the first residence Indicator as to whether the participant's/subject's source of drinking water was a private well at the first residence Was your main source of drinking water at this residence a private well? No;Yes No;Yes Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08668 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence near farm fields indicator RFQBrthAg17ResHxFstRsNrFmFdInd Indicator as to whether the participant's/subject's first residence was located near farm fields (within 1/4mile) Indicator as to whether the participant's/subject's first residence was located near farm fields (within 1/4mile) Was this residence located near farm fields (within 1/4 mile)? No;Yes No;Yes Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08669 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence pesticide use indicator RFQBrthAg17ResHxFstRsPstUseInd Indicator as to whether the participant's/subject's first residence was located near pesticide spraying activities during the span of residence Indicator as to whether the participant's/subject's first residence was located near pesticide spraying activities during the span of residence Was there pesticide spraying at or around this residence when you lived there? No;Yes No;Yes Alphanumeric Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08670 Risk Factor Questionnaire (RFQ) - birth age 17 residential history first residence pesticide use frequency RFQBrthAg17ResHxFstRsPstUsFreq Frequency of pesticide spraying near the participant's/subject's first residence during the span of residence Frequency of pesticide spraying near the participant's/subject's first residence during the span of residence How often did the spraying happen? <1 time per year;1-3 times per year;4-10 times per year;>10 times per year;Don't know <1 time per year;1-3 times per year;4-10 times per year;>10 times per year;Don't know Alphanumeric

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Pediatric Supplemental 3.00 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C22790 Risk Factor Questionnaire (RFQ) ? residential history age 0-17 residence duration RFQResHxAge017ResDur Duration at residence lived from birth through age 17. Duration at residence lived from birth through age 17. Duration of Residence Alphanumeric Pediatric Supplemental 1.00 2016-10-28 11:48:26.0 Risk Factor Questionnaire (RFQ) - Residential History Epidemiology/Environmental History Participant History and Family History 255

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