CDE Detailed Report
Disease: Cerebral Palsy
Subdomain Name: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Residential History
Displaying 1 - 10 of 10
Subdomain Name: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Residential History
Displaying 1 - 10 of 10
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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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 |
Free-Form Entry |
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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 |
Choose one. |
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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
Choose one. |
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 |
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| 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 1 | 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 |
Free-Form Entry |
