CDE Detailed Report
Disease: Cerebral Palsy
Subdomain Name: General Health History
CRF: Vaccination History
Displaying 1 - 5 of 5
Subdomain Name: General Health History
CRF: Vaccination History
Displaying 1 - 5 of 5
| 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. |
Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Vaccination 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;Unknown | Yes;No;Unknown | Alphanumeric |
Answer for each vaccination type. Choose one. If yes, specify. |
Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Vaccination 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 | Natural infection, specify age | Numeric Values |
Record age in years |
Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Vaccination History | General Health History | Participant History and Family History |
Free-Form Entry |
year | ||||||||||
| C22792 | Vaccines received indicator | VaccineRcvInd | Indicates whether participant/subject received the vaccine | Indicates whether participant/subject received the vaccin | Did patient receive this vaccine? | Natural infection, specify age;No;Not Asked;Unknown;Yes | Natural infection, specify age;No;Not Asked;;Yes | Alphanumeric |
Answer, choosing one. 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. |
Pediatric | Supplemental | 1.00 | 2016-10-28 13:16:57.0 | Vaccination History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C22793 | Vaccine history report informant specify type | VaccHxRptInformSpcfyTyp | The type of informant the vaccine history report was collected from | The type of informant the vaccine history report was collected from | Report obtained by: | Other specify;Parent;Physician;Record Review;Self | Other specify;Parent;Physician;Record Review;Self | Alphanumeric |
Choose all that apply. |
Pediatric | Supplemental | 1.00 | 2016-10-28 13:43:21.0 | Vaccination History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
