CDE Detailed Report

Disease: content
Sub-Domain: General Health History
CRF: welcome

Displaying 1 - 5 of 5
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
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

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

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 pox. 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 vaccine. 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

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

CSV