CDE Detailed Report

Disease: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage
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CRF: Aneurysm History

Displaying 1 - 29 of 29
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
C52557 Amphetamine strong desire use past three month frequency AmphStrngDesUsePastThreeMoFreq How often the participant/subject has had a strong desire to use amphetamine type stimulants How often the participant/subject has had a strong desire to use amphetamine type stimulants During the past three months, how often have you used amphetamine type stimulants? Never;Once or twice;Monthly;Weekly;Daily or almost daily Never;Once or twice;Monthly;Weekly;Daily or almost daily Alphanumeric

Speed, diet pils, ecstasy, etc.

Adult;Pediatric Supplemental 1.00 2017-01-23 13:58:14.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00707 Alcohol consume six or more drinks frequency AlcConsume6MoreDrinkFreq The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol. The rate of occurrence for when the participant/subject consumes six or more drinks containing alcohol on one occasion. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another. How often do you have six or more drinks on one occasion? Never;Less than monthly;Monthly;Weekly;Daily or almost daily;Unknown Never;Less than monthly;Monthly;Weekly;Daily or almost daily;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171659
C52541 Subarachnoid hemorrhage associated disorders indicator SAHAssocDisorderInd Indicator for whether the partici[ant/subject has associated disorders with SAH Indicator for whether the partici[ant/subject has associated disorders with SAH Do you have associated disorders with SAH? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00708 Alcohol use related to hospitalization indicator AlcUseRelatedHospInd Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) Indicator of whether the participant/subject has been hospitalized for an alcohol-related problem (i.e., esophageal varices, delirium tremens (DTs), cirrhosis and others) Have you ever been hospitalized for an alcohol-related problem Yes;No;Unknown Yes;No;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171677
C52542 Family history brain aneurysm indicator FamHistBrainAneurInd Indicator for whether the participant/subject has a family history of brain aneurysms Indicator for whether the participant/subject has a family history of brain aneurysms Do you have a family history of brain aneurysms? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00709 Tobacco cigarettes smoked daily average number TobcoCigaretSmokedDlyAvgNum Average number of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) Average number of cigarettes the participant/subject smokes daily (On the days you smoked cigarettes during the past 30 days, how many cigarettes did you smoke per day, on average?) Average number of cigarettes smoked per day Less than one cigarette per day;1 cigarette per day;2 to 5 cigarettes per day;6 to 15 cigarettes per day (about 1/2 pack);16 to 25 cigarettes per day (about 1 pack);26 to 35 cigarettes per day (about 1 1/2 packs);More than 35 cigarettes per day (about 2 packs or more);Unknown Less than one cigarette per day;1 cigarette per day;2 to 5 cigarettes per day;6 to 15 cigarettes per day (about ½ pack);16 to 25 cigarettes per day (about 1 pack);26 to 35 cigarettes per day (about 1 ½ packs);More than 35 cigarettes per day (about 2 packs or more);Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

PhenX Toolkit: https://www.phenxtoolkit.org/index.php - Protocol 1: Tobacco - 30-Day Quantity and Frequency (Adolescent Protocol) #030801 Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3170853
C52543 Brain aneurysm unruptured indicator BrainAneurUnruptInd Indicator for whether the participant/subject has an unruptured brain aneurysm Indicator for whether the participant/subject has an unruptured brain aneurysm Do you have an unruptured brain aneurysm? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00710 Tobacco current use indicator TobcoUseCurntInd Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present time. Indicator for whether the participant/subject regularly uses tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) at the present time. Current tobacco use? Yes;No;Unknown Yes;No;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3170060
C52544 Brain aneurysm unruptured number BrainAneurUnruptNum Number of unruptured brain aneurysms the participant/usbject has Number of unruptured brain aneurysms the participant/usbject has Number of unruptured brain aneurysm(s) Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Free-Form Entry

C00700 Alcohol use stopped age value AlcUseStopAgeVal Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking Age in years when participant/subject stopped ingesting alcoholic beverages, including social drinking Age quit drinking Numeric Values

History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected.

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Free-Form Entry

0 120 year 2008448
C00711 Tobacco prior use indicator TobcoPriorUseInd Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months Indicator of the participant's/subject's past regular tobacco (e.g., cigarettes, cigars, chewing tobacco or pipe) use prior to the past 12 months Past tobacco use? Yes;No;Unknown Yes;No;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3170080
C52545 Brain aneurysm unruptured anatomic site BrainAneurUnrupAnatSite Location of unruptured brain aneurysm(s) Location of unruptured brain aneurysm(s) Location of unruptured brain aneurysm(s) A-comm;Basilar artery;Left ACA;Left intradural internal cerebral artery;Left MCA;Left PCA;Left vertebral artery;Other, specify;Right ACA;Right intradural internal cerebral artery;Right MCA;Right PCA;Right vertebral artery A-comm;Basilar artery;Left ACA;Left intradural internal cerebral artery;Left MCA;Left PCA;Left vertebral artery;Other, specify;Right ACA;Right intradural internal cerebral artery;Right MCA;Right PCA;Right vertebral artery Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Multiple Pre-Defined Values Selected

C00701 Tobacco use stopped age value TobcoUseStopAgeVal Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) Age in years when participant/subject stopped using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) Age stopped tobacco use Numeric Values

History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected.

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Free-Form Entry

0 120 year 2524471
C00719 Tobacco product used type TobcoProdctUsedTyp Type of tobacco product (e.g., cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject Type of tobacco product (e.g., cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject Type(s) of tobacco used Filtered cigarettes;Non-filtered cigarettes;Low tar cigarettes;Cigars;Pipes;Chewing tobacco;Other, specify Filtered cigarettes;Non-filtered cigarettes;Low tar cigarettes;Cigars;Pipes;Chewing tobacco;Other, specify Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Aneurysm History [php] [php_1]

Multiple Pre-Defined Values Selected

3179449v1
C52546 Brain aneurysm anatomic site other text BrainAneurUnrupAnatSiteOTH Free-text field to specify location of unruptured brain aneurysm(s) Free-text field to specify location of unruptured brain aneurysm(s) Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1] 255

Free-Form Entry

C00702 Alcohol use started age value AlcUseStrtAgeVal Age in years when participant/subject started ingesting alcoholic beverages, including social drinking Age in years when participant/subject started ingesting alcoholic beverages, including social drinking Age started drinking Numeric Values

History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected.

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Free-Form Entry

0 120 year 2008447
C00730 Alcohol use frequency AlcUseFreq The frequency of consumption of alcohol by the participant. The frequency of consumption of alcohol by the participant. How often do you have a drink containing alcohol? Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Unknown;Never Monthly or less;2 to 4 times a month;2 to 3 times a week;4 or more times a week;Unknown;Never Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171627
C52547 Brain aneurysm unruptured measurement BrainAneurUnrupMeas The size (diameter in mm) of the unruptured brain aneurysm(s) The size (diameter in mm) of the unruptured brain aneurysm(s) Size of unruptured brain aneurysm(s) Numeric Values

Diameter in mm

Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Free-Form Entry

C00703 Tobacco use started age value TobcoUseStrtAgeVal Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) Age in years when participant/subject started using tobacco products (e.g., cigarettes, cigars, chewing tobacco or pipe) Age started tobacco use Numeric Values

History can be obtained from participant/ subject, family member, friend, or chart/ medical record. The age in years should be collected or N/A (Not applicable if subject never smoked) should be selected.

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Free-Form Entry

0 120 year 2178045
C18770 Tobacco product used other text TobcoProdctUsedOTH The free-text field related to 'Tobacco product used type' specifying other text. Type of tobacco product (e.g. cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject The free-text field related to 'Tobacco product used type' specifying other text. Type of tobacco product (e.g. cigarettes, cigars, chewing tobacco or pipe) used by the participant/subject Other, specify Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Aneurysm History [php] [php_1] 4000

Free-Form Entry

3170860
C52548 Brain aneurysm unruptured days since count BrainAneurUnrupDaysSinceCt The number of days since having the unruptured brain aneurysm(s) The number of days since having the unruptured brain aneurysm(s) Number of days since having an unruptured brain aneurysm Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Free-Form Entry

C00704 Alcohol drinking day average drinks consumed range AlcDrinkingDayAvgDrinks The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another, so the most common alcoholic beverages likely to be consumed will be defined as well as quantity of each that constitutes a drink (approximately 10 grams of pure ethanol). For example, one bottle of beer (330 ml at 5% ethanol), a glass of wine (140 ml at 12% ethanol), and a shot of spirits (40 ml at 40% ethanol) represent a standard drink of about 13 g of ethanol. The counted number of drinks containing alcohol consumed by the participant/subject on a typical day when he/she is drinking. It is noted that the meaning of "drinks consumed" differs from one nation and culture to another. How many alcoholic drinks do you have on a typical day when you are drinking 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown 1 or 2;3 or 4;5 or 6;7, 8, or 9;10 or more;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

Question is from the Alcohol Use Disorders Identification Test (AUDIT) - http://www.who.int/substance_abuse/activities/sbi/en/ Adult;Pediatric Supplemental 3.00 2013-07-18 16:35:19.49 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171647
C52538 History subarachnoid hemorrhage indicator HisSAHInd Indicator for whether the participant/subject has a history of subarachnoid hemorrhage Indicator for whether the participant/subject has a history of subarachnoid hemorrhage Do you have a history of subarachnoid hemorrhage (SAH) No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C52549 Hypertensive episode indicator HypertenEpisodeInd Indicator for whether the participant/subject has experienced a hypertensive episode Indicator for whether the participant/subject has experienced a hypertensive episode Have you experienced a hypertensive episode? Yes;No;Suspected;Unknown Yes;No;Suspected;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00705 Alcohol current use indicator AlcCurntUseInd Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months Indicator of whether the participant/subject consumed at least one alcoholic drink within the past 12 months Current drinker? Yes;No;Unknown Yes;No;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record. In the U.S., a single drink serving contains about 14 grams of ethanol or "pure" alcohol. Although the drinks below are different sizes, each one contains the same amount of pure alcohol and counts as a single drink: 12 oz. of beer (about %% alcohol) = 8-9 oz. of malt liquor (about 7% alcohol) = 5 oz. of wine (about 12% alcohol) = 1.5 oz. of hard liquor (about 40% alcohol)

No references available Adult;Pediatric Supplemental 3.00 2013-07-18 14:26:06.9 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171540
C52539 Family history subarachnoid hemorrhage indicator FamHisSAHInd Indicator for whether the participant/subject has a family history of subarachnoid hemorrhage Indicator for whether the participant/subject has a family history of subarachnoid hemorrhage Do you have a family history of SAH? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C52551 Birth control use type BirthControlTyp Describes whether the participant/subject currently or previously uses birth control Describes whether the participant/subject currently or previously uses birth control Birth control use Current user;Former user;Never used;Unknown Current user;Former user;Never used;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

C00706 Alcohol prior use indicator AlcPriorUseInd Indicator of the participant's/subject's alcohol consumption prior to the past 12 months Indicator of the participant's/subject's alcohol consumption prior to the past 12 months Past drinker Yes;No;Unknown Yes;No;Unknown Alphanumeric

History can be obtained from participant/ subject, family member, friend, or chart/ medical record.

No references available Adult;Pediatric Supplemental 3.00 2013-07-20 10:21:25.65 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

3171578
C52540 Family history subarachnoid hemorrhage indeterminate indicator FamHisSAHIndeterInd Indicator for whether the family history for subarachnoid hemorrhage is indeterminate Indicator for whether the family history for subarachnoid hemorrhage is indeterminate Is your family history of SAH indeterminate? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Aneurysm History [php] [php_1]

Single Pre-Defined Value Selected

CSV