CDE Detailed Report

Disease: Sport Related Concussion
Sub-Domain: General Health History
CRF: Personal Medical History

Displaying 1 - 42 of 42
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 / 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
C53063 Confusion indicator ConfusionInd Indicator as to whether the participant/subject has a medical history of confusion Indicator as to whether the participant/subject has a medical history of confusion Confusion Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53078 Migraine headache illness indicator MigraineHeadacheIllnessInd Indicator as to whether participant/subject experiences illness when having a migraine headache Indicator as to whether participant/subject experiences illness when having a migraine headache If yes, did you get nauseous or sick to your stomach? Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55576 Neurological disorder indicator text NeuroDisorderIndTxt Text relating to whether the participant/subject has a neurological disorder Ttext relating to whether the participant/subject has a neurological disorder Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 16:07:02.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53045 Developmental disorder type DevelopmentallDisorderTyp Type of developmental disorder of the participant/subject. Type of developmental disorder of the participant/subject. Check all that apply ADD;HD;LD;Other specify ADD;HD;LD;Other specify Alphanumeric Adult;Pediatric Supplemental 1.10 2018-07-30 00:00:00.0 Personal Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C53064 Diabetes mellitus indicator text DiabetesMellIndTxt Text related to participant/subject medical history of diabetes mellitus (type I or type II) Text related to participant/subject medical history of diabetes mellitus (type I or type II) Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53079 General anesthesia indicator GeneralAnesthesiaInd Indicator as to whether participant/subject has a medical history of general anesthesia Indicator as to whether participant/subject has a medical history of general anesthesia General Anesthesia Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55662 Major CV risk type text MajorCVRiskTypeTxt Text regarding type of cardiovascular risk type. Text regarding type of cardiovascular risk type. Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-22 15:38:02.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53049 Traumatic brain injury indicator TraumaticBrainInjuryInd Indicator of whether participant/subject has medical history of traumatic brain injury. Indicator of whether participant/subject has medical history of traumatic brain injury. Moderate/Severe Traumatic Brain injury Yes;No Yes;No Alphanumeric

This does NOT include concussions

Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53065 Confusion indicator text ConfusionIndicatorTxt Text related to participant/subject medical history of confusion Text related to participant/subject medical history of confusion Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53080 General anesthesia indicator count GeneralAnesthesiaIndCt Count of the number of times participant/subject has had general anesthesia Count of the number of times participant/subject has had general anesthesia If yes, how many times? Numeric Values Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Free-Form Entry

0 100
C53050 Vision problem indicator VisionProblemInd Indicator of whether participant/subject has medical history of a vision problem. Indicator of whether participant/subject has medical history of a vision problem. Vision Problems (other than need for glasses/contacts) Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53066 Memory difficulty indicator MemoryDifficultyInd Indicator as to whether the participant/subject has medical history of memory difficulty Indicator as to whether the participant/subject has a medical history of memory difficulty Memory Difficulties Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53081 Headache past three months indicator HeadachePstThreeMoInd Indicator whether participant/subject has had headache in the past three months Indicator whether participant/subject has had headache in the past three months Have you had one or more headaches (unrelated to alcohol/substance use) in the past 3 months? Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 1.00 2017-02-03 15:56:09.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C08113 Born prematurely indicator BornPrematurInd Indicator of whether the participant/subject was informed by a physician or parent/guardian that he/she was born prematurely Indicator of whether the participant/subject was informed by a physician or parent/guardian that he/she was born prematurely Premature birth Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53052 Hearing problem indicator HearingProblemInd Indicator of whether participant/subject has medical history of a hearing problem. Indicator of whether participant/subject has medical history of a hearing problem. Hearing Problems Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53067 Memory difficulty indicator text MemoryDifficultyIndTxt Text related to participant/subject medical history of memory difficulty Text related to participant/subject medical history of memory difficulty Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53088 Meningitis indicator text MeningitisIndTxt Text related to participant/subject medical history of meningitis Text related to participant/subject medical history of meningitis Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C08114 Meningitis or encephalitis history indicator MengtisEncphtisHistInd Indicator of whether the participant/subject has ever had meningitis or encephalitis (brain infection) diagnosed by a physician Indicator of whether the participant/subject has ever had meningitis or encephalitis (brain infection) diagnosed by a physician Meningitis Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53057 Vision problem indicator text VisionProblemIndicatorTxt Text relating to participant/subject medical history of a vision problem. Text relating to participant/subject medical history of a vision problem. Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53069 Balance disorder indicator BalanceDisorderInd Indicator as to whether the participant/subject has a medical history of a balance disorder Indicator as to whether the participant/subject has a medical history of a balance disorder Balance Disorder Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55544 Other Medical Problems indicator OtherMedProbInd Indicator as to whether the participant/subject hasother medical problems Indicator as to whether the participant/subject hasother medical problems Other medical problems Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 13:54:21.0 Personal Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C15936 Headache history indicator HeadachHistInd Indicates whether participant/subject suffers from headaches Indicates whether participant/subject suffers from headaches Headache (Non-Migraine) Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53058 Hearing problem indicator text HearingProblemIndicatorTxt Text relating to participant/subject medical history of a hearing problem. Text relating to participant/subject medical history of a hearing problem. Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53070 Balance disorder indicator text BalanceDisorderIndTxt Text related to participant/subject medical history of a balance disorder Text related to participant/subject medical history of a balance disorder Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C55557 Other medical problem indicator text OtherMedProbIndicatorTxt Text relating to participant/subject's other medical problems Text relating to participant/subject's other medical problems Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:01:00.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C17402 Site name SiteName The name of the site for the study The name of the site for the study Site Name Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-21 00:00:00.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53059 Stroke indicator StrokeInd Indicator of whether participant/subject has a medical history of stroke. Indicator of whether participant/subject has a medical history of stroke. Stroke Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:44:15.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53072 Migraine headache indicator MigraineHeadacheInd Indicator as to whether the participant/subject has a medical history of migraine headache Indicator as to whether the participant/subject has a medical history of migraine headache Migraine Headaches Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55568 Arthritis Indicator ArthritisInd Indicator as to whether the participant/subject has been diagnosed with arthritis Indicator as to whether the participant/subject has been diagnosed with arthritis Arthritis Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 16:07:02.0 Personal Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Subject ID Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-05 13:10:49.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53060 Stroke indicator text StrokeIndicatorTxt Text relating to participant/subject medical history of stroke. Text relating to participant/subject medical history of stroke. Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:44:15.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53073 Headache indicator text HeadacheIndicatorTxt Text related to participant/subject medical history of headache Text related to participant/subject medical history of headache Comment Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C55572 Arthritis indicator text ArthritisIndicatorTxt Text relating to participant/subject medical history of arthritis Text relating to participant/subject medical history of arthritis Comment Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-03 14:44:15.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C19256 Study protocol name StudyProtocolName Name of study protocol Name of study protocol Study Name/ID Alphanumeric Adult;Pediatric Supplemental 1.00 2014-06-05 16:38:14.0 Personal Medical History General Health History Participant History and Family History 4000

Free-Form Entry

C53061 Developmental disorder type other text DevelopmntlDisordrOtherTypeTxt The free-text field related to 'Developmental disorder type' specifying other text The free-text field related to 'Developmental disorder type' specifying other text Other specify Alphanumeric Adult;Pediatric Supplemental 1.10 2018-07-30 00:00:00.0 Personal Medical History General Health History Participant History and Family History 255

Free-Form Entry

C53076 Migraine headache ability limitation indicator MigraineHeadacheAbilLimitInd Indicator as to whether the participant/subject migraine headache limits activities of daily life Indicator as to whether the participant/subject migraine headache limits activites of daily life If yes, was your ability to work, study, or do what you wanted to do limited? Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55574 Major cv risk type MajorCvRiskTyp Type of major cv risk the participant/subject has Type of major cv risk the participant/subject has Major CV risk HTN;CAD/MI;PVD Hypertension;Coronary artery disease/Myocardial infarction;Peripheral vascular disease Alphanumeric Adult;Pediatric Supplemental 2.00 2019-07-03 15:25:34.0 Personal Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C53042 Neonatal intensive care unit (NICU) indicator NICUInd Indicator of whether the participant/subject has a medical history of being in the Neonatal Intensive Care Unit (NICU) at birth. ndicator of whether the participant/subject has a medical history of being in the Neonatal Intensive Care Unit (NICU) at birth. NICU (Neonatal Intensive Care Unit) at Birth Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one.

Adult;Pediatric Supplemental 1.00 2017-02-03 13:40:30.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53062 Diabetes mellitus medical history indicator DiabetesMellMedHistInd Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Diabetes Yes;No Yes;No Alphanumeric

Choose one

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C53077 Migraine headache light indicator MigraineHeadacheLightInd Indicator as to whether light bothers participant/subject when experiencing a migraine headache Indicator as to whether light bothers participant/subject when experiencing a migraine headache If yes, did light bother you (more than when you don't have a headache)? Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55575 Neurological disorder indicator NeuroDisorderInd Indicator as to whether the participant/subject has a neurological disorder Indicator as to whether the participant/subject has a neurological disorder Neurological Disorder Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 16:07:02.0 Personal Medical History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C53043 Developmental disorder indicator DevelopmenatlDisorderInd Indicator of whether the participant/subject has a medical history of a developmental disorder. Indicator of whether the participant/subject has a medical history of a developmental disorder. Other developmental disorder Yes;No Yes;No Alphanumeric

Choose one.

Adult;Pediatric Supplemental 1.00 2017-02-03 13:45:43.0 Personal Medical History General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV