CDE Detailed Report

Disease: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage
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CRF: 12-Item Short Form Health Survey (SF-12)

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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
C52351 12-item Short Form Health Survey Version 2 (SF-12v2) -Social Functioning Raw Score SF12SocialFunctRawScore Raw score of soocial functioning (SF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of soocial functioning (SF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Social Function Raw Score Numeric Values

Items 2a+2b/ possible raw scale range=4

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 10:56:09.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Free-Form Entry

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C52341 12-item Short Form Health Survey Version 2 (SF-12v2)- Limited work activities physical health scale SF12LmtWrkActPhyHlthScale Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale for surveyee-reported limited work or activities as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) During the past 4 weeks, you: Were limited in the kind of work or other activities? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52352 12-item Short Form Health Survey Version 2 (SF-12v2) -Mental Health Raw Score SF12MentalHealthRawScore Raw score of mental health (MH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of mental health (MH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Mental Health Raw Score Numeric Values

Items 3a+3b/ possible raw scale range=8

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 10:56:58.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C06000 Site identifier number SiteIDNum Unique identification number given to the study site to distinguish the location where data is recorded Unique identification number given to the study site to distinguish the location where data is recorde Site No. Alphanumeric Adult Exploratory 3.00 2013-07-17 09:26:36.973 12-Item Short Form Health Survey (SF-12) [php] [php_1] 255

Free-Form Entry

C52342 12-item Short Form Health Survey Version 2 (SF-12v2)- Less accomplished emotional problems scale SF12LesAccompEmotProbScale Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) Scale for surveyee-reported less accomplishment as a result of emotional problems, as part of version2.0 of 12-item Short Form Health Survey (SF-12) During the past 4 weeks, have you: Accomplished less than you would like? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

"Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)? "

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52353 12-item Short Form Health Survey Version 2 (SF-12v2) - Bodily Pain Raw Score SF12BodilyPainRawScore Raw score of bodily pain (BP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of bodily pain (BP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Bodily Pain Raw Score Numeric Values

Items 2a+2b/ possible raw scale range=4

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 11:04:16.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C08500 36-item Short Form Health Survey (SF-36) - General health score SF36GenHlthScore Score of surveyee-reported general health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Score of surveyee-reported general health as a part of version 1.0 of 36-item Short Form Health Survey (SF-36) In general, would you say your health is: 1;2;3;4;5 Excellent;Very good;Good;Fair;Poor Numeric Values SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52343 12-item Short Form Health Survey Version 2 (SF-12v2) - Work not carefully emotional problem scale SF12WkNotCarefulEmotProbScale Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale for surveyee-reported doing work or other activities not as carefully as usual as a result of emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) During the past 4 weeks, you: did work or other activities less carefully than usual? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 16:57:17.79 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52354 12-item Short Form Health Survey Version 2 (SF-12v2) - Physical Functioning Raw Score SF12PhysFunctRawScore Raw score of physical functioning (PF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of physical functioning (PF) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Physical Functions Raw Score Numeric Values

Items 2a (SF36HlthLmtModActScore)+2b/ possible raw scale range=4

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 11:04:52.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Free-Form Entry

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C08504 36-item Short Form Health Survey (SF-36) - Health limited moderate activities score SF36HlthLmtModActScore Score of surveyee-reported limited moderate activities due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Score of surveyee-reported limited moderate activities due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Moderate activite, such as moving a table, pushing a vacuum cleaner, bowling, or playing golf? 1;2;3 Yes, limited a lot;Yes, limited a little;No, not limited at all Numeric Values

The following questions are about activities you might do during a typical day. Does your health now limit you in these activites? If so, how much?

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52344 12-item Short Form Health Survey Version 2 (SF-12v2) - Times calm peaceful scale SF12TimesCalmPcfulScale Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale of times feeling calm and peaceful during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) How much of the time during the past 4 weeks: Have you felt calm and peaceful? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks...

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 16:57:17.79 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52355 12-item Short Form Health Survey Version 2 (SF-12v2) - General Health Raw Score SF12GeneralHealthRawScore Raw score of general health (GH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of general health (GH) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) General Health Raw Score Numeric Values

Items 2a+2b/ possible raw scale range=4

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 11:05:33.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Free-Form Entry

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C08507 36-item Short Form Health Survey (SF-36) - Health limited climbing one stair score SF36HlthLmtClmb1StairScore Score of surveyee-reported limited climbing one flight of stairs due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Score of surveyee-reported limited climbing one flight of stair due to physical health as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Climbing several flights for stairs 1;2;3 Yes, limited a lot;Yes, limited a little;No, not limited at all Numeric Values

The following questions are about activities you might do during a typical day. Does your health now limit you in these activites? If so, how much?

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52345 12-item Short Form Health Survey Version 2 (SF-12v2) - Times energy scale SF12TimesEnrgyScale Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale of times having a lot of energy during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) How much of the time during the past 4 weeks: Did you have a lot of energy? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks...

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52356 12-item Short Form Health Survey Version 2 (SF-12v2) -Scaled score SF12ScaledScore Scaled score, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scaled score, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scaled Score Numeric Values

[(acutal raw score-lowest posssible raw score)/possible raw scale range]*100

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 11:06:01.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Free-Form Entry

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C08522 36-item Short Form Health Survey (SF-36) - Pain interfere work score SF36PainInterfWrkScore Score of bodily pain interfering with work (in home and outside) during the past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) Score of interfered work (in home and outside) by bodily pain during the past 4 weeks as part of version 1.0 of 36-item Short Form Health Survey (SF-36) During the past 4 weeks how much did pain interfere with your normal work (including both outside the home and housework)? 1;2;3;4;5 Not at all;A little bit;Moderately;Quite a bit;Extremely Numeric Values SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52346 12-item Short Form Health Survey Version 2 (SF-12v2) - Times downhearted depressed scale SF12TimesDownDepressedScale Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale of times feeling downhearted and depressed during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) How much of the time during the past 4 weeks: Have you felt downhearted and depressed? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: These questions are about how you feel and how things have been with you during the past 4 weeks. For each question, please give the one answer that comes closest to the way you have been feeling. How much of the time during the past 4 weeks...

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C17397 Visit number VisitNum The numeric value associated with a particular assessment/examination of a participant/subject on a study The numeric value associated with a particular assessment/examination of a participant/subject on a study Visit No. Numeric Values Adult Exploratory 1.00 2012-12-20 00:00:00.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Free-Form Entry

C52347 12-item Short Form Health Survey Version 2 (SF-12v2) -Role Emotional Raw Score SF12RoleEmotinalRawScore Raw score of role emotional (RE) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of role emotional (RE) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Role Emotional Raw Score Numeric Values

Items 3a+3b/ possible raw scale range=8

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 10:16:55.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C17409 Visit date VisitDate Date of interview or visit (actually the date when data in the form were captured) Date of interview or visit Visit Date Date or Date & Time Adult Exploratory 3.00 2013-06-21 00:00:00.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C52348 12-item Short Form Health Survey Version 2 (SF-12v2) - Vitality Raw Score SF12VitalityRawScore Raw score of vitality (VT) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of vitality (VT) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Vitality Raw Score Numeric Values

Items 2a+2b/ possible raw scale range=4

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 10:19:14.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Participant No. Alphanumeric Adult Exploratory 1.00 2014-06-05 13:10:49.0 12-Item Short Form Health Survey (SF-12) [php] [php_1] 255

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C52349 12-item Short Form Health Survey Version 2 (SF-12v2) - Interfering social activties physical emotional scale SF12InterfSocPhyEmotScale Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale of interfered normal social activities due to physical and emotional problems during the past 4 weeks as part of version 2.0 of 12-item Short Form Health Survey (SF-12) During the past 4 weeks, how much of the time has your physicalhealth of emotional problems interfered with your social activities (like visiting friends, relatives, etc.)? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

C52339 Subject initial text SubjectInitialTxt The free-text field related to the initials of the subject The free-text field related to the initials of the subjec Initials Alphanumeric Adult Exploratory 1.00 2016-12-04 21:30:04.0 12-Item Short Form Health Survey (SF-12) [php] [php_1] 3

Free-Form Entry

C52350 12-item Short Form Health Survey Version 2 (SF-12v2) - Role Physical Raw Score SF12RolePhysRawScore Raw score of role physical (RP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Raw score of role physical (RP) as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Role Physical Raw Score Numeric Values

Items 3a+3b/ possible raw scale range=8

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 1.00 2016-12-30 10:55:01.0 12-Item Short Form Health Survey (SF-12) [php] [php_1]

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C52340 12-item Short Form Health Survey Version 2 (SF-12v2) - Less accomplished physical health scale SF12LesAccompPhyHlthScale Scale for surveyee-reported less accomplishment as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) Scale for surveyee-reported less accomplishment as a result of physical health, as part of version 2.0 of 12-item Short Form Health Survey (SF-12) During the past 4 weeks, have you: Accomplished less than you would like? 1;2;3;4;5 All of the time;Most of the time;Some of the time;A little of the time;None of the time Numeric Values

Text before question group: During the past 4 weeks, have you had any of the following problems with your work or other regular daily activities as a result of your physical health?

SF-12 Health Survey copyrighted 1994, 2002 by Medical Outcomes Trust and QualityMEtric Incorporated (http://www.outcomes-trust.org/instruments.htm). All rights Reserved / HOW TO scale VERSION 2 OF THE SF-12 HEALTH SURVEY (WITH A SUPPLEMENT DOCUMENTING VERSION 1),Author: John Ware. Adult Exploratory 3.00 2013-07-22 12:47:20.623 12-Item Short Form Health Survey (SF-12) [php] [php_1]

Single Pre-Defined Value Selected

CSV