CDE Detailed Report
Disease: Sport Related Concussion
Subdomain Name: History of Disease/Injury Event
CRF: Injury Report
Displaying 1 - 50 of 82
Subdomain Name: History of Disease/Injury Event
CRF: Injury Report
Displaying 1 - 50 of 82
| 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) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C05408 | Hospital admission date and time | HospitlAdmissDateTime | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Date (and time, if applicable and known) the participant/subject was admitted to the hospital | Hospital admission date; Hospital admission time | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Adult;Pediatric | Supplemental | 3.00 | 2013-07-25 08:54:08.2 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C55479 | Participation continue activity post injury duration text | PrtcptnCntnActvPstInjDurtnTxt | Text specifying the duration for which the subject/participant continued to participate in the activity in which he or she incurred the suspected injury, after incurring the suspected injury | Text specifying the duration for which the subject/participant continued to participate in the activity in which he or she incurred the suspected injury, after incurring the suspected injur | If so, for how long? | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:14:45.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 50 |
Free-Form Entry |
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| C55559 | Education current level USA text | EduCurrLvlUSAOTH | The free-text field related to 'Education current level USA type' specifying other text | The free-text field related to 'Education current level USA type' specifying other text | Please indicate the grade that your child is currently enrolled in: other, specify: | Alphanumeric | Pediatric | Supplemental | 1.00 | 2017-05-12 15:31:40.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C22804 | Pain present eleven point intensity scale | PainPrsnt11IntensityScl | Scale for the participant's current pain intensity based on an a scale of 0-10 | Scale for the participant's current pain intensity based on an a scale of 0-10 | Pain assessment | 0;1;10;2;3;4;5;6;7;8;9 | 0;1;10;2;3;4;5;6;7;8;9 | Numeric Values | Adult;Pediatric | Supplemental | 4.00 | 2023-05-18 16:39:30.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55498 | Participant activity penalize indicator | PtcpntActvtyPnlzInd | Indicator of whether a participant in the activity in which the subject/participant incurred the suspected injury was penalized for conduct directly related to the injury event | Indicator of whether a participant in the activity in which the subject/participant incurred the suspected injury was penalized for conduct directly related to the injury event | Was a penalty called directly related to the injury event | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 11:37:05.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55465 | Concussion determine confidence category | CncssnDtrmnCnfdncCat | Category of the clinical assessor's confidence in his or her determination that the injury was a concussion | Category of the clinical assessor's confidence in his or her determination that the injury was a concussion | How confident was clinician that injury was a concussion? | Barely confident;Fairly confident;Not at all confident;Somewhat confident;Very confident | Barely confident;Fairly confident;Not at all confident;Somewhat confident;Very confident | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:12:30.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55527 | Headache Impact Test 6 baseline score | HIT6BaselineScore | Score obtained from a baseline administration of the Headache Impact Test-6 (HIT-6) | Score obtained from a baseline administration of the Headache Impact Test-6 (HIT-6) | Baseline Headache Impact Test-6 (HIT-6) | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:58:31.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
36 | 78 | ||||||||||
| C05411 | Injury immediate medical service receive indicator | InjImmdtMedclServRecvdInd | Indicator of whether initial medical services were received directly after injury | Indicator of whether initial medical services were received directly after injury | Were initial medical services received immediately after injury? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55480 | Participation continue activity post injury turn count | PrtcptnCntnuActvyPostInjTurnCt | Count of discrete turns for which the subject/participant continued to participate in the activity in which the suspected injury was received, after receiving the suspected injury | Count of discrete turns for which the subject/participant continued to participate in the activity in which the suspected injury was received, after receiving the suspected injury | For how many plays? | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:17:55.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | Turns | ||||||||||
| C55561 | Academic achievement average USA category | AcdmcAchvmntAvgUSACat | Category describing the average academic achievement of the subject/participant in relation to the typical academic achievement scale used in the USA | Category describing the average academic achievement of the subject/participant in relation to the typical academic achievement scale used in the USA | Please indicate your child's average academic achievement prior to the concussion | A & B grades;B & C grades;Below C grades;Straight A student;Straight B student | A & B grades;B & C grades;Below C grades;Straight A student;Straight B student | Alphanumeric | Pediatric | Supplemental | 1.00 | 2017-05-12 15:34:02.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C52398 | Injury mechanism type | InjuryMechTyp | The type of mechanism leading to the subject's injury | The type of mechanism leading to the subject's injury | Mechanism of injury | Direct blow to head;Fell and hit head;Hit head on environment;Non-head injury;Contact with another participant;Impact with ground;Impact with object | Direct blow to head;Fell and hit head;Hit head on environment;Non-head injury;Contact with another participant;Impact with ground;Impact with object (i.e., ball) | Alphanumeric | Adult;Pediatric | Supplemental | 1.10 | 2017-05-12 11:35:57.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55499 | Participant activity penalize text | PtcpntActvtyPnlzTxt | Free-text field for describing any penalty for conduct directly related to the injury event that was assessed to a participant in the activity in which the subject/participant incurred the suspected injury | Free-text field for describing any penalty for conduct directly related to the injury event that was assessed to a participant in the activity in which the subject/participant incurred the suspected injury | Was a penalty called directly related to the injury event: if yes, describe | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 11:37:05.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C55467 | First evaluation injury elapsed hour count | FrstEvalInjElpsdHrCt | Count of hours elapsed between the injury and the first evaluation | Count of hours elapsed between the injury and the first evaluation | How many hours after the injury did the first evaluation take place? | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:27:39.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | Hours | ||||||||||
| C55528 | Headache Impact Test 6 follow-up score | HIT6FollowupScore | Score obtained from a follow-up administration of the Headache Impact Test-6 (HIT-6) | Score obtained from a follow-up administration of the Headache Impact Test-6 (HIT-6) | Follow-up Headache Impact Test-6 (HIT-6) | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:58:31.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
36 | 78 | ||||||||||
| C05412 | Injury immediate medical service received type | InjImmdtMedServRecvdTyp | Type of initial medical services received directly after injury | Type of initial medical services received directly after injury | Medical Services received | CT/MRI;Hospitalization;Specialized therapies (speech, physical, occupational therapy);Evaluations (neurological, psychological);Medication;Education about course of symptoms;Other, specify | CT/MRI;Hospitalization;Specialized therapies (speech, physical, occupational therapy);Evaluations (neurological, psychological);Medication;Education about course of symptoms;Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55481 | Emergency room visit indicator | ERVisitInd | Indicator of whether the subject/participant visited an emergency room (ER) or equivalent facility | Indicator of whether the subject/participant visited an emergency room (ER) or equivalent facilit | Did athlete go to ER? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:26:22.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55562 | Imaging prior head injury CT MRI indicator | ImgPriorHdInjCTMRIInd | Indicator of whether the subject/participant was given a CT or MRI scan for a previous head injury | Indicator of whether the subject/participant was given a CT or MRI scan for a previous head injury | Has your child had a CT or MRI for a PREVIOUS head injury? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Pediatric | Supplemental | 1.00 | 2017-05-12 15:42:56.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C52400 | Injury date | InjuryDate | The date the subject received his or her injury | The date the subject received his or her injury | Date Injury Occurred | Date or Date & Time |
Record the date/time according to the ISO 8601, the International Standard for the representation of dates and times (http://www.iso.org/iso/home.html). The date/time should be recorded to the level of granularity known (e.g., year, year and month, complete date plus hours and minutes, etc.). |
Adult;Pediatric | Supplemental | 1.00 | 2017-01-18 09:25:29.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
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| C55500 | Participant activity penalize identify text | PtcpntActvtyPnlzIdntfyTxt | Free-text field for identifying the participant(s) in the activity in which the subject/participant incurred the suspected injury who was/were assessed a penalty for conduct directly related to the injury event | Free-text field for identifying the participant(s) in the activity in which the subject/participant incurred the suspected injury who was/were assessed a penalty for conduct directly related to the injury event | Who received penalty | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 11:37:05.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C01037 | Post traumatic amnesia indicator | PstTraumtcAmnsInd | The indicator for whether the participant/subject experienced any period of post-traumatic amnesia. | The indicator for whether the participant/subject experienced any period of post-traumatic amnesia. | Post traumatic amnesia | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55468 | Second evaluation injury elapsed hour count | ScndEvalInjElpsdHrCt | Count of hours elapsed between the injury and the second evaluation | Count of hours elapsed between the injury and the second evaluation | How many hours after the injury did the second evaluation take place? | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:27:39.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | Hours | ||||||||||
| C55534 | Suicide ideation text | SuicideIdeationTxt | The free-text field for describing suicidal ideation | The free-text field for describing suicidal ideation | Suicidal ideation | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:17:21.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C05460 | Seizure indicator | SeizInd | Indicator of seizure activity | Indicator of seizure activity | After your child's head injury did he/she have a seizure? | Yes;No | Yes;No | Alphanumeric | Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55482 | Injury treatment hospital prior study center indicator | InjTxHospPriorStyCtrInd | Indicator of whether the subject/participant received treatement for his or her suspected injury at a hospital prior to being seen at the study center | Indicator of whether the subject/participant received treatement for his or her suspected injury at a hospital prior to being seen at the study cente | Treated at hospital before study center? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:30:54.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55563 | Hospitalize prior head injury indicator | HosptlzePriorHdInjInd | Indicator of whether the subject/participant has ever been hospitalized for a previous head injury | Indicator of whether the subject/participant has ever been hospitalized for a previous head injury | Has your child been hospitalized for a previous head injury? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Pediatric | Supplemental | 1.00 | 2017-05-12 15:45:58.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C52426 | Sport Concussion Assessment Tool - 3rd Edition (SCAT3) - Disorientation confusion indicator | SCAT3DisorientConfusInd | The indicator relating to whether or not the subject has any disorientation or confusion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3) | The indicator relating to whether or not the subject has any disorientation or confusion, as part of the Sport Concussion Assessment Tool - 3rd Edition (SCAT3 | Confusion/disorientation | Y;N | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-01-18 14:14:31.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55501 | Injury type location anatomic site | InjTypLocAnatSite | The free-text field for specifying the types and locations of suspected injuries | The free-text field for specifying the types and locations of suspected injuries | Injury location for each type of injury (often more than one injury at time of injury- list of all injury types and body parts) | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 11:48:53.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C01052 | Loss of consciousness indicator | LOCInd | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC) | The indicator for whether the participant/subject experienced any period of loss of consciousness (LOC | Loss of consciousness | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55469 | Third evaluation injury elapsed hour count | ThrdEvalInjElpsdHrCt | Count of hours elapsed between the injury and the third evaluation | Count of hours elapsed between the injury and the third evaluation | How many hours after the injury did the third evaluation take place? | Numeric Values | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:27:39.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Free-Form Entry |
0 | Hours | ||||||||||
| C55535 | Injury orthopedic non concussive indicator | InjuryOrthopedicNoConcusInd | Indicator of whether the subject/participant has any non-concussive orthopedic injuries | Indicator of whether the subject/participant has any non-concussive orthopedic injuries | Did/Does athlete have any other orthopedic injuries? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:19:17.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55565 | Medication post injury type | MedicatnPostInjTyp | Type(s) of medication(s) received by the subject/participant after incurring the suspected injury | Type(s) of medication(s) received by the subject/participant after incurring the suspected injury | Specify which medication(s) your child received since the time of their injury | Gravol;Acetaminophen;Ibuprofen;Other, specify | Gravol;Acetaminophen (Tylenol, Tempra);Ibuprofen (Advil, Motrin);Other, specify | Alphanumeric | Pediatric | Supplemental | 1.00 | 2017-05-12 15:50:47.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C08147 | Data source | DataSource | Source of the data provided on the case report form | Source of the data provided on the case report form | Source of information | Clinician;Coach;Other;Parent;Player | Clinician;Coach;Other;Parent;Player | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:46:24.96 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55483 | Hospital admission date time not applicable status | HospAdmsnDtTmNoAplcblStatus | Status indicating that date and time of hospital admission does not apply to the subject/participant | Status indicating that date and time of hospital admission does not apply to the subject/participant | Hospital admission date | N/A | N/A | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:38:31.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C54333 | Acute Concussion Evaluation (ACE) ? Injury description text | ACEInjuryDescriptnTxt | Text of injury description as related to the Acute Concussion Evaluation (ACE) | Text of injury description as related to the Acute Concussion Evaluation (ACE) | Injury description | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 19:20:57.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C55504 | Injury circumstance describe text | InjCrcmstncDscrbTxt | The free-text field for describing the circumstances of the occurrence of the suspected injury | The free-text field for describing the circumstances of the occurrence of the suspected injury | Describe events surrounding the injury | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 11:59:39.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 4000 |
Free-Form Entry |
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| C01053 | Loss of consciousness duration range | LOCDurRang | The range of duration of loss of consciousness the participant/subject experienced | The range of duration of loss of consciousness the participant/subject experienced | Loss of consciousness duration | <1 minute;1-29 minutes;30 minutes to 24 hours | <1 minute;1-29 minutes;30 minutes to 24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-20 10:21:25.65 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55470 | Concussion assessment baseline exist indicator | CncssnAssmntBslnExstInd | Indicator of whether a baseline evaluation exists for the subject/participant to aid in concussion assessment | Indicator of whether a baseline evaluation exists for the subject/participant to aid in concussion assessment | Does subject have a baseline? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:33:51.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55539 | Injury orthopedic non concussive anatomic site | InjOrthpdcNoCncsvAnatSite | Anatomic site(s) of non-concussive orthopedic suspected injuries incurred by the subject/participant | Anatomic site(s) of non-concussive orthopedic suspected injuries incurred by the subject/participant | Did/Does athlete have any other orthopedic injuries? | Neck;Shoulder;Arm/Elbow;Wrist/Hand/Fingers;Back;Trunk;Knee;Hip/Thigh;Lower leg/Foot/Toe;Head (non-concussive) | Neck;Shoulder;Arm/Elbow;Wrist/Hand/Fingers;Back;Trunk;Knee;Hip/Thigh;Lower leg/Foot/Toe;Head (non-concussive) | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:25:20.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55567 | Academic year current organize sport grade | AcadYrCurrOrganizSportGrade | Grade representing the current year of schooling for which the subject/participant is participating in organized sport | Grade representing the current year of schooling for which the subject/participant is participating in organized sport | Current academic year in which your child will be participating in enrolled sport (i.e. basline test in spring or summer for fb, academic year is what they will be when participating in sport in fall) | 6th Grade;7th Grade;8th Grade;College-5th Yr;College-6th Yr;College-Fr;College-Jr;College-So;College-Sr;HS-Fr;HS-Jr;HS-So;HS-Sr | 6th Grade;7th Grade;8th Grade;Fifth year of college;Sixth year of college;College freshman;College junior;College sophomore;College senior;High school freshman;High school junior;High school sophomore;High school senior | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 15:57:01.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C12245 | Symptom presentation type | SymptmPresentTyp | Symptoms participant/ subject shows at presentation | Symptoms participant/ subject shows at presentation | Symptoms | Balance problems;Dizziness;Fogginess/confusion;Headache;Memory loss;Nausea/vomiting;Vision Changes | Balance problems;Dizziness;Fogginess/confusion;Headache;Memory loss;Nausea/vomiting;Vision Changes | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2017-05-12 12:45:20.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55484 | Injury immediate medical service received other text | InjImmdtMedServRecvdOTH | The free-text field related to 'Injury immediate medical service received type' specifying other text | The free-text field related to 'Injury immediate medical service received type' specifying other text | Medical Services received: Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:50:20.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
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| C54336 | Acute Concussion Evaluation (ACE) - Impact location anatomic site | ACEImpactLocationAnatSite | Anatomic site of impact injury as related to the Acute Concussion Evaluation (ACE) | Anatomic site of impact injury as related to the Acute Concussion Evaluation (ACE | Location of impact | Frontal;Indirect Force;Left Parietal;Left Temporal;Neck;Occipital;Right Parietal;Right Temporal | Frontal;Indirect Force;Left Parietal;Left Temporal;Neck;Occipital;Right Parietal;Right Temporal | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 20:16:54.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Multiple Pre-Defined Values Selected |
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| C55507 | Dizziness vertigo duration range | DizznsVrtgoDuratnRng | Range of time within which the duration of the subject/participant's dizziness or vertigo falls | Range of time within which the duration of the subject/participant's dizziness or vertigo fall | Dizziness duration | Less than 1 hour;1-24 hours;>24 hours | Less than 1 hour;1-24 hours;>24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 12:10:01.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C01055 | Post traumatic amnesia duration range | PstTraumAmnsDurRang | The range of duration of post-traumatic amnesia the participant/subject experienced | The range of duration of post-traumatic amnesia the participant/subject experienced | Post traumatic amnesia duration | >24 hours;<1 hour;1-24 hours | >24 hours;<1 hour;1-24 hours | Alphanumeric | Adult;Pediatric | Supplemental | 3.10 | 2017-05-12 12:30:51.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55472 | Remove participation activity indicator | RmvPrtcptnActvtyInd | Indicator of whether subject/participant was removed from participation in the activity in which he or she incurred the condition or injury being documented | Indicator of whether subject/participant was removed from participation in the activity in which he or she incurred the condition or injury being documented | Was athlete taken out of game? | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 13:54:14.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55540 | Neck sore uninjured indicator | NeckSoreUninjurdInd | Indicator of whether the subject/participant's neck is sore but otherwise uninjured | Indicator of whether the subject/participant's neck is sore but otherwise uninjured | Neck sore but not injured | No;Yes | No;Yes | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 13:31:57.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55569 | Educational assistance supplemental formal indicator | EduAsstncSupplFormlInd | Indicator of whether the subject/participant has ever received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | Indicator of whether the subject/participant has ever received formal supplemental educational assistance, such as an Individualized Education Program (IEP) | Have you ever had an IEP (Individualized Education Program) or extra support for studies? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-12 16:08:25.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C13523 | Dizziness or vertigo indicator | DizzinessVertigoInd | Indicator of whether the participant/subject experienced dizziness or vertigo | Indicator of whether the participant/subject experienced dizziness or vertig | Dizziness | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-21 00:00:00.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C55485 | Injury activity circumstance type | InjActvtyCrcmstncTyp | Type of circumstances of the activity during which the suspected injury was incurred | Type of circumstances of the activity during which the suspected injury was incurred | Injury occurred during | Training;Other;Game;Practice;Dryland/fitness | Training;Other;Game;Practice;Dryland/fitness | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-05-11 16:53:27.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events |
Single Pre-Defined Value Selected |
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| C54338 | Acute Concussion Evaluation (ACE) - Injury cause type sports text | ACEInjuryCauseTypSportsTxt | Text specifying the cause of the impact injury as related to the Acute Concussion Evaluation (ACE) | Text specifying the cause of the impact injury as related to the Acute Concussion Evaluation (ACE | Sport at time of injury | Alphanumeric | Adult;Pediatric | Supplemental | 1.00 | 2017-02-27 20:29:51.0 | Injury Report | History of Disease/Injury Event | Disease/Injury Related Events | 255 |
Free-Form Entry |
