CDE Detailed Report

Disease: Sport-Related Concussion
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 / 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
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

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

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

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

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

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

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

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

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

C55508 Amnesia retrograde duration range AmnsiaRtrogrdDuratnRng Range of time within which the duration of the subject/participant's retrograde amnesia falls Range of time within which the duration of the subject/participant's retrograde amnesia falls Retrograde amnesia 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 12:17:20.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55473 Injury report delay elapsed time duration InjRptDlyElpsdTimDur Duration of time elapsed between occurrence of injury and initial report of injury by subject/participant if not immediately reported Duration of time elapsed between occurrence of injury and initial report of injury by subject/participant if not immediately reported How many minutes/hours after injury did athlete report it to someone? Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-11 14:50:06.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0
C55541 Concussion prior current year text ConcusnPriorCurrYrTxt The free-text field for documenting prior concussions suffered by the subject/participant during the current year The free-text field for documenting prior concussions suffered by the subject/participant during the current year Repeat concussion this year Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 13:35:06.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events 4000

Free-Form Entry

C04813 Return work school status RtrnWrkSchlStatus Status of participant's/subject's return to work and/or school Status of participant's/subject's return to work and/or school Return to work/school Returned to previous level;Same work or school, reduced level;Different work or school;Only in sheltered environment;Did not return to work or school;N/A;Unknown Returned to previous level;Same work or school, reduced level;Different work or school;Only in sheltered environment;Did not return to work or school;N/A;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

C55486 Equipment protective worn injury incur type EqpmntPrtctvWrnInjryIncrTyp Type of protective equipment being worn by the subject/participant when he or she incurred the suspected injury Type of protective equipment being worn by the subject/participant when he or she incurred the suspected injury At the time of injury, was any protective equipment worn? Helmet;Mouthguard;Brace;Tape;Other Helmet;Mouthguard;Brace;Tape;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 16:57:20.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C55570 Educational assistance supplemental formal subject type EduAsstncSupplFormlSbjTyp Type of academic subject(s) for which the subjec/participant received formal supplemental educational assistance, such as an Individualized Education Program (IEP) Type of academic subject(s) for which the subjec/participant received formal supplemental educational assistance, such as an Individualized Education Program (IEP) What did you have an IEP in? Reading;Writing;Math;Other Reading;Writing;Math;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 16:11:30.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Multiple Pre-Defined Values Selected

C17499 Special education indicator SpecialEduInd Indicator as to whether the participant/subject has or had special education Indicator as to whether the participant/subject has or had special education Does your child have a history of Special Education? For example, have you had any special classes or accommodations in school? Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C54340 Acute Concussion Evaluation (ACE) - Amnesia before no memory events indicator ACEAmnesiaBfNoMemEvntsInd Indicator of whether subject/participant had no memory of events before (retrograde) amnesia as related to the Acute Concussion Evaluation (ACE) Indicator of whether subject/participant had no memory of events before (retrograde) amnesia as related to the Acute Concussion Evaluation (ACE Retrograde amnesia No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2017-02-27 20:29:51.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55511 Amnesia event lacuna indicator AmnsiaEvntLacunaInd Indicator of whether the subject/participant experienced lacunar amnesia of the suspected injury event Indicator of whether the subject/participant experienced lacunar amnesia of the suspected injury event Amnesia of event No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 12:20:44.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55474 Injury report delay elapsed time unit of measure InjRptDlyElpsdTimUOM Unit of measure related to 'Injury report delay elapsed time duration' for recording the units of the elapsed time between the occurrence and reporting of the injury that was recorded Unit of measure related to 'Injury report delay elapsed time duration' for recording the units of the elapsed time between the occurrence and reporting of the injury that was recorded How many minutes/hours after injury did the athlete report it to someone? Hour;Minute Hour;Minute Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 14:55:12.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55542 Injury external cause ICD-10 code InjExtrnlCausICD10Code Code from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for the external cause of the suspected injury Code from the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) for the external cause of the suspected injury Injury ICD external cause code Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 13:42:56.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events 10

Free-Form Entry

C05403 Injury date time estimation type InjDateTimeEstTyp The type as related to the point in time estimated as injury date and time The type as related to the point in time estimated as injury date and time If injury data is ESTIMATED, injury data type (point in time) Time that the participant/subject became symptomatic;Time of first trauma activation;Time of presentation to emergency department Time that the participant/subject became symptomatic;Time of first trauma activation;Time of presentation to emergency department 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

C55487 Injury incur activity role text InjryIncurActvtyRolTxt The free-text field for specifying the subject/participant's role in the activity in which he or she incurred the suspected injury The free-text field for specifying the subject/participant's role in the activity in which he or she incurred the suspected injury Position at time of injury Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 17:08:21.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C55571 Academic performance high school category AcadPerfrmncHiSchlCat Category of the subject/participant's overall academic performance in high school Category of the subject/participant's overall academic performance in high school What type of student were/are you in high school? Below Average;Average;Above Average Below Average;Average;Above Average Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 16:17:04.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C18397 Influence alcohol likelihood type InfAlcLkhdTyp Indicator for the likelihood the subject was under the influence of alcohol Indicator for the likelihood the subject was under the influence of alcoho Likelihood participant under influence of alcohol None;Suspected;Confrimed;Unknown None;Suspected;Confrimed;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

C55462 Injury day week name InjuryDayWeekName Name of the day of the week on which the injury occurred Name of the day of the week on which the injury occurred Day of week of injury Monday;Friday;Wednesday;Tuesday;Thursday;Sunday;Saturday Monday;Friday;Wednesday;Tuesday;Thursday;Sunday;Saturday Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 11:55:34.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55512 Amnesia event lacuna duration range AmnsiaEvntLacunaDuratnRng Range of time within which the duration of the subject/participant's lacunar amnesia of the suspected injury event falls Range of time within which the duration of the subject/participant's lacunar amnesia of the suspected injury event falls Amnesia of event: 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 12:17:20.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55475 Injury report immediate indicator InjRptImmedInd Indicator of whether the injury was reported by the injured party immediately upon occurrence Indicator of whether the injury was reported by the injured party immediately upon occurrence Did athlete immediately report the injury? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 16:05:32.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55543 Days school missed count range DaysSchoolMissedCtRng Range in which the count of days of school missed by the subject/participant falls Range in which the count of days of school missed by the subject/participant falls Approximately how many days of school has the child missed? 1-2 days;0 days;3–6 days;7 or more days 1-2 days;0 days;3–6 days;7 or more days Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 13:48:24.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C05404 Symptom onset date and time SymptmOnsetDateTime Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms Date (and time, if applicable and known) reported for onset of participant's/subject's symptoms Symptom onset date; Symptom onset 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

C55496 Injury onset participant involvment category InjOnstPtcptInvlvmntCat Category of onset speed of the suspected injury and involvment of other participants in the activity in which the subject/participant incurred the suspected injury Category of onset speed of the suspected injury and involvment of other participants in the activity in which the subject/participant incurred the suspected injury Injury involved: Gradual onset/overuse;Sudden onset and contact with another participant;Sudden onset and no contact with another participant;Unknown Gradual onset/overuse;Sudden onset and contact with another participant;Sudden onset and no contact with another participant;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 10:36:03.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55573 Pain intensity visual analogue scale value PainIntnstyVslAnalogSclVal Value indicated by the subject/participant for his or her pain intensity using a visual analogue scale Value indicated by the subject/participant for his or her pain intensity using a visual analogue scale Pain assessment Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-12 16:23:04.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0 10
C19197 Injury time InjuryTime Time of injury Time of injury Time of Injury (24 hour clock) 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 2014-06-02 16:13:18.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55463 Injury data reliability category InjDataReliablCat Category of reliability for the injury data being reported Category of reliability for the injury data being reported Reliability of injury data Verified;Estimated;Unknown Verified;Estimated;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

C55517 Symptom duration value SymptmDuratnVal Value for the duration of the symptom(s) being documented Value for the duration of the symptom(s) being documented How long did symptoms last after injury/impact? Numeric Values Adult;Pediatric Supplemental 1.00 2017-05-12 12:33:35.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

0
C55477 Participation continue activity post injury indicator PtcptnCntnuActvtyPostInjyInd Indicator of whether the injured party continued to participate in the activity in which he or she received the suspected injury, after the occurrence of the suspected injury Indicator of whether the injured party continued to participate in the activity in which he or she received the suspected injury, after the occurrence of the suspected injur Did athlete continue participation after suspected injury event? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 16:08:03.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55558 Education current level USA type EduCurrLvlUSATyp Current grade or level of school in which participant/subject is enrolled Current grade or level of school in which participant/subject is enrolled Please indicate the grade that your child is currently enrolled in: 1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade;Kindergarten;Not currently enrolled;Other, specify 1st Grade;2nd Grade;3rd Grade;4th Grade;5th Grade;6th Grade;7th Grade;8th Grade;9th Grade;10th Grade;11th Grade;12th Grade;Kindergarten;Not currently enrolled;Other, specify Alphanumeric Pediatric Supplemental 3.00 2013-07-25 08:54:08.2 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

3134878
C05406 Hospital first treat arrival date time HospFirstTreatArrDateTime Date (and time, if applicable and known) of arrival at the first hospital, if the participant/subject was transferred to the study center from another hospital Date (and time, if applicable and known) of arrival at the first hospital, if the participant/subject was transferred to the study center from another hospital Date treated at hospital; Time treated at hospital 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 2013-07-20 10:21:25.65 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Free-Form Entry

C55497 Injury cause activity behavior text InjCausActvtyBehvrTxt The free-text field for describing the activity behavior or action that caused the suspected injury The free-text field for describing the activity behavior or action that caused the suspected injury Cause of injury (will depend on sport) – body check, tackle, intentional player contact (elbowing, roughing, cross-check, dueling for header, etc) Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 10:42:48.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events 255

Free-Form Entry

C22622 Wong-Baker FACES - Pain rating scale WongBakerFacesPainRatingScale This scale uses faces and corresponding numbers to indicate the amount of pain the subject feels This scale uses faces and corresponding numbers to indicate the amount of pain the subject feel Pain assessment 0;10;2;4;6;8 No Hurt;Hurts Worst;Hurts Little Bit;Hurts Little More;Hurts Even More;Hurts Whole Lot Numeric Values Pediatric Supplemental 1.00 2016-07-13 13:21:18.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55464 Assessment clinical perform occupation type AssmntClnclPrfrmOccptnTyp Type of occupation of the person performing the clinical assessment Type of occupation of the person performing the clinical assessment Who was the clinical assessment completed by? Medical doctor;Athletic trainer;Coach;Physician's Assistant;Physical therapist;Other Medical doctor;Athletic trainer;Coach;Physician's Assistant;Physical therapist;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-11 12:34:42.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

C55518 Symptom duration unit of measure SymptmDuratnUOM Unit of measure related to 'Symptom duration value' Unit of measure related to 'Symptom duration value' How long did symptoms last after injury/impact? Days;Hours;minutes Days;Hours;minutes Alphanumeric Adult;Pediatric Supplemental 1.00 2017-05-12 12:35:09.0 Injury Report History of Disease/Injury Event Disease/Injury Related Events

Single Pre-Defined Value Selected

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

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

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

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

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

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

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
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

CSV