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 / 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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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| 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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| 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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| 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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| 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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| 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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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 | |||||||||||
| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 |
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| 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 | |||||||||||
| 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 |
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| 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 |
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| 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 |
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| 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 |
