CDE Detailed Report

Disease: content
Sub-Domain: General Health History
CRF: welcome

Displaying 1 - 29 of 29
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C10981 Birth control method type BirthCntrlMethdTyp The female participant's/subject's method of birth control The female participant's/subject's method of birth control If Yes, indicate all forms of contraception used (choose all that apply) Oral contraceptives – combined pill;Oral contraceptives – progestin-only pill;Transdermal patch;Shot/injection;Vaginal ring;Implantable devices with hormone;Abstinence;None of these Oral contraceptives – combined pill;Oral contraceptives – progestin-only pill;Transdermal patch;Shot/injection;Vaginal ring;Implantable devices with hormone;Abstinence;None of these Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Pregnancy Information General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C16020 Pregnancy infection illness indicator PregInfectnIllnessInd Indicator of whether there were any infections/illnesses that occurred during this pregnancy Indicator of whether there were any infections/illnesses that occurred during this pregnancy Did/Has the participant subject experienced any infections or illnesses during the pregnancy? Yes, specify;No;Unknown Yes;No;Unknown Alphanumeric

Choose one. If yes, specify the infection or illness.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17995 Pregnancy infection illness text PregInfectnIllnessTxt Text specifying any infections or illnesses the participant/subject experienced during this pregnancy Text specifying any infections or illnesses the participant/subject experienced during this pregnancy If yes specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 255

Free-Form Entry

C15624 Pregnancy indicator PregInd Indicates if the participant/subject is currently pregnant Indicates if the participant/subject is currently pregnant Is the participant/subject pregnant? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If No or Unknown skip to Pregnant ever indicator

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16022 Pregnancy prior history births full-term count PregPriorHistBirthFulltermCt Count of the total number of pregnancies the participant/subject has carried for a full term (>= 37 weeks) Count of the total number of pregnancies the participant/subject has carried to a full term (>= 37 weeks) Full term (>= 37 weeks) births Numeric Values

No additional Instructions

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

0 30
C17996 Pregnancy prior history birth defect text PregPriorHistBirthDefectTxt Text of any comments about any birth defects that occurred during the participant/subject's previous pregnancies Text of any comments about any birth defects that occurred during the participant/subject's previous pregnancies If Yes specify birth defect Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 255

Free-Form Entry

C16008 Birth control indicator BirthControlInd Indicates if participant/subject uses birth control Indicates if participant/subject uses birth control Was birth control being used? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16023 Pregnancy prior history births pre-term count PregPriorHistBirthPretermCt Count of the total number of pregnancies the participant/subject carried for less than a full term (< 37 weeks) Count of the total number of pregnancies the participant/subject carried for less than a full term (< 37 weeks) Pre-term (< 37 weeks) births Numeric Values

No additional Instructions

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

0 30
C19040 Prenatal testing other text PrenatalTestOTH The free-text field related to 'Prenatal testing type' specifying other text. The type of prenatal testing that was performed for the current pregnancy The free-text field related to 'Prenatal testing type' specifying other text. The type of prenatal testing that was performed for the current pregnancy Other, specify Alphanumeric

Record the date for each prenatal test performed and the results

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 4000

Free-Form Entry

C16009 Birth control last used date and time BirthControlLastUsedDateTime Date (and time, if applicable and known) birth control was last used Date birth control was last used Last date birth control used 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.).

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C16024 Pregnancy prior history birth defect indicator PregPriorHistBirthDefectInd Indicator of whether a birth defect occurred in any of the participant/subject's previous pregnancies Indicator of whether a birth defect occurred in any of the participant/subject's previous pregnancies Did a birth defect occur in any previous pregnancy? Yes, specify;No;Unknown Yes;No;Unknown Alphanumeric

Choose one

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C19044 Pregnancy prior history toxic exposure other text PregPriorHistToxExposOTH The free-text field related to 'Pregnancy prior history toxic exposure type' specifying other text. Type of any substances or radiation potentially harmful to the embryo or fetus to which the participant/subject has ever been exposed during pregnancy The free-text field related to 'Pregnancy prior history toxic exposure type' specifying other text. Type of any substances or radiation potentially harmful to the embryo or fetus to which the participant/subject has ever been exposed during pregnancy Other, specify Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 4000

Free-Form Entry

C16011 Pregnancy confirmed date and time PregConfirmDateTime Date the participant/subject's current pregnancy was confirmed Date the participant/subject's current pregnancy was confirmed Date pregnancy confirmed 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.).

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C16026 Pregnancy prior history loss indicator PregPriorHistLossInd Indicator of whether a miscarriage (<= 20 weeks) or stillbirth (> 20 weeks) occurred in any previous pregnancy Indicator of whether a miscarriage (<= 20 weeks) or stillbirth (> 20 weeks) occurred in any previous pregnancy Did a miscarriage (<= 20 weeks) or stillbirth (> 20 weeks) occur in any previous pregnancy? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C55934 Pregnancy prior history births count PrgnncyPrrHstryBrthCt Count of the total number of pregnancies, either full-term or pre-term, that the patient/subject has been through. Count of the total number of pregnancies, either full-term or pre-term, that the patient/subject has been through. Number of prior pregnancies: Numeric Values

No additional instructions

No references available Adult;Pediatric Supplemental 1.00 2017-06-02 16:08:22.0 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

0 30 weeks
C16013 Pregnancy estimated delivery date ultrasound based indicator PregDelEstDateUltrasndInd Indicator of whether the estimated delivery date is based on an ultrasound examination Indicator of whether the estimated delivery date is based on an ultrasound examination Was the EDD based on an ultrasound? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16027 Pregnancy prior history loss week count PregPriorHistLossWeekCt Number of the week of pregnancy during which the stillbirth or miscarriage occurred Number of the week of pregnancy during which the stillbirth or miscarriage occurred If Yes in what week of pregnancy did the miscarriage or stillbirth occur? Week(s) Numeric Values

Record in weeks

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

1 45 week
C16014 Pregnancy prenatal testing performed indicator PregPrenatalTestPerfInd Indicator of whether prenatal testing was performed for the current pregnancy Indicator of whether prenatal testing was performed for the current pregnancy Was prenatal testing performed? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If yes, please complete the following questions regarding prenatal testing

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16028 Pregnancy prior history toxic exposure type PregPriorHistToxExposTyp Type of any substances or radiation potentially harmful to the embryo or fetus to which the participant/subject has ever been exposed during pregnancy Type of any substances or radiation potentially harmful to the embryo or fetus to which the participant/subject has ever been exposed during pregnancy Has the participant/subject ever had exposure to any of the following during pregnancy? Concurrent medications;Teratogens;Smoking;Exposure to X-ray;Alcohol;Other, specify Concurrent medications;Teratogens;Smoking;Exposure to X-ray;Alcohol;Other, specify Alphanumeric

Choose all that apply

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C16015 Prenatal testing type PrenatalTestTyp The type of prenatal testing that was performed for the current pregnancy The type of prenatal testing that was performed for the current pregnancy If Yes, please complete the following questions regarding prenatal testing: Ultrasound;Amniocentesis;Screening for neural tube defects;Screening for gestational diabetes before or at 28 weeks;Screening for asymptomatic bacteriuria before or at 16 weeks gestation;Hepatitis B specific antigen screening at first visit;HIV screening at first visit;Group B streptococcus screening (GBS) at 35 to 37 weeks;Maternal serum alpha fetoprotein;Other, specify Ultrasound;Amniocentesis;Screening for neural tube defects;Screening for gestational diabetes before or at 28 weeks;Screening for asymptomatic bacteriuria before or at 16 weeks gestation;Hepatitis B specific antigen screening at first visit;HIV screening at first visit;Group B streptococcus screening (GBS) at 35 to 37 weeks;Maternal serum alpha fetoprotein;Other, specify Alphanumeric

Record the date for each prenatal test performed and the results

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16173 Pregnancy estimated delivery date and time PregEstDeliveryDateTime The date and time (if applicable) the participant/subject is estimated to deliver the pregnancy The date and time (if applicable) the participant/subject is estimated to deliver the pregnancy Estimated delivery date EDD 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.).

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C16016 Prenatal testing date and time PrenatalTestDateTime Date the selected prenatal testing type was performed for the current pregnancy Date the selected pregnancy prenatal testing type was performed for the current pregnancy Dates of testing 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.).

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C16175 Menstrual period last date MenstrualPeriodLastDate Date of the participant's/subject's last menstrual period Date of the participant's/subject's last menstrual period Date of last menstrual period 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.).

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C06005 Data collected date and time DataCollDateTime Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date (and time, if applicable and known) the data were collected. This may be the date/time a particular examination or procedure was performed. Date pregnancy information obtained 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.).

ISO 8601 - http://www.iso.org/iso/iso_catalogue.htm Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Pregnancy Information General Health History Participant History and Family History

Free-Form Entry

C16017 Prenatal testing result PrenatalTestReslt Results of the selected prenatal testing type Results of the selected prenatal testing type Results of Test Alphanumeric

To be answered for each prenatal test performed.

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 255

Free-Form Entry

C17993 Prenatal test text PrenatalTestTxt Text notes of any comments regarding the selected prenatal testing type Text notes of any comments regarding the selected prenatal testing type Comments Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 255

Free-Form Entry

C10556 Pregnant ever indicator PregEverInd Indicator as to whether or not the participant/subject has every been pregnant, both term and not to term Indicator as to whether or not the participant/subject has every been pregnant, both term and not to term Has the participant/subject ever been pregnant? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If No or Unknown, stop

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16018 Pregnancy complication indicator PregComplicationInd Indicator of whether the participant/subject had complications during the pregnancy Indicator of whether the participant/subject had complications during the pregnancy Did/Has the participant subject experienced any complications during the pregnancy? Yes, specify;No;Unknown Yes;No;Unknown Alphanumeric

Choose one. If yes, specify the complication(s).

No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History

Single Pre-Defined Value Selected

C17994 Pregnancy complication text PregComplicationTxt Text specifying any complications the participant/subject experienced during this pregnancy Text specifying any complications the participant/subject experienced during this pregnancy If yes specify Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Pregnancy Information General Health History Participant History and Family History 255

Free-Form Entry

CSV