CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Sub-Domain: General Health History
CRF: Reproductive and Hormonal History

Displaying 1 - 34 of 34
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) 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
C16178 Post-menopausal cause type PostMnpslCauseTyp Cause or reason for the post-menopausal period in the female participant/subject Cause or reason for the post-menopausal period in the female participant/subject If Yes, indicate cause Natural;Medications or chemotherapy;Surgical (complete hysterectomy- ovaries and uterus removed) Natural;Medications or chemotherapy;Surgical (complete hysterectomy- ovaries and uterus removed) Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57246 Hyperthyroidism diagnosis age value HyperthyDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with hyperthyroidism. The value representing the age the subject was when he/she was diagnosed with hyperthyroidism. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:53:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C06358 Diabetes mellitus type DiabetesMellitusTyp Type of diabetes mellitus Type of diabetes mellitus Type Type 1;Type 2;Unknown;Other, specify Type 1;Type 2;Unknown;Other, specify Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57257 Diabetes insipidus type DiabInsipTyp The type of diabetes insipidus the subject has. The type of diabetes insipidus the subject has. Type Central;Nephrogenic;Other, specify Central;Nephrogenic;Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:24:35.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16179 Post-menopausal surgery date PostMnpslSurgDate The date and time (if applicable and known) of the surgery that induced the post-menopausal period Date (and time if applicable and known) of the surgery that induced the post-menopausal period Date last ovary removed Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57247 Hypothyroidism indicator HypothyInd The indicator relating to whether the subject has hypothyroidism. The indicator relating to whether the subject has hypothyroidism. Hypothyroidism No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:52:19.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16164 Hormonal therapy start date HormonalTherapyStartDate The date and time (if applicable and known) the participant/subject started hormonal therapy Date (and time, if applicable and known) the participant/subject started hormonal therapy Start date Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57258 Diabetes insipidus other text DaibInsipOthrTxt Text describing another type of diabetes insipidus the subject has been diagnosed with. Text describing another type of diabetes insipidus the subject has been diagnosed with. Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:28:14.0 Reproductive and Hormonal History General Health History Participant History and Family History 4000

Free-Form Entry

C53062 Diabetes mellitus medical history indicator DiabetesMellMedHistInd Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Diabetes mellitus Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57248 Hypothyroidism diagnosis age value HypothyDiagnosAgeVal The value representing age the subject was when he/she was diagnosed with hypothyroidism. The value representing age the subject was when he/she was diagnosed with hypothyroidism. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:53:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16165 Hormonal therapy stop date HormonalTherapyStopDate The date and time (if applicable and known) the participant/subject stopped hormonal therapy Date (and time, if applicable and known) the participant/subject stopped hormonal therapy End date Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57238 Hormonal therapy medication device name HormTherpyMedDevName The name of the medication or device being used for hormonal therapy. The name of the medication or device being used for hormonal therapy. Medication/device name Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:41:12.0 Reproductive and Hormonal History General Health History Participant History and Family History 255

Free-Form Entry

C57249 Cushings syndrome indicator CushSyndInd The indicator relating to whether the subject has Cushing's syndrome. The indicator relating to whether the subject has Cushing's syndrome. Cushing's sydrome indicator No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:55:10.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16170 Menstrual period occurrence indicator MenstrualPrdOcurInd Indicates whether participant/subject has ever had a menstrual period. Indicates whether participant/subject has ever had a menstrual period. Have you ever had a menstrual period? Yes;No Yes;No Alphanumeric

If no, section is complete. Do not proceed to further questions.

Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57239 Hormonal therapy medication device dose frequency text HormTherMedDevDoseFreqTxt Text indicating the dose of the medication or frequency of the device being used for hormonal therapy. Text indicating the dose of the medication or frequency of the device being used for hormonal therapy. Dose/frequency (if applicable) Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:44:01.0 Reproductive and Hormonal History General Health History Participant History and Family History 255

Free-Form Entry

C57250 Cushings syndrome diagnosis age value CushSyndDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with Cushing's syndrome. The value representing the age the subject was when he/she was diagnosed with Cushing's syndrome. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:56:35.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16172 Pregnant current indicator PregCurntInd Whether the female participant/subject is currently pregnant Whether the female participant/subject is currently pregnant Pregnant? Yes;No;Don't know Yes;No;Don't know Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57240 Pregnant in past year indicator PregPastYrInd The indicator relating to whether the subject was pregnant within the past year. The indicator relating to whether the subject was pregnant within the past year. If no, pregnant within past year? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:45:42.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57251 Adrenal insufficiency indicator AdrInsufInd The indicator relating to whether the subject has adrenal insuffciency. The indicator relating to whether the subject has adrenal insuffciency. Adrenal insufficiency No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:00:15.0 Reproductive and Hormonal History 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 If yes, estimated due date: Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57241 Nursing indicator NursingInd The indicator relating to whether the subject is nursing. The indicator relating to whether the subject is nursing. Nursing? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:47:24.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57252 Adrenal insufficiency diagnosis age value AdrInsufDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with adrenal insufficiency. The value representing the age the subject was when he/she was diagnosed with adrenal insufficiency. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:01:15.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16174 Menopause indicator MenopauseInd Indicates whether participant/subject is currently menopausal. Indicates whether participant/subject is currently menopausal. Do you believe you are currently experiencing menopause (perimenopausal)? Yes;No;Don't know Yes;No;Don't know Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57242 Menstrual period regularity type MenstPdRegTyp The type of menstrual period regularity the subject has been experiencing, if applicable. The type of menstrual period regularity the subject has been experiencing, if applicable. Menstrual periods Regular;Irregular;Not applicable Regular;Irregular;Not applicable Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:48:07.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57253 Diabetes mellitus diagnosis age value DiabMellDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with diabetes mellitus. The value representing the age the subject was when he/she was diagnosed with diabetes mellitus. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:05:34.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
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 If Yes, indicate the approximate date of your last menstrual period Date or Date & Time Adult;Pediatric Supplemental 3.00 2013-07-16 14:01:43.01 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57243 Polycystic ovary syndrome indicator PolyOvarySyndInd The indicator related to whether the subject has polycystic ovary syndrome. The indicator related to whether the subject has polycystic ovary syndrome. Polycystic ovary syndrome No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:49:53.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57254 Diabetes mellitus other text DiabMellOthrTxt Text describing another type of diabetes mellitus the subject has. Text describing another type of diabetes mellitus the subject has. Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:14:51.0 Reproductive and Hormonal History General Health History Participant History and Family History 4000

Free-Form Entry

C16176 Hormone therapy indicator HormoneTherapyInd Indicates whether participant/subject has taken hormonal therapy Indicates whether participant/subject has taken hormonal therapy Are you currently on, or have you been on within the past year, sex hormone-related therapy? (Includes, but not limited to, hormonal contraceptives, including hormone-releasing contraceptive
devices; hormone replacement therapy, eg, estrogens, progestins; testosterone)
Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57244 Polycystic ovary syndrome diagnosis age value PolyOvarySyndDiagnosAgeVal The value representing the age the subject was when she was diagnosed with polycystic ovary syndrome. The value repreenting the age the subject was when she was diagnosed with polycystic ovary syndrome. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:51:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C57255 Diabetes insipidus indicator DiabInsipInd The indicator relating to whether the subject has diabetes insipidus. The indicator relating to whether the subject has diabetes insipidus. Diabetes insipidus No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:16:07.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16177 Post-menopausal indicator PostMnpslInd Indicates whether participant/subject is post-menopausal Indicates whether participant/subject is post-menopausal Are you post-menopausal? Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57245 Hyperthyroidism indicator HyperthyInd The indicator relating to whether the subject has hyperthyroidism. The indicator relating to whether the subject has hyperthyroidism. Hyperthyroidism No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:52:19.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57256 Diabetes insipidus diagnosis age value DiabInsipDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with diabetes insipidus. The value representing the age the subject was when he/she was diagnosed with diabetes insipidus. If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:21:23.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
CSV