CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Subdomain Name: General Health History
CRF: Medical History - Immune Module

Displaying 101 - 113 of 113
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
C57316 Adverse reaction drug receive year text AdverseRxnDrugYrTxt Free-text field to indicate the year(s) the participant/subject has received a drug which causes an adverse reaction Free-text field to indicate the year(s) the participant/subject has received a drug which causes an adverse reaction Year(s) received Alphanumeric Adult Exploratory 1.00 2018-01-05 10:46:28.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry
C57423 Ear nose throat condition medication name EarNoseThroatCondMedName The name of the medication(s) the subject is taking for an ear, nose, throat condition The name of the medication(s) the subject is taking for an ear, nose, throat condition Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-08 09:38:14.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry
C57774 Blood immune condition medication work well indicator BldImmuneMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for blood or immune conditions is (are) working well The indicator relating to whether the medication(s) the subject is taking for blood or immune conditions is (are) working well Medications work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-10 13:02:58.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
C57361 ROME I criteria PLUS type ROMEICritPLUSTyp The ROME I criteria that requires two or more of the following conditions under the PLUS section The ROME I criteria that requires two or more of the following conditions under the PLUS sectio Two or more of the following, on at least one-fourth of occassions or days: Altered stool form (lumpy and hard, or loose and watery);Altered stool passage (straining, urgency, or a feeling of incomplete evacuatioin);Altered stool freuqency (for research purposes, ''altered'' may be defined as more than three bowel movements each day or fewer than three bowel movements each week);Passage of mucus;Bloating or feeling of abdominal Altered stool form (lumpy and hard, or loose and watery);Altered stool passage (straining, urgency, or a feeling of incomplete evacuatioin);Altered stool freuqency (for research purposes, ''altered'' may be defined as more than three bowel movements each day or fewer than three bowel movements each week);Passage of mucus;Bloating or feeling of abdominal Alphanumeric Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:45:19.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C57595 Gut condition diagnosis type GutCondDiagnosTyp Any gut conditions the subject has ever been diagnosed with Any gut conditions the subject has ever been diagnosed wit Condition diagnosed Peptic ulcer;Hiatus hernia;Hepatitis A;Hepatitis B;Hepatitis C;Hepatitis, type unspecified;Gall bladder disease;Liver disease;Cirrhosis;Chronic pancreatitis;Pancreatitis;Celiac disease;Irritable bowel syndrome;Crohn's disease;Colorectal cancer;Ulcerative colitis;Other, specify Peptic ulcer;Hiatus hernia;Hepatitis A;Hepatitis B;Hepatitis C;Hepatitis, type unspecified;Gall bladder disease;Liver disease;Cirrhosis;Chronic pancreatitis;Pancreatitis;Celiac disease;Irritable bowel syndrome;Crohn's disease;Colorectal cancer;Ulcerative colitis;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-09 10:24:06.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C57264 Antibiotic long term repeated history use year text AntibLongTermRepHistUseYrTxt The year(s) that the subject has used antibiotics repeatedly or long term The year(s) that the subject has used antibiotics repeatedly or long ter When (year(s)): Alphanumeric Adult Exploratory 1.00 2018-01-05 09:57:29.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry
C57814 Infection condition medication work well indicator InfectCondMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for infections is (are) working well The indicator relating to whether the medication(s) the subject is taking for infections is (are) working well Medications work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-11 08:54:19.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
C57381 Eye condition medication current indicator EyeCondMedctnCurrentInd The indicator relating to whether the subject currently takes medication for eye conditions The indicator relating to whether the subject currently takes medication for eye conditions Currently take medications Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-08 08:40:14.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected
C57714 Skin condition medication past year indicator SkinCondMedPastYrInd The indicator relating to whether the subject has taken medication for skin condition(s) in the past year The indicator relating to whether the subject has taken medication for skin condition(s) in the past yea Take medications No;Yes No;Yes Alphanumeric

In the past year

 Adult Exploratory 1.00 2018-01-10 11:02:19.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
C57277 Food component hypersensitivity reaction type text FoodCompHypersRxnTypTxt Free-text field describing the reaction the participant/subject has as a result of a food component hypersensitivity Free-text field describing the reaction the participant/subject has as a result of a food component hypersensitivity Reaction Alphanumeric

Hives, vomiting, other

 Adult Exploratory 1.00 2018-01-05 10:16:42.0 Medical History - Immune Module General Health History Participant History and Family History 500

Free-Form Entry
C57319 Atopy allergic disorder history indicator AtopyAllDisordrHistInd The indicator relating to whether the participant/subject has a history of atopy/allergic disorders The indicator relating to whether the participant/subject has a history of atopy/allergic disorder History of atopy/allergic disorders No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-05 10:49:14.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
C57424 Ear nose throat condition medication work well indicator EarNoseThroatMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for ear, nose, throat condition(s) is(are) working well The indicator relating to whether the medication(s) the subject is taking for ear, nose, throat condition(s) is(are) working wel Medication(s) work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-08 09:39:58.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
C57780 Blood immune condition active indicator BldImmuneCondActInd The indicator relating to whether the subject currently has an active blood or immune condition The indicator relating to whether the subject currently has an active blood or immune condition Condition active No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-10 13:27:49.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected
CSV