CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Sub-Domain: 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 / 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
C57712 Skin condition diagnosis other text SkinCondDiagnosOthrTxt Text specifying another skin condition the subject has ever been diagnosed with. Text specifying another skin condition the subject has ever been diagnosed with. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-10 10:37:03.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57274 Food hypersensitivity indicator FoodHypersensInd The indicator relating to whether the subject has food hypersensitivity The indicator relating to whether the subject has food hypersensitivity Food hypersensitivity No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-05 10:10:39.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C58437 Gut condition inactive resolved other text GutCondInactResolvOthTxt Free-text field to describe other type of gut condition that is no longer active in the subject or is considered resolved or cured. Free-text field to describe other type of gut condition that is no longer active in the subject or is considered resolved or cured. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-10 10:03:15.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57422 Ear nose throat condition medication current indicator EarNoseThroatCondMedCurrInd The indicator relating to whether the subject currently takes medication for an ear, nose, throat condition The indicator relating to whether the subject currently takes medication for an ear, nose, throat condition Currently take medications No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-08 09:30:14.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57773 Blood immune condition medication name BldImmuneMedName The name of any medication(s) the subject is taking for blood or immune conditions The name of any medication(s) the subject is taking for blood or immune conditions Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-10 13:02:30.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57315 Adverse reaction drug route text AdverseRxnDrugRouteTxt Free-text field to describe the route used for a drug which causes an adverse reaction for the participant/subject Free-text field to describe the route used for a drug which causes an adverse reaction for the participant/subject Route Alphanumeric Adult Exploratory 1.00 2018-01-05 10:45:43.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57590 Lung condition inactive resolved type LundCondInactResolvTyp Any lung conditions the subject has had that are no longer active or are considered resolved or cured Any lung conditions the subject has had that are no longer active or are considered resolved or cured Condition(s) no longer active/resolved Pneumonia in the past 12 weeks;Pneumonia, ever;Pleurisy;Asthma (as a child);Asthma (as an adult);Bronchitis;Emphysema;Chronic obstructive lung disease (COPD or COLD);Chronic restrictive lung disease;Silicosis;Asbestosis;Other, specify Pneumonia in the past 12 weeks;Pneumonia, ever;Pleurisy;Asthma (as a child);Asthma (as an adult);Bronchitis;Emphysema;Chronic obstructive lung disease (COPD or COLD);Chronic restrictive lung disease;Silicosis;Asbestosis;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-09 09:29:41.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57263 Antibiotic long term repeated history name AntibLongTermRepHistName The name of the antibiotic(s) that the subject has a history of using repeatedly or long term The name of the antibiotic(s) that the subject has a history of using repeatedly or long term If yes, what antibiotic(s): Alphanumeric Adult Exploratory 1.00 2018-01-05 09:56:26.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57813 Infection condition medication name InfectCondMedName The name of the medication(s) the subject is taking for infections The name of the medication(s) the subject is taking for infections Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-11 08:51:25.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57359 ROME I criteria abdominal pain discomfort type ROMEICritAbPainDiscomfrtTyp The type of abdominal pain or discomfort that the subject might be experiencing in relation to the ROME I criteria for Irritable Bowel Syndrome. The type of abdominal pain or discomfort that the subject might be experiencing in relation to the ROME I criteria for Irritable Bowel Syndrome. Abdominal pain or discomfort that is: Relieved with defecation;Associated with a change in consistency of stool;Associated with a change in frequency of stool Relieved with defecation;Associated with a change in consistency of stool;Associated with a change in frequency of stool Alphanumeric Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:15:40.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57379 Eye condition medication past year indicator EyeCondMedPastYrInd The indicator relating to whether the subject has taken medications for eye conditions in the past year. The indicator relating to whether the subject has taken medications for eye conditions in the past year. 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

Medications taken in the last year

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

C57713 Skin condition active indicator SkinCondActInd The indicator relating to whether the subject currently has active skin condition(s) The indicator relating to whether the subject currently has active skin condition(s) Condition(s) active No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-10 10:44:02.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57275 Food hypersensitivity component type FoodHypersensCompTyp The food component(s) to which the subject has a hypersensitivity The food component(s) to which the subject has a hypersensitivity Have hypersensitivity? Lactose;Gluten (any intolerance);Gluten (celiac disease);Milk protein;Alcohol;Eggs;Sugar/Fructose;Caffeine;Nuts;Chocolate;Aspartame;Other, specify Lactose;Gluten (any intolerance);Gluten (celiac disease);Milk protein;Alcohol;Eggs;Sugar/Fructose;Caffeine;Nuts;Chocolate;Aspartame;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-05 10:12:01.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

CSV