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CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Headache
Sub-Domain: General Health History
CRF: Medical and Family History
Item count: 39 (39 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C08147
Data source
DataSource
Source of the data provided on the case report form
Source from which medical and family history obtained?
Participant/subject;Family, specify relation;Unknown;
Participant/subject;Family, specify relation;Unknown;
Alphanumeric
Choose all that apply
No references available
Adult;Pediatric
Supplemental
3.0
7/20/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Data source
 
Multiple Pre-Defined Values Selected
       
C10813
Adopted indicator
AdoptedInd
Whether the subject/participant was adopted
Are you adopted?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
Choose one
No references available
Adult;Pediatric
Supplemental
3.0
7/22/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Adopted indicator
 
Single Pre-Defined Value Selected
       
C15997
Relative first degree total count
Reltv1stDegTotlCt
Count of the total number of first-degree relatives the participant/subject has
How many total number of first-degree relatives do you have?
  
Numeric Values
This number can be calculated with informant after enumerating relatives of each type provided in the ‘Name of Family Member with Condition” code list.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
First-degree relative total count
 
Free-Form Entry
       
C17986
Relative first degree total count unknown indicator
Reltv1stDegTotCntUnknownInd
Indicator of the unknown total number of first-degree relatives
How many total number of first-degree relatives do you have?
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C15998
Relative first degree live count
Reltv1stDegLivCt
The total number of the participant/subject first-degree living relatives
Number alive
  
Numeric Values
Provide the number of first/second degree relatives. The participant/subject should refer to the Name of Family Member with Condition” code list to provide any information on each of family member that he/she has knowledge of.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
First-degree living relative count
 
Free-Form Entry
       
C17987
Relative first degree live count unknown indicator
Reltv1stDegLivCtUnknownInd
Indicator of the unknown number of living first-degree relatives
Number alive
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C15999
Relative first degree decease count
Reltv1stDegDeceasCt
The total number of the participant/subject first-degree deceased relatives
Number deceased
  
Numeric Values
Provide the number of first/second degree relatives. The participant/subject should refer to the Name of Family Member with Condition” code list to provide any information on each of family member that he/she has knowledge of.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
First-degree deceased relative count
 
Free-Form Entry
       
C17988
Relative first degree decease count unknown indicator
Reltv1stDegDecCntUnknownInd
Indicator of the unknown number of deceased first-degree relatives
Number deceased
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C56017
Relative first degree decease death age value
RelFirstDegDecDeathAgeVal
Value representing the age of the subject's first-degree relative at their time of death.
Age at death
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Free-Form Entry
       
C56018
Relative first degree decease primary cause text
RelFirstDegDecPrimCauseTxt
Text describing the primary cause of the subject's first-degree relative's death.
Primary cause of death
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C56028
Sibling count
SiblingCt
The total number of siblings the subject has
How many siblings do you have?
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Free-Form Entry
       
C56019
Sibling live count
SiblingLiveCt
The total number of alive siblings that the subject has.
Number alive
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Free-Form Entry
       
C56020
Sibling live count unknown indicator
SiblingLiveCtUnkInd
The indicator relating to whether or not the subject knows how many living siblings he/she has.
Number alive
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C56021
Sibling decease count
SiblingDeceaseCt
The total number of deceased siblings that the subject has.
Number deceased
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Free-Form Entry
       
C56022
Sibling decease count unknown indicator
SiblingDeceaseCtUnkInd
The indicator relating to whether or not the subject knows how many deceased siblings he/she has.
Number deceased
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C08087
Sibling death age value
SiblingDeathAgeVal
Age of sibling when he/she died
Age at death
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/22/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Sibling death age value
 
Free-Form Entry
       
C56023
Sibling decease primary cause text
SiblingDeceasePrimCauseTxt
Text describing the primary cause of the subject's sibling's death.
Primary cause of death
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C16001
Relative second degree total count
ReltvScndDegTotlCt
The total number of the participant/subject second-degree relatives
How many total number of second-degree relatives do you have?
  
Numeric Values
This number can be calculated with informant after enumerating relatives of each type provided in the ‘Name of Family Member with Condition” code list.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Second-degree relative total count
 
Free-Form Entry
       
C17989
Relative second degree total count unknown indicator
ReltvSecDegTotlCntUnknownInd
Indicator of the unknown total number of second-degree relatives
How many total number of second-degree relatives do you have?
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C16002
Relative second degree live count
ReltvScndDegLivCt
The total number of the participant/subject second-degree living relatives
Number alive
  
Numeric Values
Provide the number of first/second degree relatives. The participant/subject should refer to the Name of Family Member with Condition” code list to provide any information on each of family member that he/she has knowledge of.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Second-degree living relative count
 
Free-Form Entry
       
C17990
Relative second degree live count unknown indicator
ReltvSecDegLivCntUnknownInd
Indicator of the unknown number of living second-degree relatives
Number alive
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C16003
Relative second degree decease count
ReltvScndDegDeceasCt
The number of the participant/subject second-degree deceased relatives
Number deceased
  
Numeric Values
Provide the number of first/second degree relatives. The participant/subject should refer to the Name of Family Member with Condition” code list to provide any information on each of family member that he/she has knowledge of.
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Second-degree deceased relative count
 
Free-Form Entry
       
C17991
Relative second degree decease count unknown indicator
ReltvSecDegDecCntUnknownInd
Indicator of the unknown number of deceased second-degree relatives
Number deceased
Unknown;
Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
3.0
7/16/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C56024
Relative second degree decease death age value
RelSecondDegDecDeathAgeVal
Value representing the age of the subject's second-degree relative at their time of death.
Age at death
  
Numeric Values
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
  
Free-Form Entry
       
C56025
Relative second degree decease primary cause text
RelSecondDegDecPrimCauseTxt
Text describing the primary cause of the subject's second-degree relative's death.
Primary cause of death
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
6/5/2017
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C00312
Body system category
BodySysCat
Category or grouping used in the comprehensive assessment of a participant/subject, which includes a subjective history taking component as well as an objective based structured interview and physical examination of all the body systems.
Condition
Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;
Allergic/Immunologic;Cardiovascular;Constitutional symptoms (e.g., fever, weight loss);Dermatological;Ears, Nose, Mouth, Throat;Endocrine;Eyes;Gastrointestinal;Gastrointestinal/Abdominal;Genitourinary;Gynecologic/Urologic/ Renal;Hematologic/Lymphatic;Hepatobiliary;Integumentary (skin and/or breast);Musculoskeletal;Musculoskeletal (separate from ALS exam);Neurological;Neurologic/CNS;Neurological (separate from ALS exam);Oncologic;Psychiatric;Pulmonary;Respiratory;Other, specify:;
Alphanumeric
Each body system is pre-populated on the case report form.
Review of Symptoms from Centers for Medicare and Medicaid Services https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/eval_mgmt_serv_guide-ICN006764.pdf
Adult;Pediatric
Supplemental
3.0
7/25/2013
Aliases for variable name not defined
Medical and Family History
General Health History
Participant History and Family History
Body system category
 
Single Pre-Defined Value Selected
     
2002895
 
06-20-2019
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