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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: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Sub-Domain: General Health History
CRF: Medical History - Immune Module
Item count: 113 (113 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
C17402
Site name
SiteName
The name of the site for the study
Site name:
  
Alphanumeric
No instructions available
No references available
Adult
Supplemental
3.0
6/21/2013
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
Site name
255
Free-Form Entry
       
C19247
Subject ID
SubIDNam
Subject identification ID
Subject ID:
  
Alphanumeric
No instructions available
No references available
Adult
Supplemental
1.0
6/5/2014
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C19256
Study protocol name
StudyProtocolName
Name of study protocol
Study name/ID
  
Alphanumeric
No instructions available
No references available
Adult
Supplemental
1.0
6/5/2014
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
4000
Free-Form Entry
       
C00314
Medical history taken date and time
MedclHistTakenDateTime
Date (and time, if applicable and known) the participant/subject's medical history was taken
Date history taken:
  
Date or Date & Time
No instructions available
No references available
Adult
Exploratory
3.0
7/25/2013
PT_REL_MED_HIST_DT
Medical History - Immune Module
General Health History
Participant History and Family History
Medical history taken date and time
 
Free-Form Entry
     
2179659
 
C57261
Immune symptom onset type
ImmSymptmOnsetTyp
The type of general immune/infectious symptom(s) that the subject experienced at onset (within first month of illness).
At onset (within first month of illness), did participant/subject experience of the following?
Fever;Chills;Night sweats;Sore throats;Swollen/tender glands;Rashes;N/V/D;Arthalgia/arthritis;Mouth ulcers;History of autoimmune disease;Family history of autoimmune disease (biological relatives only, if applicable);
Fever;Chills;Night sweats;Sore throats;Swollen/tender glands;Rashes;N/V/D;Arthalgia/arthritis;Mouth ulcers;History of autoimmune disease;Family history of autoimmune disease (biological relatives only, if applicable);
Alphanumeric
Check all that apply
No references available
Adult
Core
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Multiple Pre-Defined Values Selected
       
C57957
Immune symptom onset current type
ImmSymptmOnsetCurrTyp
Whether the types of general immune/infectious symptom(s) that the subject experienced at onset (within first month of illness) are being currently experienced.
If yes, are any of those symptoms current?
Fever;Chills;Night sweats;Sore throats;Swollen/tender glands;Rashes;N/V/D;Arthalgia/arthritis;Mouth ulcers;History of autoimmune disease;Family history of autoimmune disease (biological relatives only, if applicable);
Fever;Chills;Night sweats;Sore throats;Swollen/tender glands;Rashes;N/V/D;Arthalgia/arthritis;Mouth ulcers;History of autoimmune disease;Family history of autoimmune disease (biological relatives only, if applicable);
Alphanumeric
Check all that apply
No references available
Adult
Supplemental
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Multiple Pre-Defined Values Selected
       
C57958
Antibiotic long term repeated history indicator
AntibLongTermRepeatHistInd
Indicator related to whether the participant/subject has a history of repeated or long-term antibiotic use
Does the participant/subject have a history of repeated or long-term antibiotic use?
Yes;No;
Yes;No;
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Single Pre-Defined Value 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
If yes, what antibiotic(s):
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57262
Antibiotic long term repeated history indication text
AntibLngTermRepHistIndicTxt
Free-text field to describe the indication for which the participant/subject has had a history of long-term or repeated use
Indication:
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57264
Antibiotic long term repeated history use year text
AntibLongTermRepHistUseYrTxt
The year(s) that the subject has used antibiotics repeatedly or long term.
When (year(s)):
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Free-Form Entry
       
C57265
Medical history immune condition type
MedHistImmuneCondTyp
Immune condition(s) of which the participant/subject has a medical history
Condition
Zoster;Malignancy (cancer) affecting the immune system;Immunodeficiency syndrome(s);
Zoster;Malignancy (cancer) affecting the immune system;Immunodeficiency syndrome(s);
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Multiple Pre-Defined Values Selected
       
C57267
Medical history Immunodeficiency syndrome name text
MedHistImmunodefSyndNameTxt
The name of the immunodeficiency syndrome(s) the subject has as medical history of
Name of syndrome:
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57270
Medical history immune malignancy name text
MedHistImmMalignancyNameTxt
The name of any malignancy or malignancies affecting the subject's immune system as part of the medical history
Name of syndrome:
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57268
Medical history immune symptom onset text
MedHistImmSymptmOnsetTxt
Text describing symptoms at onset the participant/subject experienced for immune conditions as part of medical history
Symptoms at onset
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57271
Medical history immune diagnosis year text
MedHistImmDiagYrTxt
Year of diagnosis for immune condition(s) the participant/subject has as part of medical history
Year of diagnosis
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
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
Food hypersensitivity
Yes;No;
Yes;No;
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
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
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
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Multiple Pre-Defined Values 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
Reaction
  
Alphanumeric
Hives, vomiting, other
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Free-Form Entry
       
C57280
Food hypersensitivity reaction onset date
FoodHypersensRxnOnsetDate
The date of onset for reaction(s) as a result of food hypersensitivity
Date of onset
  
Date or Date & Time
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Free-Form Entry
       
C57308
Food hypersensitivity component other text
FoodHyperCompOthrTxt
Text describing another food component to which the subject has hypersensitivity
Other, specify:
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57312
Adverse drug reaction indicator
AdvDrugRxnInd
The indicator relating to whether the subject experiences reactions to adverse drugs.
Adverse drug reactions
Yes;No;
Yes;No;
Alphanumeric
If yes, specify
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
C57313
Adverse reaction drug name
AdverseRxnDrugName
The name of the drug to which the participant/subject has an adverse reaction
Drug name
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
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
Route
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C57282
Adverse reaction drug type text
AdvRxnDrugTypTxt
Free-text field to describe the type of adverse reaction the participant/subject has from a drug
Reaction
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Free-Form Entry
       
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
Year(s) received
  
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
 
255
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.
History of atopy/allergic disorders
Yes;No;
Yes;No;
Alphanumeric
No instructions available
No references available
Adult
Exploratory
1.0
1/5/2018
Aliases for variable name not defined
Medical History - Immune Module
General Health History
Participant History and Family History
  
Single Pre-Defined Value Selected
       
06-20-2019
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