CDE Detailed Report

Disease: Huntington's Disease
Sub-Domain: Epidemiology/Environmental History
CRF: Risk Factor Questionnaire (RFQ) - Female Health History

Displaying 1 - 18 of 18
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
C16629 Risk Factor Questionnaire (RFQ) - female health history-ever pregnant indicator RFQFemHlthHxEverPregInd Has the participant/subject ever been pregnant as part of the risk factor questionnaire female health history. Has the participant/subject ever been pregnant as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Have you ever been pregnant? Yes;No;Don't know Yes;No;Don't know Alphanumeric

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Exploratory 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16640 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy start age year value RFQFemHlthHxHRTStartAgeYrVal Age or year participant/subject started taking hormone replacement therapy as part of the risk factor questionnaire female health history. Age (or year) participant/subject started taking hormone replacement therapy as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, at what age did you start taking hormone replacement therapy? Numeric Values

Age oe YeaR

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16630 Risk Factor Questionnaire (RFQ) - female health history-pregnancy number RFQFemHlthHxPregNum If yes, how many pregnancies as part of the risk factor questionnaire female health history. If yes, how many pregnancies as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, how many pregnancies have you had? Numeric Values

pregancies

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16641 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy start age year unknown indicator RFQFemHlthHxHRTStrtAgeYrUnkInd The indicator if the participant/subject does not know when she started taking hormone replacement therapy, indicate as "Don't Know" as part of the risk factor questionnaire female health history. If the participant/subject does not know when she started taking hormone replacement therapy, indicate as Don't Know as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, at what age did you start taking hormone replacement therapy? Don't know Don't know Alphanumeric

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16631 Risk Factor Questionnaire (RFQ) - female health history-live birth number RFQFemHlthHxLiveBirthNum If yes, how many live births as part of the risk factor questionnaire female health history. If yes, how many live births as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, how many live births have you had? Numeric Values

live births

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16642 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy stop age or year value RFQFemHlthHxHRTStopAgeYrVal Age (or year) participant/subject stopped taking hormone replacement therapy as part of the risk factor questionnaire female health history. Age (or year) participant/subject stopped taking hormone replacement therapy as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, at what age did you stop taking hormone replacement therapy? Numeric Values

Age oe YeaR

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16632 Risk Factor Questionnaire (RFQ) - female health history-first menstrual period age status RFQFemHlthHxFrstMensPdStatus The status related to participant's/subject's first menstrual period as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Age value of a participant's/subject's first menstrual period as part of the Risk Factor Questionnaire (RFQ) - Female Health History. At what age did you have your first menstrual period? Never had a menstrual period;Don't know Never had a menstrual period;Don't know Alphanumeric

If value is "Never had a menstrual period", then end questionnaire

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16643 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy stop age year indicator RFQFemHlthHxHRTStopAgeYrInd If the participant/subject currently takes or does not know when she stopped taking hormone replacement therapy, indicate as Currently Take or Don't Know as part of the risk factor questionnaire female health history. If the participant/subject currently takes or does not know when she stopped taking hormone replacement therapy, indicate as Currently Take or Don't Know as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, at what age did you stop taking hormone replacement therapy? Currently Take;Don't know Currently Take;Don't know Alphanumeric

If currently on hormone replacement therapy, leave blank and check "currently take".

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16633 Risk Factor Questionnaire (RFQ) - female health history-current menstrual status indicator RFQFemHlthHxCrntMenstrlStatInd Participant's/subject's current menstrual status as part of the risk factor questionnaire female health history. Participant's/subject's current menstrual status as part of the Risk Factor Questionnaire (RFQ) - Female Health History. What is your current menstrual status? Pregnant or breastfeeding;Still having periods and not going through menopause;Still having periods and on hormone replacement therapy;Going through menopause;Periods stopped themselves or natural menopause;Periods stopped by surgery or surgical menopause Pregnant or breastfeeding;Still having periods and not going through menopause;Still having periods and on hormone replacement therapy;Going through menopause;Periods stopped themselves or natural menopause;Periods stopped by surgery or surgical menopause Alphanumeric

No instructions available

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16644 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy total year value RFQFemHlthHxHRTTtlYrVal The total number of years participant/subject took hormone replacement therapy as part of the risk factor questionnaire female health history. The total number of years participant/subject took hormone replacement therapy as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If Yes, during the above period, how many years in total did you take hormone replacement therapy? Numeric Values

The period of time in question is during or after menopause for a period of at least 6 months. Do not include any months/years during the above period when participant/subject may have temporarily stopped taking hormone replacement therapy.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C16634 Risk Factor Questionnaire (RFQ) - female health history-age year menstrual period stopped natural value RFQFemHlthHxAgYrMnstPdStpNtVal The age (or year) the participant's/subject's periods stopped naturally or by menopause as part of the Risk factor questionnaire Female Health History. The age (or year) the participant's/subject's periods stopped naturally or by menopause as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Age or Year Numeric Values

Answer only if "Periods stopped themselves or natural menopause" is answered. Answer for age OR year, NOT both.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C17695 Risk Factor Questionnaire (RFQ) - Female Health History-first menstrual period age value RFQFHHFrstMenstrlPeriodAgeVal Age of participant's/subject's first menstrual period as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Age of participant's/subject's first menstrual period as part of the Risk Factor Questionnaire (RFQ) - Female Health History. At what age did you have your first menstrual period? Numeric Values Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-08-30 17:06:52.8 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16635 Risk Factor Questionnaire (RFQ) - female health history-age year menstrual period stop surgery surgical menopause value RFQFemHlthHxPdStpSxSugMenpsVal The age (or year) the participant's/subject's periods stopped by surgery or surgical menopause The age (or year) the participant's/subject's periods stopped by surgery or surgical menopause Age or Year Numeric Values

Answer only if "Periods stopped by surgery or surgical menopause" is answered. Answer for age OR year, NOT both.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C19054 Risk Factor Questionnaire (RFQ) - female health history-surgery stop menopause other text RFQFemHlthHxSxStpMenopsOTH The free-text field related to 'Risk Factor Questionnaire (RFQ) - female health history-surgery stop menopause type' specifying other text. If periods stopped by surgery or surgical menopause, indicate type of surgery the participant/subject underwent as part of the risk factor questionnaire female health history. The free-text field related to 'Risk Factor Questionnaire (RFQ) - female health history-surgery stop menopause type' specifying other text. If periods stopped by surgery or surgical menopause, indicate type of surgery the participant/subject underwent Other, specify Alphanumeric

Answered only if current menstrual status is "Periods stopped by surgery or surgical menopause"

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History 4000

Free-Form Entry

C16636 Risk Factor Questionnaire (RFQ) - female health history-surgery stop menopause type RFQFemHlthHxSxStpMenopsTyp If periods stopped by surgery or surgical menopause, indicate type of surgery the participant/subject underwent as part of the risk factor questionnaire female health history. If periods stopped by surgery or surgical menopause, indicate type of surgery the participant/subject underwent as part of the Risk Factor Questionnaire (RFQ) - Female Health History. What type of surgery did you have? Removal of uterus and both ovaries;Removal of one ovary;Removal of both ovaries;Removal of uterus but not both ovaries;Other, specify;Don't know Removal of uterus and both ovaries;Removal of one ovary;Removal of both ovaries;Removal of uterus but not both ovaries;Other, specify;Don't know Alphanumeric

Answered only if current menstrual status is "Periods stopped by surgery or surgical menopause"

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16637 Risk Factor Questionnaire (RFQ) - female health history-age year surgery stop menstrual value RFQFemHlthHxAgYrSxStpMenopsVal The age (or year) of the participant/subject in relation to current menstrual status as part of the risk factor questionnaire female health history. The age (or year) of the participant/subject in relation to current menstrual status as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Age or Year Numeric Values

Answer for year OR age, not both. Answer only if current menstrual status is "Other specify".

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16638 Risk Factor Questionnaire (RFQ) - female health history-no menopause indicator RFQFemHlthHxNoMenopsInd If the participant/subject has not experienced menopause, check the box on the CRF as part of the risk factor questionnaire female health history. If the participant/subject has not experienced menopause, check the box on the CRF as part of the Risk Factor Questionnaire (RFQ) - Female Health History. If you have not experienced menopause, check this box Alphanumeric

End questionnaire

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16639 Risk Factor Questionnaire (RFQ) - female health history-hormone replacement therapy use six month indicator RFQFemHlthHxHRTUse6MnthInd Participant/subject used hormone replacement therapy during or after menopause for a period of at least 6 months as part of the risk factor questionnaire female health history. Participant/subject used hormone replacement therapy during or after menopause for a period of at least 6 months as part of the Risk Factor Questionnaire (RFQ) - Female Health History. Have you ever used hormone replacement therapy during or after menopause for a period of at least 6 months? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Hormone replacement therapy includes pills, injections, vaginal creams, skin patches, and suppositories.

Epi Info: http://wwwn.cdc.gov/epiinfo/index.htm RFQ-U CRFs, Version 1.0 developed by the Epidemiology Working Group of the collaborative centers for PD. Adult Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Female Health History Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

CSV