CDE Detailed Report

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

Displaying 1 - 20 of 20
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
C08032 Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type RFQSignfcntInjSxAnesthAdmType Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). Type of Anesthesia Used General;Local;Other, specify;Spinal block General;Local;Other, specify;Spinal block 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;Pediatric Supplemental 3.00 2013-07-22 09:34:41.527 Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16621 Risk Factor Questionnaire (RFQ) - significant injury treatment immobilized cast indicator RFQSignfcntInjTxImmobCstInd The indicator of whether any body part(s) were immobilized or needed a cast as a result of the injury as part of the risk factor questionnaire (RFQ). The indicator of whether any body part(s) were immobilized or needed a cast as a result of the injury as part of the Risk Factor Questionnaire (RFQ). Body Part(s) Immobolized or Need Cast? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Only answer if Yes was answered for "Has the participant/ subject ever had any significant injury that caused them to seek treatment"

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16611 Risk Factor Questionnaire (RFQ) - significant injury treatment indicator RFQSignfcntInjTreatmtInd The indicator whether a participant has had any significant injury to cause him/her to seek treatment as part of the risk factor questionnaire (RFQ). The indicator whether a participant has had any significant injury to cause him/her to seek treatment as part of the Risk Factor Questionnaire (RFQ). Have you ever had any significant injury that caused you to seek treatment? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Include any type of injury, such as sprains/strains, fractures, contusions or severe bruises, burns, lacerations, or whiplash for which you sought treatment.

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16622 Risk Factor Questionnaire (RFQ) - significant injury lasting effects indicator RFQSignfcntInjLastEffectInd The indicator of whether the participant/subject had lasting effects from the injury as part of the risk factor questionnaire (RFQ). The indicator of whether the participant/subject had lasting effects from the injury Lasting Effects from this Injury? 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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16612 Risk Factor Questionnaire (RFQ) - significant injury name RFQSignfcntInjName Name of injury sustained by participant/subject as part of the risk factor questionnaire (RFQ) Name of injury sustained by participant/subject as part of the Risk Factor Questionnaire (RFQ) Type of Injury Alphanumeric

Type of Injury and Body Part(s) Involved

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16623 Risk Factor Questionnaire (RFQ) - significant injury lasting effects text RFQSignfcntInjLastEffectTxt The free text field to specify the lasting effects from the injury as part of the risk factor questionnaire (RFQ). The free text field to specify the lasting effects from the injury Yes, Alphanumeric

Lasting Effects from this Injury?

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16613 Risk Factor Questionnaire (RFQ) - significant injury anatomic site RFQSignfcntInjAntmicSite Anatomic site of injury sustained by participant/subject as part of the risk factor questionnaire (RFQ) Anatomic site of injury sustained by participant/subject as part of the Risk Factor Questionnaire (RFQ) Body Part(s) Alphanumeric

Type of Injury and Body Part(s) Involved

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16624 Risk Factor Questionnaire (RFQ) - significant injury surgery administered name RFQSignfcntInjSxAdmName Anatomic site of the surgery performed as part of the risk factor questionnaire (RFQ). Anatomic site of the surgery performed as part of the Risk Factor Questionnaire (RFQ). Body Part(s) Involved 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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16614 Risk Factor Questionnaire (RFQ) - significant injury age value RFQSignfcntInjAgeVal Age in years of the participant/subject at the time of the injury as part of the risk factor questionnaire (RFQ) Age in years of the participant/subject at the time of the injury as part of the Risk Factor Questionnaire (RFQ). Age at injury Numeric Values

(first/next)

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16625 Risk Factor Questionnaire (RFQ) - significant injury surgery administered anatomic site RFQSignfcntInjSxAdmAntmicSite The name of the surgery performed as part of the risk factor questionnaire (RFQ). The name of the surgery performed as part of the Risk Factor Questionnaire (RFQ). Type of Surgery 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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16615 Risk Factor Questionnaire (RFQ) - significant injury school work missed indicator RFQSignfcntInjSchoolWrkMissInd Indication of whether the participant/subject missed school or work because of the injury as part of the risk factor questionnaire (RFQ) Indication of whether the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) School or Work missed? 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 Supplemental 3.00 2013-07-14 19:48:50.273 Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16626 Risk Factor Questionnaire (RFQ) - significant injury surgery administered year age value RFQSignfcntInjSxAdmYrAgeVal Year or Age of participant/subject at time of surgery as part of the risk factor questionnaire (RFQ). Year or Age of participant/subject at time of surgery as part of the Risk Factor Questionnaire (RFQ). Year or Age of Surgery Numeric Values

Answer should be recorded as an integer. Only answered if Yes was answered for "Have you ever had surgery for any reason?"

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16616 Risk Factor Questionnaire (RFQ) - significant injury school work missed duration RFQSignfcntInjSchoolWrkMissDur Unit of measure for length of time the participant/subject missed school or work because of the injury as part of the risk factor questionnaire (RFQ) Length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) If Yes, how long? Numeric Values

If School or Work missed?

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C16627 Risk Factor Questionnaire (RFQ) - significant injury surgery administered year age unit of measure RFQSignfcntInjSxAdmYrAgeUOM Year or Age unit of measure of participant/subject at time of surgery as part of the risk factor questionnaire (RFQ). Year or Age unit of measure of participant/subject at time of surgery as part of the Risk Factor Questionnaire (RFQ). Year or Age of Surgery Year;Age Year;Age 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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16617 Risk Factor Questionnaire (RFQ) - significant injury school work missed duration unit of measure RFQSignfcntInjSchlWrkMssDurUOM Unit of measurement for the length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) Unit of measurement for the length of time the participant/subject missed school or work because of the injury as part of the Risk Factor Questionnaire (RFQ) If Yes, how long? Day;Week;Month Day;Week;Month Alphanumeric

If School or Work missed?

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C17696 Risk Factor Questionnaire (RFQ) - significant injury surgery administered indicator RFQSignfcntInjSxAdmInd The indicator of whether surgery was performed as part of the Risk Factor Questionnaire (RFQ). The indicator of whether surgery was performed as part of the Risk Factor Questionnaire (RFQ). Have you ever had surgery for any reason? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Please include any outpatient surgical procedures and any oral/dental surgeries you may have had.

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C16618 Risk Factor Questionnaire (RFQ) - significant injury treatment administered indicator RFQSignfcntInjTreatmtAdmInd The indicator whether a participant had treatment administered for any significant injury as part of the risk factor questionnaire (RFQ). The indicator whether a participant had treatment administered for any significant injury as part of the Risk Factor Questionnaire (RFQ). Seek Treatment for Injury? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Seek Treatment for Injury?

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C18750 Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered other text RFQSignfcntInjSxAnesthAdmOTH The free-text field related to 'Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type' specifying other text. Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). The free-text field related to 'Risk Factor Questionnaire (RFQ) - significant injury surgery anesthesia administered type' specifying other text. Type of anesthesia given to participant/subject as part of the Risk Factor Questionnaire (RFQ). Other, specify 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;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Risk Factor Questionnaire (RFQ) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 4000

Free-Form Entry

C16619 Risk Factor Questionnaire (RFQ) - significant injury treatment administered text RFQSignfcntInjTreatmtAdmTxt The free text field to specify the treatment administered for any significant injury as part of the risk factor questionnaire (RFQ). The free text field to specify the treatment administered for any significant injury as part of the Risk Factor Questionnaire (RFQ). Yes, Alphanumeric

Seek Treatment for Injury?

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C16620 Risk Factor Questionnaire (RFQ) - significant injury treatment hospitalization indicator RFQSignfcntInjTreatmtHospInd The indicator of whether the participant/subject was hospitalized for injury as part of the risk factor questionnaire (RFQ). The indicator of whether the participant/subject was hospitalized for injury as part of the Risk Factor Questionnaire (RFQ). Hospitalized for this Injury? Yes;No;Don't know Yes;No;Don't know Alphanumeric

Only complete if Yes was answered for "Has the participant/ subject ever had any significant injury that caused them to seek treatment"

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) - Epidemiology of Dystonia Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

CSV