CDE Detailed Report

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

Displaying 1 - 50 of 106
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
C08799 Risk Factor Questionnaire (RFQ) - age stopped regularly soldering period 2 value RFQAgStpRgSolderingPr2Val Age when the participant stopped regularly soldering period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly soldering period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08735 Risk Factor Questionnaire (RFQ) - stopped using adhesives value RFQStpUseAdhesivesVal Age/year the participant stopped using adhesives as part of the Risk Factor Questionnaire for Toxicants Age/year the participant stopped using adhesives as part of the Risk Factor Questionnaire for Toxicants If Yes, at what age or year did you stop using glues or adhesives? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C17725 Risk Factor Questionnaire (RFQ) - age started regularly soldering period 1 value RFQAgStrtRgSolderingPr1Val Age when the participant started regularly soldering period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly soldering period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08767 Risk Factor Questionnaire (RFQ) - use toluol xylol xylene indicator RFQUseToluolXylolXyleneInd Ever use toluol/xylol/xylene as part of the Risk Factor Questionnaire for Toxicants Ever use toluol/xylol/xylene as part of the Risk Factor Questionnaire for Toxicants Did or do you use toluol/xylol/xylene? No;Yes No;Yes Alphanumeric

If 'No' skip to Q25

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08812 Risk Factor Questionnaire (RFQ) - metal dust or fume 1 worked around text RFQMetalDustFume1WrkArndTxt Text description of first metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants Text description of first metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants What specific types of metal dust or metal fumes did you work around? 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08746 Risk Factor Questionnaire (RFQ) - use other solvent-based adhesives text RFQUseOthrSlvntBsdAdhsvesTxt Text description of which other solvent-based adhesives used as part of the Risk Factor Questionnaire for Toxicants Text description of which other solvent-based adhesives used as part of the Risk Factor Questionnaire for Toxicants If Yes, specify other solvent-based adhesives used 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08778 Risk Factor Questionnaire (RFQ) - age stopped regularly weld braze or flame cut metals period 1 value RFQAgStpRgWldBrzFlmCtMtlPr1Val Age when the participant stopped regularly weld, braze, or flame cut metals period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly weld, braze, or flame cut metals period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT weld, braze, or flame cut metals? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C10472 Risk Factor Questionnaire (RFQ) - currently working around metal dust fumes indicator RFQCrrntlyWrkgArndMtlDstFmInd Currently working around metal dust or fumes as part of the Risk Factor Questionnaire for Toxicants Currently working around metal dust or fumes as part of the Risk Factor Questionnaire for Toxicants If Yes, at what age or year did you stop working around metal dust or metal fumes? Currently work around metal dust or metal fumes checked/selected;"Currently work around metal dust or metal fumes" NOT checked/selected Currently work around metal dust or metal fumes checked/selected;"Currently work around metal dust or metal fumes" NOT checked/selected 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08757 Risk Factor Questionnaire (RFQ) - use trichloroethane indicator RFQUseTrichloroethaneInd Ever use trichloroethane as part of the Risk Factor Questionnaire for Toxicants Ever use trichloroethylene or PERC (perchloroethylene) as part of the Risk Factor Questionnaire for Toxicants Did or do you use trichloroethane? No;Yes No;Yes Alphanumeric

If 'No' skip to Q15

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08789 Risk Factor Questionnaire (RFQ) - ever weld cut braze cast iron indicator RFQEvrWldCtBrzCastIronInd Has the participant ever weld, cut, braze cast iron as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze cast iron as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze cast iron? No;Yes No;Yes Alphanumeric

If 'No' skip to Q38

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08800 Risk Factor Questionnaire (RFQ) - age stopped regularly soldering period 3 value RFQAgStpRgSolderingPr3Val Age when the participant stopped regularly soldering period 3 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly soldering period 3 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08736 Risk Factor Questionnaire (RFQ) - year not regularly using adhesives indicator RFQYrNtRegUseAdhesivesInd Periods of a year or more when the participant did not regularly use adhesives as part of the Risk Factor Questionnaire for Toxicants Periods of a year or more when the participant did not regularly use adhesives as part of the Risk Factor Questionnaire for Toxicants Were there periods of a year or more when you did NOT regularly use glues or adhesives? No;Yes No;Yes Alphanumeric

If 'No' skip to Question 3

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C17726 Risk Factor Questionnaire (RFQ) - age started regularly soldering period 2 value RFQAgStrtRgSolderingPr2Val Age when the participant started regularly soldering period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly soldering period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08768 Risk Factor Questionnaire (RFQ) - use turpentine indicator RFQUseTurpentineInd Ever use turpentine as part of the Risk Factor Questionnaire for Toxicants Ever use turpentine as part of the Risk Factor Questionnaire for Toxicants Did or do you use turpentine? No;Yes No;Yes Alphanumeric

If 'No' skip to Q26

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08813 Risk Factor Questionnaire (RFQ) - metal dust or fume 2 worked around text RFQMetalDustFume2WrkArndTxt Text description of second metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants Text description of second metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants What specific types of metal dust or metal fumes did you work around? 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08747 Risk Factor Questionnaire (RFQ) - used solvents or degreasers 100 days indicator RFQUsedSlvntsDgrsrs100DaysInd Has the participant ever used solvents or degreasers for at least 100 days at work or home as part of the Risk Factor Questionnaire for Toxicants Has the participant ever used solvents or degreasers for at least 100 days at work or home as part of the Risk Factor Questionnaire for Toxicants In your lifetime, have you used solvents or degreasers 100 or more days at work or at home? No;Yes No;Yes Alphanumeric

If 'No' skip to Question 10

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08779 Risk Factor Questionnaire (RFQ) - age stopped regularly weld braze or flame cut metals period 2 value RFQAgStpRgWldBrzFlmCtMtlPr2Val Age when the participant stopped regularly weld, braze, or flame cut metals period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly weld, braze, or flame cut metals period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT weld, braze, or flame cut metals? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C17716 Risk Factor Questionnaire (RFQ) - age started regularly using adhesives period 1 value RFQAgeStrtRegUseAdhesvePer1Val Age when the participant started regularly using adhesives period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly using adhesives period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08758 Risk Factor Questionnaire (RFQ) - use trichloroethylene or PERC indicator RFQUseTrichloroethylenePERCInd Ever use trichloroethylene or PERC (perchloroethylene) as part of the Risk Factor Questionnaire for Toxicants Ever use trichloroethane as part of the Risk Factor Questionnaire for Toxicants Did or do you use trichloroethylene or PERC (perchloroethylene)? No;Yes No;Yes Alphanumeric

If 'No' skip to Q16

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08790 Risk Factor Questionnaire (RFQ) - ever weld cut braze copper indicator RFQEvrWldCtBrzCopperInd Has the participant ever weld, cut, braze copper as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze copper as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze copper? No;Yes No;Yes Alphanumeric

If 'No' skip to Q39

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08801 Risk Factor Questionnaire (RFQ) - ever used tin-lead indicator RFQEvrUseTinLeadInd Has the participant ever used tin-lead as part of the Risk Factor Questionnaire for Toxicants Has the participant ever used tin-lead as part of the Risk Factor Questionnaire for Toxicants Did or do you use tin-lead? No;Yes No;Yes Alphanumeric

If 'No' skip to Q44

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08737 Risk Factor Questionnaire (RFQ) - age stopped regularly using adhesives period 1 value RFQPer1AgeStpRegUseAdhesiveVal Age when the participant stopped regularly using adhesives period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly using adhesives period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C17727 Risk Factor Questionnaire (RFQ) - age started regularly soldering period 3 value RFQAgStrtRgSolderingPr3Val Age when the participant started regularly soldering period 3 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly soldering period 3 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08769 Risk Factor Questionnaire (RFQ) - use other solvent indicator RFQUseOthrSolventInd Ever use another solvent as part of the Risk Factor Questionnaire for Toxicants Ever use another solvent as part of the Risk Factor Questionnaire for Toxicants Did or do you use another solvent? No;Yes No;Yes Alphanumeric

If 'No' skip to Question 27

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08814 Risk Factor Questionnaire (RFQ) - metal dust or fume 3 worked around text RFQMetalDustFume3WrkArndTxt Text description of third metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants Text description of third metal dust or metal fume was worked around as part of the Risk Factor Questionnaire for Toxicants What specific types of metal dust or metal fumes did you work around? 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08748 Risk Factor Questionnaire (RFQ) - started using solvents or degreasers value RFQStrtUseSlvntsDgrsrsVal Age/year the participant started using solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants Age/year the participant started using solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants If Yes, at what age or year did you first use solvents or degreasers? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C08780 Risk Factor Questionnaire (RFQ) - age stopped regularly weld braze or flame cut metals period 3 value RFQAgStpRgWldBrzFlmCtMtlPr3Val Age when the participant stopped regularly weld, braze, or flame cut metals period 3 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly weld, braze, or flame cut metals period 3 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT weld, braze, or flame cut metals? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C17717 Risk Factor Questionnaire (RFQ) - age started regularly using adhesives period 2 value RFQAgeStrtRegUseAdhesvePr2Val Age when the participant started regularly using adhesives period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly using adhesives period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08759 Risk Factor Questionnaire (RFQ) - use acids alkalis or alcohols indicator RFQUseAcidsAlkalisAlcInd Ever use acids, alkalis or alcohols as part of the Risk Factor Questionnaire for Toxicants Ever use acids, alkalis or alcohols as part of the Risk Factor Questionnaire for Toxicants Did or do you use acids, alkalis or alcohols? No;Yes No;Yes Alphanumeric

If 'No' skip to Q17

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08791 Risk Factor Questionnaire (RFQ) - ever weld cut braze aluminum indicator RFQEvrWldCtBrzAluminumInd Has the participant ever weld, cut, braze aluminum as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze aluminum as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze aluminum? No;Yes No;Yes Alphanumeric

If 'No' skip to Q40

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08802 Risk Factor Questionnaire (RFQ) - ever used silver indicator RFQEvrUseSilverInd Has the participant ever used silver as part of the Risk Factor Questionnaire for Toxicants Has the participant ever used silver as part of the Risk Factor Questionnaire for Toxicants Did or do you use silver? No;Yes No;Yes Alphanumeric

If 'No' skip to Q45

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08738 Risk Factor Questionnaire (RFQ) - age stopped regularly using adhesives period 2 value RFQPer2AgeStpRegUseAdhesiveVal Age when the participant stopped regularly using adhesives period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly using adhesives period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C17728 Risk Factor Questionnaire (RFQ) - age started regularly working around metal dust or metal fumes period 1 value RFQAgStrtRgWrkArdMtlDtFmPr1Val Age when the participant started regularly working around metal dust or metal fumes period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly working around metal dust or metal fumes period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08770 Risk Factor Questionnaire (RFQ) - use other solvent text RFQUseOthrSolventTxt Text description of which solvent was used as part of the Risk Factor Questionnaire for Toxicants Text description of which solvent was used as part of the Risk Factor Questionnaire for Toxicants If Yes, specify other solvent used 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08815 Risk Factor Questionnaire (RFQ) - worked around other chemicals or fumes indicator RFQWrkdArndOthrChmclsFumeInd Has the participant ever worked around any other chemicals or fumes not discussed as part of the Risk Factor Questionnaire for Toxicants Has the participant ever worked around any other chemicals or fumes not discussed as part of the Risk Factor Questionnaire for Toxicants In your lifetime, have you ever worked around any other chemicals or fumes that we haven't discussed? No;Yes No;Yes Alphanumeric

If 'No' 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08749 Risk Factor Questionnaire (RFQ) - stopped using solvents or degreasers value RFQStpUseSlvntsDgrsrsVal Age/year the participant stopped using solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants Age/year the participant stopped using solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants If Yes, at what age or year did you stop using solvents or degreasers? Numeric Values

Only answer for Age or Year; not both. Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

C08781 Risk Factor Questionnaire (RFQ) - ever weld cut braze stainless steel indicator RFQWldCtBrzStainlessSteelInd Has the participant ever weld, cut, braze stainless steel as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze stainless steel as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze stainless steel? No;Yes No;Yes Alphanumeric

If 'No' skip to Q30

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C17718 Risk Factor Questionnaire (RFQ) - age started regularly using adhesives period 3 value RFQAgeStrtRegUseAdhesvePr3Val Age when the participant started regularly using adhesives period 3 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly using adhesives period 3 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08760 Risk Factor Questionnaire (RFQ) - use avgas or jet fuel indicator RFQUseAvgasJetFuelInd Ever use Freon as part of the Risk Factor Questionnaire for Toxicants Ever use Freon as part of the Risk Factor Questionnaire for Toxicants Did or do you use avgas, jet fuel? No;Yes No;Yes Alphanumeric

If 'No' skip to Q18

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08792 Risk Factor Questionnaire (RFQ) - ever weld cut braze another metal indicator RFQEvrWldCtBrzOthrMetalInd Has the participant ever weld, cut, braze another metal as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze another metal as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze another metal? No;Yes No;Yes Alphanumeric

If 'No' skip to Q41

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08803 Risk Factor Questionnaire (RFQ) - ever used another metal or alloy indicator RFQEvrUseOthrMetalAlloyInd Has the participant ever used another metal or alloy as part of the Risk Factor Questionnaire for Toxicants Has the participant ever used another metal or alloy as part of the Risk Factor Questionnaire for Toxicants Did or do you use another metal or alloy? No;Yes No;Yes Alphanumeric

If 'No' skip to Q46

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08739 Risk Factor Questionnaire (RFQ) - age stopped regularly using adhesives period 3 value RFQPer3AgeStpRegUseAdhesiveVal Age when the participant stopped regularly using adhesives period 3 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly using adhesives period 3 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use glues or adhesives? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C17729 Risk Factor Questionnaire (RFQ) - age stopped regularly working around metal dust or metal fumes period 2 value RFQAgStpRgWrkArdMtlDstFmPr2Val Age when the participant stopped regularly working around metal dust or metal fumes period 2 as part of the Risk Factor Questionnaire for Toxicants Age when the participant stopped regularly working around metal dust or metal fumes period 2 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT solder? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08771 Risk Factor Questionnaire (RFQ) - ever weld braze or flame cut metals 100 days indicator RFQWldedBrzdFlmCtMtl100DaysInd Has the participant ever welded, brazed, or flame cut metals at least 100 days at work or home as part of the Risk Factor Questionnaire for Toxicants Has the participant ever welded, brazed, or flame cut metals at least 100 days at work or home as part of the Risk Factor Questionnaire for Toxicants In your lifetime, have you welded, brazed, or flame cut metals 100 or more days at work or at home? No;Yes No;Yes Alphanumeric

If 'No' skip to Question 28

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08816 Risk Factor Questionnaire (RFQ) - chemical or fume 1 worked around text RFQChemFume1WrkArndTxt Text description of first chemical or fume was worked around as part of the Risk Factor Questionnaire for Toxicants Text description of first chemical or fume was worked around as part of the Risk Factor Questionnaire for Toxicants If Yes, specify other solvent-based adhesives used. 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

C08750 Risk Factor Questionnaire (RFQ) - year not regularly using solvents or degreasers indicator RFQYrNtRegUseSlvntsDgrsrsInd Periods of a year or more when the participant did not regularly use solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants Periods of a year or more when the participant did not regularly use solvents or degreasers as part of the Risk Factor Questionnaire for Toxicants Were there periods of a year or more when you did NOT regularly use solvents or degreasers? No;Yes No;Yes Alphanumeric

If 'No' skip to Question 11

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08782 Risk Factor Questionnaire (RFQ) - ever weld cut braze mild steel indicator RFQEvrWldCtBrzMildSteelInd Has the participant ever weld, cut, braze mild steel as part of the Risk Factor Questionnaire for Toxicants Has the participant ever weld, cut, braze mild steel as part of the Risk Factor Questionnaire for Toxicants Did or do you weld, cut, or braze mild steel? No;Yes No;Yes Alphanumeric

If 'No' skip to Q31

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C17719 Risk Factor Questionnaire (RFQ) - age started regularly using solvents or degreasers period 1 value RFQAgStrtRgUseSlvntDgrsrPr1Val Age when the participant started regularly using solvents or degreasers period 1 as part of the Risk Factor Questionnaire for Toxicants Age when the participant started regularly using solvents or degreasers period 1 as part of the Risk Factor Questionnaire for Toxicants If Yes, what ages were you when you did NOT use solvents or degreasers? Numeric Values

Age should be answered in years Year should be answered in the 4-digit format

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) - Toxicants Epidemiology/Environmental History Participant History and Family History

Free-Form Entry

year
C08761 Risk Factor Questionnaire (RFQ) - use freon indicator RFQUseFreonInd Ever use avgas or jet fuel as part of the Risk Factor Questionnaire for Toxicants Ever use avgas or jet fuel as part of the Risk Factor Questionnaire for Toxicants Did or do you use Freon? No;Yes No;Yes Alphanumeric

If 'No' skip to Q19

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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History

Single Pre-Defined Value Selected

C08793 Risk Factor Questionnaire (RFQ) - ever weld flame cut braze another metal text RFQEvrWldFlmCtBrzOthrMetalTxt Text description of which other metal was welded, flame cut, or brazed as part of the Risk Factor Questionnaire for Toxicants Text description of which other metal was welded, flame cut, or brazed as part of the Risk Factor Questionnaire for Toxicants If Yes, specify other metal welded, flame cut, or brazed 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 2013-07-18 09:11:50.26 Risk Factor Questionnaire (RFQ) - Toxicants Epidemiology/Environmental History Participant History and Family History 255

Free-Form Entry

CSV