CDE Detailed Report

Disease: Unruptured Cerebral Aneurysms and Subarachnoid Hemorrhage
Sub-Domain: [php]
CRF: History Data Source and Reliability

Displaying 1 - 6 of 6
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
C52564 Data source family relation specify text DataSourceFamRelST Specify the relationship of the family member from which data on the participant/subject was obtained Specify the relationship of the family member from which data on the participant/subject was obtained Family, specify relation Alphanumeric Adult;Pediatric Supplemental 1.00 2017-01-24 09:30:26.0 History Data Source and Reliability [php] [php_1] 255

Free-Form Entry

C08147 Data source DataSource Source of the data provided on the case report form Source of the data provided on the case report form From whom/ what were the medical history data obtained Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Participant/subject;Mother;Father;Sister;Brother;Son;Daughter;Family, specify relation;Friend;Physician;Chart/Medical record;Other, specify;Unknown;Spouse Alphanumeric

Choose all that apply.

No references available Adult;Pediatric Core 3.00 2013-07-20 10:46:24.96 History Data Source and Reliability [php] [php_1]

Multiple Pre-Defined Values Selected

C11133 History data not obtained reason HistDataNotObtRsn Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). If the medical history data were NOT obtained from the participant/subject, Indicate the reason(s) why Dementia;Aphasia;Other cognitive impairment;Not fluent in examiner's language;Poor historian;Too young;Other, specify Dementia;Aphasia;Other cognitive impairment;Not fluent in examiner's language;Poor historian;Too young;Other, specify Alphanumeric

Choose all that apply. All the permissible values describe the participant/ subject.

No references available Adult;Pediatric Core 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability [php] [php_1]

Multiple Pre-Defined Values Selected

C11134 History data reliability type HistDataReliablTyp Overall assessment of the reliability of the medical/family history data obtained Overall assessment of the reliability of the medical/family history data obtained Overall assessment of the reliability of the medical history data obtained Definitely reliable;Probably reliable;Not reliable Definitely reliable;Probably reliable;Not reliable Alphanumeric

No instructions available

No references available Adult;Pediatric Exploratory 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability [php] [php_1]

Single Pre-Defined Value Selected

C18667 Data source other text DataSourcOTH The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form The free-text field related to 'Data source' specifying other text. Source of the data provided on the case report form Other, specify Alphanumeric

Choose all that apply.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 History Data Source and Reliability [php] [php_1] 4000

Free-Form Entry

C18824 History data not obtained other text HistDataNotObtOTH The free-text field related to 'History data not obtained reason' specifying other text. Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s). The free-text field related to 'History data not obtained reason' specifying other text. Reason(s) the medical/family history data were not obtained from the participant/subject and instead were obtained from alternate source(s).` Other, specify Alphanumeric

Choose all that apply. All the permissible values describe the participant/ subject.

No references available Adult;Pediatric Supplemental 3.00 2013-07-11 15:03:49.2 History Data Source and Reliability [php] [php_1] 4000

Free-Form Entry

CSV