CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Subdomain Name: General Health History
CRF: Reproductive and Hormonal History

Displaying 1 - 34 of 34
CDE ID CDE Name Variable Name Definition Short Description 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 / Guidance) Subdomain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C57247 Hypothyroidism indicator HypothyInd The indicator relating to whether the subject has hypothyroidism The indicator relating to whether the subject has hypothyroidis Hypothyroidism No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:52:19.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57258 Diabetes insipidus other text DaibInsipOthrTxt Text describing another type of diabetes insipidus the subject has been diagnosed with Text describing another type of diabetes insipidus the subject has been diagnosed wit Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:28:14.0 Reproductive and Hormonal History General Health History Participant History and Family History 4000

Free-Form Entry

C16164 Hormonal therapy start date/time HormonalTherapyStartDateTime The date and time (if applicable and known) the participant started hormonal therapy Date (and time, if applicable and known) the participant started hormonal therapy Start date Date or Date & Time Adult;Pediatric Supplemental 4.00 2024-02-02 12:57:37.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C53062 Diabetes mellitus medical history indicator DiabetesMellMedHistInd Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Indicator as to whether the participant/subject has a medical history of diabetes mellitus (type I or type II) Diabetes mellitus Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-15 16:08:48.687 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57248 Hypothyroidism diagnosis age value HypothyDiagnosAgeVal The value representing age the subject was when he/she was diagnosed with hypothyroidism The value representing age the subject was when he/she was diagnosed with hypothyroidis If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:53:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16165 Hormonal therapy stop date/time HormonalTherapyStopDateTIme The date and time (if applicable and known) the participant stopped hormonal therapy Date (and time, if applicable and known) the participant stopped hormonal therapy End date Date or Date & Time Adult;Pediatric Supplemental 4.00 2024-02-02 13:04:55.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57238 Hormonal therapy medication device name HormTherpyMedDevName The name of the medication or device being used for hormonal therapy The name of the medication or device being used for hormonal therap Medication/device name Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:41:12.0 Reproductive and Hormonal History General Health History Participant History and Family History 255

Free-Form Entry

C57249 Cushings syndrome indicator CushSyndInd The indicator relating to whether the subject has Cushing's syndrome The indicator relating to whether the subject has Cushing's syndrom Cushing's sydrome indicator No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:55:10.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16170 Menstrual period occurrence indicator MenstrualPrdOcurInd Indicates whether participant has ever had a menstrual period Indicates whether participant has ever had a menstrual period Have you ever had a menstrual period? Yes;No Yes;No Alphanumeric

If no, section is complete. Do not proceed to further questions.

Adult;Pediatric Supplemental 3.10 2024-02-02 08:23:32.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57239 Hormonal therapy medication device dose frequency text HormTherMedDevDoseFreqTxt Text indicating the dose of the medication or frequency of the device being used for hormonal therapy Text indicating the dose of the medication or frequency of the device being used for hormonal therap Dose/frequency (if applicable) Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:44:01.0 Reproductive and Hormonal History General Health History Participant History and Family History 255

Free-Form Entry

C57250 Cushings syndrome diagnosis age value CushSyndDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with Cushing's syndrome The value representing the age the subject was when he/she was diagnosed with Cushing's syndrom If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:56:35.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16172 Pregnant current indicator PregCurntInd Indicator of whether the participant is currently pregnant Indicator of whether the participant is currently pregnant Pregnant? Yes;No;Don't know Yes;No;Don't know Alphanumeric Adult;Pediatric Supplemental 3.10 2024-02-02 11:45:08.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57240 Pregnant in past year indicator PregPastYrInd The indicator relating to whether the subject was pregnant within the past year The indicator relating to whether the subject was pregnant within the past yea If no, pregnant within past year? No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:45:42.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57251 Adrenal insufficiency indicator AdrInsufInd The indicator relating to whether the subject has adrenal insuffciency The indicator relating to whether the subject has adrenal insuffcienc Adrenal insufficiency No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:00:15.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16173 Pregnancy estimate delivery date and time PregEstDeliveryDateTime The date and time (if applicable) the participant is estimated to deliver the pregnancy The date and time (if applicable) the participant is estimated to deliver the pregnancy If yes, estimated due date: Date or Date & Time Adult;Pediatric Supplemental 3.10 2024-02-02 11:48:32.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57241 Nursing indicator NursingInd The indicator relating to whether the subject is nursing The indicator relating to whether the subject is nursin Nursing? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:47:24.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57252 Adrenal insufficiency diagnosis age value AdrInsufDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with adrenal insufficiency The value representing the age the subject was when he/she was diagnosed with adrenal insufficienc If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:01:15.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16174 Menopause indicator MenopauseInd Indicates whether participant is currently menopausal Indicates whether participant/subject is currently menopausa Do you believe you are currently experiencing menopause (perimenopausal)? Yes;No;Don't know Yes;No;Don't know Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57242 Menstrual period regularity type MenstPdRegTyp The type of menstrual period regularity the subject has been experiencing, if applicable The type of menstrual period regularity the subject has been experiencing, if applicabl Menstrual periods Regular;Irregular;Not applicable Regular;Irregular;Not applicable Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:48:07.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57253 Diabetes mellitus diagnosis age value DiabMellDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with diabetes mellitus The value representing the age the subject was when he/she was diagnosed with diabetes mellitu If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:05:34.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16175 Menstrual period last date MenstrualPeriodLastDate Date of the participant's last menstrual period Date of the participant's last menstrual period If Yes, indicate the approximate date of your last menstrual period Date or Date & Time Adult;Pediatric Supplemental 3.10 2024-02-02 12:18:50.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

C57243 Polycystic ovary syndrome indicator PolyOvarySyndInd The indicator related to whether the subject has polycystic ovary syndrome The indicator related to whether the subject has polycystic ovary syndrom Polycystic ovary syndrome No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:49:53.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57254 Diabetes mellitus other text DiabMellOthrTxt Text describing another type of diabetes mellitus the subject has Text describing another type of diabetes mellitus the subject ha Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:14:51.0 Reproductive and Hormonal History General Health History Participant History and Family History 4000

Free-Form Entry

C16176 Hormone therapy indicator HormoneTherapyInd Indicates whether participant/subject has taken hormonal therapy Indicates whether participant/subject has taken hormonal therapy Are you currently on, or have you been on within the past year, sex hormone-related therapy? (Includes, but not limited to, hormonal contraceptives, including hormone-releasing contraceptive
devices; hormone replacement therapy, eg, estrogens, progestins; testosterone)
Yes;No Yes;No Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57244 Polycystic ovary syndrome diagnosis age value PolyOvarySyndDiagnosAgeVal The value representing the age the subject was when she was diagnosed with polycystic ovary syndrome The value representing the age the subject was when she was diagnosed with polycystic ovary syndrom If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:51:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C57255 Diabetes insipidus indicator DiabInsipInd The indicator relating to whether the subject has diabetes insipidus The indicator relating to whether the subject has diabetes insipidu Diabetes insipidus No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:16:07.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16177 Post-menopausal indicator PostMnpslInd Indicates whether participant is post-menopausal Indicates whether participant/subject is post-menopausal Are you post-menopausal? Yes;No;Unknown Yes;No;Unknown Alphanumeric Adult;Pediatric Supplemental 3.00 2013-06-11 00:00:00.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57245 Hyperthyroidism indicator HyperthyInd The indicator relating to whether the subject has hyperthyroidism The indicator relating to whether the subject has hyperthyroidis Hyperthyroidism No;Yes;Unknown No;Yes;Unknown Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 10:52:19.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57256 Diabetes insipidus diagnosis age value DiabInsipDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with diabetes insipidus The value representing the age the subject was when he/she was diagnosed with diabetes insipidu If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 11:21:23.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C16178 Post-menopausal cause type PostMnpslCauseTyp Type of cause or reason for the post-menopausal period in the participant Tpye of cause or reason for the post-menopausal period in the participant If Yes, indicate cause Natural;Medications or chemotherapy;Surgical (complete hysterectomy- ovaries and uterus removed) Natural;Medications or chemotherapy;Surgical (complete hysterectomy- ovaries and uterus removed) Alphanumeric Adult;Pediatric Supplemental 4.00 2024-03-18 15:21:17.0 Reproductive and Hormonal History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57246 Hyperthyroidism diagnosis age value HyperthyDiagnosAgeVal The value representing the age the subject was when he/she was diagnosed with hyperthyroidism The value representing the age the subject was when he/she was diagnosed with hyperthyroidis If yes, age at diagnosis Numeric Values Adult;Pediatric Supplemental 1.00 2018-01-04 10:53:12.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

year
C57257 Diabetes insipidus type DiabInsipTyp The type of diabetes insipidus the subject has The type of diabetes insipidus the subject ha Type Central;Nephrogenic;Other, specify Central;Nephrogenic;Other, specify Alphanumeric Adult;Pediatric Supplemental 1.00 2018-01-04 11:24:35.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C06358 Diabetes mellitus type DiabetesMellitusTyp Type of diabetes mellitus Type of diabetes mellitus Type Type 1;Type 2;Unknown;Other, specify Type 1;Type 2;Unknown;Other, specify Alphanumeric Adult;Pediatric Supplemental 4.00 2024-02-29 15:41:20.0 Reproductive and Hormonal History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C16179 Post-menopausal surgery date/time PostMnpslSurgDateTime The date and time (if applicable and known) of the surgery that induced the post-menopausal period Date (and time if applicable and known) of the surgery that induced the post-menopausal period Date last ovary removed Date or Date & Time Adult;Pediatric Supplemental 4.00 2024-02-02 13:21:13.0 Reproductive and Hormonal History General Health History Participant History and Family History

Free-Form Entry

CSV