CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Sub-Domain: General Health History
CRF: Medical History - Immune Module

Displaying 1 - 50 of 113
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 / 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
C57712 Skin condition diagnosis other text SkinCondDiagnosOthrTxt Text specifying another skin condition the subject has ever been diagnosed with. Text specifying another skin condition the subject has ever been diagnosed with. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-10 10:37:03.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57274 Food hypersensitivity indicator FoodHypersensInd The indicator relating to whether the subject has food hypersensitivity The indicator relating to whether the subject has food hypersensitivity Food hypersensitivity No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-05 10:10:39.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C58437 Gut condition inactive resolved other text GutCondInactResolvOthTxt Free-text field to describe other type of gut condition that is no longer active in the subject or is considered resolved or cured. Free-text field to describe other type of gut condition that is no longer active in the subject or is considered resolved or cured. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-10 10:03:15.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57378 Eye condition active indicator EyeCondActiveInd The indicator relating to whether the subject currently has an eye condition The indicator relating to whether the subject currently has an eye condition Condition active Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-08 08:39:13.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57422 Ear nose throat condition medication current indicator EarNoseThroatCondMedCurrInd The indicator relating to whether the subject currently takes medication for an ear, nose, throat condition The indicator relating to whether the subject currently takes medication for an ear, nose, throat condition Currently take medications No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-08 09:30:14.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57773 Blood immune condition medication name BldImmuneMedName The name of any medication(s) the subject is taking for blood or immune conditions The name of any medication(s) the subject is taking for blood or immune conditions Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-10 13:02:30.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57315 Adverse reaction drug route text AdverseRxnDrugRouteTxt Free-text field to describe the route used for a drug which causes an adverse reaction for the participant/subject Free-text field to describe the route used for a drug which causes an adverse reaction for the participant/subject Route Alphanumeric Adult Exploratory 1.00 2018-01-05 10:45:43.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57590 Lung condition inactive resolved type LundCondInactResolvTyp Any lung conditions the subject has had that are no longer active or are considered resolved or cured Any lung conditions the subject has had that are no longer active or are considered resolved or cured Condition(s) no longer active/resolved Pneumonia in the past 12 weeks;Pneumonia, ever;Pleurisy;Asthma (as a child);Asthma (as an adult);Bronchitis;Emphysema;Chronic obstructive lung disease (COPD or COLD);Chronic restrictive lung disease;Silicosis;Asbestosis;Other, specify Pneumonia in the past 12 weeks;Pneumonia, ever;Pleurisy;Asthma (as a child);Asthma (as an adult);Bronchitis;Emphysema;Chronic obstructive lung disease (COPD or COLD);Chronic restrictive lung disease;Silicosis;Asbestosis;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-09 09:29:41.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57263 Antibiotic long term repeated history name AntibLongTermRepHistName The name of the antibiotic(s) that the subject has a history of using repeatedly or long term The name of the antibiotic(s) that the subject has a history of using repeatedly or long term If yes, what antibiotic(s): Alphanumeric Adult Exploratory 1.00 2018-01-05 09:56:26.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57813 Infection condition medication name InfectCondMedName The name of the medication(s) the subject is taking for infections The name of the medication(s) the subject is taking for infections Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-11 08:51:25.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57359 ROME I criteria abdominal pain discomfort type ROMEICritAbPainDiscomfrtTyp The type of abdominal pain or discomfort that the subject might be experiencing in relation to the ROME I criteria for Irritable Bowel Syndrome. The type of abdominal pain or discomfort that the subject might be experiencing in relation to the ROME I criteria for Irritable Bowel Syndrome. Abdominal pain or discomfort that is: Relieved with defecation;Associated with a change in consistency of stool;Associated with a change in frequency of stool Relieved with defecation;Associated with a change in consistency of stool;Associated with a change in frequency of stool Alphanumeric Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:15:40.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57713 Skin condition active indicator SkinCondActInd The indicator relating to whether the subject currently has active skin condition(s) The indicator relating to whether the subject currently has active skin condition(s) Condition(s) active No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-10 10:44:02.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57275 Food hypersensitivity component type FoodHypersensCompTyp The food component(s) to which the subject has a hypersensitivity The food component(s) to which the subject has a hypersensitivity Have hypersensitivity? Lactose;Gluten (any intolerance);Gluten (celiac disease);Milk protein;Alcohol;Eggs;Sugar/Fructose;Caffeine;Nuts;Chocolate;Aspartame;Other, specify Lactose;Gluten (any intolerance);Gluten (celiac disease);Milk protein;Alcohol;Eggs;Sugar/Fructose;Caffeine;Nuts;Chocolate;Aspartame;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-05 10:12:01.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57379 Eye condition medication past year indicator EyeCondMedPastYrInd The indicator relating to whether the subject has taken medications for eye conditions in the past year. The indicator relating to whether the subject has taken medications for eye conditions in the past year. Take Medications Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Alphanumeric

Medications taken in the last year

Adult Exploratory 1.00 2018-01-08 08:40:14.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57423 Ear nose throat condition medication name EarNoseThroatCondMedName The name of the medication(s) the subject is taking for an ear, nose, throat condition The name of the medication(s) the subject is taking for an ear, nose, throat condition Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-08 09:38:14.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57774 Blood immune condition medication work well indicator BldImmuneMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for blood or immune conditions is (are) working well The indicator relating to whether the medication(s) the subject is taking for blood or immune conditions is (are) working well Medications work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-10 13:02:58.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57316 Adverse reaction drug receive year text AdverseRxnDrugYrTxt Free-text field to indicate the year(s) the participant/subject has received a drug which causes an adverse reaction Free-text field to indicate the year(s) the participant/subject has received a drug which causes an adverse reaction Year(s) received Alphanumeric Adult Exploratory 1.00 2018-01-05 10:46:28.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57595 Gut condition diagnosis type GutCondDiagnosTyp Any gut conditions the subject has ever been diagnosed with. Any gut conditions the subject has ever been diagnosed with. Condition diagnosed Peptic ulcer;Hiatus hernia;Hepatitis A;Hepatitis B;Hepatitis C;Hepatitis, type unspecified;Gall bladder disease;Liver disease;Cirrhosis;Chronic pancreatitis;Pancreatitis;Celiac disease;Irritable bowel syndrome;Crohn's disease;Colorectal cancer;Ulcerative colitis;Other, specify Peptic ulcer;Hiatus hernia;Hepatitis A;Hepatitis B;Hepatitis C;Hepatitis, type unspecified;Gall bladder disease;Liver disease;Cirrhosis;Chronic pancreatitis;Pancreatitis;Celiac disease;Irritable bowel syndrome;Crohn's disease;Colorectal cancer;Ulcerative colitis;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-09 10:24:06.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57264 Antibiotic long term repeated history use year text AntibLongTermRepHistUseYrTxt The year(s) that the subject has used antibiotics repeatedly or long term. The year(s) that the subject has used antibiotics repeatedly or long term. When (year(s)): Alphanumeric Adult Exploratory 1.00 2018-01-05 09:57:29.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57814 Infection condition medication work well indicator InfectCondMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for infections is (are) working well The indicator relating to whether the medication(s) the subject is taking for infections is (are) working well Medications work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-11 08:54:19.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57361 ROME I criteria PLUS type ROMEICritPLUSTyp The ROME I criteria that requires two or more of the following conditions under the PLUS section. The ROME I criteria that requires two or more of the following conditions under the PLUS section. Two or more of the following, on at least one-fourth of occassions or days: Altered stool form (lumpy and hard, or loose and watery);Altered stool passage (straining, urgency, or a feeling of incomplete evacuatioin);Altered stool freuqency (for research purposes, ''altered'' may be defined as more than three bowel movements each day or fewer than three bowel movements each week);Passage of mucus;Bloating or feeling of abdominal Altered stool form (lumpy and hard, or loose and watery);Altered stool passage (straining, urgency, or a feeling of incomplete evacuatioin);Altered stool freuqency (for research purposes, ''altered'' may be defined as more than three bowel movements each day or fewer than three bowel movements each week);Passage of mucus;Bloating or feeling of abdominal Alphanumeric Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:45:19.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57714 Skin condition medication past year indicator SkinCondMedPastYrInd The indicator relating to whether the subject has taken medication for skin condition(s) in the past year. The indicator relating to whether the subject has taken medication for skin condition(s) in the past year. Take medications No;Yes No;Yes Alphanumeric

In the past year

Adult Exploratory 1.00 2018-01-10 11:02:19.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57277 Food component hypersensitivity reaction type text FoodCompHypersRxnTypTxt Free-text field describing the reaction the participant/subject has as a result of a food component hypersensitivity Free-text field describing the reaction the participant/subject has as a result of a food component hypersensitivity Reaction Alphanumeric

Hives, vomiting, other

Adult Exploratory 1.00 2018-01-05 10:16:42.0 Medical History - Immune Module General Health History Participant History and Family History 500

Free-Form Entry

C57381 Eye condition medication current indicator EyeCondMedctnCurrentInd The indicator relating to whether the subject currently takes medication for eye conditions The indicator relating to whether the subject currently takes medication for eye conditions Currently take medications Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Optic neuritis;Uveitis or scleritis;Dry eye;Eye infections;Sjogren's syndrome;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-08 08:40:14.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57424 Ear nose throat condition medication work well indicator EarNoseThroatMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for ear, nose, throat condition(s) is(are) working well. The indicator relating to whether the medication(s) the subject is taking for ear, nose, throat condition(s) is(are) working well. Medication(s) work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-08 09:39:58.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57780 Blood immune condition active indicator BldImmuneCondActInd The indicator relating to whether the subject currently has an active blood or immune condition The indicator relating to whether the subject currently has an active blood or immune condition Condition active No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-10 13:27:49.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57319 Atopy allergic disorder history indicator AtopyAllDisordrHistInd The indicator relating to whether the participant/subject has a history of atopy/allergic disorders. The indicator relating to whether the participant/subject has a history of atopy/allergic disorders. History of atopy/allergic disorders No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-05 10:49:14.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57601 Gut condition diagnosis other text GutCondDiagnosOthrTxt Text specifying another gut condition that the subject has ever been diagnosed with. Text specifying another gut condition that the subject has ever been diagnosed with. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-09 11:23:28.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57265 Medical history immune condition type MedHistImmuneCondTyp Immune condition(s) of which the participant/subject has a medical history Immune condition(s) of which the participant/subject has a medical history Condition Zoster;Malignancy (cancer) affecting the immune system;Immunodeficiency syndrome(s) Zoster;Malignancy (cancer) affecting the immune system;Immunodeficiency syndrome(s) Alphanumeric Adult Exploratory 1.00 2018-01-05 10:02:04.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57880 Infection condition inactive resolved type InfectCondInactResolvTyp Any type of the infections listed that are no longer active in the patient or are considered resolved or cured. Any type of the infections listed that are no longer active in the patient or are considered resolved or cured. Condition no longer active/resolved Mononucleosis;Lyme disease, Specify type;HIV/AIDS;Fungal disease (not including skin infection);Chronic parasitic infection;Tuberculosis;Syphilis;Subacute bacterial endocarditis;Sepsis, ever;Sepsis in the past 12 weeks;Osteomyelitis;Other, specify Mononucleosis;Lyme disease, Specify type;HIV/AIDS;Fungal disease (not including skin infection);Chronic parasitic infection;Tuberculosis;Syphilis;Subacute bacterial endocarditis;Sepsis, ever;Sepsis in the past 12 weeks;Osteomyelitis;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-11 13:06:25.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57362 ROME I criteria indicator ROMEICritInd The indicator relating to whether the ROME I criteria for Irritable Bowel Syndrome has been met. The indicator relating to whether the ROME I criteria for Irritable Bowel Syndrome has been met. Rome I criteria: No;Yes No;Yes Alphanumeric Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:49:23.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57716 Skin condition medication currently indicator SkinCondMedCurrentInd The indicator relating to whether the subject currently takes medication for skin condition(s) The indicator relating to whether the subject currently takes medication for skin condition(s) Currently take medications No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-10 11:02:19.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57279 Blood immune condition diagnosis year value BldImmuneCondDiagYrVal Year of diagnosis of a blood or immune condition Year of diagnosis of a blood or immune condition Year(s) of diagnosis Numeric Values Adult Exploratory 1.00 2018-01-05 10:18:14.0 Medical History - Immune Module General Health History Participant History and Family History

Free-Form Entry

C57382 Eye condition medication name EyeCondMedctnName The name of the medication(s) the subject takes for eye conditions The name of the medication(s) the subject takes for eye conditions Medication name(s) Alphanumeric Adult Exploratory 1.00 2018-01-08 08:43:05.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57485 Ear nose throat condition inactive resolved type EarNoseThroatCondInactResTyp Element related to ear, nose, throat conditions that are considered no longer active or resolved Element related to ear, nose, throat conditions that are considered no longer active or resolved Condition(s) no longer active/resolved Chronic rhinitis (runny nose);Chronic sinusitis;Chronic/repeated otitis media (ear infections);Hay fever;Impaired hearing;Easy nasal bleeding;Nasal allergies;Tonsillectomy;Other, specify;Chronically infected tonsils Chronic rhinitis (runny nose);Chronic sinusitis;Chronic/repeated otitis media (ear infections);Hay fever;Impaired hearing;Easy nasal bleeding;Nasal allergies;Tonsillectomy;Other, specify;Chronically infected tonsils Alphanumeric Adult Exploratory 1.00 2018-01-08 11:20:01.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57804 Blood immune condition inactive resolved type BldImmuneCondInactResolvTyp Any type of blood and/or immune system conditions that are no longer active in the subject or are considered resolved or cured. Any type of blood and/or immune system conditions that are no longer active in the subject or are considered resolved or cured. Condition no longer active/resolved Anemia;Sickle cell disease;Thalassemia;Hemochromatosis;Myeloproliferative disorders (myelodysplasia);Other, specify Anemia;Sickle cell disease;Thalassemia;Hemochromatosis;Myeloproliferative disorders (myelodysplasia);Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-10 16:57:15.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57321 Atopy allergic disorder condition diagnosis type AtopyAllDisordrCondDiagnosTyp The type of condition(s) that the participant/subject was diagnosed with in relation to his/her history of atopy/allergic disorders. The type of condition(s) that the participant/subject was diagnosed with in relation to his/her history of atopy/allergic disorders. Condition diagnosis Allergic rhinitis/hay fever;Asthma;Atopic dermatitis;Hives;Mast cell activation syndrome;Other, specify Allergic rhinitis/hay fever;Asthma;Atopic dermatitis;Hives;Mast cell activation syndrome;Other, specify Alphanumeric Adult Exploratory 1.00 2018-01-05 10:51:03.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57602 Gut condition active indicator GutCondActInd The indicator relating to whether the subject currently has an active gut condition The indicator relating to whether the subject currently has an active gut condition Condition active No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-09 11:27:55.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57266 Ear nose throat condition diagnosis year value EarNoseThroatCondDiagnosYrVal The year the subject was diagnosed with an ear, nose, throat condition The year the subject was diagnosed with an ear, nose, throat condition Year(s) of diagnosis Numeric Values Adult Exploratory 1.00 2018-01-05 10:02:54.0 Medical History - Immune Module General Health History Participant History and Family History

Free-Form Entry

C57881 Infection condition inactive resolved other text InfectCondInactResolvOthrTxt Text specifying an infection other than the ones already mentioned that is no longer active in the subject or is considered resolved or cured. Text specifying an infection other than the ones already mentioned that is no longer active in the subject or is considered resolved or cured. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-11 13:09:26.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57363 ROME II criteria type ROMEIICritTyp The type of condition that is required for the ROME II criteria for Irritable Bowel Syndrome to be met. The type of condition that is required for the ROME II criteria for Irritable Bowel Syndrome to be met. Abdominal distention or pain Relieved with defecation;An onset associated with change in the form (appearance) of stool;Onset associated with change in the frequency of stool Relieved with defecation;An onset associated with change in the form (appearance) of stool;Onset associated with change in the frequency of stool Alphanumeric

Of at least 12 weeks duration (not necessarily consecutive weeks) in the preceding 12 months accompanied by two of the following three features of altered bowel habits.

Adult Supplemental-Highly Recommended 1.00 2018-01-05 12:51:04.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57717 Skin condition medication work well indicator SkinCondMedWorkWellInd The indicator relating to whether the medication(s) the subject is taking for skin condition(s) is(are) working well. The indicator relating to whether the medication(s) the subject is taking for skin condition(s) is(are) working well. Medication(s) work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-10 11:04:35.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57280 Food hypersensitivity reaction onset date FoodHypersensRxnOnsetDate The date of onset for reaction(s) as a result of food hypersensitivity The date of onset for reaction(s) as a result of food hypersensitivity Date of onset Date or Date & Time Adult Exploratory 1.00 2018-01-05 10:19:54.0 Medical History - Immune Module General Health History Participant History and Family History

Free-Form Entry

C57383 Eye condition medication work well indicator EyeCondMedctnWorkWellInd The indicator relating to whether the subject's medication(s) for eye conditons is(are) working well. The indicator relating to whether the subject's medication(s) for eye conditons is(are) working well. Medications work well Yes;No;Not applicable Yes;No;Not applicable Alphanumeric Adult Exploratory 1.00 2018-01-08 08:43:57.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57489 Lung condition diagnosed indicator LungCondDiagInd Indicator related to lung condition(s) the participant/subject has been diagnosed with Indicator related to lung condition(s) the participant/subject has been diagnosed with Condition diagnosed No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-08 12:33:33.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57805 Blood immune condition inactive resolved other text BldImmunCondInactResolvOthrTxt Text specifying a blood and/or immune system condition other than the ones previously mentioned that is no longer active in the subject or is considered resolved or cured. Text specifying a blood and/or immune system condition other than the ones previously mentioned that is no longer active in the subject or is considered resolved or cured. Other, specify: Alphanumeric Adult Exploratory 1.00 2018-01-10 17:00:23.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57323 Atopic allergy disorder condition diagnosed information status AllRhiHayFeverCondInfoStat Status for atopy/allergic disorder(s) with which the participant/subject has been diagnosed Status for atopy/allergic disorder(s) with which the participant/subject has been diagnosed If diagnosed: Condition active past one year;Condition currently active;Medications are taken for this condition;Medications taken daily for this condition Condition active past one year;Condition currently active;Medications are taken for this condition;Medications taken daily for this condition Alphanumeric Adult Exploratory 1.00 2018-01-05 10:54:30.0 Medical History - Immune Module General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C57603 Gut condition medication past year indicator GutCondMedPastYrInd The indicator relating to whether the subject has taken medication for gut condition(s) in the past year The indicator relating to whether the subject has taken medication for gut condition(s) in the past year Take medications No;Yes No;Yes Alphanumeric

In the past year

Adult Exploratory 1.00 2018-01-09 11:28:54.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

C57267 Medical history Immunodeficiency syndrome name text MedHistImmunodefSyndNameTxt The name of the immunodeficiency syndrome(s) the subject has as medical history of The name of the immunodeficiency syndrome(s) the subject has as medical history of Name of syndrome: Alphanumeric Adult Exploratory 1.00 2018-01-05 10:04:11.0 Medical History - Immune Module General Health History Participant History and Family History 255

Free-Form Entry

C57882 Immune disorder treatment received indicator ImmDisordrTreatmtRecInd Indicator related to whether treatments were received for any immune disorders Indicator related to whether treatments were received for any immune disorders Treatments received for any immune disorders? No;Yes No;Yes Alphanumeric Adult Exploratory 1.00 2018-01-11 13:10:35.0 Medical History - Immune Module General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV