ID

15065

Descrizione

NINDS Common Data Elements [Participant/Subject History and Family History] [Amyotrophic Lateral Sclerosis] Used from the National Institute of Neurological Disorders and Stroke Common Data Elements (https://www.commondataelements.ninds.nih.gov/) References: Grinnon ST, Miller K, Marler JR, Lu Y, Stout A, Odenkirchen J, Kunitz S. National Institute of Neurological Disorders and Stroke Common Data Element Project - approach and methods. Clin Trials. 2012;9(3):322-9.

collegamento

https://www.commondataelements.ninds.nih.gov/

Keywords

  1. 19/02/16 19/02/16 -
  2. 19/02/16 19/02/16 -
  3. 13/05/16 13/05/16 -
Caricato su

13 maggio 2016

DOI

Per favore, per richiedere un accesso.

Licenza

Creative Commons BY-NC 3.0

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NINDS CDE [Medical History][Amyotrophic Lateral Sclerosis]

General Health History

  1. StudyEvent: ODM
    1. General Health History
Medical history
Descrizione

Medical history

Study-ID
Descrizione

study ID

Tipo di dati

integer

Alias
UMLS CUI [1]
C2826693
Study site name
Descrizione

Study site

Tipo di dati

text

Alias
UMLS CUI [1]
C2825164
Subject ID
Descrizione

Patient Study ID

Tipo di dati

text

Alias
UMLS CUI [1]
C2348585
Date Medical History Taken
Descrizione

Date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Have you experienced problems with constitutional symptoms in the past?
Descrizione

Constitutional symptoms (e.g., fever, weight loss)

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0009812
Please specify the constitutional symptom you experienced. If there´s more than one, please describe one be one.
Descrizione

Constitutional symptoms (e.g., fever, weight loss...)Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description

Tipo di dati

text

Alias
UMLS CUI [1]
C0009812
Start date of constitutional symptom
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of constitutional symptom
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your eyes in the past?
Descrizione

Eye problems

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0262477
Please specify the eye problems you experienced. If there´s more than one, please describe one be one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description

Tipo di dati

text

Alias
UMLS CUI [1]
C0262477
Start date of eye problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of eye problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced ENT or mouth problems in the past?
Descrizione

Otorhinolaryngologic conditions

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0029896
Please specify the otorhinolaryngologic conditions or problems with your mouth you experienced. If there´s more than one, please describe one be one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description

Tipo di dati

text

Alias
UMLS CUI [1]
C0029896
Start date of you ENT or mouth problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your ENT or mouth problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your cardiovascular system in the past?
Descrizione

Cardiovascular diseases

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0007222
Please specify the problems you experienced with your cardiovascular system. If there´s more than one, describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0007222
Start date of your cardiovascular problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your cardiovascular problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced respiratory problems in the past?
Descrizione

Respiratory disorders

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0035204
Please specify the respiratory problems you experienced. If there´s more than one, describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0035204
Start date of your respiratory problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your respiratory problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced gastrointestinal problems in the past?
Descrizione

Gastrointestinal system

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0012240
Please specify the gastrointestinal problem you experienced. If there´s more than one, describe it one by one
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0012240
Start date of your gastrointestinal problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your gastrointestinal problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your genitourinary system in the past?
Descrizione

Genitourinary system

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0042066
Please specify the problems with your genitourinary system. If there´s more than one, describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0042066
Start date of your genitourinary problems
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your genitourinary problems
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with musculoskeletal system in the past?
Descrizione

Musculoskeletal system

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0026860
Please specify the problem with your musculoskeletal system. If there´s more than one, describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0026860
Start date of your musculoskeletal problem
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your musculoskeletal problem
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your skin or your breast in the past?
Descrizione

Integumentary system

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0037267
Please specify the problems with your integumentary system you experienced. If there´s more than one, describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0037267
Start date of your problems with the integumentary system
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your problems with the integumentary system
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced neurological problems with in the past?
Descrizione

Neurological problems

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0221571
Please specify the neurological problems you experienced. If there´s more than one, please describe it one be one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0221571
Start date of the neurological problem
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of the neurological problem
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your mental health in the past?
Descrizione

Mental disorders

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0004936
Please specify the mental problem you experienced. If there´s more than one, please describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0004936
Start date of your mental illness
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your mental illness
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your endocrine system in the past?
Descrizione

Endocrine system diseases

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0014130
Please specify the endocrine system disease you experienced. If there´s more than one,please describe it one by one
Descrizione

Endocrine system diseases

Tipo di dati

text

Alias
UMLS CUI [1]
C0014130
Start date of the endocrine system disease
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of the endocrine system disease
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with diseases of blood and bloodforming organs in the past?
Descrizione

Hematological disease

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0018939
Please specify the disease of blood and bloodforming organs you experienced. If there´s more than one,please describe it one by one.
Descrizione

Hematological disease

Tipo di dati

text

Alias
UMLS CUI [1]
C0018939
Start date of your problems with the blood or bloodforming system
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of the problems with your blood or bloodforming system
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with lymphatic diseases in the past?
Descrizione

Lymphatic disease

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0024228
Please specify the problem with your lymphatic system you experienced. If there´s more than one, please describe it one by one
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0024228
Start date of your problems with the lymphatic system
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of your problems with the lymphatic system
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with allergies in the past?
Descrizione

Allergies

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0020517
Please specify the allergy you experienced. If there´s more than one, please describe it one by one.
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0020517
Start date of the allergy
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of the allergy
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the allergy persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Have you experienced problems with your immune system in the past?
Descrizione

Immunologic diseases

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0021053
Please specify the problem with your immune system you experienced. If there´s more than one, please desribe it one by one
Descrizione

Enter all significant medical history items, including surgeries, EXCEPT the problem/condition that is the focus of this study. Use only one line per description.

Tipo di dati

text

Alias
UMLS CUI [1]
C0021053
Start date of your problems with the immune system
Descrizione

Start date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
End date of the problems with your immune system
Descrizione

End date

Tipo di dati

date

Alias
UMLS CUI [1]
C0011008
Is the symptom persistent?
Descrizione

Ongoing

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0549178
Does the subject have allergies?
Descrizione

Allergies

Tipo di dati

boolean

Alias
UMLS CUI [1]
C0020517
If the subject does have allergies, please specify which type:
Descrizione

Allergies

Tipo di dati

text

Alias
UMLS CUI [1]
C0020517
Is the subject of childbearing potential?
Descrizione

Childbearing potential

Tipo di dati

boolean

Alias
UMLS CUI [1]
C3831118
Females of childbearing potential, using safe contraceptive measures? Please check one below
Descrizione

Contraceptive measures

Tipo di dati

text

Alias
UMLS CUI [1]
C0700589
Please specify other contraceptive measures, if none of the above applied.
Descrizione

Contraceptive measures

Tipo di dati

text

Alias
UMLS CUI [1]
C0700589
If the subject was surgically sterilized, please specify:
Descrizione

Surgical sterilization

Tipo di dati

text

Alias
UMLS CUI [1]
C0015787
Please specify other method of surgical sterilization if none of the above applied.
Descrizione

Surgical sterilization

Tipo di dati

text

Alias
UMLS CUI [1]
C0015787

Similar models

General Health History

  1. StudyEvent: ODM
    1. General Health History
Name
genere
Description | Question | Decode (Coded Value)
Tipo di dati
Alias
Item Group
Medical history
study ID
Item
Study-ID
integer
C2826693 (UMLS CUI [1])
Study site
Item
Study site name
text
C2825164 (UMLS CUI [1])
Patient Study ID
Item
Subject ID
text
C2348585 (UMLS CUI [1])
Date
Item
Date Medical History Taken
date
C0011008 (UMLS CUI [1])
Constitutional symptoms
Item
Have you experienced problems with constitutional symptoms in the past?
boolean
C0009812 (UMLS CUI [1])
Constitutional symptoms
Item
Please specify the constitutional symptom you experienced. If there´s more than one, please describe one be one.
text
C0009812 (UMLS CUI [1])
Start date
Item
Start date of constitutional symptom
date
C0011008 (UMLS CUI [1])
End date
Item
End date of constitutional symptom
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Eye problems
Item
Have you experienced problems with your eyes in the past?
boolean
C0262477 (UMLS CUI [1])
Eye problems
Item
Please specify the eye problems you experienced. If there´s more than one, please describe one be one.
text
C0262477 (UMLS CUI [1])
Start date
Item
Start date of eye problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of eye problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Otorhinolaryngologic conditions
Item
Have you experienced ENT or mouth problems in the past?
boolean
C0029896 (UMLS CUI [1])
Otorhinolaryngologic conditions
Item
Please specify the otorhinolaryngologic conditions or problems with your mouth you experienced. If there´s more than one, please describe one be one.
text
C0029896 (UMLS CUI [1])
Start date
Item
Start date of you ENT or mouth problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your ENT or mouth problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Cardiovascular diseases
Item
Have you experienced problems with your cardiovascular system in the past?
boolean
C0007222 (UMLS CUI [1])
Cardiovascular Diseases
Item
Please specify the problems you experienced with your cardiovascular system. If there´s more than one, describe it one by one.
text
C0007222 (UMLS CUI [1])
Start date
Item
Start date of your cardiovascular problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your cardiovascular problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Respiratory disorders
Item
Have you experienced respiratory problems in the past?
boolean
C0035204 (UMLS CUI [1])
Respiration disorders
Item
Please specify the respiratory problems you experienced. If there´s more than one, describe it one by one.
text
C0035204 (UMLS CUI [1])
Start date
Item
Start date of your respiratory problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your respiratory problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Gastrointestinal system
Item
Have you experienced gastrointestinal problems in the past?
boolean
C0012240 (UMLS CUI [1])
Gastrointestinal system
Item
Please specify the gastrointestinal problem you experienced. If there´s more than one, describe it one by one
text
C0012240 (UMLS CUI [1])
Start date
Item
Start date of your gastrointestinal problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your gastrointestinal problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Genitourinary system
Item
Have you experienced problems with your genitourinary system in the past?
boolean
C0042066 (UMLS CUI [1])
Genitourinary system
Item
Please specify the problems with your genitourinary system. If there´s more than one, describe it one by one.
text
C0042066 (UMLS CUI [1])
Start date
Item
Start date of your genitourinary problems
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your genitourinary problems
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Musculoskeletal system
Item
Have you experienced problems with musculoskeletal system in the past?
boolean
C0026860 (UMLS CUI [1])
Musculoskeletal System
Item
Please specify the problem with your musculoskeletal system. If there´s more than one, describe it one by one.
text
C0026860 (UMLS CUI [1])
Start date
Item
Start date of your musculoskeletal problem
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your musculoskeletal problem
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent
boolean
C0549178 (UMLS CUI [1])
Integumentary system
Item
Have you experienced problems with your skin or your breast in the past?
boolean
C0037267 (UMLS CUI [1])
Integumentary system
Item
Please specify the problems with your integumentary system you experienced. If there´s more than one, describe it one by one.
text
C0037267 (UMLS CUI [1])
Start date
Item
Start date of your problems with the integumentary system
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your problems with the integumentary system
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Neurological problems
Item
Have you experienced neurological problems with in the past?
boolean
C0221571 (UMLS CUI [1])
Neurological problems
Item
Please specify the neurological problems you experienced. If there´s more than one, please describe it one be one.
text
C0221571 (UMLS CUI [1])
Start date
Item
Start date of the neurological problem
date
C0011008 (UMLS CUI [1])
End date
Item
End date of the neurological problem
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Mental disorders
Item
Have you experienced problems with your mental health in the past?
boolean
C0004936 (UMLS CUI [1])
Mental disorders
Item
Please specify the mental problem you experienced. If there´s more than one, please describe it one by one.
text
C0004936 (UMLS CUI [1])
Start date
Item
Start date of your mental illness
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your mental illness
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Endocrine system diseases
Item
Have you experienced problems with your endocrine system in the past?
boolean
C0014130 (UMLS CUI [1])
Endocrine system diseases
Item
Please specify the endocrine system disease you experienced. If there´s more than one,please describe it one by one
text
C0014130 (UMLS CUI [1])
Start date
Item
Start date of the endocrine system disease
date
C0011008 (UMLS CUI [1])
End date
Item
End date of the endocrine system disease
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Hematological disease
Item
Have you experienced problems with diseases of blood and bloodforming organs in the past?
boolean
C0018939 (UMLS CUI [1])
Hematological disease
Item
Please specify the disease of blood and bloodforming organs you experienced. If there´s more than one,please describe it one by one.
text
C0018939 (UMLS CUI [1])
Start date
Item
Start date of your problems with the blood or bloodforming system
date
C0011008 (UMLS CUI [1])
End date
Item
End date of the problems with your blood or bloodforming system
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Lymphatic disease
Item
Have you experienced problems with lymphatic diseases in the past?
boolean
C0024228 (UMLS CUI [1])
Lymphatic disease
Item
Please specify the problem with your lymphatic system you experienced. If there´s more than one, please describe it one by one
text
C0024228 (UMLS CUI [1])
Start date
Item
Start date of your problems with the lymphatic system
date
C0011008 (UMLS CUI [1])
End date
Item
End date of your problems with the lymphatic system
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Allergies
Item
Have you experienced problems with allergies in the past?
boolean
C0020517 (UMLS CUI [1])
Allergies
Item
Please specify the allergy you experienced. If there´s more than one, please describe it one by one.
text
C0020517 (UMLS CUI [1])
Start date
Item
Start date of the allergy
date
C0011008 (UMLS CUI [1])
End date
Item
End date of the allergy
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the allergy persistent?
boolean
C0549178 (UMLS CUI [1])
Immunologic diseases
Item
Have you experienced problems with your immune system in the past?
boolean
C0021053 (UMLS CUI [1])
Immunologic diseases
Item
Please specify the problem with your immune system you experienced. If there´s more than one, please desribe it one by one
text
C0021053 (UMLS CUI [1])
Start date
Item
Start date of your problems with the immune system
date
C0011008 (UMLS CUI [1])
End date
Item
End date of the problems with your immune system
date
C0011008 (UMLS CUI [1])
Ongoing
Item
Is the symptom persistent?
boolean
C0549178 (UMLS CUI [1])
Allergies
Item
Does the subject have allergies?
boolean
C0020517 (UMLS CUI [1])
Item
If the subject does have allergies, please specify which type:
text
C0020517 (UMLS CUI [1])
Code List
If the subject does have allergies, please specify which type:
CL Item
food (1)
CL Item
seasonal (2)
CL Item
medication (3)
Childbearing potential
Item
Is the subject of childbearing potential?
boolean
C3831118 (UMLS CUI [1])
Item
Females of childbearing potential, using safe contraceptive measures? Please check one below
text
C0700589 (UMLS CUI [1])
Code List
Females of childbearing potential, using safe contraceptive measures? Please check one below
CL Item
Abstinence (1)
CL Item
Hormonal (oral,implanted,injected...) (2)
CL Item
Intrauterine device in place for ≥ 3 months (3)
CL Item
Adequate barrier method in conjunction with spermicide (4)
CL Item
Postmenopausal (5)
CL Item
Surgically sterile (6)
CL Item
Non-surgically sterile  (7)
CL Item
Other (8)
Contraceptive measures
Item
Please specify other contraceptive measures, if none of the above applied.
text
C0700589 (UMLS CUI [1])
Item
If the subject was surgically sterilized, please specify:
text
C0015787 (UMLS CUI [1])
Code List
If the subject was surgically sterilized, please specify:
CL Item
Hysterectomy (1)
CL Item
Tubal ligation (2)
CL Item
Other (3)
Surgical sterilization
Item
Please specify other method of surgical sterilization if none of the above applied.
text
C0015787 (UMLS CUI [1])

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