ID

22600

Beschreibung

Terms of use: You may not use this document or the information contained herein to a regulatory authority in connection with an application for a marketing authorization or any other regulatory submission without the express written consent of Roche Study #: FVF4168g Drug: Ranibizumab Study Title: A Phase III, Double-Masked, Multicenter, Randomized, Sham-Controlled Study Of The Efficacy And Safety Of Ranibizumab Injection In Subjects With Clinically Significant Macular Edema With Center Involvement Secondary To Diabetes Mellitus

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  1. 08.06.17 08.06.17 -
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TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

Englisch

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulare  
Patient administration
Beschreibung

Patient administration

Subject Number
Beschreibung

PT

Datentyp

integer

Alias
UMLS CUI [1]
C2348585
Subject Initials:
Beschreibung

PTINIT

Datentyp

text

Alias
UMLS CUI [1,1]
C1997894
UMLS CUI [1,2]
C2986440
Report Date:
Beschreibung

VDT

Datentyp

date

Alias
UMLS CUI [1,1]
C1302584
TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
Beschreibung

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)

Glaucoma
Beschreibung

Glaucoma

Datentyp

integer

Alias
UMLS CUI [1]
C0017601
No Known History
Beschreibung

Glaucoma medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0017601
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

glaucoma active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0017601
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

glaucoma onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0017601
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

glaucoma onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0017601
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Dry AMD
Beschreibung

dry AMD

Datentyp

integer

Alias
UMLS CUI [1]
C3888461
No Known History
Beschreibung

dry AMD medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888461
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

dry AMD active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888461
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

dry AMD onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C3888461
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

dry AMD onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888461
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Wet AMD
Beschreibung

wet AMD

Datentyp

text

Alias
UMLS CUI [1]
C3888896
Condition Currently Active?
Beschreibung

wet AMD active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888896
UMLS CUI [1,2]
C2707252
No Known History
Beschreibung

wet AMD medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888896
UMLS CUI [1,2]
C0262926
Onset Date
Beschreibung

wet AMD onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C3888896
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

wet AMD onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C3888896
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Hypertension
Beschreibung

Hypertension

Datentyp

boolean

Alias
UMLS CUI [1]
C0020538
No Known History
Beschreibung

hypertension medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

hypertension active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

hypertension onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

hypertension onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0020538
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Angina
Beschreibung

Angina

Datentyp

boolean

Alias
UMLS CUI [1]
C0002962
No Known History
Beschreibung

angina medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0002962
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

angina active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0002962
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

angina onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0002962
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

angina onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0002962
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Myocardial Infarction
Beschreibung

Myocardial Infarction

Datentyp

boolean

Alias
UMLS CUI [1]
C0027051
No Known History
Beschreibung

myocardial infarction medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

myocardial infarction active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

myocardial infarction onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

myocardial infacrction onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0027051
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Congestive Heart Failure
Beschreibung

Congestive Heart Failure

Datentyp

boolean

Alias
UMLS CUI [1]
C0018802
No Known History
Beschreibung

congestive heart failure medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

congestive heart failure active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

congestive heart failure onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

congestive heart failure onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0018802
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Transient Ischemic Attack
Beschreibung

Transient Ischemic Attack

Datentyp

boolean

Alias
UMLS CUI [1]
C0007787
No Known History
Beschreibung

Transient Ischemic Attack medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Transient Ischemic Attack active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Transient Ischemic Attack onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Transient Ischemic Attack onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0007787
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Cerebral Vascular Accident (Stroke)
Beschreibung

Cerebral Vascular Accident (Stroke)

Datentyp

boolean

Alias
UMLS CUI [1]
C0038454
No Known History
Beschreibung

Cerebral Vascular Accident (Stroke) medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Cerebral Vascular Accident (Stroke) active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Cerebral Vascular Accident (Stroke) onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Cerebral Vascular Accident (Stroke) onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0038454
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Diabetes Mellitus
Beschreibung

Diabetes Mellitus

Datentyp

boolean

Alias
UMLS CUI [1]
C0011849
No Known History
Beschreibung

Diabetes Mellitus medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011849
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Diabetes Mellitus active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011849
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Diabetes Mellitus onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0011849
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Diabetes Mellitus onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011849
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Prior Non-Ocular Hemorrhage
Beschreibung

Prior Non-Ocular Hemorrhage

Datentyp

boolean

Alias
UMLS CUI [1]
C0019080
No Known History
Beschreibung

Prior Non-Ocular Hemorrhage medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Prior Non-Ocular Hemorrhage active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Prior Non-Ocular Hemorrhage onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Prior Non-Ocular Hemorrhage onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0019080
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Deep Venous Thrombosis
Beschreibung

Deep Venous Thrombosis

Datentyp

boolean

Alias
UMLS CUI [1]
C0149871
No Known History
Beschreibung

dvt medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

dvt active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

dvt onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

dvt onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0149871
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Endarterectomy
Beschreibung

Endarterectomy

Datentyp

boolean

Alias
UMLS CUI [1]
C0014098
No Known History
Beschreibung

Endarterectomy medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014098
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Endarterectomy active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014098
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Endarterectomy onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0014098
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Endarterectomy onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014098
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Renal Failure
Beschreibung

Renal Failure

Datentyp

boolean

Alias
UMLS CUI [1]
C1533077
No Known History
Beschreibung

Renal Failure medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1533077
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Renal Failure active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1533077
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Renal failure onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C1533077
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Renal failure onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1533077
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Coronary Artery Bypass Surgery
Beschreibung

Coronary Artery Bypass Surgery

Datentyp

boolean

Alias
UMLS CUI [1]
C0010055
No Known History
Beschreibung

Coronary Artery Bypass Surgery medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Coronary Artery Bypass Surgery active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Coronary Artery Bypass Surgery onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Coronary Artery Bypass Surgery onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0010055
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Coronary Stents
Beschreibung

Coronary Stents

Datentyp

boolean

Alias
UMLS CUI [1]
C0687568
No Known History
Beschreibung

Coronary Stents medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0687568
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Coronary Stents active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0687568
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Coronary Stents onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0687568
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Coronary Stents onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0687568
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Coronary Artery Disease (CAD)
Beschreibung

Coronary Artery Disease (CAD)

Datentyp

boolean

Alias
UMLS CUI [1]
C1956346
Condition Currently Active?
Beschreibung

cad active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1956346
UMLS CUI [1,2]
C2707252
No Known History
Beschreibung

cad medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1956346
UMLS CUI [1,2]
C0262926
Onset Date
Beschreibung

cad onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C1956346
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

cad onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1956346
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Nose Bleeds
Beschreibung

Nose Bleeds

Datentyp

boolean

Alias
UMLS CUI [1]
C0014591
Condition Currently Active?
Beschreibung

Nose Bleeds active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014591
UMLS CUI [1,2]
C2707252
No Known History
Beschreibung

Nose Bleeds medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014591
UMLS CUI [1,2]
C0262926
Onset Date
Beschreibung

Nose Bleeds onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0014591
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Nose Bleeds onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0014591
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Arrhythmia
Beschreibung

Arrhythmia

Datentyp

boolean

Alias
UMLS CUI [1]
C0003811
Condition Currently Active?
Beschreibung

Arrhythmia active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003811
UMLS CUI [1,2]
C2707252
No Known History
Beschreibung

Arrhythmia medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003811
UMLS CUI [1,2]
C0262926
Onset Date
Beschreibung

Arrhythmia onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0003811
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Arrhythmia onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003811
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Diverticular Disease
Beschreibung

Diverticular Disease

Datentyp

boolean

Alias
UMLS CUI [1]
C1510475
No Known History
Beschreibung

diverticular disease medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1510475
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Diverticular disease active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1510475
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Diverticular disease onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C1510475
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Diverticular Disease onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C1510475
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Proteinuria
Beschreibung

Proteinuria

Datentyp

boolean

Alias
UMLS CUI [1]
C0033687
No Known History
Beschreibung

Proteinuria medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0033687
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Proteinuria active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0033687
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Proteinuria onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0033687
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Proteinuria onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0033687
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Rheumatoid Arthritis
Beschreibung

Rheumatoid Arthritis

Datentyp

boolean

Alias
UMLS CUI [1]
C0003873
No Known History
Beschreibung

Rheumatoid Arthritis medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003873
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Rheumatoid Arthritis active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003873
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Rheumatoid Arthritis onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0003873
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Rheumatoid Arthritis onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0003873
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
Dermatitis
Beschreibung

Dermatitis

Datentyp

boolean

Alias
UMLS CUI [1]
C0011603
No Known History
Beschreibung

Dermatitis medical history

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011603
UMLS CUI [1,2]
C0262926
Condition Currently Active?
Beschreibung

Dermatitis active

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011603
UMLS CUI [1,2]
C2707252
Onset Date
Beschreibung

Dermatitis onset date

Datentyp

date

Maßeinheiten
  • DD/MMM/YY
Alias
UMLS CUI [1,1]
C0011603
UMLS CUI [1,2]
C0574845
DD/MMM/YY
Date Unknown
Beschreibung

Dermatitis onset date unknown

Datentyp

boolean

Alias
UMLS CUI [1,1]
C0011603
UMLS CUI [1,2]
C0574845
UMLS CUI [1,3]
C0439673
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Ähnliche Modelle

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4168G Macular Edema NCT00473330

1 Formulare
Name
Typ
Description | Question | Decode (Coded Value)
Datentyp
Alias
Item Group
Patient administration
PT
Item
Subject Number
integer
C2348585 (UMLS CUI [1])
PTINIT
Item
Subject Initials:
text
C1997894 (UMLS CUI [1,1])
C2986440 (UMLS CUI [1,2])
VDT
Item
Report Date:
date
C1302584 (UMLS CUI [1,1])
Item Group
TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)
Item
Glaucoma
integer
C0017601 (UMLS CUI [1])
PROCEDURE_TYPE [PRCTYP]
Code List
Glaucoma
CL Item
Applanation tonometry (1)
CL Item
Non-contact tonometry (2)
CL Item
Tonopen (3)
CL Item
Pneumotonometry (4)
Glaucoma medical history
Item
No Known History
boolean
C0017601 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
glaucoma active
Item
Condition Currently Active?
boolean
C0017601 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
glaucoma onset date
Item
Onset Date
date
C0017601 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
glaucoma onset date unknown
Item
Date Unknown
boolean
C0017601 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Item
Dry AMD
integer
C3888461 (UMLS CUI [1])
PROCEDURE_TYPE [PRCTYP]
Code List
Dry AMD
CL Item
Applanation tonometry (1)
CL Item
Non-contact tonometry (2)
CL Item
Tonopen (3)
CL Item
Pneumotonometry (4)
dry AMD medical history
Item
No Known History
boolean
C3888461 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
dry AMD active
Item
Condition Currently Active?
boolean
C3888461 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
dry AMD onset date
Item
Onset Date
date
C3888461 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
dry AMD onset date unknown
Item
Date Unknown
boolean
C3888461 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
wet AMD
Item
Wet AMD
text
C3888896 (UMLS CUI [1])
wet AMD active
Item
Condition Currently Active?
boolean
C3888896 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
wet AMD medical history
Item
No Known History
boolean
C3888896 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
wet AMD onset date
Item
Onset Date
date
C3888896 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
wet AMD onset date unknown
Item
Date Unknown
boolean
C3888896 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Hypertension
Item
Hypertension
boolean
C0020538 (UMLS CUI [1])
hypertension medical history
Item
No Known History
boolean
C0020538 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
hypertension active
Item
Condition Currently Active?
boolean
C0020538 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
hypertension onset date
Item
Onset Date
date
C0020538 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
hypertension onset date unknown
Item
Date Unknown
boolean
C0020538 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Angina
Item
Angina
boolean
C0002962 (UMLS CUI [1])
angina medical history
Item
No Known History
boolean
C0002962 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
angina active
Item
Condition Currently Active?
boolean
C0002962 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
angina onset date
Item
Onset Date
date
C0002962 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
angina onset date unknown
Item
Date Unknown
boolean
C0002962 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Myocardial Infarction
Item
Myocardial Infarction
boolean
C0027051 (UMLS CUI [1])
myocardial infarction medical history
Item
No Known History
boolean
C0027051 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
myocardial infarction active
Item
Condition Currently Active?
boolean
C0027051 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
myocardial infarction onset date
Item
Onset Date
date
C0027051 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
myocardial infacrction onset date unknown
Item
Date Unknown
boolean
C0027051 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Congestive Heart Failure
Item
Congestive Heart Failure
boolean
C0018802 (UMLS CUI [1])
congestive heart failure medical history
Item
No Known History
boolean
C0018802 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
congestive heart failure active
Item
Condition Currently Active?
boolean
C0018802 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
congestive heart failure onset date
Item
Onset Date
date
C0018802 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
congestive heart failure onset date unknown
Item
Date Unknown
boolean
C0018802 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Transient Ischemic Attack
Item
Transient Ischemic Attack
boolean
C0007787 (UMLS CUI [1])
Transient Ischemic Attack medical history
Item
No Known History
boolean
C0007787 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Transient Ischemic Attack active
Item
Condition Currently Active?
boolean
C0007787 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Transient Ischemic Attack onset date
Item
Onset Date
date
C0007787 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Transient Ischemic Attack onset date unknown
Item
Date Unknown
boolean
C0007787 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Cerebral Vascular Accident (Stroke)
Item
Cerebral Vascular Accident (Stroke)
boolean
C0038454 (UMLS CUI [1])
Cerebral Vascular Accident (Stroke) medical history
Item
No Known History
boolean
C0038454 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Cerebral Vascular Accident (Stroke) active
Item
Condition Currently Active?
boolean
C0038454 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Cerebral Vascular Accident (Stroke) onset date
Item
Onset Date
date
C0038454 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Cerebral Vascular Accident (Stroke) onset date unknown
Item
Date Unknown
boolean
C0038454 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Diabetes Mellitus
Item
Diabetes Mellitus
boolean
C0011849 (UMLS CUI [1])
Diabetes Mellitus medical history
Item
No Known History
boolean
C0011849 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Diabetes Mellitus active
Item
Condition Currently Active?
boolean
C0011849 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Diabetes Mellitus onset date
Item
Onset Date
date
C0011849 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Diabetes Mellitus onset date unknown
Item
Date Unknown
boolean
C0011849 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Prior Non-Ocular Hemorrhage
Item
Prior Non-Ocular Hemorrhage
boolean
C0019080 (UMLS CUI [1])
Prior Non-Ocular Hemorrhage medical history
Item
No Known History
boolean
C0019080 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Prior Non-Ocular Hemorrhage active
Item
Condition Currently Active?
boolean
C0019080 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Prior Non-Ocular Hemorrhage onset date
Item
Onset Date
date
C0019080 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Prior Non-Ocular Hemorrhage onset date unknown
Item
Date Unknown
boolean
C0019080 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Deep Venous Thrombosis
Item
Deep Venous Thrombosis
boolean
C0149871 (UMLS CUI [1])
dvt medical history
Item
No Known History
boolean
C0149871 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
dvt active
Item
Condition Currently Active?
boolean
C0149871 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
dvt onset date
Item
Onset Date
date
C0149871 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
dvt onset date unknown
Item
Date Unknown
boolean
C0149871 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Endarterectomy
Item
Endarterectomy
boolean
C0014098 (UMLS CUI [1])
Endarterectomy medical history
Item
No Known History
boolean
C0014098 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Endarterectomy active
Item
Condition Currently Active?
boolean
C0014098 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Endarterectomy onset date
Item
Onset Date
date
C0014098 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Endarterectomy onset date unknown
Item
Date Unknown
boolean
C0014098 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Renal Failure
Item
Renal Failure
boolean
C1533077 (UMLS CUI [1])
Renal Failure medical history
Item
No Known History
boolean
C1533077 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Renal Failure active
Item
Condition Currently Active?
boolean
C1533077 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Renal failure onset date
Item
Onset Date
date
C1533077 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Renal failure onset date unknown
Item
Date Unknown
boolean
C1533077 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Coronary Artery Bypass Surgery
Item
Coronary Artery Bypass Surgery
boolean
C0010055 (UMLS CUI [1])
Coronary Artery Bypass Surgery medical history
Item
No Known History
boolean
C0010055 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Coronary Artery Bypass Surgery active
Item
Condition Currently Active?
boolean
C0010055 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Coronary Artery Bypass Surgery onset date
Item
Onset Date
date
C0010055 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Coronary Artery Bypass Surgery onset date unknown
Item
Date Unknown
boolean
C0010055 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Coronary Stents
Item
Coronary Stents
boolean
C0687568 (UMLS CUI [1])
Coronary Stents medical history
Item
No Known History
boolean
C0687568 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Coronary Stents active
Item
Condition Currently Active?
boolean
C0687568 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Coronary Stents onset date
Item
Onset Date
date
C0687568 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Coronary Stents onset date unknown
Item
Date Unknown
boolean
C0687568 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Coronary Artery Disease (CAD)
Item
Coronary Artery Disease (CAD)
boolean
C1956346 (UMLS CUI [1])
cad active
Item
Condition Currently Active?
boolean
C1956346 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
cad medical history
Item
No Known History
boolean
C1956346 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
cad onset date
Item
Onset Date
date
C1956346 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
cad onset date unknown
Item
Date Unknown
boolean
C1956346 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Nose Bleeds
Item
Nose Bleeds
boolean
C0014591 (UMLS CUI [1])
Nose Bleeds active
Item
Condition Currently Active?
boolean
C0014591 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Nose Bleeds medical history
Item
No Known History
boolean
C0014591 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Nose Bleeds onset date
Item
Onset Date
date
C0014591 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Nose Bleeds onset date unknown
Item
Date Unknown
boolean
C0014591 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Arrhythmia
Item
Arrhythmia
boolean
C0003811 (UMLS CUI [1])
Arrhythmia active
Item
Condition Currently Active?
boolean
C0003811 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Arrhythmia medical history
Item
No Known History
boolean
C0003811 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Arrhythmia onset date
Item
Onset Date
date
C0003811 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Arrhythmia onset date unknown
Item
Date Unknown
boolean
C0003811 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Diverticular Disease
Item
Diverticular Disease
boolean
C1510475 (UMLS CUI [1])
diverticular disease medical history
Item
No Known History
boolean
C1510475 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Diverticular disease active
Item
Condition Currently Active?
boolean
C1510475 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Diverticular disease onset date
Item
Onset Date
date
C1510475 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Diverticular Disease onset date unknown
Item
Date Unknown
boolean
C1510475 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Proteinuria
Item
Proteinuria
boolean
C0033687 (UMLS CUI [1])
Proteinuria medical history
Item
No Known History
boolean
C0033687 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Proteinuria active
Item
Condition Currently Active?
boolean
C0033687 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Proteinuria onset date
Item
Onset Date
date
C0033687 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Proteinuria onset date unknown
Item
Date Unknown
boolean
C0033687 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Rheumatoid Arthritis
Item
Rheumatoid Arthritis
boolean
C0003873 (UMLS CUI [1])
Rheumatoid Arthritis medical history
Item
No Known History
boolean
C0003873 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Rheumatoid Arthritis active
Item
Condition Currently Active?
boolean
C0003873 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Rheumatoid Arthritis onset date
Item
Onset Date
date
C0003873 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Rheumatoid Arthritis onset date unknown
Item
Date Unknown
boolean
C0003873 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
Dermatitis
Item
Dermatitis
boolean
C0011603 (UMLS CUI [1])
Dermatitis medical history
Item
No Known History
boolean
C0011603 (UMLS CUI [1,1])
C0262926 (UMLS CUI [1,2])
Dermatitis active
Item
Condition Currently Active?
boolean
C0011603 (UMLS CUI [1,1])
C2707252 (UMLS CUI [1,2])
Dermatitis onset date
Item
Onset Date
date
C0011603 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
Dermatitis onset date unknown
Item
Date Unknown
boolean
C0011603 (UMLS CUI [1,1])
C0574845 (UMLS CUI [1,2])
C0439673 (UMLS CUI [1,3])
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