TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

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StudyEvent: ODM
1. TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

Name

Tipo

Description | Question | Decode (Coded Value)

Tipo de dados

Alias

Patient administration

Item Group

Patient administration

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])

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)

Item Group

TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING)

Glaucoma

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])

dry AMD

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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TARGETED MEDICAL HISTORY AND BASELINE CONDITIONS (SCREENING) CRFs Roche FVF4170G Macular Edema NCT-Nummer: NCT00473382

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