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Medical History

1 forms  
  1. StudyEvent: ODM
    1. Medical History
Administrative Data
Description

Administrative Data

Alias
UMLS CUI-1
C1320722
Subject Screening number
Description

Subject Screening No.

Data type

integer

Alias
UMLS CUI [1,1]
C0220908
UMLS CUI [1,2]
C0600091
Subject no.
Description

Subject Number

Data type

integer

Alias
UMLS CUI [1]
C2348585
Date Information Collected
Description

Date Information Collected

Data type

date

Alias
UMLS CUI [1,1]
C3244127
UMLS CUI [1,2]
C0011008
Medical History
Description

Medical History

Alias
UMLS CUI-1
C0262926
Any past and/or present conditions/surgical procedures associated with the following?
Description

Past or Presen Conditions or Surgical Procedures

Data type

text

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0543467
UMLS CUI [2]
C0262926
UMLS CUI [3]
C0009488
Organ System
Description

Organ System

Data type

integer

Alias
UMLS CUI [1]
C0678852
Comorbidity Specification and Date
Description

Comorbidity Specification and Date

Data type

text

Alias
UMLS CUI [1,1]
C0009488
UMLS CUI [1,2]
C2348235
UMLS CUI [2,1]
C0011008
UMLS CUI [2,2]
C0009488
Does the subject have a current or past history of any seizure disorder or brain injury or any condition which predisposes to seizure?
Description

Medical History of Seizure, Brain Injury of Predisposition to Seizure

Data type

boolean

Alias
UMLS CUI [1,1]
C0262926
UMLS CUI [1,2]
C0036572
UMLS CUI [2,1]
C0262926
UMLS CUI [2,2]
C0270611
UMLS CUI [3,1]
C0220898
UMLS CUI [3,2]
C0036572
Does the subject have a history of hypersensitivity to lamotrigine?
Description

Hypersensitivity to Lamotrigine

Data type

boolean

Alias
UMLS CUI [1,1]
C0020517
UMLS CUI [1,2]
C0064636
Has the subject donated blood in excess of 500ml within 56 days prior to the first dose of study medication?
Description

Recent Blood Donation

Data type

boolean

Alias
UMLS CUI [1,1]
C0005794
UMLS CUI [1,2]
C0332185
Participation in a trial with and investigational drug within 30 days or 5 half lives (whichever is longer) prior to dosing
Description

Recent Study Participation within Investigational Drug

Data type

boolean

Alias
UMLS CUI [1,1]
C2348568
UMLS CUI [1,2]
C0013230
Specification
Description

If items above are ticked yes, please give details

Data type

text

Alias
UMLS CUI [1]
C2348235
Conclusion
Description

Conclusion

Alias
UMLS CUI-1
C1707478
Staff initials
Description

Staff initials

Data type

text

Alias
UMLS CUI [1,1]
C2986440
UMLS CUI [1,2]
C1552089
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Similar models

Medical History

1 forms
  1. StudyEvent: ODM
    1. Medical History
Name
Type
Description | Question | Decode (Coded Value)
Data type
Alias
Item Group
Administrative Data
C1320722 (UMLS CUI-1)
Subject Screening No.
Item
Subject Screening number
integer
C0220908 (UMLS CUI [1,1])
C0600091 (UMLS CUI [1,2])
Subject Number
Item
Subject no.
integer
C2348585 (UMLS CUI [1])
Date Information Collected
Item
Date Information Collected
date
C3244127 (UMLS CUI [1,1])
C0011008 (UMLS CUI [1,2])
Item Group
Medical History
C0262926 (UMLS CUI-1)
Past or Presen Conditions or Surgical Procedures
Item
Any past and/or present conditions/surgical procedures associated with the following?
text
C0262926 (UMLS CUI [1,1])
C0543467 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2])
C0009488 (UMLS CUI [3])
Item
Organ System
integer
C0678852 (UMLS CUI [1])
Organ System
Code List
Organ System
CL Item
Cardiovascular system (1)
CL Item
Respiratory system (incl. influenza, asthma) (2)
CL Item
Gastrointestinal system (incl. indigestion, heartburn, bowel disorders, nausea, vomiting, diarrhoea) (3)
CL Item
Renal system (4)
CL Item
Hepatic system (5)
CL Item
Endocrine system/metabolism (6)
CL Item
Neurological system (incl. convulsions, fits, blackouts) (7)
CL Item
Lymphatic system (8)
CL Item
Haematological system (9)
CL Item
Immunological system (incl. allergies, drug hypersensitivity) (10)
CL Item
Musculoskeletal system/connective tissue (11)
CL Item
Dermatological system (12)
CL Item
Genito-urinary system (13)
CL Item
Psychiatric function (14)
CL Item
Other (15)
Comorbidity Specification and Date
Item
Comorbidity Specification and Date
text
C0009488 (UMLS CUI [1,1])
C2348235 (UMLS CUI [1,2])
C0011008 (UMLS CUI [2,1])
C0009488 (UMLS CUI [2,2])
Medical History of Seizure, Brain Injury of Predisposition to Seizure
Item
Does the subject have a current or past history of any seizure disorder or brain injury or any condition which predisposes to seizure?
boolean
C0262926 (UMLS CUI [1,1])
C0036572 (UMLS CUI [1,2])
C0262926 (UMLS CUI [2,1])
C0270611 (UMLS CUI [2,2])
C0220898 (UMLS CUI [3,1])
C0036572 (UMLS CUI [3,2])
Hypersensitivity to Lamotrigine
Item
Does the subject have a history of hypersensitivity to lamotrigine?
boolean
C0020517 (UMLS CUI [1,1])
C0064636 (UMLS CUI [1,2])
Recent Blood Donation
Item
Has the subject donated blood in excess of 500ml within 56 days prior to the first dose of study medication?
boolean
C0005794 (UMLS CUI [1,1])
C0332185 (UMLS CUI [1,2])
Recent Study Participation within Investigational Drug
Item
Participation in a trial with and investigational drug within 30 days or 5 half lives (whichever is longer) prior to dosing
boolean
C2348568 (UMLS CUI [1,1])
C0013230 (UMLS CUI [1,2])
Specification
Item
Specification
text
C2348235 (UMLS CUI [1])
Item Group
Conclusion
C1707478 (UMLS CUI-1)
Staff initials
Item
Staff initials
text
C2986440 (UMLS CUI [1,1])
C1552089 (UMLS CUI [1,2])
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