Visit 1: General Medical History

Administrative data
Beschrijving

Administrative data

Subject Number
Beschrijving

Subject Number

Datatype

integer

Physical Examination
Beschrijving

Physical Examination

Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
Beschrijving

Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?

Datatype

text

Cutaneous
Beschrijving

Cutaneous

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Eyes
Beschrijving

Eyes

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Ears-Nose-Throat
Beschrijving

Ears-Nose-Throat

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Cardiovascular
Beschrijving

Cardiovascular

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Respiratory
Beschrijving

Respiratory

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Gastrointestinal
Beschrijving

Gastrointestinal

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Muskuloskeletal
Beschrijving

Muskuloskeletal

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Neurological
Beschrijving

Neurological

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Genitourinary
Beschrijving

Genitourinary

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Haematology
Beschrijving

Haematology

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Allergies
Beschrijving

Allergies

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Endocrine
Beschrijving

Endocrine

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Persistent crying
Beschrijving

Persistent crying

Diagnosis
Beschrijving

crying continuous (i.e., not episodic, not interrupted within the time period of 3 hours by e.g. naps) and unaltered for >=3 hours

Datatype

text

Status
Beschrijving

Status

Datatype

text

Other, specify
Beschrijving

Other, specify

Diagnosis
Beschrijving

Diagnosis

Datatype

text

Status
Beschrijving

Status

Datatype

text

Similar models

Visit 1: General Medical History

Name
Type
Description | Question | Decode (Coded Value)
Datatype
Alias
Item Group
Administrative data
Subject Number
Item
Subject Number
integer
Item Group
Physical Examination
Item
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
text
Code List
Are you aware of any pre-existing conditions or signs and/or symptoms present in the subject prior to the start of the study?
CL Item
Yes (please tick appropriate box(es) and give diagnosis (1)
CL Item
No (2)
Item Group
Cutaneous
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Eyes
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Ears-Nose-Throat
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Cardiovascular
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Respiratory
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Gastrointestinal
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Muskuloskeletal
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Neurological
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Genitourinary
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Haematology
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Allergies
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Endocrine
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Persistent crying
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)
Item Group
Other, specify
Diagnosis
Item
Diagnosis
text
Item
Status
text
Code List
Status
CL Item
Past (1)
CL Item
Current (2)