| # | Question | Response / annotation |
|---|---|---|
|
1
|
Medical History Verbatim
field_001
|
MHTERM |
|
2
|
Approximate start date of condition
field_002
|
MHSTDTC |
|
3
|
Outcome of the condition
field_003
|
MHOUT |
|
4
|
Approximate date of recovery from the condition
field_004
|
MHENDTC |
|
5
|
Severity of the condition
field_005
|
MHSEV |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Collection Date
mh801_1.MHDAT
|
MHDTC |
|
2
|
Date of Diagnosis of Diabetes?
mh801_1.MHSTDAT
|
MHSTDTC |
|
3
|
Type of Diabetes
mh801_1.MHTERM
|
MHTERM |
|
4
|
Prespecified diabetes history (study population with diabetes)
field_004
|
MHCAT = DIABETES MHPRESP = Y MHOCCUR = Y |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Collection Date
mh801_1.MHDAT
|
MHDTC |
|
2
|
Diabetic Retinopathy
mh801_2.MHTERM</br>_mh801_2.MHOCCUR
|
MHOCCUR when MHTERM = DIABETIC RETINOPATHY |
|
3
|
Neuropathy
mh801_2.MHTERM</br>_mh801_2.MHOCCUR_2
|
MHOCCUR when MHTERM = NEUROPATHY |
|
4
|
Nephropathy
mh801_2.MHTERM</br>_mh801_2.MHOCCUR_3
|
MHOCCUR when MHTERM = NEPHROPATHY |
|
5
|
Peripheral Vascular Disease
mh801_2.MHTERM</br>_mh801_2.MHOCCUR_4
|
MHOCCUR when MHTERM = PERIPHERAL VASCULAR DISEASE |
|
6
|
Diabetic Ketoacidosis
mh801_2.MHTERM</br>_mh801_2.MHOCCUR_5
|
MHOCCUR when MHTERM = DIABETIC KETOACIDOSIS |
|
7
|
Date of Diagnosis
mh801_2.MHSTDAT
|
MHSTDTC |
|
8
|
Prespecified diabetes complications
field_008
|
MHCAT = DIABETES MHSCAT = COMPLICATIONS MHPRESP = Y |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Collection Date
mh801_3.MHDAT
|
MHDTC |
|
2
|
Medical History Verbatim
mh801_3.MHTERM
|
MHTERM MHCAT = GENERAL |
|
3
|
Start Date
mh801_3.MHSTDAT
|
MHSTDTC |
|
4
|
End Date
mh801_3.MHENDAT
|
MHENDTC |
|
5
|
Ongoing
mh801_3.MHONGO
|
MHENRTPT |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Medical Condition
field_001
|
MHTERM |
|
2
|
Date of diagnosis
field_002
|
MHSTDTC |
|
3
|
Did the patient have any symptoms of Anemia in the past? (if yes, tick all that apply)
field_003
|
[NOT SUBMITTED] |
|
4
|
Shortness of breath
field_004
|
FAORRES when FATESTCD = OCCUR and FAOBJ = SHORTNESS OF BREATH FACAT = ANEMIA HISTORY |
|
5
|
Fatigue
field_005
|
FAORRES when FATESTCD = OCCUR and FAOBJ = FATIGUE |
|
6
|
Other symptoms
field_006
|
FAORRES when FATESTCD = OCCUR and FAOBJ = OTHER SYMPTOM |
|
7
|
If 'Other', specify
field_007
|
FAOBJ |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
Medical Condition
field_001
|
MHTERM = CHRONIC KIDNEY DISEASE |
|
2
|
Date of diagnosis
field_002
|
MHSTDTC |
|
3
|
Stage of Chronic Kidney Disease
field_003
|
FAORRES when FATESTCD = STAGE |
|
4
|
What is the likely etiology of CKD?
field_004
|
FAORRES when FATESTCD = CKDET |
| # | Question | Response / annotation |
|---|---|---|
|
1
|
What type of heart failure does the subject have?
MHTERM
|
MHTERM |
|
2
|
What was the date of diagnosis of heart failure?
MHSTDAT
|
MHSTDTC |
|
3
|
What was the primary cause of heart failure?
MHPRC
|
MHPRC in SUPPMH |
|
4
|
Specify Other
MHPRCOTH
|
MHPRCOTH in SUPPMH |
|
5
|
What is the etiology of the heart failure?
MHETOLGY
|
MHETOLGY in SUPPMH |
|
6
|
What was the NYHA functional classification at entry into the study?
NHYACLS_RSORRES
|
RSORRES when RSTEST = NYHA Functional Classification |
|
7
|
Was the subject ever administered IV diuretics for heart failure?
IVD_CM_OCCUR
|
CMOCCUR CMTRT = DIURETICS CMPRESP = Y CMROUTE = INTRAVENOUS |
|
8
|
Did the subject have any episodes of worsening heart failure in the last 6 months?
HFWOR_MHOCCUR
|
MHOCCUR when MHTERM = WORSENING HEART FAILURE MHPRESP = Y |
|
9
|
What was the start date of the most recent episode of worsening heart failure in the last 6 months?
HFWOR_MHSTDAT
|
MHSTDTC when MHTERM = WORSENING HEART FAILURE |
|
10
|
Did this event require hospitalization?
HOCCUR
|
HOOCCUR HOTERM = HOSPITALIZATION HOPRESP = Y |
|
11
|
What was the date of the test to determine estimated LVEF?
CVDAT
|
CVDTC when CVTESTCD = LVEF |
|
12
|
What was the estimated LVEF at entry into the study?
CVORRES
|
CVORRES when CVTESTCD = LVEF |
|
13
|
What was the method used to determine the estimated LVEF?
CVMETHOD
|
CVMETHOD when CVTESTCD = LVEF |