History of Crohn's Disease


This CRF collects pre-specified questions about a subject's Crohn's disease medical history.


This CRF illustrates questions that ask the investigator to "check all that apply". This format was used only to save space. CDASH best practices recommend that a "No" or "Yes" response be entered for each listed response.


"History of Crohn's Disease [CD_MHCD]" Form Preview
History of Crohn's Disease
History of Crohn's Disease
* Was the medical history event prespecified?
* What was the category of the medical history?
* At what age did the subject's Crohn's symptoms start?
* Has the subject ever had Crohn's ileitis? No  Yes  
* Has the subject ever had Crohn's colitis? No  Yes  
* Has the subject ever had Crohn's ileocolitis? No  Yes  
* Has the subject ever had upper gastrointestinal Crohn's disease? No  Yes  
* Has the subject ever had any strictures? No  Yes  
If Yes, what is the estimated number of strictures?
If Yes, what are the anatomical location(s) of the strictures? Ileum  Colon  Upper GI tract  
* Has the subject ever had any abscesses? No  Yes  
If Yes, what is the estimated number of abscesses?
* Has the subject ever had any fistulas? No  Yes  
If Yes, what is the estimated number of fistulas?
If Yes, where are the fistulas located?
If Yes, what anatomical type(s) of fistulas?
If "Other", specify.
* What was the category of the medical history?
* Has the subject ever had any diagnosed pyoderma gangrenosum as an extra-intestinal manifestation of Crohn's disease? No  Yes  
If Yes, what is the estimated number of pyoderma gangrenosum lesions?
If Yes, what is the longest diameter of the primary pyoderma gangrenosum lesion?
What is the unit for the longest diameter of the primary pyoderma gangrenosum lesion? mm  cm  in  
What was the location of the primary pyoderma gangrenosum lesion?
* Has the subject ever had arthritis as an extra-intestinal manifestation of Crohn's disease? No  Yes  
* Has the subject ever had arthralgia as an extra-intestinal manifestation of Crohn's disease? No  Yes  
* Has the subject ever had erythema nodosum as an extra-intestinal manifestation of Crohn's disease? No  Yes  
* Has the subject ever suffered from malnutrition as an extra-intestinal manifestation of Crohn's disease? No  Yes  
* Mandatory field

Package(s)
CD MHCD Package