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The table represents the items from the ADSD V1.0 instrument as well as the total score. Rows 8-14 show how to represent data when the entire instrument was not done due to the subject refusing the test.
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| Row | STUDYID | DOMAIN | USUBJID | QSSEQ | QSTESTCD | QSTEST | QSCAT | QSORRES | QSSTRESC | QSSTRESN | QSSTATQSREASND | QSLOBXFL | VISITNUM | QSDTC | QSEVINTX |
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| 1 | STUDYX | QS | 2324-P0001 | 1 | ADSD0101 | ADSD01-Rate Breathing at Its Worst | ADSD V1.0 | 6 | 6 | 6 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 2 | STUDYX | QS | 2324-P0001 | 2 | ADSD0102 | ADSD01-Rate Wheezing at Its Worst | ADSD V1.0 | None | 0 | 0 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 3 | STUDYX | QS | 2324-P0001 | 3 | ADSD0103 | ADSD01-Rate Shortness of Breath at Worst | ADSD V1.0 | 3 | 3 | 3 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 4 | STUDYX | QS | 2324-P0001 | 4 | ADSD0104 | ADSD01-Rate Chest Tightness at Its Worst | ADSD V1.0 | 2 | 2 | 2 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 5 | STUDYX | QS | 2324-P0001 | 5 | ADSD0105 | ADSD01-Rate Chest Pain at Its Worst | ADSD V1.0 | 5 | 5 | 5 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 6 | STUDYX | QS | 2324-P0001 | 6 | ADSD0106 | ADSD01-Rate Cough at Its Worst | ADSD V1.0 | As bad as you can imagine | 10 | 10 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 7 | STUDYX | QS | 2324-P0001 | 7 | ADSD0107 | ADSD01-Total Score | ADSD V1.0 | 4.3 | 4.3 | 4.3 |
| Y | 1 | 2015-05-15 | SINCE GETTING UP THIS MORNING | | 8 | STUDYX | QS | 2324-P0020 | 1 | ADSD0101 | ADSD01-Rate Breathing at Its Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 | | | 9 | STUDYX | QS | 2324-P0020 | 2 | ADSD0102 | ADSD01-Rate Wheezing at Its Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
| | 10 | STUDYX | QS | 2324-P0020 | 3 | ADSD0103 | ADSD01-Rate Shortness of Breath at Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
| | 11 | STUDYX | QS | 2324-P0020 | 4 | ADSD0104 | ADSD01-Rate Chest Tightness at Its Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
| | 12 | STUDYX | QS | 2324-P0020 | 5 | ADSD0105 | ADSD01-Rate Chest Pain at Its Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
| | 13 | STUDYX | QS | 2324-P0020 | 6 | ADSD0106 | ADSD01-Rate Cough at Its Worst | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
| | 14 | STUDYX | QS | 2324-P0020 | 7 | ADSD0107 | ADSD01-Total Score | ADSD V1.0 |
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| NOT DONE | Y | 1 | 2015-05-20 |
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