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MedDRA Coding Basics

MedDRA was developed under the auspices of the

International Council for Harmonisation of Technical
Requirements for Pharmaceuticals for Human Use
(ICH). The activities of the MedDRA Maintenance
and Support Services Organization (MSSO) are
overseen by an ICH MedDRA Management
Committee, which is composed of the ICH parties,
the Medicines and Healthcare products Regulatory
Agency (MHRA) of the UK, Health Canada, and the
WHO (as Observer).

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Disclaimer &
Copyright Notice

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Course Overview

• Gain knowledge of MedDRA’s scope, structure, and

characteristics
• Discuss coding conventions
• Learn about the MedDRA Term Selection: Points to Consider
(MTS:PTC) document
• Learn about MedDRA browsers
• Watch a demonstration of coding with browser
• Use browser to code with MedDRA
• Conclude with question and answer session

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MedDRA Overview

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MedDRA Definition

MedDRA is a clinically-validated international medical

terminology used by regulatory authorities and the
regulated biopharmaceutical industry. The
terminology is used through the entire regulatory
process, from pre-marketing to post-marketing, and
for data entry, retrieval, evaluation, and
presentation.

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Where MedDRA is Used

Regulatory Authority and Industry Databases

Individual Case Safety Reports and Safety Summaries
Clinical Study Reports
Investigators’ Brochures
Core Company Safety Information
Marketing Applications
Publications
Prescribing Information
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Advertising
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Scope of MedDRA
OUT Frequency
Not a drug qualifiers
dictionary IN
Medical conditions
Indications
Investigations (tests, results)
Patient demographic Numerical values for
Medical and surgical procedures
terms results
Medical, social, family history
Medication errors
Product quality issues
Device-related issues
Product use issues
Clinical trial study Severity descriptors
Pharmacogenetic terms
design terms
Toxicologic issues
Standardized queries
Not an equipment, device,
diagnostic product dictionary
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MedDRA Structure
System Organ Class (SOC) 27

High Level Group Term (HLGT) 337

High Level Term (HLT) 1738

Preferred Term (PT) 26409

Lowest Level Term (LLT) 88345

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System Organ Classes

• Blood and lymphatic system disorders • Musculoskeletal and connective tissue

• Cardiac disorders disorders
• Congenital, familial and genetic disorders • Neoplasms benign, malignant and
unspecified (incl cysts and polyps)
• Ear and labyrinth disorders
• Nervous system disorders
• Endocrine disorders
• Pregnancy, puerperium and perinatal
• Eye disorders
conditions
• Gastrointestinal disorders
• Product issues
• General disorders and administration site
• Psychiatric disorders
conditions
• Renal and urinary disorders
• Hepatobiliary disorders
• Reproductive system and breast disorders
• Immune system disorders
• Respiratory, thoracic and mediastinal
• Infections and infestations
disorders
• Injury, poisoning and procedural
• Skin and subcutaneous tissue disorders
complications
• Social circumstances
• Investigations
• Surgical and medical procedures
• Metabolism and nutrition disorders
• Vascular disorders
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The Five Levels of MedDRA

SOC Cardiac disorders

HLGT Cardiac arrhythmias

HLT Rate and rhythm disorders NEC

Note:
Not all
HLGTs, HLTs,
PT Arrhythmia PTs or LLTs
shown

LLT Arrhythmia NOS

LLT Arrhythmia
LLT LLT (Non-current) Other specified
cardiac dysrhythmias
LLT Dysrhythmias
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Non-Current Terms LLT

• Flagged at the LLT level in MedDRA

• Not recommended for continued use
• Retained to preserve historical data for
retrieval and analysis
• Terms that are vague, ambiguous, out-
dated, truncated, or misspelled
• Terms derived from other terminologies
that do not fit MedDRA rules

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MedDRA Codes

PT Anaemia
[10002034]

• Each MedDRA term is assigned an 8-digit numeric code

– Non-expressive
– Assigned sequentially
• Codes can fulfill a data field in various electronic
submission types (e.g., E2B (R3))

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A Multi-Axial Terminology
Multi-axial = the representation of a medical concept in
multiple SOCs

 Allows grouping by different classifications

 Allows retrieval and presentation via different data sets

All PTs assigned a primary SOC

Determines which SOC will represent a PT during cumulative

data outputs
Prevents “double counting”
Supports standardized data presentation
Pre-defined allocations should not be changed by users
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A Multi-Axial Terminology
(cont)
SOC = Metabolism and nutrition SOC = Cardiac disorders
disorders
(Secondary SOC) (Primary SOC)

HLGT = Appetite and general HLGT = Myocardial disorders

nutritional disorders

HLT = General nutritional disorders NEC HLT = Cardiomyopathies

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A Multi-Axial Terminology
(cont)
SOC = Respiratory, thoracic and SOC = Infections and
mediastinal disorders infestations
(Secondary SOC) (Primary SOC)

HLGT = Respiratory tract HLGT = Viral infectious

infections disorders

HLT = Viral upper respiratory HLT = Influenza viral

tract infections infections

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Rules for Primary SOC

Allocation
• PTs represented in only one SOC are automatically assigned that
SOC as primary

• PTs for diseases, signs and symptoms are assigned to prime

manifestation site SOC

• Congenital and hereditary anomalies terms have SOC Congenital,

familial and genetic disorders as Primary SOC
• Neoplasms terms have SOC Neoplasms benign, malignant and
unspecified (incl cysts and polyps) as Primary SOC
– Exception: Cysts and polyps have prime manifestation site SOC as Primary SOC
• Infections and infestations terms have SOC Infections and
infestations as Primary SOC

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Primary SOC Priority

If a PT links to more than one of the exceptions,

the following priority will be used to determine
primary SOC:
Congenital, familial and genetic disorders

Neoplasms benign, malignant and unspecified

(incl cysts and polyps)

Infections and infestations

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A Multi-Axial Terminology
(cont)

PTs in the following SOCs only appear in that

particular SOC and not in others, i.e., they are
not multi-axial
• Investigations
• Surgical and medical procedures
• Social circumstances

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Coding Conventions

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What are Coding

Conventions?
• Written guides and sets of principles for using MedDRA
that help achieve consistency in coding and data
retrieval
• Conventions harmonize exchange of MedDRA coded data
worldwide
• Common topics
– Misspellings, abbreviations and acronyms
– Combination terms and “due to” concepts
– “Always query” terms, e.g., “Chest pain”

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Why Do We Need Coding

Conventions?

• Differences in medical
aptitude of coders

• Consistency concerns (many more “choices” in

MedDRA vs. older terminologies)

• Even with autoencoder, may still need manual

coding
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Autoencoder Pitfalls

• Inappropriate terms may be selected by

autoencoder

• Review all autoencoding carefully

– “Allergic to CAT scan” autoencoded as:
LLT Allergic to cats
– “Myocardial infarction in the fall of 2000” autoencoded as:
LLT Myocardial infarction
LLT Fall

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MedDRA Term Selection

Points to Consider Document

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MedDRA Term Selection:

Points to Consider (MTS:PTC)

• Provides term selection advice

for industry and regulatory
purposes
• Objective is to promote
accurate and consistent term
selection to facilitate common
understanding of shared data
• Recommended to be used as
basis for individual
organization’s own coding
conventions

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MedDRA Term Selection:

PTC (cont)
• Developed by a working group of the ICH
Management Committee
• Updated annually in March
• Complete versions available in
– English, Japanese, Chinese, Korean, Spanish, and Russian
• Condensed versions available for other MedDRA
languages*
• Available on MedDRA and JMO websites

*Arabic, Brazilian Portuguese, Czech, Dutch, French, German, Hungarian, Italian,

Portuguese
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MTS:PTC Points of Note

• In some cases, with more than one option for

selecting terms, a “preferred option” is identified but
this does not limit MedDRA users to applying that
option. Organizations should be consistent in their
choice of option.

• Section 4 – Appendix
- 4.1 Versioning (which refers reader to MedDRA Best
Practices document)
- 4.2 Links and References

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General Term Selection

Principles
• Quality of Source Data
• Quality Assurance
• Do Not Alter MedDRA
• Always Select a Lowest Level Term
• Select Only Current Lowest Level Terms
• When to Request a Term
• Use of Medical Judgment in Term Selection
• Select Terms for All Reported Information,
Do Not Add Information
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Quality of Source Data

Quality Assurance
• Quality of original information impacts quality of output
• Obtain clarification of data
• Can be optimized by careful design of data collection
forms and proper training of staff
• Organizations’ coding guidelines should be consistent
with MTS:PTC
• Review of term selection by qualified individuals
• Human oversight of automated coding results

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Do Not Alter MedDRA

• MedDRA is a standardized terminology with a

pre-defined term hierarchy
• Users must not make ad hoc structural
alterations, including changing the primary SOC
allocation

If terms are incorrectly placed, submit

a change request to the MSSO

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MTS:PTC General Principle

• Always Select a Lowest Level Term
Select Only Current LLTs

 Select the Lowest Level Term that most accurately reflects the
reported verbatim information

“Abscess on face”
 Do not simply select LLT Abscess

 Select a term with greater specificity LLT Facial abscess

 Select current LLTs only

– Non-current terms for legacy conversion/historical purposes
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When to Request a Term

Use of Medical Judgment

• Avoid company-specific “work-arounds” for MedDRA

deficiencies. If concept not adequately represented
in MedDRA, submit Change Request to MSSO.

• If no exact match in MedDRA, use medical

judgment to match to an existing term that
adequately represents the concept

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Select Terms for All

Reported Information

• Select terms for every AR/AE reported, regardless of

causal association

• Select terms for device-related events, product

quality issues, medication errors, medical and social
history, investigations and indications as appropriate

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Do Not Add Information

• Do not make diagnosis if only signs/symptoms reported

Reported LLT Selected Comment

Abdominal pain

Abdominal pain, It is inappropriate to

increased serum Serum amylase assign an LLT for
amylase, and increased increased diagnosis of
serum lipase “pancreatitis”

Lipase increased

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Term Selection Points

• Diagnoses and Provisional Diagnoses with or without Signs
and Symptoms
• Death and Other Patient Outcomes
• Suicide and Self-Harm
• Conflicting/Ambiguous/Vague Information
• Combination Terms
• Age vs. Event Specificity
Section 3

• Body Site vs. Event Specificity

• Location-Specific vs. Microorganism-Specific Infection
• Modification of Pre-existing Conditions
• Exposures During Pregnancy and Breast Feeding
• Congenital Terms
• Neoplasms
• Medical and Surgical Procedures
• Investigations
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Term Selection Points

• Medication Errors, Accidental Exposures and Occupational Exposures
• Misuse, Abuse and Addiction
• Transmission of Infectious Agent via Product
• Overdose, Toxicity and Poisoning
• Device-related Terms
• Drug Interactions
Section 3

• No Adverse Effect and “Normal” Terms

• Unexpected Therapeutic Effect
• Modification of Effect
• Social Circumstances
• Medical and Social History
• Indication for Product Use
• Off Label Use
• Product Quality Issues

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Introduction to MedDRA Browsers

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MSSO’s MedDRA Browsers

Title 04

MedDRA Desktop Browser (MDB)

Download MDB and release files from MedDRA website
Mobile MedDRA
Browser
MedDRA Web-Based Browser (WBB) https://mmb.meddra.org
https://tools.meddra.org/wbb/
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MSSO’s MedDRA
Browsers (cont)

• Features
– Each require MedDRA ID and password
– View/search MedDRA and SMQs
– Support for all MedDRA languages
– Language specific interface
– Ability to export search results and
Research Bin to local file system
(MDB and WBB only)

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MDB and WBB Special

Features

• Preview upcoming (supplemental)

changes in next release*
*Supplemental view not available on MDB

• View primary and secondary link information

• Upload terms to run against SMQs
• Advanced search options (e.g., NOT, OR)

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MedDRA Browser Demonstration

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Approach to Finding Best LLTs

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Assessing the Reported

Information
• Consider what is being reported. Is it a:
– Clinical condition - Diagnosis, sign or symptom?
– Indication?
– Test result?
– Injury? The type of report will
– Procedure? influence the way you
search for a suitable
– Medication error? LLT.
– Product use issue? It may indicate in which
SOC you expect to find
– Product quality issue? the closest match.
– Social circumstance?
– Device issue?
– Procedural complication?

– Is it a combination of these?
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Coding Example 1
Specificity

The patient suffered from an allergic reaction to an

antibiotic

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Coding Example 2

Symptoms

The patient states she has been experiencing cold

sweats

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Coding Example 3

Investigations

Lab results indicate the patient has increased

troponin and increased CPK-MB

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Coding Example 4

Medication errors

Patient accidentally took drug Y instead of drug X

and became short of breath

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Coding Example 5

Patient demographics

A 2 day old baby was noted to have a mild fever

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Coding Example 6

Indications

A 35 year old woman was taking Drug X to prevent

relapses of multiple sclerosis

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Coding Example 7

Specificity

She had a pathologic fracture of the neck of the left

femur

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Coding Example 8

Specificity

Following the procedure, the patient experienced

several days of constipation

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Coding Example 9

Death and other patient

outcomes

The 66 year old man died

from a ruptured aortic
aneurysm

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Coding Example 10

Product quality issues

It was determined that the product was counterfeit

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Coding Example 11

Social circumstances

The patient was confined to a wheelchair

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Coding Example 12

Medication errors/Product use errors and issues

The pharmacist made a mistake in compounding

the medication

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Coding Example 13

Narrative vignette
A 75-year-old male receiving Drug X for
rheumatoid arthritis developed symptomatic
aortic valve stenosis. The patient’s medical
history is significant for colon cancer and
cigarette smoking. He underwent an aortic valve
replacement and developed a sternal wound
infection three days post-surgery.

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Additional Coding Exercises

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Try to Code Some Verbatims

• Open either the Desktop or Web-Based Browser

• Try to find the best LLT to code several short
verbatims
• Select an LLT from MedDRA using either a “top
down” or “bottom up” approach
• Use Poll Everywhere to submit your proposed
answers
• Correct LLTs for each verbatim will be discussed

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Short Verbatim #1

“She was diagnosed with pneumonia

caused by COVID-19 infection”

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Correct Answer -
Verbatim #1

LLT COVID-19 pneumonia

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Short Verbatim #2

“Woman ingested her husband's blood

pressure drug by mistake”

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Correct Answer -
Verbatim #2

LLT Accidental ingestion of drug

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Short Verbatim #3

“The patient developed hyponatraemia while

hospitalised”

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Correct Answer -
Verbatim #3

LLT Hospital acquired hyponatraemia

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Short Verbatim #4

“Nurse noticed that the injection solution had

an unusual odor”

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Correct Answer -
Verbatim #4

LLT Product odor abnormal

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Short Verbatim #5

“Elderly woman complained her arm was

tender where she had received her seasonal
flu vaccine”

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Correct Answer -
Verbatim #5

LLT Vaccination site tenderness

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Summary

 Discussed scope, structure, and characteristics of

MedDRA
 Discussed coding conventions
 Introduced the MedDRA Term Selection: Points to
Consider document
 Introduced the MedDRA browser and showed how it is
used for coding
 Performed some coding exercises on your own

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MSSO Contacts
• Website
– www.meddra.org
• Email
– [email protected]
• Frequently Asked Questions
– www.meddra.org/faq
• MedDRA Browsers
– https://www.meddra.org/meddra-desktop-browsers
(Desktop Browser)
– https://tools.meddra.org/wbb/ (Web-Based
Browser)
– https://mmb.meddra.org (Mobile Browser)

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MSSO Contacts (cont)

• Change Request Submission

–https://www.meddra.org/how-to-use/change-
requests
• Training Schedule
–https://www.meddra.org/training/schedule
• MedDRA Support Documentation
– https://www.meddra.org/how-to-use/support-
documentation

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Question and Answer Session

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