of0
Export
 
CDE Detailed Report
This report contains detailed information about the selected CDEs.
Note: If at least one CDE was selected from a copyright- or trademark-protected instrument/scale then all of the CDEs from that instrument/scale are included in this report.
Disease: Cerebral Palsy
Sub-Domain: General Health History
CRF: Family History
Item count: 9 (9 distinct CDEs)
CDE ID
CDE Name
Variable Name
Definition / Description
Question Text
Permissible Value
Description
Data Type
Instructions
References
Population
Classification (e.g., Core)
Version #
Version Date
Aliases for Variable Name
CRF Module / Guideline
© or TM
Sub-Domain
Domain
Previous Title
Size
Input Restrictions
Min Value
Max Value
Measurement Type
LOINC ID
SNOMED
caDSR ID
CDISC ID
C17402
Site name
SiteName
The name of the site for the study
Site Name
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Core
3.0
6/21/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Site name
255
Free-Form Entry
       
C19247
Subject ID
SubIDNam
Subject identification ID
Subject ID
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Core
1.0
6/5/2014
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
 
255
Free-Form Entry
       
C17681
Family history collection source
FamHxCollSrce
The source of collected family history data
Source from which medical and family history obtained?
Participant/subject;Informant;Medical records;
Participant/subject;Informant;Medical records;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Core
3.0
8/30/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
  
Multiple Pre-Defined Values Selected
       
C10813
Adopted indicator
AdoptedInd
Whether the subject/participant was adopted
Are you (participant/subject) adopted?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Core
3.0
7/22/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Adopted indicator
 
Single Pre-Defined Value Selected
       
C00720
Family history medical condition type
FamHistMedclCondTyp
Type of medical condition or health related event for which the family history is taken
Condition
  
Alphanumeric
This CDE should be collected along with the "Family history medical condition indicator".
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Family history medical condition type
 
Multiple Pre-Defined Values Selected
     
3165585
 
C00721
Family history medical condition indicator
FamHistMedclCondInd
Indicator of whether a family member or first and second degree blood relatives of the participant/subject has had a history of the particular medical condition or health related event
Family History?
Yes;No;Unknown;
Yes;No;Unknown;
Alphanumeric
Indicator of whether a family member or first and second degree blood relatives of the participant/subject has had a history of the particular medical condition or health related event
No references available
Adult;Pediatric
Core
3.0
7/24/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Family history medical condition indicator
 
Single Pre-Defined Value Selected
     
3165788
 
C00722
Family history medical condition relative type
FamHistMedclCondReltvTy
Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject
Relationship of Family Member Participant/Subject
Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Maternal cousin;Paternal cousin;Great-grandchild;Other, specify;
Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Maternal cousin;Paternal cousin;Great-grandchild;Other, specify;
Alphanumeric
Select the relationship from the options of the family members listed. Record/choose more than one family member, if applicable.
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Family history medical condition relative type
 
Multiple Pre-Defined Values Selected
     
3165810
 
C18679
Family history medical condition relative other text
FamHistMedclCondReltvOTH
The free-text field related to 'Family history medical condition relative type' specifying other text. Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject
Other, specify
  
Alphanumeric
No instructions available
No references available
Adult;Pediatric
Supplemental
1.0
5/27/2014
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
 
4000
Free-Form Entry
     
3165810
 
C12663
Family history member with medical condition number
FamHistMembMedclCondNum
Number of family members with history of medical condition
Number of Affected Family Members
  
Numeric Values
Enter total number of family members affected by the condition
No references available
Adult;Pediatric
Supplemental
3.0
7/24/2013
Aliases for variable name not defined
Family History
General Health History
Participant History and Family History
Family history members with medical condition number
 
Free-Form Entry
1
99
     
07-15-2019
Page 1 of 1