CDE Detailed Report
Disease: Amyotrophic Lateral Sclerosis
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 9 of 9
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 9 of 9
| CDE ID | CDE Name | Variable Name | Definition | Short Description | Question Text | Permissible Values | Description | Data Type | Disease Specific Instructions | Disease Specific Reference | Population | Classification (e.g., Core) | Version Number | Version Date | CRF Name (CRF Module / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C00721 | Family history medical condition indicator | FamHistMedclCondInd | Indicator of whether a family member or first and second degree blood relatives of the participant has had a history of the particular medical condition or health related event | Indicator of whether a family member or first and second degree blood relatives of the participant has had a history of the particular medical condition or health related event | Has anyone in your family ever been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Frontotemporal Dementia (FTD)? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
If Yes, attach pedigree and complete the table. |
No references available | Adult;Pediatric | Core | 4.00 | 2024-02-29 15:42:36.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3165788 | |||||||
| C00722 | Family history medical condition relative type | FamHistMedclCondReltvTyp | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relative | 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;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | 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;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | 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 | Core | 4.00 | 2024-03-18 15:21:17.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165810 | |||||||
| C08000 | Family history relative type total membercount | FmlyHistRelTypeTotalMembrCt | Count of total family members and ancestors for the specified relative type | Count of total family members and ancestors for the specified relative type | Number of family members | Numeric Values |
Record the number of family members that correspond to the relative listed. |
No references available | Adult | Supplemental | 4.00 | 2022-07-01 10:51:19.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 100 | ||||||||
| C08001 | Family history relative type biological sample in repository indicator | FmlyHistRelTypBioSampleRepInd | Indicator of whether the participant's family member has donated biological sample(s) to a repository | Indicator of whether the participant's family member has donated biological sample(s) to a repository | Family Member Sample/s in Repository? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one for each relative type |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:54:21.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C08002 | Family history relative type biological sample identifier number | FamHistReltvTypBioSampIDNum | Identification (ID) number assigned to family member's biological sample in repository | Identification (ID) number assigned to family member's biological sample in repository | Yes, Subject ID/s | Alphanumeric |
Only answered if "Family member sample(s) in repository?" is answered YES |
No references available | Adult | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C10813 | Adopted indicator | AdoptedInd | Indicator of whether the participant was adopted | Indicator of whether the participant was adopted | Are you adopted? | Yes;No | Yes;No | Alphanumeric |
Choose one |
No references available | Adult;Pediatric | Core | 3.10 | 2024-02-29 15:42:33.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C10814 | Parents biologically related indicator | ParntsBioRltdInd | The indicator whether the subject's/participant's parents are biologically related | The indicator whether the subject's/participant's parents are biologically relat | Are your parents, cousins, or otherwise biologically related to each other? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Choose one |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-22 16:57:17.79 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18679 | Family history medical condition relative type other text | FamHistMedclCondReltvTypOTH | 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 | 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 | 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 | 1.10 | 2024-02-29 15:42:37.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165810 | ||||||||
| C00720 | Family history medical condition type | FamHistMedclCondTyp | Type of medical condition or health related event for which the family history is taken | Type of medical condition or health related event for which the family history is taken | Diagnosis | Amyotrophic lateral sclerosis (ALS);Frontotemporal dementia (FTD);Other neurological disorder, specify | Amyotrophic lateral sclerosis (ALS);Frontotemporal dementia (FTD);Other neurological disorder, (specify) | Alphanumeric |
This CDE should be collected along with the "Family history medical condition indicator". |
No references available | Adult;Pediatric | Core | 4.00 | 2024-02-29 15:42:34.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165585 |
