CDE Detailed Report

Disease: Spinal Muscular Atrophy
Sub-Domain: General Health History
CRF: Family History - SMA

Displaying 1 - 6 of 6
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 / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
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 Condition Alzheimer's disease;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Dystonia;Epilepsy;Seizures without diagnosis of epilepsy;Early childhood death;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease;Neuromuscular disease;Neuropathy;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Spinal muscular atrophy (SMA);Suicide or suicide attempt;Stroke;Tourette syndrome;Walking delays / Late acquisition of walking;Other, specify Alzheimer's disease;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Dystonia;Epilepsy;Seizures without diagnosis of epilepsy;Early childhood death;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease;Neuromuscular disease;Neuropathy;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Spinal muscular atrophy (SMA);Suicide or suicide attempt;Stroke;Tourette syndrome;Walking delays / Late acquisition of walking;Other, specify Alphanumeric

Answer for first and second degree blood relatives.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Family History - SMA General Health History Participant History and Family History

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 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

If there is a history of this condition in the first or second degree family, indicate YES, otherwise choose NO.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Family History - SMA General Health History Participant History and Family History

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 the family member or ancestor with the medical condition or health related event to the participant/subject Relationship of Family Member to 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;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 in the "Relationship of family member to participant/subject" column. Record/choose more than one family member, if applicable.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Family History - SMA General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

3165810
C12663 Family history member with medical condition number FamHistMembMedclCondNum Number of family members with history of medical condition Number of family members with history of medical condition Number of Affected Family Members Numeric Values

Record the total number of family members affected by condition.

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Family History - SMA General Health History Participant History and Family History

Free-Form Entry

1 99
C18678 Family history medical condition other text FamHistMedclCondOTH The free-text field related to 'Family history medical condition type' specifying other text. Type of medical condition or health related event for which the family history is taken The free-text field related to 'Family history medical condition type' specifying other text. Type of medical condition or health related event for which the family history is taken Other, specify Alphanumeric

Answer for first and second degree blood relatives.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Family History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

3165585
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 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

Select the relationship from the options of the family members listed in the "relationship of family member to participant/subject" column. Record/choose more than one family member, if applicable.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Family History - SMA General Health History Participant History and Family History 4000

Free-Form Entry

3165810
CSV