CDE Detailed Report
Disease: Duchenne Muscular Dystrophy/Becker Muscular Dystrophy
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 14 of 14
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 14 of 14
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C12666 | Family history muscle disease type | FmlyHistMuscleDiseaseTyp | Type of muscle disease for which participant/subject has family history | Type of muscle disease for which participant/subject has family history | Muscle Disease not Duchenne Muscular Dystrophy or Becker Muscular Dystrophy | DMD or BMD;Other, specify;Hereditary, specify;Inflammatory, specify | DMD or BMD;Other, specify;Hereditary, specify;Inflammatory, specify | Alphanumeric |
Supplemental - Highly Recommended |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
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| C17872 | Family history medical condition text | FmlyHistMedclCondTxt | Specification of other disease that a family member or ancestor of the participant/subject has had a history of a medical condition or health related event | Specification of other disease that a family member or ancestor of the participant/subject has had a history of a medical condition or health related event | Condition | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 11:24:12.51 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C18201 | Family history DMD BMD diagnosis age value | FmlyHistDMDBMDDiagnsisAgeVal | Age at which relative was diagnosed with DMD or BMD | Age at which relative was diagnosed with DMD or BMD | Age when diagnosed? | Numeric Values | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C18203 | Family history DMD BMD death cause text | FmlyHistDMDBMDDeathCauseTxt | Text describing the cause of death for relative with DMD or BMD | Text describing the cause of death for relative with DMD or BMD | Cause of Death? | Alphanumeric |
Record the cause of death using explanatory text and the associated ICD-9-CM code. Include the primary cause of death first followed by any secondary causes. |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C18205 | Family history DMD BMD current decease age value | FmlyHistDMDBMDCrrntDecesAgeVal | Value of current age or age at death for relative with DMD or BMD | Value of current age or age at death for relative with DMD or BMD | Current Age or Age at Death | Numeric Values | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
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| C18206 | Family history DMD BMD relative decease indicator | FmlyHistDMDBMDReltvDeceseInd | Indicator for whether relative with DMD or BMD is deceased | Indicator for whether relative with DMD or BMD is deceased | Deceased? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18207 | Family history DMD BMD diagnosis type | FmlyHistDMDBMDDiagnsisTyp | Type of diagnosis method for relative with DMD or BMD | Type of diagnosis method for relative with DMD or BMD | Diagnosed? | Clinical diagnosis;Genetic Testing;Muscle biopsy;Obligate carrier based on family structure;Don't know/ Unsure;Not applicable | Clinical diagnosis;Genetic Testing;Muscle biopsy;Obligate carrier based on family structure;Don't know/ Unsure;Not applicable | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-21 12:11:21.037 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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;Dementia;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Duchenne or Becker Muscular Dystrophy;Dystonia;Epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease (not Duchenne or Becker muscular dystrophy);Neuromuscular disease;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Stroke;Suicide or suicide attempt;Tourette syndrome;Other, specify | Alzheimer's disease;Dementia;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Duchenne or Becker Muscular Dystrophy;Dystonia;Epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease (not Duchenne or Becker muscular dystrophy);Neuromuscular disease;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Stroke;Suicide or suicide attempt;Tourette syndrome;Other, specify | Alphanumeric |
Supplemental - Highly Recommended |
No references available | Adult;Pediatric | Supplemental | 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 | |||||||
| C18678 | Family history medical condition type other text | FamHistMedclCondTypOTH | 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 | No references available | Adult;Pediatric | Supplemental | 1.10 | 2024-02-29 15:42:35.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165585 | |||||||||
| 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 | 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-Highly Recommended | 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 | |||||||
| 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 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-Highly Recommended | 1.10 | 2024-02-29 15:42:37.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165810 | ||||||||
| 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 | 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 |
Supplemental - Highly Recommended |
No references available | Adult;Pediatric | Supplemental-Highly Recommended | 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 | |||||||
| C18866 | Family history muscle disease other text | FmlyHistMuscleDiseaseOTH | The free-text field related to 'Family history muscle disease type' specifying other text. Type of muscle disease for which participant/subject has family history | The free-text field related to 'Family history muscle disease type' specifying other text. Type of muscle disease for which participant/subject has family history | Muscle Disease not Duchenne Muscular Dystrophy or Becker Muscular Dystrophy | Alphanumeric | No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-07-24 21:00:23.88 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
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| C12663 | Family history member with medical condition count | FamHistMembWithMedclCondCt | Count of family members with history of medical condition | Count 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 | 4.00 | 2022-08-08 10:47:27.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
1 | 99 |
