CDE Detailed Report
Disease: Congenital Muscular Dystrophy
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 11 of 11
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 11 of 11
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C19655 | Family history CMD LGMD disorder indicator | FamHisCMDLGMDDisordrInd | Indicator for whether the participant/subject has a family history of CMD to LGMD spectrum disorder | Indicator for whether the participant/subject has a family history of CMD to LGMD spectrum disorde | Is there a family history of CMD to LGMD spectrum disorder? | No;Yes | No;Yes | Alphanumeric |
If yes, fill out chart below; if no, end form |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C19656 | Family history living relative status | FamHisLivRelStatus | Status of life of the participant/subject's relative with the family history of a specific condition | Status of life of the participant/subject's relative with the family history of a specific conditio | Alive/Deceased | Alive;Deceased | Alive;Deceased | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C19657 | Family history birth year text | mHisBirthYrTxt | Free-text field to indicate the year of birth of the participant/subject's relative with the family history of a specific condition | Free-text field to indicate the year of birth of the participant/subject's relative with the family history of a specific conditio | Year of birth | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Family History | General Health History | Participant History and Family History | 4 |
Free-Form Entry |
|||||||||
| C19659 | Family history side type | FamHisSideTyp | Free-text field to indicate the side of the family in which the participant/subject has a family history of the listed conditions | Free-text field to indicate the side of the family in which the participant/subject has a family history of the listed condition | Family Side | Maternal;Paternal;Unknown | Maternal;Paternal;Unknown | Alphanumeric |
(see key 1) |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
||||||||
| C19663 | Family history relationship type | FamHisRelTyp | Field where participant/subject can indicate which family member(s) has a history of the listed conditions | Field where participant/subject can indicate which family member(s) has a history of the listed condition | Relationship of Family Member to Participant/Subject | Mother;Father;Sister;Brother;Grandmother;Grandfather;Daughter;Son;Uncle;Aunt;Cousin;Other, specify | Mother;Father;Sister;Brother;Grandmother;Grandfather;Daughter;Son;Uncle;Aunt;Cousin;Other, specify | Alphanumeric |
(See Key 2 - Choose all that apply) |
No references available | Adult;Pediatric | Supplemental | 1.00 | 2015-02-18 00:00:00.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
||||||||
| 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 | Difficulty walking;Intellectual disability;Contractures;Muscle weakness;Collagen VI CMD;Dystroglycanopathy;Merosin deficient CMD;SEPN1 related myopathy (Rigid spine);L-CMD;Alpha 7 integrin CMD;CMD, undiagnosed;Other, specify | Difficulty walking;Intellectual disability;Contractures;Muscle weakness;Collagen VI CMD;Dystroglycanopathy;Merosin deficient CMD;SEPN1 related myopathy (Rigid spine);L-CMD;Alpha 7 integrin congenital muscular dystrophy;CMD, undiagnosed;Other, specify | Alphanumeric |
Is there a family history of any of the following? Please indicate any first or second degree blood relatives (i.e., siblings, parents, cousins, grandparents) that have/had the following conditions: Difficulty walking; Intellectual disability; Contractures; Muscle weakness |
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 | |||||||
| 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 | Yes;No | Alphanumeric |
No instructions available |
No references available | Adult;Pediatric | Supplemental | 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 | |||||||
| 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 | Any history of consanguinity (parents distantly related to one another)? | Yes;No | Yes;No | Alphanumeric |
No instructions available |
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 |
||||||||
| C16146 | Family history relative age at death value | FmlyHistReltvAgeDeathVal | Age at death of the participant/subject's relative, if applicable | Age at death of the participant/subject's relative, if applicable | Age at death | Numeric Values |
No instructions available |
No references available | Adult;Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
0 | 130 | year | |||||||
| C16159 | Family history relative age at onset value | FmlyHistRltveAgeOnsetVal | Age the participant's relative experienced the onset of the disease or disorder | Age the participant's relative experienced the onset of the disease or disorder | Age at first symptoms | Numeric Values |
No instructions available |
No references available | Adult;Pediatric | Supplemental | 3.10 | 2024-02-29 15:41:31.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
year | |||||||||
| 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 instructions available |
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 |
