CDE Detailed Report

Disease: content
Sub-Domain: General Health History
CRF: welcome

Displaying 1 - 11 of 11
CDE ID CDE Name Variable Name Definition Short Description Additional Notes (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
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/subject's relative experienced the onset of the disease or disorder Age the participant's/subject'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 3.00 2013-06-11 00:00:00.0 Family History General Health History Participant History and Family History

Free-Form Entry

year
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

No instructions available

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

Free-Form Entry

3165585
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 disorder. 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 condition. 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 condition. 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 conditions. 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 conditions. 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 3.00 2013-07-24 11:38:01.2 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/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 Yes;No Alphanumeric

No instructions available

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 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 related. 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

CSV