CDE Detailed Report

Disease: Myotonic Muscular Dystrophy
Sub-Domain: General Health History
CRF: Family History

Displaying 1 - 13 of 13
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
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 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 Alphanumeric

(choose all that apply)

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

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 Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Family History 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 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
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 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

3165810
C19667 Family history diagnosis type FmlyHistDiagnsisTyp Type of diagnosis method for relative Type of diagnosis method for relative 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 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

C19668 Family history medical condition relationship type FamHistMedclCondRelshpTyp Relationship of the family member with the medical condition or health related event to the participant/subject Relationship of the family member with the medical condition or health related event to the participant/subject Relative Relationship of Family Member to Participant/Subject Mother;Father;Brother;Sister;Son;Daughter;Maternal grandmother;Maternal grandfather;Paternal grandmother;Paternal grandfather;Maternal aunt;Maternal uncle;Paternal aunt;Paternal uncle Mother;Father;Brother;Sister;Son;Daughter;Maternal grandmother;Maternal grandfather;Paternal grandmother;Paternal grandfather;Maternal aunt;Maternal uncle;Paternal aunt;Paternal uncle Alphanumeric

If there is a family history of myotonic muscular dystrophy, complete the table below.

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

C19669 Family history diagnosis age value FmlyHistDiagnsisAgeVal Age at which relative was diagnosed with the disease in question Age at which relative was diagnosed with the disease in question Age when diagnosed? Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Family History General Health History Participant History and Family History

Free-Form Entry

0 130 years
C19670 Family history diagnosis age indicator FmlyHistDiagnsisAgeInd Indicator for whether the participant/subject knows the age of the relative when diagnosed Indicator for whether the participant/subject knows the age of the relative when diagnosed Not known Not known Alphanumeric 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

C19671 Family history current decease age value FmlyHistCrrntDecesAgeVal Value of current age or age at death for relative with the disease in question Value of current age or age at death for relative with the disease in question Current Age, or Age at Death Numeric Values Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Family History General Health History Participant History and Family History

Free-Form Entry

0 130 years
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;Epilepsy;Seizures without diagnosis of epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease;Neuromuscular junction;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Suicide or suicide attempt;Stroke;Tourette syndrome;Other, specify;Dystonia Alzheimer's disease;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Epilepsy;Seizures without diagnosis of epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease;Neuromuscular junction;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Suicide or suicide attempt;Stroke;Tourette syndrome;Other, specify;Dystonia Alphanumeric

For each question below, regarding relationship of family member, please indicate all that apply:

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
C19672 Family history death cause text FmlyHistDeathCauseTxt Text describing the cause of death for relative with the disease in question Text describing the cause of death for relative with the disease in question Cause of Death? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 00:00:00.0 Family History General Health History Participant History and Family History 255

Free-Form Entry

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 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
C19673 Family history relative decease indicator FmlyHistReltvDeceseInd Indicator for whether relative with the disease in question is deceased Indicator for whether relative with the disease in question is deceased Deceased? No;Yes No;Yes Alphanumeric 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

CSV