CDE Detailed Report
Disease: Myotonic Muscular Dystrophy
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 13 of 13
Subdomain Name: 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 / 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 unknown status | FmlyHistDiagnsisAgeUnkStat | Status related to whether the participant knows the age of the relative when diagnosed | Status related to whether the participantknows the age of the relative when diagnosed | Not known | Not known | Alphanumeric | Adult;Pediatric | Supplemental | 2.00 | 2024-02-29 15:41:31.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| 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 | 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 | ||||||||
| 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 |
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| 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 | 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 | |||||||||
| 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 |
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| 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 | 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 | 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 | ||||||||
| 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 | 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 | ||||||||||
| 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 | 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 | ||||||||||
| 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 | Adult;Pediatric | Supplemental | 1.10 | 2024-02-29 15:42:37.0 | 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 |
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| 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 |
