CDE Detailed Report
Disease: Facioscapulohumeral Muscular Dystrophy
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 12 of 12
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 12 of 12
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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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| 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 | Age 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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| 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 |
The majority of the medical conditions are Supplemental with the exception of the following which are Core: Developmental Delays; Epilepsy (pediatric only); Seizures without epilepsy diagnosis (pediatric only); Heart Disease; Muscle Disease; Peripheral Neuropathy |
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 | |||||||
| 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 |
If applicable. |
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 | ||||||||
| 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. Unknown response should be used if uncertain about family history. |
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 | |||||||
| 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 |
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 | 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 |
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 | ||||||||
| C14943 | Family history relative deceased indicator | FamHxReltvDeceaseInd | Indicator of whether family member is deceased | Indicator of whether family member is deceased | Deceased? | Yes;No | Yes;No | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-07-14 19:48:50.273 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C16147 | Family history relative death cause text | FmlyHistRltvDeathCauseTxt | Cause of death of the participant/subject's relative, if applicable | Cause of death of the participant/subject's relative, if applicable | Cause of Death? | Alphanumeric | Adult;Pediatric | Supplemental | 3.00 | 2013-06-11 00:00:00.0 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| 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 |
Answer for first and second degree blood relatives. The majority of the medical conditions are Supplemental with the exception of the following which are Core: Developmental Delays; Epilepsy (pediatric only); Seizures without epilepsy diagnosis (pediatric only); Heart Disease; Muscle Disease; Peripheral Neuropathy |
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 | ||||||||
| 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 | 1.10 | 2024-02-29 15:42:37.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165810 |
