CDE Detailed Report

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

Displaying 1 - 12 of 12
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
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

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 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

Record the total number of family members affected by condition.

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

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

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

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

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 1.00 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

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 1.00 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

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 Age 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

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 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
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/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

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 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
CSV