CDE Detailed Report

Disease: Mitochondrial Disease
Sub-Domain: Physical Examinations
CRF: Mitochondrial and Gastrointestinal Diseases Assessment

Displaying 1 - 50 of 218
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
C20039 Mitochondrial disease infant formula text MitDisInfFormTxt The free text field to specify the kind of infant formula used by participant/subject The free text field to specify the kind of infant formula used by participant/subject What kind of infant formula? (Specify) Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 255

Free-Form Entry

C20209 Mitochondrial disease bowel movement treat medicine type MitDisBowelMvmntTreatMedcinTyp The type of medicine the participant/subject uses to help with bowel movements The type of medicine the participant/subject uses to help with bowel movements Do you/your child use medicine or other treatment to help with bowel movements? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20136 Mitochondrial disease prior burp specific drink food indicator MitDisPriBurpSpfcDrinkFdInd Indicator of whether participant's/subject's past burping occurred with specific drinks or food Indicator of whether participant's/subject's past burping occurred with specific drinks or food Did the burping occur with any specific drinks or food? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20072 Mitochondrial disease vomit symptom consistent indicator MitDisVomitSymptmConsistInd Indicator of whether past symptoms were consistent day to day Indicator of whether past symptoms were consistent day to day In the past, were the symptoms consistent from day to day? I don't know;No;Yes I don't know;No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20329 Mitochondrial disease past restrict diet indicator MitDisPastRestrictDietInd Indicator of whether participant/subject has been on a restricted diet in the past Indicator of whether participant/subject has been on a restricted diet in the past Are you/your child currently on a restricted diet? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20168 Mitochondrial disease abdominal pain worsen text MitDisAbdomnlPainWorsenTxt The free text field to specify about what specifically makes the participant's/subject's abdominal pain worse The free text field to specify about what specifically makes the participant's/subject's abdominal pain worse Is there anything specific that makes the pain worse? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20104 Mitochondrial disease prior GI symptom consistent day to day indicator MitDisPrirGISyptmCnstDyToDyInd Indicator of whether past symptoms of GERD, heartburn, mid-line chest pain, esophageal burning were consistent day to day Indicator of whether past symptoms of GERD, heartburn, mid-line chest pain, esophageal burning were consistent day to day In the past, where symptoms pretty consistent from day to day? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20051 Mitochondrial disease present vomit trigger other text MitDisPresTrigOTH The free text field to specify the other trigger the participant/subject may have had when symptoms began The free text field to specify the other trigger the participant/subject may have had when symptoms began Present trigger other. Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20220 Mitochondrial disease alternative medicine type MitDisAlternMedsType Select the alternative medical treatments tried by the participant/subject. Select the alternative medical treatments tried by the participant/subject. What types of alternative medicine have you/your child tried? Meditation;Other;Items bought over the internet;Over the counter medicine;Ginger;Marijuana;Supplemental vitamins (not prescribed);Antioxidants;Aromatherapy;Colon cleansing;Chiropractic care;Homeopathic medicine;Herbal supplements or medicine;Exercise;Massage;Prayer;Faith healer;Crystal;Acupuncture;Yoga Meditation;Other;Items bought over the internet;Over the counter medicine;Ginger;Marijuana;Supplemental vitamins (not prescribed);Antioxidants;Aromatherapy;Colon cleansing;Chiropractic care;Homeopathic medicine;Herbal supplements or medicine;Exercise;Massage;Prayer;Faith healer;Crystal;Acupuncture;Yoga Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20147 Mitochondrial disease swallow pain text MitDisSwallwPainTxt The free text field to specify comments about participant's/subject's pain with swallowing The free text field to specify comments about participant's/subject's pain with swallowing Please add comments about pain with swallowing Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20083 Mitochondrial disease prior vomit color blood category MitDisPriVomitClrBloodCat The category of color of the blood present in participant's/subject's vomit during prior episodes of vomiting The category of color of the blood present in participant's/subject's vomit during prior episodes of vomiting What was the color of the blood? Bright red;Dark red;Brown;Black;I don't know Bright red;Dark red;Brown;Black;I don't know Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20179 Mitochondrial disease prior abdominal pain duration text MitDisPrAbdomnlPainDuratnTxt The free text field to specify additional details about participant's/subject's past abdominal pain duration The free text field to specify additional details about participant's/subject's past abdominal pain duration Please provide additional comments about duration of past abdominal pain? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20188 Mitochondrial disease bloat abdominal distension current prior status MitDisBloatAbdmlDstnCurPriStat The status, present or past, of bloating or abdominal distension experienced by the participant/subject The status, present or past, of bloating or abdominal distension experienced by the participant/subject Do you/your child have bloating or abdominal distension or have they had it in the past? Past;Present Past;Present Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20115 Mitochondrial disease details oral regurgitation text MitDisDetOralRegurgTxt The free text field to specify additional details about participant's/subject's oral regurgitation symptoms The free text field to specify additional details about participant's/subject's oral regurgitation symptoms Please provide additional details about your/their oral regurgitation symptoms. Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20126 Mitochondrial disease current burp consistent day to day indicator MitDisCurrBurpConsistDytoDyInd Indicator of whether current symptoms of burping are consistent day to day Indicator of whether current symptoms of burping are consistent day to day Is the burping pretty consistent from day to day? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20062 Mitochondrial disease vomit blood indicator MitDisVomitBloodInd Indicator of whether participant/subject has ever vomited blood Indicator of whether participant/subject has ever vomited blood Do you/your child ever vomit blood? I don't know;No;Yes I don't know;No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20231 Mitochondrial disease GI symptom result diagnosis text MitDisGISymptmResultDiagnosTxt The free text field to provide the GI symptoms that lead to a Mitochondrial disease diagnosis The free text field to provide the GI symptoms that lead to a Mitochondrial disease diagnosis Were these GI symptoms what led to your/your child's mitochondrial disease diagnosis? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20158 Mitochondrial disease abdominal pain anatomic site MitDisAbdomnlPainAntmicSite Select where participant's/subject's abdominal pain is located Select where participant's/subject's abdominal pain is located Where is the abdominal pain located? Entire abdomen;Entire lower abdomen;Entire upper abdomen;I don't know;Left lower quadrant;Lower abdomen midline;Near the belly button;Right lower quadrant;Upper abdomen midline;Upper abdomen on the left;Upper abdomen on the right;Variable locations Entire abdomen;Entire lower abdomen;Entire upper abdomen;I don't know;Left lower quadrant;Lower abdomen midline;Near the belly button;(below umbilicus);(between umbilicus bottom of ribs);Upper abdomen on the left;Upper abdomen on the right;Variable locations Alphanumeric

Choose all that apply. Response is obtained from participant/ subject, family member, friend, or chart/medical record.

Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20094 Mitochondrial disease GERD heartburn mid-line chest pain esophageal burn current prior status MitDsGERDHtbnPainBrnCrtPriStat The status present or prior GERD, heartburn, mid-line chest pain, esophageal burning symptoms experienced by the participant/subject The status present or prior GERD, heartburn, mid-line chest pain, esophageal burning symptoms experienced by the participant/subject Has you/your child had GERD, heartburn, mid-line chest pain, esophageal burning in the past or currently? Past;Present Past;Present Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20029 Mitochondrial disease diagnosis text MitDisDiagnosisTxt The free-text field specifying the mitochondrial disease diagnosis that is present. The free-text field specifying the mitochondrial disease diagnosis that is present. What mitochondrial disease diagnosis is present? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 255

Free-Form Entry

C20199 Mitochondrial disease prior bloat abdominal distension text MitDisPriBloatAbdminlDstnsnTxt The free text field to specify additional details about the participant's/subject's past abdominal bloating/distension The free text field to specify additional details about the participant's/subject's past abdominal bloating/distension Please provide additional details about past abdominal bloating and distension Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20040 Mitochondrial disease eat reason text MitDisWhyEatRsnTxt The free text field to specify why participant/subject eats that way The free text field to specify why participant/subject eats that way Why do you/they eat that way? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20210 Mitochondrial disease defecation other treatment text MitDisDefecateOtherTreatmntTxt The free text field to specify about the participant's/subject's use of other treatment to defecate The free text field to specify about the participant's/subject's use of other treatment to defecate Defecation Treatment Other (Specify) Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20137 Mitchondrial disease prior burp specific food drink cause text MtDisPriBurpSpfcFdDrinkCausTxt This free text field to specify which specific foods or drinks caused participant's/subject's past burping This free text field to specify which specific foods or drinks caused participant's/subject's past burping What food or drink? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20073 Mitochondrial disease prior vomit frequency MitDisPriorVomitFreq The frequency of the participant/subject's prior episodes of vomiting The frequency of the participant/subject's prior episodes of vomiting During that period, how often did you/they vomit? About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20330 Mitochondrial disease special diet reason text MitDisSpeclDietReasonTxt The free text field to specify why the participant/subject is on a specialized diet The free text field to specify why the participant/subject is on a specialized diet Why are you/they on a specialized diet? Alphanumeric

(Specify)

Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20169 Mitochondrial disease current abdominal pain detail text MitDisCurrAbdomnlPainDetlTxt The free text field to specify additional details about the participant's/subject's present abdominal pain The free text field to specify additional details about the participant's/subject's present abdominal pain Please provide additional details about present abdominal pain. Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20105 Mitochondrial disease prior GERD heartburn mid-line chest pain esophogeal burning frequency MitDisPrirGERDHeBuCPEsBuFreq The frequency of the participant/subject's prior GERD, heartburn, mid-line chest pain, esophageal burning The frequency of the participant/subject's prior GERD, heartburn, mid-line chest pain, esophageal burning How often did you/they have GERD, heartburn, mid-line chest pain, esophageal burning? About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20052 Mitochondrial disease symptom consistent indicator MitDisSymptmConsistInd Indicator of whether symptoms are consistent day to day Indicator of whether symptoms are consistent day to day Are the symptoms pretty consistent from day to day? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20221 Mitochondrial disease alternative medicine treatment other text MitDisAlternMedsTreatOtherTxt The free text field to specify other alternative medicine used to treatment The free text field to specify other alternative medicine used to treatment What other alternative medicine have you/your child tried? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20148 Mitochondrial disease food stuck esophagus indicator MitDisFoodStuckEsophagusInd Indicator of whether participant's/subject's gets food stuck in their esophagus Indicator of whether participant's/subject's gets food stuck in their esophagus Do you/your child feel food gets stuck in your/their esophagus? I don't know;No;Yes I don't know;No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20084 Mitochondrial disease prior vomit blood clot indicator MitDisPriorVomitBloodClotInd Indicator of whether participant's/subject's vomit had blood clots Indicator of whether participant's/subject's vomit had blood clots Did you ever see blood clots in what you/they vomited?` I don't know;No;Yes I don't know;No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20180 Mitochondrial disease prior abdominal pain trigger type MitDisPriorAbdomnlPainTrigrTyp The type of trigger of the participant's/subject's prior abdominal pain The type of trigger of the participant's/subject's prior abdominal pain Did any of the following trigger's occur before past abdominal pain started? Anxiety;Depression;Exercise;Fasting more than 12 hours;Headache/Migraine/Light sensitivity;Other;Other Psychological Issues;Particular Foods;Right after feeding;Seizure;Stress;Taking medicine;Viral illness/Fever Anxiety;Depression;Exercise;Fasting more than 12 hours;Headache/Migraine/Light sensitivity;Other;Other Psychological Issues;Particular Foods;Right after feeding;Seizure;Stress;Taking medicine;Viral illness/Fever Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20189 Mitochondrial disease bloat abdominal distension onset age category MitDisBloatAbdmlDstnOnstAgeCat The category of the participant/subject's age at onset of abdominal bloating/distension The category of the participant/subject's age at onset of abdominal bloating/distension What was your/your child's age when abdominal bloating/distension began? 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20116 Mitochondrial disease prior oral regurgitation onset age category MitDisPriOralRegurgOnstAgeCat The category of participant/subject's age at onset of prior oral regurgitation episodes The category of participant/subject's age at onset of prior oral regurgitation episodes In the past oral regurgitation episodes, what was your/your child's age when the problems began? 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20200 Mitochondrial disease bowel movement frequency type MitDisBowelMovemntFreqTyp Select the participant's/subject's bowel movement frequency Select the participant's/subject's bowel movement frequency How often do you have bowel movements? A few times a week;Every other day;I don't know;Less than one a week;More than once a day;Once a day;Once a week;Only after a suppository;Only after an enema/irrigation/suppository;Other;Requires disimpaction with a finger;Requires Go Lightly by mouth or tube;Uses a cecostomy to induce bowel movements A few times a week;Every other day;I don't know;Less than one a week;More than once a day;Once a day;Once a week;Only after a suppository;Only after an enema/irrigation/suppository;Other;Requires disimpaction with a finger;(Laxative that works by drawing large amounts of water into the colon);Uses a cecostomy to induce bowel movements Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20127 Mitochondrial disease burp reflux abdominal distention accompany type MitDisBurpReflxAbDistnAccmpTyp The type of reflux or abdominal distention that accompanies current burping episodes for the participant/subject. The type of reflux or abdominal distention that accompanies current burping episodes for the participant/subject. Does the burping occur with reflux or abdominal distention? Abdominal distension;Both;Reflux Abdominal distension;Both;Reflux Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20063 Mitochondrial disease vomit color blood category MitDisVomitColorBloodCat The category of color of the blood present in participant's/subject's vomit The category of color of the blood present in participant's/subject's vomit What color is the blood? Bright red;Dark red (maroon);Black;I don't know;Brown Bright red;Dark red (maroon);Black;I don't know;Brown Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20232 Mitochondrial disease significant GI symptom prior diagnosis text MitDisSignifGISymptmPriDiagTxt The free text field to provide significant GI symptoms before mitochondrial diseas diagnosis The free text field to provide significant GI symptoms before mitochondrial diseas diagnosis Were your/your child's GI symptoms recognized as significant before diagnosis of mitochondrial disease? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20159 Mitochondrial disease abdominal frequency pain type MitDisAbdomnlFreqPainTyp Select how often a participant/subject has abdominal pain Select how often a participant/subject has abdominal pain How often does abdominal pain occur? About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20095 Mitochondrial disease current GERD heartburn mid-line chest pain esophageal burning age category MitDisCrtGERDHtbnMLCPEBuAgeCat The category of the participant/subject's age at GERD, heartburn, mid-line chest, pain esophageal burning onset The category of the participant/subject's age at GERD, heartburn, mid-line chest, pain esophageal burning onset For current GERD, heartburn, mid-line chest pain, esophageal burning episodes, what was your/their age when the problems began? 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20030 Mitochondrial disease known genetic diagnosis indicator MitDisKnownGenDiagInd Indicator of whether the participant/subject has a known genetically diagnosed mitochondrial disease. Indicator of whether the participant/subject has a known genetically diagnosed mitochondrial disease. Is there a known genetic diagnosis? No;Yes No;Yes Alphanumeric

Choose one. Response is obtained from participant/ subject, family member, friend, or chart/medical record.

Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20041 Mitochondrial disease liquid diet text MitDisLiqDietTxt The free text field to specify the type of liquid diet used by participant/subject The free text field to specify the type of liquid diet used by participant/subject What liquid diet do you/they use? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20211 Mitochondrial disease prior bowel movement other treatment text MitDisPriBwlMvmntOthrTrtmntTxt Indicate whether participant/subject used other treatments for bowel movements in the past Indicate whether participant/subject used other treatments for bowel movements in the past Have they used any other treatments in the past to help with bowel movements? Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20138 Mitochondrial disease prior burp detail text MitDisPriorBurpDetailTxt The free text field to specify additional details about participant's/subject's past burping symptoms The free text field to specify additional details about participant's/subject's past burping symptoms Please provide additional details about your/their past burping symptoms Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20074 Mitochondrial disease vomit time period frequency other text MitDisVomitTimePeriodFreqOTH The free text field to specify how often the participant/subject vomited in the past The free text field to specify how often the participant/subject vomited in the past Past vomiting frequency, Other (Specify) Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations 4000

Free-Form Entry

C20331 Mitochondrial disease severe vomit symptom type MitDisSevVomitSympTyp The type of symptom that was most severe with the patient/subject's vomiting episodes. The type of symptom that was most severe with the patient/subject's vomiting episodes. Which symptom was most severe with past vomiting episodes? Abdominal pain;Nausea;Both Abdominal pain;Nausea;Both Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 15:47:25.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values Selected

C20170 Mitochondrial disease prior abdominal pain onset age category MitDisPriAbdomnlPainOnstAgeCat The category of the participant/subject's age at onset of prior abdominal pain The category of the participant/subject's age at onset of prior abdominal pain What was your/your child's age when past abdominal pain began? 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth 13 mo to 18 mo;14 y to 18 y;19 mo to 3 y;2 mo to 5 mo;4 y to 6 y;6 mo to 12 mo;7 y to 13 y;Greater than 18 y;I don't know;Less than 2 mo old (not on day of birth);On the day of birth Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20106 Mitochondrial disease prior GERD heartburn mid-line chest pain esophageal burn disrupt activity indicator MitDisPriGRDHeBuCPEBnDsrpAcInd Indicator of whether past GERD, heartburn, mid-line chest pain, esophageal burning disrupted activity Indicator of whether past GERD, heartburn, mid-line chest pain, esophageal burning disrupted activity Did past GERD, heartburn, mid-line chest pain, esophageal disrupt activity? No;Yes No;Yes Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

C20053 Mitochondrial disease vomit frequency MitDisVomitFreq The frequency with which the participant/subject vomits The frequency with which the participant/subject vomits How often does your child vomit? About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other About once a year;At least once a week, but not daily;Daily;I don't know;Less than once a month, more than once a year;One to 4 times per month;Only once;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-26 00:00:00.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

CSV