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
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

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

C20085 Mitochondrial disease prior stool black indicator MitDisPriorStoolBlackInd Indicator of whether participant's/subject's stools were black Indicator of whether participant's/subject's stools were black Did you/your child ever have black stools? 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

C20181 Mitochondrial disease prior abdominal pain trigger text MitDisPriorAbdomnlPainTrigrTxt The free text field to specify additional details about participant's/subject's past abdominal pain triggers The free text field to specify additional details about participant's/subject's past abdominal pain triggers Please provide additional comments about past abdominal pain triggers? 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

C20190 Mitochondrial disease bloat abdominal distension time type MitDisBloatAbdmnlDstnsnTimeTyp The type, as time of day, at which the abdominal bloating/distension is worse for the participant/subject. The type, as time of day, at which the abdominal bloating/distension is worse for the participant/subject. Is the bloating or abdominal distension worse at any particular time of day? Afternoon;All times of the day;Evening;I don't know;Morning;Overnight (12pm - 5pm);All times of the day;(5pm - Bed);I don't know;(wake up until 12pm);(wakes from sleep) 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

C20117 Mitochondrial disease age prior oral regurgitation stop age category MitDisPriOralRegurgStopAgeCat The category of participant/subject's age at end of prior oral regurgitation episodes The category of participant/subject's age at end of prior oral regurgitation episodes How old were you/your child when the symptoms stopped? 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

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

C20222 Mitochondrial disease alternative medicine treatment improve GI problem text MitDisAltrnMedTrtImpvGIPblmTxt The free text field to specify about what alternative medicines made the participant's/subject's GI problems better The free text field to specify about what alternative medicines made the participant's/subject's GI problems better Did any of these alternative medicine treatments help your/your child's GI problems? 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

C20149 Mitochondrial disease food stuck esophagus anatomic site MitDisFoodStuckEsphgsAntmicSit The anatomic site of food getting stuck in the participant/subject's esophagus The anatomic site of food getting stuck in the participant/subject's esophagus Where do you feel things get stuck? Back of the throat;Lower chest;Neck;Upper chest Back of the throat;Lower chest;Neck;Upper chest 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

C20096 Mitochondrial disease GI symptom consistent day to day indicator MitDisGISymptmConsistDyToDyInd Indicator of whether symptoms of GERD, heartburn, mid-line chest pain, esophageal burning were consistent day to day Indicator of whether symptoms of GERD, heartburn, mid-line chest pain, esophageal burning were 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

C20031 Mitochondrial disease DNA mutation type MitDisDNAMutatTyp The type of DNA mutation (nuclear or mitochondrial) present in the participant/subject's genetic diagnosis The type of DNA mutation (nuclear or mitochondrial) present in the participant/subject's genetic diagnosis Is this a nuclear or mitochondrial DNA mutation? Mitochondrial;Nuclear Mitochondrial;Nuclear 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

C20201 Mitochondrial disease bowel movement other frequency text MitDisBowelMvmtOthrFrqTxt The free text field to specify the participant's/subject's other stool frequency The free text field to specify the participant's/subject's other stool frequency Stool 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

C20128 Mitochondrial disease burp occur specific drink food indicator MitDisBurpOccSpecDrinkFoodInd Indicator of whether participant's/subject's burping occurs with specific drinks or food Indicator of whether participant's/subject's burping occurs with specific drinks or food Does 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

C20064 Mitochondrial disease vomit blood clot indicator MitDisVomitBloodClotsInd Indicator of whether participant's/subject's vomit has blood clots Indicator of whether participant's/subject's vomit has blood clots Do you ever see blood clots in what you/they vomit? 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

C20233 Mitochondrial disease delay treatment GI problem indicator MitDisDelayTreatmntGIProblmInd Indicator of whether participant/subject delayed treatment of GI problem Indicator of whether participant/subject delayed treatment of GI problem Have you ever delayed treatment for your/their GI problems for fear of not being believed about these symptoms? 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

C20160 Mitochondrial disease abdominal pain frequency other text MitDisAbdomnlPainFreqOtherTxt The free text field to specify frequency of participant's/subject's other abdominal pain The free text field to specify frequency of participant's/subject's other abdominal pain Abdominal Pain 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

C20171 Mitochondrial disease prior abdominal pain stop age category MitDisPriAbdomnlPainStopAgeCat The category of the participant/subject's age at the end of prior abdominal pain episodes The category of the participant/subject's age at the end of prior abdominal pain episodes What was your/your child's age when past abdominal pain stopped? 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

C20107 Mitochondrial disease prior GERD heartburn mid-line chest pain esophageal burn wake indicator MitDisPriGERDHeBuMLCPEBuWakInd Indicator of whether past GERD, heartburn, mid-line chest pain, esophageal burning woke participant/subject from sleep Indicator of whether past GERD, heartburn, mid-line chest pain, esophageal burning woke participant/subject from sleep Did past GERD, heartburn, mid-line chest pain, esophageal burning wake you/your child from sleep? 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

C20042 Mitochondrial disease restrict diet indicator MidtDisRestrictDietInd Indicator of whether participant/subject are on a restricted diet Indicator of whether participant/subject are on a restricted diet 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

C20212 Mitochondrial disease bowel movement treatment efficacy text MitDisBowelMovemntEfficacyTxt The free text field to specifyabout participant's/subject's treatments helping or worsening bowel movement problem The free text field to specifyabout participant's/subject's treatments helping or worsening bowel movement problem Did these treatments help or worsen the bowel movement problem? 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

C20139 Mitochondrial disease swallow difficult pain type MitDisSwallowDiffcultPainTyp The type of difficulty or pain experienced by the participant/subject when swallowing The type of difficulty or pain experienced by the participant/subject when swallowing Do you/your child have difficulty or pain with swallowing? Both;Difficulty;Pain Both;Difficulty;Pain 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

C20075 Mitochondrial disease vomit prior episode intensity type MitDisVomitPriorEpiIntTyp The type of intensity of the participant/subject's prior episodes of vomiting The type of intensity of the participant/subject's prior episodes of vomiting In the past, when you/your child had vomiting, was it only a single episode or did you/they usually vomit repeatedly? Single episode;Vomit more than once;Vomit repeatedly until there is nothing left Single episode;Vomit more than once;Vomit repeatedly until there is nothing left 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

C20086 Mitochondrial disease prior pain abdominal before vomit indicator MitDisPriorPainAbdmBefVomitInd Indicator of whether participant/subject experienced abdominal pain before vomiting Indicator of whether participant/subject experienced abdominal pain before vomiting Did you/your child ever have abdominal pain before vomiting? 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

C20182 Mitochondrial disease prior abdominal pain disrupt activity indicator MitDisPriAbdmlPainDsrptActvInd Indicator of whether participant's/subject's prior abdominal pain disrupted activity Indicator of whether participant's/subject's prior abdominal pain disrupted activity Did past abdominal pain disrupt activity? 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

C20191 Mitochondrial disease abdominal distension cause air stool reason MtDisAbdmnlDstnCausAirStoolRsn The reason the participant/subject thinks the belly is distended The reason the participant/subject thinks the belly is distended Do you think the belly is distended with air or with stool? Air;Both;I don't know;Stool Air;Both;I don't know;Stool 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

C20118 Mitochondrial disease prior oral regurgitation stop specific text MitDisPastOralRegurgStopST The free text field to specify when participant's/subject's past oral regurgitation stopped The free text field to specify when participant's/subject's past oral regurgitation stopped What stopped the oral regurgitation? 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

C20054 Mitochondrial disease vomit frequency other text MitDisVomitFreqOTH The free text field to specify how often the participant/subject vomits The free text field to specify how often the participant/subject vomits Vomiting Frequency 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

C20223 Mitochondrial disease alternative medicine treatment worsen GI problem text MitDisAltrnMedTrtWrsnGIPblmTxt The free text field to specify about what alternative medicine treatments made the participant's/subject's GI problems worse The free text field to specify about what alternative medicine treatments made the participant's/subject's GI problems worse Did any of these alternative medicine treatments worsen your/your child's GI problems? 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

C20150 Mitochondrial disease remove food pill esophagus indicator MitDisRemvFoodPillEsophagusInd Indicator of whether participant/subject has food or pill removed from esophagus Indicator of whether participant/subject has food or pill removed from esophagus Have you/your child ever had food or a pill removed from the esophagus? 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

C20097 Mitochondrial disease GERD heartburn mid-line chest pain esophageal burn frequency MitDzGRDHtbnChstPnEsBrnFreq The frequency with which the participant/subject has GERD, heartburn, mid-line chest pain, esophageal burning The frequency with which the participant/subject has GERD, heartburn, mid-line chest pain, esophageal burning How often do 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

C20032 Mitochondrial disease nuclear mutation text MitDisNucMutatTxt The free text field to specify the mitochondrial disease nuclear DNA mutation. The free text field to specify the mitochondrial disease nuclear DNA mutation. Nuclear mutation 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

C20202 Mitochondrial disease bowel movement consistency result MitDisBowelMovmntConsistncyRes Select the participant's/subject's bowel movement consistency Select the participant's/subject's bowel movement consistency What is the consistency of bowel movements? Formed;Greasy;Hard;Hard and large;I don't know;Mushy;Soft;Type 1: Separate hard lumps, like nuts;Type 2: Sausage-shaped, but lumpy;Type 3: Like a sausage but with cracks on its surface;Type 4: Like a sausage or snake, smooth and soft;Type 5: Soft blobs with clear cut edges;Type 6: Fluffy pieces with ragged edges, a mushy stool;Type 7: Watery, no solid pieces. Entirely liquid;Variable;Watery Formed;Greasy;Hard;Hard and large;I don't know;Mushy;Soft;(hard to pass);Type 2: Sausage-shaped, but lumpy;Type 3: Like a sausage but with cracks on its surface;Type 4: Like a sausage or snake, smooth and soft;(passed easily);Type 6: Fluffy pieces with ragged edges, a mushy stool;Type 7: Watery, no solid pieces. Entirely liquid;Variable;Watery Alphanumeric

Bristol stool scale classification

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

C20129 Mitchondrial disease burp specific food drink cause text MitDisBurpSpecFoodDrinkCausTxt The free text field to specify which specific foods or drinks cause participant's/subject's burping The free text field to specify which specific foods or drinks cause participant's/subject's 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

C20065 Mitochondrial disease black stool indicator MitDisBlackStoolInd Indicator of whether participant's/subject's stools are black Indicator of whether participant's/subject's stools are black Does you/your child have black stool? Note: If they answer yes, confirm that stool was really black not dark brown or dark green. 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

C20234 Mitochondrial disease GI symptom refer psychiatric professional indicator MitDisGISymptmReferPsychiatInd Indicator of whether participant/subject has ever been referred to a psychiatric professional regarding GI symptoms Indicator of whether participant/subject has ever been referred to a psychiatric professional regarding GI symptoms Have you ever been referred to a psychiatric professional regarding your/your child's GI symtoms? 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

C20161 Mitochondrial disease abdominal pain interval type MitDisAbdomnlPainIntrvlTyp Select the length of time participant/subject has abdominal pain Select the length of time participant/subject has abdominal pain How long does the abdominal pain last when it occurs? 31 minutes to many hours;All day;Day and night;I don't know;Less than a minute;None of the above;One minute to 30 minutes;Until you/the child eats;Until you/the child falls asleep;Until you/the child has a bowel movement;Until you/the child passes gas;Until you/the child urinates;Until you/the child vomits;Variable 31 minutes to many hours;All day;Day and night;I don't know;Less than a minute;None of the above;One minute to 30 minutes;Until you/the child eats;Until you/the child falls asleep;Until you/the child has a bowel movement;Until you/the child passes gas;Until you/the child urinates;Until you/the child vomits;Variable 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

C20172 Mitochondrial disease prior abdominal pain stop text MitDisPriorAbdomnlPainStopTxt The free text field to specify what stopped participant's/subject's past abdominal pain The free text field to specify what stopped participant's/subject's past abdominal pain What stopped the 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

C20108 Mitochondrial disease prior GI detail text MitDisPriorGIDetailText The free text field to specify additional details about participant's/subject's past GERD, heartburn, mid-line chest pain, esophageal burning symptoms The free text field to specify additional details about participant's/subject's past GERD, heartburn, mid-line chest pain, esophageal burning symptoms Please provide additional details about your/their past GERD, heartburn, mid-line chest pain, esophageal burning 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

C20043 Mitochondrial disease special diet type MitDisSpecialDietTyp Select the type of specialized diet of the participant/subject Select the type of specialized diet of the participant/subject What type of specialized diet do you/they eat? Celiac diet / gluten free;Food allergen avoidance;Fructose;High carbohydrate;High fat;High protein;Ketogenic diet;Lactose free;Low carbohydrate;Low fat;Low fermentable oligo-Di-Monosaccharides and Polyols;Low protein;Organic;Other;Sucrose free;Vegan;Vegetarian Celiac diet / gluten free;(shellfish, eggs, nuts, etc.);Fructose;High carbohydrate;High fat;High protein;Ketogenic diet;Lactose free;Low carbohydrate;Low fat;short chain carbohydrates and related alcohols that are poorly absorbed in the small intestine;Low protein;Organic;Other;Sucrose free;Vegan;Vegetarian Alphanumeric

Choose one

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

C20213 Mitochondrial disease bowel movement problem text MitDisBowelMovemntProblmTxt The free text field to specify additional details about the participant's/subject's bowel movement problems The free text field to specify additional details about the participant's/subject's bowel movement problems Please provide additional details about bowel movement problems 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

C20140 Mitochondrial disease swallow problem onset age category MitDisSwallowProblemOnstAgeCat The category of the participant/subject's age at onset of difficulty or pain with swallowing The category of the participant/subject's age at onset of difficulty or pain with swallowing For the current burping problems, 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

C20076 Mitochondrial disease prior vomit time of day category MitDisPriVomitTimeDyCat The time-of-day category of the participant/subject's prior episodes of vomiting. The time-of-day category of the participant/subject's prior episodes of vomiting. Did the vomiting happen during a specific time of the day? Afternoon;All times of the day;Evening;I don't know;Morning;Overnight (12pm - 5pm);All times of the day;(5pm - Bed);I don't know;(wake up until 12pm);(wakes from sleep) 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

C20087 Mitochondrial disease prior vomit onset trigger type MitDisPriorVomitOnstTrigrTyp The type of trigger present at symptom onset of the participant's/subject's prior episodes of vomiting The type of trigger present at symptom onset of the participant's/subject's prior episodes of vomiting In past episodes of vomiting, was any of the following triggers present at the time symptoms began? After a seizure;After starting a medicine;After trauma;Diarrhea;During exercise;Fever;I don't know;Other;Prolonged fasting;Right after birth;Surgery;Upper respiratory infection After a seizure;After starting a medicine;After trauma;Diarrhea;During exercise;Fever;I don't know;Other;(i.e., not eating well);Right after birth;Surgery;Upper respiratory infection 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

C20183 Mitochondrial disease prior abdominal pain wake indicator MitDisPrioAbdomnlPainWakeInd Indicator of whether participant's/subject's prior abdominal pain woke self/child from sleep Indicator of whether participant's/subject's prior abdominal pain woke self/child from sleep Did past abdominal pain wake you/your child from sleep? 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

C20192 Mitochondrial disease swallow air indicator MitDisSwallowAirInd Indicator of whether participant/subject are air swallowers Indicator of whether participant/subject are air swallowers Are you/your child an air swallower? 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

CSV