CDE Detailed Report

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

Displaying 151 - 200 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
C20236 Mitochondrial disease Munchausen by proxy syndrome health care professional setting indicator MitDisMBPSymHlthCrProSetInd Indicator of whether participant/subject has been confronted by a health care professional about Munchausen by proxy syndrome Indicator of whether participant/subject has been confronted by a health care professional about Munchausen by proxy syndrome Have you ever had a confrontation with a health care professional about Munchausen by proxy syndrome? 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

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

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

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

C20215 Mitochondrial disease current medication type MitDisCurrMedsType Select other medicines that participant/subject are currently taking Select other medicines that participant/subject are currently taking What other medicines are you/your child taking now? Other;Antibiotics;Levbid/Levsin/Bentyl;Pancreatic enzyme supplements (Creon);Gabapentin (Neurontin);Oxycarbazine (Trileptal);Topamax (Topiramate);Phenytoin (Dilantin);Pregabalin (Lyrica);Lamotrigine (Lamictal);Levetircetam (Keppra);Tiagabine (Gabatril);Felbatol (Felbamate);Ethosuximide (Zarontin);Carbamazepine (Tegretol, Carbatrol);Folinic acid;Alpha lipoic acid;Vitamin C;Vitamin E;B vitamins (other);L-Carnitine;L-Arginine;L-Creatine;Riboflavin (vitamin B2);CoQ10 (Ubiquinol, Ubiquinone);Linaclotide (Linzess);Tegaserod (Zelnorm, Zelmac);Reglan (metaclopramide);Domperidone (Motilium);Cisapride (Propulsid);Erythromycin;SSRI: Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertaline (Zoloft);Tricyclic antidepressant: Amitriptyline, desipramine, imipramine, nortiptyline;Ondansetron (Zofran);Carafate;H-2 receptor antagonist: Pepcid (famotidine), Zantac (ranitidine), Tagemet (cimetidine);Proton pump inhibitor: Prilosec (omeprazole), Nexium, Prevacid (lansoprazole), Protonix (pantoprazole), or Aciphex (rabeprazole) Other;Antibiotics;Levbid/Levsin/Bentyl;Pancreatic enzyme supplements (Creon);Gabapentin (Neurontin);Oxycarbazine (Trileptal);Topamax (Topiramate);Phenytoin (Dilantin);Pregabalin (Lyrica);Lamotrigine (Lamictal);Levetircetam (Keppra);Tiagabine (Gabatril);Felbatol (Felbamate);Ethosuximide (Zarontin);Carbamazepine (Tegretol, Carbatrol);Folinic acid;Alpha lipoic acid;Vitamin C;Vitamin E;B vitamins (other);L-Carnitine;L-Arginine;L-Creatine;Riboflavin (vitamin B2);CoQ10 (Ubiquinol, Ubiquinone);Linaclotide (Linzess);Tegaserod (Zelnorm, Zelmac);Reglan (metaclopramide);Domperidone (Motilium);Cisapride (Propulsid);Erythromycin;SSRI: Citalopram (Celexa), escitalopram (Lexapro), fluoxetine (Prozac), paroxetine (Paxil, Pexeva), sertaline (Zoloft);Tricyclic antidepressant: Amitriptyline, desipramine, imipramine, nortiptyline;Ondansetron (Zofran);Carafate;H-2 receptor antagonist: Pepcid (famotidine), Zantac (ranitidine), Tagemet (cimetidine);Proton pump inhibitor: Prilosec (omeprazole), Nexium, Prevacid (lansoprazole), Protonix (pantoprazole), or Aciphex (rabeprazole) 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

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

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

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

C20194 Mitochondrial disease prior bloat abdominal distension onset age category MtDsPriBltAbdmlDstnsnOnstAgCat The category of the participant/subject's age at onset of prior abdominal bloating/distension The category of the participant/subject's age at onset of prior abdominal bloating/distension What was your/your child's age when the past abdominal bloating/distension 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

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

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

C20226 Mitochondrial disease surgery type detail text MitDisSurgTypeDetailTxt The free text field to provide additional details about the type of surgery participant/subject had The free text field to provide additional details about the type of surgery participant/subject had Provide additional details about the type of surgery 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

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

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

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

C20205 Mitochondrial disease bowel movement strain pass indicator MitDisBowelMovmntStrainPassInd Indicator of whether the participant/subject has to strain to pass a bowel movement Indicator of whether the participant/subject has to strain to pass a bowel movement Do you/they have to strain to pass bowel movements? 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

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

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

C20237 Mitochondrial disease Munchausen by proxy syndrome health care professional setting type MitDisMBPSymHlthCrProSetTyp Select the setting when confronted by a health care professional about Munchausen by proxy syndrome Select the setting when confronted by a health care professional about Munchausen by proxy syndrome What setting was this in? ER;Other;Outpatient;Clinic;Hospital ER;Other;Outpatient;Clinic;Hospital 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

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

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

C20216 Mitochondrial disease medication other text MitDisMedsOtherTxt The free text field to specify the participant's/subject's other medications The free text field to specify the participant's/subject's other medications What other medicines do you/your child take? 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

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

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

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

C20195 Mitochondrial disease prior bloat abdominal distension stop age category MtDsPriBltAbdmlDistnsnStpAgCat The category of the participant/subject's age at cessation of prior abdominal bloating/distension The category of the participant/subject's age at cessation of prior abdominal bloating/distension What was your/your child's age when the abdominal bloating/distesion 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

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

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

C20227 Mitochondiral disease life effect grade MitDisLifeEffectGrade The graded scale representing the effect of the symptoms on the participant's/subject's life. The graded scale representing the effect of the symptoms on the participant's/subject's life. How much do the symptoms we discussed affect your/your child's life? 1;10;2;3;4;5;6;7;8;9 1;10;2;3;4;5;6;7;8;9 Numeric Values

Choose one. 1 being not at all, 10 being severe interruption

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

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

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

C20206 Mitochondrial disease stool blood indicator MitDisStoolBloodInd Indicator of whether the participant/subject has blood in their stools Indicator of whether the participant/subject has blood in their stools Do you/your child ever have blood in the stool? 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

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

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

C20238 Mitochondrial disease Munchausen by proxy syndrome health care professional setting other text MitDisMBPSymHlthCrProSetOTH The free text field to provide the other setting when participant/subject confronted by a health care professional about Munchausen by proxy syndrome The free text field to provide the other setting when participant/subject confronted by a health care professional about Munchausen by proxy syndrome Munchausen Setting 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

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

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

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

C20217 Mitochondrial disease medication GI problem help text MitDisMedsGIProblmHlpTxt The free text field to specify about what medications helped the participant's/subject's GI problems The free text field to specify about what medications helped the participant's/subject's GI problems Have you/your child taken any medications in the past that you feel helped any of 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

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

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

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

C20119 Mitochondrial disease prior oral regurgitation consistent day to day indicator MtDisPriOrRgrgConsistDytoDyInd Indicator of whether past symptoms of oral regurgitation were consistent day to day Indicator of whether past symptoms of oral regurgitation were consistent day to day Were 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

CSV