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 Additional Notes (Question Text) Permissible Values Description Data Type Disease Specific Instructions Disease Specific Reference Population Classification (e.g., Core) Version Number Version Date CRF Name (CRF Module / Guideline) Sub Domain Name Domain Name Size Input Restrictions Min Value Max Value Measurement Type External Id Loinc External Id Snomed External Id caDSR External Id CDISC
C20082 Mitochondiral disease prior vomit blood indicator MitDisPriorVomitBloodInd Indicator of whether participant/subject had ever vomited blood Indicator of whether participant/subject had ever vomited blood Did 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

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

C20178 Mitochondrial disease prior abdominal pain duration type MitDisPriorAbdomnlDuratnTyp Select the length of time participant/subject had past abdominal pain Select the length of time participant/subject had past abdominal pain How long did the past abdominal pain last when it occurred? 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

C20114 Mitochondrial disease oral regurgitation occurrence timing type MitDisOralRegurgOccurTimngTyp The type of timing of the participant/subject's episodes of oral regurgitation with respect to meals The type of timing of the participant/subject's episodes of oral regurgitation with respect to meals Is the oral regurgitation before, during, or after meals? After;Before;During;Variable After;Before;During;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

C20050 Mitochondrial disease current vomit episode trigger present symptom onset type MtDsCrtVtEpTrgrPrstSptmOnstTyp The type triggers participant/subject may have had when symptoms began The type triggers participant/subject may have had when symptoms began For the current vomiting episodes, were 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

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

C20146 Mitochondrial disease swallow pain disrupt activity wake type MitDisSwlwPnDsrptActWakTyp The type of activity or sleep disrupted by the participant/subject's swallowing pain The type of activity or sleep disrupted by the participant/subject's swallowing pain Does pain with swallowing disrupt activity or wake child from sleep? I don't know;No;Pain disrupts activity;Pain wakes child and disrupts activity;Pain wakes child from sleep I don't know;No;Pain disrupts activity;Pain wakes child and disrupts activity;Pain wakes child 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

Single Pre-Defined Value Selected

C20093 Mitochondrial disease vision change aura experience type MitDisVisChngAuraExperTyp The type of vision change or aura experienced by the participant/subject The type of vision change or aura experienced by the participant/subject Have you/they ever experienced vision changes or auras? Vision Changes;Auras;Both;Neither Vision Changes;Auras;Both;Neither 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

C01582 Height unit of measure HgtUOM Unit of measure for the height numerical value for subject/participant Unit of measure for the height numerical value for subject/participant Height measurement Inches;Centimeters Inches;Centimeters Alphanumeric Adult;Pediatric Supplemental 3.00 2013-07-24 11:38:01.2 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Single Pre-Defined Value Selected

2538920
C20125 Mitochondrial disease current burp onset age category MitDisCurrBurpOnstAgeCat The category of participant/subject's age at onset of current burping episodes The category of participant/subject's age at onset of current burping episodes 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

C20061 Mitochondrial disease vomit bright green yellow frequency MitDisVomitBrghtGrnYelFreq The frequency with which the participant's/subject's vomit is green or yellow The frequency with which the participant's/subject's vomit is green or yellow How often has green or yellow vomiting occurred? Only once;Less than half of vomiting episodes;Most vomiting episodes;All vomiting episodes Only once;Less than half of vomiting episodes;Most vomiting episodes;All vomiting episodes 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

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

C20157 Mitochondrial disease abdominal pain detail text MitDisAbdomnlPainDetailTxt The free text field to specify additoinal details about participant's/subject's abdominal pain The free text field to specify additoinal details about participant's/subject's abdominal pain Please provide additional details about your/your child's 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

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

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

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

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

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

C20228 Mitochondrial disease GI clinical trial participate indicator MitDisGIClinTrialPartcipateInd Indicator of whether participant/subject would participate in a clinical trial Indicator of whether participant/subject would participate in a clinical trial If there was a clinical trial regarding GI issues, would you/they participate in it? 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

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

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

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

C20196 Mitochondrial disease prior bloat abdominal distension stop text MitDisPriBltAbdmlDistnsnStpTxt The free text field to specify what stopped participant's/subject's past abdominal bloating/distension The free text field to specify what stopped participant's/subject's past abdominal bloating/distension What stopped the abdominal bloating/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

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

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

C20239 Mitochondrial disease other comment text MitDisOtherCommentTxt The free text field to provide additional information The free text field to provide additional information Is there anything else you want to tell us? 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

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

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

C20207 Mitochondrial disease stool blood color category MitDisStoolColorBloodCat The category of color of blood in participant's/subject's stool The category of color of blood in participant's/subject's stool What color is the blood in the stool? Bright red;Dark red (maroon);Black;I don't know Bright red;Dark red (maroon);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

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

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

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

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

C20218 Mitochondrial disease medication GI problem worsen text MitDisMedsWorsenGIProblmTxt The free text field to specify about what medicines made the participant's/subject's GI problems worse The free text field to specify about what medicines made the participant's/subject's GI problems worse Have you/your child taken any medications in the past that you feel worsened 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

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

C20229 Mitochondrial disease time GI symptom occur prior diagnosis text MitDisTimGISymtmOccrPriDiagTxt The free text field to provide how long participant/subject had GI symptoms before being diagnosed with Mitochondrial disease The free text field to provide how long participant/subject had GI symptoms before being diagnosed with Mitochondrial disease How long did you/they have GI symptoms before you were diagnosed with 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

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

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

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

C20197 Mitochondrial disease prior bloat abdominal distension time of day type MitDisPriBltAbdmnlDstnsnTODTyp The type, as time of day, at which prior abdominal bloating/distension was worse for the participant/subject. The type, as time of day, at which prior abdominal bloating/distension was worse for the participant/subject. Was the past 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

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

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

C20328 Mitochondrial disease bowel movements current medication type MitDisBowelMvmntCurrMedsTyp Select medications that participant/subject are currently taking for help with bowel movements. Select medications that participant/subject are currently taking for help with bowel movements. What treatment do you/your child use to help with bowel movements? Glycolax, PEG, Polyethylene Glycol;Mineral oil;Kondrumel;Milk of Magnesia;Senakot or other Senna;Colace;Dulcolox suppository;Prune juice, apple juice, Karyo syrup;Fleets enema;Saline enema;Milk and molasses enema;Imodium;Lomotil;Peptobismol;Other Glycolax, PEG, Polyethylene Glycol;Mineral oil;Kondrumel;Milk of Magnesia;Senakot or other Senna;Colace;Dulcolox suppository;Prune juice, apple juice, Karyo syrup;Fleets enema;Saline enema;Milk and molasses enema;Imodium;Lomotil;Peptobismol;Other Alphanumeric Adult;Pediatric Supplemental 1.00 2015-02-18 13:01:27.0 Mitochondrial and Gastrointestinal Diseases Assessment Physical Examinations Assessments and Examinations

Multiple Pre-Defined Values 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

CSV