CDE Detailed Report
Disease: Cerebral Palsy
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 9 of 9
Subdomain Name: General Health History
CRF: Family History
Displaying 1 - 9 of 9
| 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 / Guidance) | Subdomain Name | Domain Name | Size | Input Restrictions | Min Value | Max Value | Measurement Type | External Id Loinc | External Id Snomed | External Id caDSR | External Id CDISC |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| C12663 | Family history member with medical condition count | FamHistMembWithMedclCondCt | Count of family members with history of medical condition | Count of family members with history of medical condition | Number of Affected Family Members | Numeric Values |
Enter total number of family members affected by the condition |
Adult;Pediatric | Supplemental | 4.00 | 2022-08-08 10:47:27.0 | Family History | General Health History | Participant History and Family History |
Free-Form Entry |
1 | 99 | |||||||||
| C17402 | Site name | SiteName | The name of the site for the study | The name of the site for the study | Site Name | Alphanumeric | Adult;Pediatric | Core | 3.00 | 2013-06-21 00:00:00.0 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C17681 | Family history collection source | FamHxCollSource | The source of collected family history data | The source of collected family history data | Source from which medical and family history obtained? | Participant/subject;Informant;Medical records | Participant/subject;Informant;Medical records | Alphanumeric | Adult;Pediatric | Core | 4.00 | 2024-02-29 15:42:31.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
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| C18679 | Family history medical condition relative type other text | FamHistMedclCondReltvTypOTH | The free-text field related to 'Family history medical condition relative type', specifying other text. Relationship of the family member or ancestor with the medical condition or health related event to the participant | The free-text field related to 'Family history medical condition relative type', specifying other text. Relationship of the family member or ancestor with the medical condition or health related event to the participant | Other, specify | Alphanumeric | Adult;Pediatric | Supplemental | 1.10 | 2024-02-29 15:42:37.0 | Family History | General Health History | Participant History and Family History | 4000 |
Free-Form Entry |
3165810 | ||||||||||
| C19247 | Subject ID | SubIDNam | Subject identification ID | Subject identification ID | Subject ID | Alphanumeric | Adult;Pediatric | Core | 1.00 | 2014-06-05 13:10:49.0 | Family History | General Health History | Participant History and Family History | 255 |
Free-Form Entry |
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| C00720 | Family history medical condition type | FamHistMedclCondTyp | Type of medical condition or health related event for which the family history is taken | Type of medical condition or health related event for which the family history is taken | Condition | Alzheimer's disease;Dementia;Ataxia;Autism;Depression;Developmental delays;Dystonia;Epilepsy;Seizures without diagnosis of epilepsy;Learning disability;Memory loss;Muscle disease: Congenital;Muscle disease: acquired or postnatal onset;Neuromuscular junction: Congenital;Neuromuscular junction: Postnatal onset;Peripheral neuropathy;Schizophrenia;Stroke;Walking delays / Late acquisition of walking;Early onset neural degeneration (loss of skills);Mitochondrial disease;Miscarriages and pregnancy-related complications;Child-onset diseases;Cerebral palsy;Thrombotic or clotting diseases;Toe walking;Blindness;Deafness;Intellectual disability or mental retardation;Known genetic syndrome;Other, specify | Alzheimer's disease;Dementia;Ataxia;Autism;Depression;Developmental delays;Dystonia;Epilepsy;Seizures without diagnosis of epilepsy;Learning disability;Memory loss;Muscle disease: Congenital;Muscle disease: acquired or postnatal onset;Neuromuscular junction: Congenital;Neuromuscular junction: Postnatal onset;Peripheral neuropathy;Schizophrenia;Stroke;Walking delays / Late acquisition of walking;Early onset neural degeneration (loss of skills);Mitochondrial disease;Miscarriages and pregnancy-related complications;Child-onset diseases;Cerebral palsy;Thrombotic or clotting diseases;Toe walking;Blindness;Deafness;Intellectual disability or mental retardation;Known genetic syndrome;Other, specify | Alphanumeric |
This CDE should be collected along with the "Family history medical condition indicator". |
Adult;Pediatric | Supplemental | 4.00 | 2024-02-29 15:42:34.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165585 | ||||||||
| C00721 | Family history medical condition indicator | FamHistMedclCondInd | Indicator of whether a family member or first and second degree blood relatives of the participant has had a history of the particular medical condition or health related event | Indicator of whether a family member or first and second degree blood relatives of the participant has had a history of the particular medical condition or health related event | Family History? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric |
Indicator of whether a family member or first and second degree blood relatives of the participant/subject has had a history of the particular medical condition or health related event |
Adult;Pediatric | Core | 4.00 | 2024-02-29 15:42:36.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
3165788 | ||||||||
| C00722 | Family history medical condition relative type | FamHistMedclCondReltvTyp | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relationship of the family member or ancestor with the medical condition or health related event to the participant | Relationship of Family Member Participant/Subject | Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | Mother;Father;Full sibling;Half sibling;Child;Maternal grandmother;Paternal grandmother;Maternal grandfather;Paternal grandfather;Maternal aunt;Paternal aunt;Maternal uncle;Paternal uncle;Maternal niece/nephew;Paternal niece/nephew;Grandchild;Other, specify;Maternal cousin;Paternal cousin;Great-grandchild | Alphanumeric |
Select the relationship from the options of the family members listed. Record/choose more than one family member, if applicable. |
Adult;Pediatric | Supplemental | 4.00 | 2024-03-18 15:21:17.0 | Family History | General Health History | Participant History and Family History |
Multiple Pre-Defined Values Selected |
3165810 | ||||||||
| C10813 | Adopted indicator | AdoptedInd | Indicator of whether the participant was adopted | Indicator of whether the participant was adopted | Are you (participant/subject) adopted? | Yes;No;Unknown | Yes;No;Unknown | Alphanumeric | Adult;Pediatric | Core | 3.10 | 2024-02-29 15:42:33.0 | Family History | General Health History | Participant History and Family History |
Single Pre-Defined Value Selected |
