CDE Detailed Report

Disease: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome
Subdomain Name: General Health History
CRF: Family Health History

Displaying 1 - 41 of 41
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
C58098 Neurological seizure type text NeurologiclSeizureTypTxt Text of type of neurological seizures that the subject's/participant's family relative has ever been diagnosed with Text of type of neurological seizures that the subject's/participant's family relative has ever been diagnosed wit Seizures, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58109 Cardiovascular arrhythmia disease type text CardiovascArrhythDiseaseTypTxt Text of cardiovascular arrhythmia disease type that the subject's/participant's family relative has ever been diagnosed with Text of cardiovascular arrhythmia disease type that the subject's/participant's family relative has ever been diagnosed wit Heart arrhythmia, atrial fibrillation, fainting, pacemaker, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58122 Other condition other gynecological condition type text OthCondtnOthGyneclCondTyptTxt Text of other conditions other gynecological condition type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions other gynecological condition type that the subject's/participant's family relative has ever been diagnosed wit Other gynecological conditions, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58088 Blood disorders anemia type text BloodDisordAnemiaTypTxt Text of anemia type blood disorder that the subject's/participant's family relative has ever been diagnosed with Text of anemia type blood disorder that the subject's/participant's family relative has ever been diagnosed wit Anemia requiring treatment/transfusions, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58099 Family health problems rheumatological history type FamHlthPrblmRheumatolHistTyp Type of rheumatological health problems that the subject's/participant's family relative has ever been diagnosed with Type of rheumatological health problems that the subject's/participant's family relative has ever been diagnosed wit Rheumatological Osteoarthritis (specify major joints involved if possible);Rheumatoid arthritis, Systemic Lupus, Sjogren's, Polymyalgia Rheumatica, or other;Fibromyalgia or myofascial pain syndrome Osteoarthritis (specify major joints involved if possible);Rheumatoid arthritis, Systemic Lupus, Sjogren's, Polymyalgia Rheumatica, or other;Fibromyalgia or myofascial pain syndrome Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58110 Endocrine metabolic diabetes type text EnocrnMetabDiabetesTypTxt Text of endocrine/metabolic diabetes type of that the subject's/participant's family relative has ever been diagnosed with Text of endocrine/metabolic diabetes type of that the subject's/participant's family relative has ever been diagnosed wit Diabetes type, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58123 Other condition other birth defect type text OthCondtnBirthDefectTyptTxt Text of other conditions birth defect type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions birth defect type that the subject's/participant's family relative has ever been diagnosed wit Specify defect: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58089 Family health problems cardiovascular history type FamHlthPrblmCardiovascHistTyp Any type of cardiovascular health problems that the subject's/participant's family relative has ever been diagnosed with Any type of cardiovascular health problems that the subject's/participant's family relative has ever been diagnosed wit Cardiovascular High blood pressure (hypertension);Very low blood pressure, orthostatic hypotension;High total or LDL (''bad'') cholesterol, or triglycerides;Heart attack, coronary artery disease, angina, bypass surgery, stent placement, other;Cardiomyopathy, myocarditis, heart value disease, heart failure, other;Heart arrhythmia, atrial fibrillation, fainting, pacemaker;Raynaud's phenomenon/syndrome High blood pressure (hypertension);Very low blood pressure, orthostatic hypotension;High total or LDL (''bad'') cholesterol, or triglycerides;Heart attack, coronary artery disease, angina, bypass surgery, stent placement, other;Cardiomyopathy, myocarditis, heart value disease, heart failure, other;Heart arrhythmia, atrial fibrillation, fainting, pacemaker;Raynaud's phenomenon/syndrome Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58100 Rheumatological arthritis type text RheumatolArthritisTypTxt Text of rheumatological arthritis type that the subject's/participant's family relative has ever been diagnosed with Text of rheumatological arthritis type that the subject's/participant's family relative has ever been diagnosed wit Arthritis type, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58111 Endocrine metabolic endocrine disorder type text EnocrnMetabEndocrnDisordTypTxt Text of endocrine/metabolic endocrine disorder type of that the subject's/participant's family relative has ever been diagnosed with Text of endocrine/metabolic endocrine disorder type of that the subject's/participant's family relative has ever been diagnosed wit Other endocrine disorder, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58124 Other condition other important condition type text OthCondtnOthImprtCondTyptTxt Text of other conditions other important conditions type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions other important conditions type that the subject's/participant's family relative has ever been diagnosed wit Other important conditions, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58090 Cardiovascular low blood pressure type text CardiovascLowBloodPressTypTxt Text of cardiovascular low blood pressure type that the subject's/participant's family relative has ever been diagnosed with Text of cardiovascular low blood pressure type that the subject's/participant's family relative has ever been diagnosed wit Very low blodd pressure, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58101 Family health problems psychological history type FamHlthPrblmPsycholHistTyp Type of psychological health problems that the subject's/participant's family relative has ever been diagnosed with Type of psychological health problems that the subject's/participant's family relative has ever been diagnosed wit Psychological Anxiety/panic disorder;Depression;Anorexia or bulimia;Substance abuse (alcohol, drugs);Obsessive-compulsive disorder, attention deficit disorder;Bipolar disorder/manic depressive disorder;Other type of psychosis Anxiety/panic disorder;Depression;Anorexia or bulimia;Substance abuse (alcohol, drugs);Obsessive-compulsive disorder, attention deficit disorder;Bipolar disorder/manic depressive disorder;Other type of psychosis Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58113 Gastrointestinal intestine problems type text GIIntestinePrlblmTypTxt Text of type of gastrointestinal intestine problems that the subject's/participant's family relative has ever been diagnosed with Text of type of gastrointestinal intestine problems that the subject's/participant's family relative has ever been diagnosed wit Intestine problems, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58091 Family health problems chest history type FamHlthPrblmChestHistTyp Any type of chest health problems that the subject's/participant's family relative has ever been diagnosed with Any type of chest health problems that the subject's/participant's family relative has ever been diagnosed wit Chest Lung or breathing problems (asthma, COPD, other) Lung or breathing problems (asthma, COPD, other) Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C58102 Obsessive compulsive attention deficit disorder type text ObsComplsAttnDefctlDsordTypTxt Text of obsessive compulsive or attention deficit disorder type that the subject's/participant's family relative has ever been diagnosed with Text of obsessive compulsive or attention deficit disorder type that the subject's/participant's family relative has ever been diagnosed wit Obsessive-compulsive disorder, attention deficit disorder, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58114 Neurological Alzheimer disease type text NeurologiclAlzheimerDisTypTxt Text of type of neurological Alzheimer disease that the subject's/participant's family relative has ever been diagnosed with Text of type of neurological Alzheimer disease that the subject's/participant's family relative has ever been diagnosed wit Specify type and age of onset: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58092 Chest lung breathing problem type text ChestLungBreathPrblmTypTxt Text of type of lung or breathing problems that the subject's/participant's family relative has ever been diagnosed with Text of type of lung or breathing problems that the subject's/participant's family relative has ever been diagnosed wit Lung or breathing problems, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58103 Family health problem other condition history type FamHlthPrblmOthConditnHistTyp Type of other conditions health problems that the subject's/participant's family relative has ever been diagnosed with Type of other conditions health problems that the subject's/participant's family relative has ever been diagnosed wit Other conditions Allergies: nasal, skin (eczema), asthma, food, hives, anaphylaxis, other;Kidney or bladder stones or infections, or other urine system problems;Cancer;Irritable bowel syndrome (IBS);Multiple chemical sensitivities (MCS);Temporo-mandibular joint disorder (TMJ);Migraine headaches;Gulf War Syndrome;Chronic fatigue syndrome, post-infectious fatigue syndrome, myalgic encephalomyelitis (ME), other;Frequent fatigue of uncertain cause (not ME or CFS);Polycystic ovaries, polycystic ovarian syndrome;Infertility;Endometriosis;Other gynecologic condition;Birth, familial or genetic defects, Marfan Syndrome, Ehlers Danlos Syndrome;Other important conditions (including autoimmune diseases) Allergies: nasal, skin (eczema), asthma, food, hives, anaphylaxis, other;Kidney or bladder stones or infections, or other urine system problems;Cancer;Irritable bowel syndrome (IBS);Multiple chemical sensitivities (MCS);Temporo-mandibular joint disorder (TMJ);Migraine headaches;Gulf War Syndrome;Chronic fatigue syndrome, post-infectious fatigue syndrome, myalgic encephalomyelitis (ME), other;Frequent fatigue of uncertain cause (not ME or CFS);Polycystic ovaries, polycystic ovarian syndrome;Infertility;Endometriosis;Other gynecologic condition;Birth, familial or genetic defects, Marfan Syndrome, Ehlers Danlos Syndrome;Other important conditions (including autoimmune diseases) Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58115 Neurological sleep disorder type text NeurologiclSleepDisTypTxt Text of type of neurological sleep disorder that the subject's/participant's family relative has ever been diagnosed with Text of type of neurological sleep disorder that the subject's/participant's family relative has ever been diagnosed wit Sleep disorders, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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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 Supplemental-Highly Recommended 3.00 2013-06-21 00:00:00.0 Family Health History General Health History Participant History and Family History 255

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C58093 Family health problems endocrine metabolic history type FamHlthPrblmEndocrMetabHistTyp Any type of endocrine/metabolic health problem that the subject's/participant's family relative has ever been diagnosed with Any type of endocrine/metabolic health problem that the subject's/participant's family relative has ever been diagnosed wit Endocrine/Metabolic Diabetes (indicate if type I, type II);Metabolic syndrome or pre-diabetes;Obesity;Pituitary, adrenal, or other endocrine disorder;Thyroid disease: Hypothyroid (underactive thyroid, like Hashimoto's), overactive thyroid, thyroid nodules, thyroid cancer, other Diabetes (indicate if type I, type II);Metabolic syndrome or pre-diabetes;Obesity;Pituitary, adrenal, or other endocrine disorder;Thyroid disease: Hypothyroid (underactive thyroid, like Hashimoto's), overactive thyroid, thyroid nodules, thyroid cancer, other Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58104 Other condition allergy type text OthConditnAllergyTyptTxt Text of other conditions allergies type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions allergies type that the subject's/participant's family relative has ever been diagnosed wit Allergies, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58116 Neurological neuromuscular disorder type text NeurologiclNeuromuscDisTypTxt Text of type of neurological neuromuscular disorder that the subject's/participant's family relative has ever been diagnosed with Text of type of neurological neuromuscular disorder that the subject's/participant's family relative has ever been diagnosed wit Neuromuscular disorders, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C18027 Comment text CmmntTxt Provide any additional information that pertains to the question Provide any additional information that pertains to the question Comments Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 3.00 2013-07-16 14:01:43.01 Family Health History General Health History Participant History and Family History 4000

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C58094 Endocrine metabolic thyroid disease type text EnocrnMetabThyroidDisTypTxt Text of endocrine/metabolic thyroid disease type of that the subject's/participant's family relative has ever been diagnosed with Text of endocrine/metabolic thyroid disease type of that the subject's/participant's family relative has ever been diagnosed wit Thyroid disease, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58105 Blood disorders bleeding disorder type text BloodDisordBleedngDisordTypTxt Text of bleedintg disorder type blood disorder that the subject's/participant's family relative has ever been diagnosed with Text of bleedintg disorder type blood disorder that the subject's/participant's family relative has ever been diagnosed wit Bleeding disorder or blood clots, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58117 Psychological other psychosis type text PsycholOtherPsychosisTypTxt Text of psychological other psychosis type that the subject's/participant's family relative has ever been diagnosed with Text of psychological other psychosis type that the subject's/participant's family relative has ever been diagnosed wit Other psychosis, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C19247 Subject ID SubIDNam Subject identification ID Subject identification ID Subject ID: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2014-06-05 13:10:49.0 Family Health History General Health History Participant History and Family History 255

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C58095 Family health problems gastrointestinal history type FamHlthPrblmGIHistTyp Any type of gastrointestinal health problem that the subject's/participant's family relative has ever been diagnosed with Any type of gastrointestinal health problem that the subject's/participant's family relative has ever been diagnosed wit Gastrointestinal Stomach problems (e.g., gastro-esophageal reflux disorder (GERD/heartburn, ulcers, celiac disease, or other);Intestine problems (e.g., colon polyps, colon cancer, ulcerative colitis, Crohns disease, other) Stomach problems (e.g., gastro-esophageal reflux disorder (GERD/heartburn, ulcers, celiac disease, or other);Intestine problems (e.g., colon polyps, colon cancer, ulcerative colitis, Crohns disease, other) Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58106 Cardiovascular cholesterol type text CardiovascCholesterolTypTxt Text of cardiovascular cholesterol type that the subject's/participant's family relative has ever been diagnosed with Text of cardiovascular cholesterol type that the subject's/participant's family relative has ever been diagnosed wit High total or LDL cholesterol or tryglycerides, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58118 Other condition kidney problem type text OthConditnsKidneyPrblmTyptTxt Text of other conditions kidney problems type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions kidney problems type that the subject's/participant's family relative has ever been diagnosed wit Kidney problems, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C19256 Study protocol name StudyProtocolName Name of study protocol Name of study protocol Study Name Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2014-06-05 16:38:14.0 Family Health History General Health History Participant History and Family History 4000

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C58096 Gastrointestinal stomach problems type text GIStomachPrlblmTypTxt Text of type of gastrointestinal stomach problems that the subject's/participant's family relative has ever been diagnosed with Text of type of gastrointestinal stomach problems that the subject's/participant's family relative has ever been diagnosed wit Stomach problems type, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58107 Cardiovascular heart disease type text CardiovascHeartDiseaseTypTxt Text of cardiovascular heart disease type that the subject's/participant's family relative has ever been diagnosed with Text of cardiovascular heart disease type that the subject's/participant's family relative has ever been diagnosed wit Heart disease, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58119 Other condition cancer type text OthConditnCancerTyptTxt Text of other conditions cancer type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions cancer type that the subject's/participant's family relative has ever been diagnosed wit Specify type, site, age when diagnosed Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58086 Family health problems history relative type FamHlthProblmHistRelatvTyp Field where participant/subject can indicate which family member(s) has a history of the listed health problem conditions Field where participant/subject can indicate which family member(s) has a history of the listed health problem condition Blood relative Mother;Father;Brothers;Sisters;Son;Daughter Mother;Father;Brothers;Sisters;Son;Daughter Alphanumeric

Indicate any of the following health problems have occurred to any blood relatives, including partient's parents, siblings (full and half), and children. Write Y for Yes, N for No, and D.K. for Don't' Know.

Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-25 16:54:19.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58097 Family health problems neurological history type FamHlthPrblmNeurologiclHistTyp Any type of neurological health problems that the subject's/participant's family relative has ever been diagnosed with Any type of neurological health problems that the subject's/participant's family relative has ever been diagnosed wit Neurological Seizures, convulsions, epilepsy, pseudoseizures;Parkinson's disease;Alzheimer's disease or other dementia(s);Multiple sclerosis;Stroke or TIA (mini-stroke);Primary sleep disorders: obstructive or central sleep apnea, narcolepsy, restless legs syndrome, other;Neuromuscular disorders: (e.g., Huntington's, amyotrophic lateral sclerosis, muscular dystrophy, myasthenia gravis) Seizures, convulsions, epilepsy, pseudoseizures;Parkinson's disease;Alzheimer's disease or other dementia(s);Multiple sclerosis;Stroke or TIA (mini-stroke);Primary sleep disorders: obstructive or central sleep apnea, narcolepsy, restless legs syndrome, other;Neuromuscular disorders: (e.g., Huntington's, amyotrophic lateral sclerosis, muscular dystrophy, myasthenia gravis) Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C58108 Cardiovascular myopathy disease type text CardiovascMyopthyDiseaseTypTxt Text of cardiovascular myopathy disease type that the subject's/participant's family relative has ever been diagnosed with Text of cardiovascular myopathy disease type that the subject's/participant's family relative has ever been diagnosed wit Cardiomyopathy, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58121 Other condition fatigue syndrome type text OthCondtnFatiqueSyndrmTyptTxt Text of other conditions fatigue syndromes type that the subject's/participant's family relative has ever been diagnosed with Text of other conditions fatigue syndromes type that the subject's/participant's family relative has ever been diagnosed wit Fatigue syndromes, Specify: Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History 255

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C58087 Family health problems blood disorders history type FamHlthPrblmBloodDisordHistTyp Any type of blood disorder(s) health problems that the subject's/participant's family relative has ever been diagnosed with Any type of blood disorder(s) health problems that the subject's/participant's family relative has ever been diagnosed wit Blood Disorders Anemia requiring treatment/transfusions (iron deficiency, sickle cell, thalassemia);Bleeding disorder or blood clots in legs or lungs;Leukemia or lymphoma Anemia requiring treatment/transfusions (iron deficiency, sickle cell, thalassemia);Bleeding disorder or blood clots in legs or lungs;Leukemia or lymphoma Alphanumeric Adult;Pediatric Supplemental-Highly Recommended 1.00 2018-01-26 09:47:06.0 Family Health History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

CSV