CDE Detailed Report

Disease: Amyotrophic Lateral Sclerosis
Sub-Domain: General Health History
CRF: Family History

Displaying 1 - 9 of 9
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
C10814 Parents biologically related indicator ParntsBioRltdInd The indicator whether the subject's/participant's parents are biologically related. The indicator whether the subject's/participant's parents are biologically related. Are your parents, cousins, or otherwise biologically related to each other? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one

No references available Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18679 Family history medical condition relative other text FamHistMedclCondReltvOTH 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/subject 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/subject Other, specify Alphanumeric

Select the relationship from the options of the family members listed. Record/choose more than one family member, if applicable.

No references available Adult;Pediatric Supplemental 1.00 2014-05-27 13:34:46.0 Family History General Health History Participant History and Family History 4000

Free-Form Entry

3165810
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 Diagnosis Amyotrophic lateral sclerosis (ALS);Frontotemporal dementia (FTD);Other neurological disorder, specify Amyotrophic lateral sclerosis (ALS);Frontotemporal dementia (FTD);Other neurological disorder, (specify) Alphanumeric

This CDE should be collected along with the "Family history medical condition indicator".

No references available Adult;Pediatric Core 3.00 2013-07-24 11:38:01.2 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/subject 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/subject has had a history of the particular medical condition or health related event Has anyone in your family ever been diagnosed with Amyotrophic Lateral Sclerosis (ALS) or Frontotemporal Dementia (FTD)? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If Yes, attach pedigree and complete the table.

No references available Adult;Pediatric Core 3.00 2013-07-24 11:38:01.2 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

3165788
C00722 Family history medical condition relative type FamHistMedclCondReltvTy Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject Relationship of the family member or ancestor with the medical condition or health related event to the participant/subject Relative 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.

No references available Adult;Pediatric Core 3.00 2013-07-24 11:38:01.2 Family History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

3165810
C08000 Family history relative type total member number FmlyHistRelTypeTotalMembrNum Number of total family relatives with a specific type of prior medical history. Number of total family relatives with a specific type of prior medical history. Number of family members Numeric Values

Record the number of family members that correspond to the relative listed.

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Free-Form Entry

0 100
C08001 Family history relative type biological sample in repository indicator FmlyHistRelTypBioSampleRepInd Indicator of whether the participant's/subject's family member has donated biological sample(s) to a repository Indicator of whether the participant's/subject's family member has donated biological sample(s) to a repository Family Member Sample/s in Repository? Yes;No;Unknown Yes;No;Unknown Alphanumeric

Choose one for each relative type

No references available Adult;Pediatric Supplemental 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C08002 Family history relative type biological sample identifier number FamHistReltvTypBioSampIDNum Identification (ID) number assigned to family member's biological sample in repository Identification (ID) number assigned to family member's biological sample in repository Yes, Subject ID/s Alphanumeric

Only answered if "Family member sample(s) in repository?" is answered YES

No references available Adult Supplemental 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History 255

Free-Form Entry

C10813 Adopted indicator AdoptedInd Whether the subject/participant was adopted Whether the subject/participant was adopted Are you adopted? Yes;No Yes;No Alphanumeric

Choose one

No references available Adult;Pediatric Core 3.00 2013-07-22 16:57:17.79 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

CSV