CDE Detailed Report

Disease: Duchenne Muscular Dystrophy/Becker Muscular Dystrophy
Sub-Domain: General Health History
CRF: Family History

Displaying 1 - 14 of 14
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
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 Relationship of Family Member to 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

Supplemental - Highly Recommended
Select the relationship from the options of the family members listed in the "Relationship of family member to participant/subject" column. Record/choose more than one family member, if applicable.

No references available Adult;Pediatric Supplemental-Highly Recommended 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
C18866 Family history muscle disease other text FmlyHistMuscleDiseaseOTH The free-text field related to 'Family history muscle disease type' specifying other text. Type of muscle disease for which participant/subject has family history The free-text field related to 'Family history muscle disease type' specifying other text. Type of muscle disease for which participant/subject has family history Muscle Disease not Duchenne Muscular Dystrophy or Becker Muscular Dystrophy Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Family History General Health History Participant History and Family History 4000

Free-Form Entry

C12663 Family history member with medical condition number FamHistMembMedclCondNum Number of family members with history of medical condition Number of family members with history of medical condition Number of Affected Family Members Numeric Values

Record the total number of family members affected by condition.

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

Free-Form Entry

1 99
C12666 Family history muscle disease type FmlyHistMuscleDiseaseTyp Type of muscle disease for which participant/subject has family history Type of muscle disease for which participant/subject has family history Muscle Disease not Duchenne Muscular Dystrophy or Becker Muscular Dystrophy DMD or BMD;Other, specify;Hereditary, specify;Inflammatory, specify DMD or BMD;Other, specify;Hereditary, specify;Inflammatory, specify Alphanumeric

Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 3.00 2013-07-24 21:00:23.88 Family History General Health History Participant History and Family History

Multiple Pre-Defined Values Selected

C17872 Family history medical condition text FmlyHistMedclCondTxt Specification of other disease that a family member or ancestor of the participant/subject has had a history of a medical condition or health related event Specification of other disease that a family member or ancestor of the participant/subject has had a history of a medical condition or health related event Condition Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-24 11:24:12.51 Family History General Health History Participant History and Family History 255

Free-Form Entry

C18201 Family history DMD BMD diagnosis age value FmlyHistDMDBMDDiagnsisAgeVal Age at which relative was diagnosed with DMD or BMD Age at which relative was diagnosed with DMD or BMD Age when diagnosed? Numeric Values No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 Family History General Health History Participant History and Family History

Free-Form Entry

C18203 Family history DMD BMD death cause text FmlyHistDMDBMDDeathCauseTxt Text describing the cause of death for relative with DMD or BMD Text describing the cause of death for relative with DMD or BMD Cause of Death? Alphanumeric

Record the cause of death using explanatory text and the associated ICD-9-CM code. Include the primary cause of death first followed by any secondary causes.

No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 Family History General Health History Participant History and Family History 255

Free-Form Entry

C18205 Family history DMD BMD current decease age value FmlyHistDMDBMDCrrntDecesAgeVal Value of current age or age at death for relative with DMD or BMD Value of current age or age at death for relative with DMD or BMD Current Age or Age at Death Numeric Values No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 Family History General Health History Participant History and Family History

Free-Form Entry

C18206 Family history DMD BMD relative decease indicator FmlyHistDMDBMDReltvDeceseInd Indicator for whether relative with DMD or BMD is deceased Indicator for whether relative with DMD or BMD is deceased Deceased? Yes;No;Unknown Yes;No;Unknown Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

C18207 Family history DMD BMD diagnosis type FmlyHistDMDBMDDiagnsisTyp Type of diagnosis method for relative with DMD or BMD Type of diagnosis method for relative with DMD or BMD Diagnosed? Clinical diagnosis;Genetic Testing;Muscle biopsy;Obligate carrier based on family structure;Don't know/ Unsure;Not applicable Clinical diagnosis;Genetic Testing;Muscle biopsy;Obligate carrier based on family structure;Don't know/ Unsure;Not applicable Alphanumeric No references available Adult;Pediatric Supplemental 3.00 2013-07-21 12:11:21.037 Family History General Health History Participant History and Family History

Single Pre-Defined Value Selected

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;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Duchenne or Becker Muscular Dystrophy;Dystonia;Epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease (not Duchenne or Becker muscular dystrophy);Neuromuscular disease;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Stroke;Suicide or suicide attempt;Tourette syndrome;Other, specify Alzheimer's disease;Dementia;Amyotrophic lateral sclerosis (ALS);Ataxia;Autism;Bi-polar disorder;Cancer;Depression;Developmental delays;Diabetes mellitus;Duchenne or Becker Muscular Dystrophy;Dystonia;Epilepsy;Headaches;Heart disease;Learning disability;Memory loss;Multiple sclerosis;Muscle disease (not Duchenne or Becker muscular dystrophy);Neuromuscular disease;Peripheral neuropathy;Parkinson's disease;Schizophrenia;Stroke;Suicide or suicide attempt;Tourette syndrome;Other, specify Alphanumeric

Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental 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
C18678 Family history medical condition other text FamHistMedclCondOTH The free-text field related to 'Family history medical condition type' specifying other text. Type of medical condition or health related event for which the family history is taken The free-text field related to 'Family history medical condition type' specifying other text. Type of medical condition or health related event for which the family history is taken Other, specify Alphanumeric 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

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 Family History? Yes;No;Unknown Yes;No;Unknown Alphanumeric

If there is a history of this condition in the first or second degree family, indicate YES, otherwise choose NO.
Supplemental - Highly Recommended

No references available Adult;Pediatric Supplemental-Highly Recommended 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
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 in the "Relationship of family member to participant/subject" column. Record/choose more than one family member, if applicable.
Supplemental - Highly Recommended

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

Free-Form Entry

3165810
CSV