CDE Detailed Report

Disease: Cerebral Palsy
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
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

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

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

Enter total number of family members affected by the condition

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
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

C17681 Family history collection source FamHxCollSrce 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 3.00 2013-08-30 17:06:52.8 Family History General Health History Participant History and Family History

Multiple Pre-Defined Values 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 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
CSV