Attachment 8 NEDSS Data Elements Optional Fields

ATT- 8 NEDSS Data Elements 11-4-05 Optional Fields.xls

The National Electronic Disease Surveillance System (NEDSS)

Attachment 8 NEDSS Data Elements Optional Fields

OMB: 0920-0728

Document [ppt]
Download: ppt | pdf

Overview

ATT-8
Generic Data Elements
Gen BMIRD
Grp A Strept
H. Influenzae
Neis. Mening.
Strept. Pneumo
Anim. Rabies
CRS
Measles
Mumps
Pertussis
Rubella
Tetanus
GEN. HEP.
Hep A, Acute
Hep B, Acute
Hep C, Acute
Hep C, Chronic
HBV, Perinatal
Isolate Tracking
Foodborne Questions
Lyme Disease

Sheet 1: ATT-8
Attachment 8

NEDSS Data Elements 11-4-05

Optional Fields.xls

Sheet 2: Generic Data Elements
UID AppVer Label Description Fmt Min Max VSName
DEM113 NEDSS 1.1.3 SubjectAdministrativeGender Subjects current administrative gender. Gender is a complex physiological, genetic and sociological concept that requires multiple observations in order to be comprehensively described. The purpose of this attribute is to provide a high level classification CE 0 1 PHVS_AdministrativeGender_CDC
DEM115 NEDSS 1.1.3 SubjectBirthTime Reported date of birth of the subject. TS 0 1
DEM128 NEDSS 1.1.3 SubjectDeathTime The date and time the subject's death occurred. TS 0 1
DEM152 NEDSS 1.1.3 SubjectRaceCategory Reported race; supports collection of multiple race categories. This field could repeat. CE 0 N PHVS_Race_CDC
DEM155 NEDSS 1.1.3 SubjectHispanicIndicator Subject Hispanic Indicator CE 0 1 PHVS_EthnicityGroup_CDC
DEM156 NEDSS 1.1.3 SubjectEthnicGroup Reported ethnicity of the subject. CE 0 N PHVS_Ethnicity_CDC
DEM163 NEDSS 1.1.3 SubjectResidencePostalCode The zip code of the residence of the subject. If the zipcode isn't coded, then use originalText attribute. CE 0 1
DEM165 NEDSS 1.1.3 SubjectResidenceCountyCode The county of residence of the subject. If the county isn't coded, then use originalText attribute. CE 0 1 PHVS_County_FIPS_6-4
INV110 NEDSS 1.1.3 Investigation Date Assigned Date the investigator was assigned to this investigation. DATE 0 1
INV111 NEDSS 1.1.3 ReportDate Date first reported by reporting source. DATE 0 1
INV112 NEDSS 1.1.3 Reporting Source Type Code Type of facility or provider associated with the source of information sent to Public Health. CE 0 1 PHVS_PHC_RPT_SRC_T
INV118 NEDSS 1.1.3 Reporting Source PostalCode Zip Code of the reporting source for this case. ST 0 1
INV120 NEDSS 1.1.3 Earliest Date Reported County Earliest date reported to county public health system. DATE 0 1
INV121 NEDSS 1.1.3 Earliest Date Reported State Earliest date reported to state public health system. DATE 0 1
INV128 NEDSS 1.1.3 Patient Hospitalized Was the patient hospitalized as a result of this event? CE 0 1 PHVS_YNU
INV129 NEDSS 1.1.3 Hospital Name Name of the hospital in which the subject was hospitalized. ST 0 1
INV130 NEDSS 1.1.3 Hospital ID The hospital ID of the hospital in which the subject is hospitalized. ID 0 1
INV132 NEDSS 1.1.3 Admission Date Subject's admission date to the hospital for the condition covered by the investigation. DATE 0 0
INV133 NEDSS 1.1.3 Discharge Date Subject's discharge date from the hospital for the condition covered by the investigation. DATE 0 1
INV134 NEDSS 1.1.3 Total Duration Hospital Stay Subject's duration of stay at the hospital for the condition covered by the investigation.(include units) PQ 0 1 PHVS_DurationUnit_UCUM
INV136 NEDSS 1.1.3 Diagnosis Date Date of diagnosis of condition being reported to public health system. DATE 0 1
INV137 NEDSS 1.1.3 Date Onset Illness Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system. DATE 0 1
INV138 NEDSS 1.1.3 Illness End Date The time at which the disease or condition ended. DATE 0 1
INV139 NEDSS 1.1.3 Illness Duration The length of time this person had this disease or condition.(Include time units) PQ 0 1 PHVS_DurationUnit_UCUM
INV145 NEDSS 1.1.3 Patient Death Did the patient die as a result of this condition? CE 0 1 PHVS_YNU
INV147 NEDSS 1.1.3 Investigation Start Date The date the investigation was started or initiated. DATE 0 1
INV148 NEDSS 1.1.3 Associated With Daycare Generic investigation element that may be used to indicate whether the patient is associated with daycare. CE 0 1 PHVS_YNU
INV149 NEDSS 1.1.3 Food Handler Generic investigation element that may be used to indicate whether patient was a food handler. CE 0 1 PHVS_YNU
INV150 NEDSS 1.1.3 Case Outbreak Indicator Denotes whether the reported case was associated with an identified outbreak. CE 0 1 PHVS_YNU
INV151 NEDSS 1.1.3 Case Outbreak Name A name assigned to an individual outbreak. State assigned in SRT. Should show only those outbreaks for the program area of the investigation. ST 0 1
INV152 NEDSS 1.1.3 Case Disease Imported Code Indication of where the disease/condition was likely acquired. CE 0 1 PHVS_PHC_IMPRT
INV153 NEDSS 1.1.3 Imported Country If the disease or condition was imported, may be used to indicate the country in which the disease was likely acquired. CE 0 1 PHVS_Country_ISO_3166-1
INV154 NEDSS 1.1.3 Imported State If the disease or condition was imported, may be used to indicate the state in which the disease was likely acquired. CE 0 1 PHVS_State_FIPS_5-2
INV155 NEDSS 1.1.3 Imported City If the disease or condition was imported, may be used to type in the city in which the disease was likely acquired. ST 0 1
INV156 NEDSS 1.1.3 Imported County If the disease or condition was imported, this field will contain the county of origin of the disease or condition. CE 0 1 PHVS_County_FIPS_6-4
INV157 NEDSS 1.1.3 Transmission Mode Indicates how the condition was transmitted to the patient. CE 0 1 PHVS_PHC_TRAN_M
INV159 NEDSS 1.1.3 Detection Method Indicates how the condition was detected or recognized. CE 0 N PHVS_PHC_DET_MT
INV161 NEDSS 1.1.3 Confirmation Method Mechanism by which the case was classified. This attribute is intended to provide information about how the case classification status was derived. CE 0 N PHVS_PHC_CONF_M
INV162 NEDSS 1.1.3 Confirmation Date Confirmation Date DATE 0 1
INV163 NEDSS 1.1.3 Case Class Status Code Indication of the level of certainty regarding whether a person has a disease/condition. Where applicable, is defined by CSTE/CDC Standard Case Definition. For example: Confirmed, Probable or Suspect case. This is a required field. CE 0 1 PHC_CLASS
INV168 NEDSS 1.1.3 Investigation Local ID System-assigned local ID of the investigation that the case subject/entity is associated with. This is a required field. ID 0 1
INV170 NEDSS 1.1.3 Condition Code Desc Text Textual description of the condition or disease for which the investigation is based. Such as HIV infection, Tuberculosis or Acute Hepatitis B. ST 0 1
INV173 NEDSS 1.1.3 State Case ID States may use this field to report the Case ID assigned at the state level. This is probably a manually input Case ID as opposed to the "InvestigationLocalId". W ID 0 1
INV176 NEDSS 1.1.3 Date First Report CDC The date the case was first reported to the CDC. DATE 0 1
INV177 NEDSS 1.1.3 Date First Reported PHD The earliest date the case was reported to a public health department. DATE 0 1
INV178 NEDSS 1.1.3 Pregnancy Status Generic investigation element that may be used to indicate whether the patient is pregnant. Though only valid for female patients, there will be no edit restricting this. CE 0 1 PHVS_YNU
INV179 NEDSS 1.1.3 Pelvic Inflammatory Disease May be used to indicate whether or not the patient has pelvic inflammatory disease (PID). Though only valid for female patients, there will be no edit restricting this. CE 0 1 PHVS_YNU
INV2001 NEDSS 1.1.3 Patient Reported Age The patient's reported age at time of event (include units) PQ 0 1 PHVS_AgeUnit_UCUM
LAB102 NEDSS 1.1.3 Text Test Result This field conveys the test result for textual results. ST 0 1
LAB108 NEDSS 1.1.3 Lab Result Date The date and time the test result was released by the laboratory. DATE 0 1
LAB114 NEDSS 1.1.3 Number Test Result This field conveys the test result when the result is numeric. REAL 0 1
LAB125 NEDSS 1.1.3 Accession Number Lab Accession Number ID 0 1
LAB143 NEDSS 1.1.3 Clia Lab Name CLIA Laboratory Name ST 0 1
LAB144 NEDSS 1.1.3 Clia Lab ID Laboratory CLIA Number ID 0 1
LAB163 NEDSS 1.1.3 Date Specimen Collection The date the specimen was collected. DATE 0 1
LAB165 NEDSS 1.1.3 Specimen Type This is the medium from which the specimen originated. Examples include whole blood, saliva, urine, etc. CE 0 1 PHVS_SpecimenSource_HL7
LAB166 NEDSS 1.1.3 Specimen Site-Source This indicates the body site where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc. CE 0 1 PHVS_BodySite_HL7_2x
LAB180 NEDSS 1.1.3 Age Reported The age of the subject when the lab specimen was collected.(include units) PQ 0 1 PHVS_AgeUnit_UCUM
LAB192 NEDSS 1.1.3 Coded Test Result Stores the test result when the result is coded CE 0 1
LAB200 NEDSS 1.1.3 Ratio Test Result Test result as a ratio of real numbers RTO_REAL_REAL 0 1
LAB201 NEDSS 1.1.3 Interval Test Result Test result as an interval of real numbers IVL_REAL 0 1
LAB202 NEDSS 1.1.3 Filler Number Filler Result Number ID 0 1
NOT106 NEDSS 1.1.3 Date Sent Date the report is sent to an entity outside the case jurisdiction of occurrence. DATE 0 1
VAC102 NEDSS 1.1.3 Vaccination Record ID A system generated ID for a vaccination record. ID 0 1
VAC103 NEDSS 1.1.3 Vaccination Administered Date The date that the vaccination was administered. DATE 0 1
VAC104 NEDSS 1.1.3 Vaccination Anatomical Site The anatomical site where the vaccination was given. CE 0 1 PHVS_NIP_ANATOMIC_ST
VAC105 NEDSS 1.1.3 Age At Vaccination The person's age at the time the vaccination was given (include age units) PQ 0 1 PHVS_AgeUnit_UCUM
VAC107 NEDSS 1.1.3 Manufacturer The manufacturer of the vaccination administered CE 0 1 PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
VAC108 NEDSS 1.1.3 Lot Number The lot number of the vaccination administered ST 0 1
VAC109 NEDSS 1.1.3 Expiration Date The expiration date of the vaccination administered. DATE 0 1
VAC112 NEDSS 1.1.3 Organization Name The name of the organization that was responsible for administering the vaccination to the person. ST 0 1
VAC117 NEDSS 1.1.3 Organization ID System-assigned Local ID for the organization who gave this vaccination. ID 0 1
VAC118 NEDSS 1.1.3 Organization ID Manufacturer System-assigned Local ID for the Vaccination manufacturer of this vaccination. ID 0 1

Sheet 3: Gen BMIRD
UID AppVer Label Description Fmt Min Max VSName
BMD100 NEDSS 1.1.3 ABCsCase Does the investigation fit the case definition for an ABCs case? CE 0 1 PHVS_YN
BMD101 NEDSS 1.1.3 StateID-ABCs The state ABCS case ID. ID 0 1
BMD102 NEDSS 1.1.3 CultHospID The hospital or lab ID number where the culture was identified. ID 0 1
BMD103 NEDSS 1.1.3 Transfer Was the patient transferred from another hospital? CE 0 1 PHVS_YNU
BMD104 NEDSS 1.1.3 TransID The ID of the initial hospital, if the patient was transferred from another hospital. ID 0 1
BMD105 NEDSS 1.1.3 Daycare If <6 years of age is the patient in daycare? CE 0 1 PHVS_YNU
BMD106 NEDSS 1.1.3 DaycareFacname The name of the daycare facility. ST 0 1
BMD107 NEDSS 1.1.3 Nurshome Does the patient reside in a nursing home or other chronic care facility? CE 0 1 PHVS_YNU
BMD108 NEDSS 1.1.3 NHName The name of the nursing home or chronic care facility. ST 0 1
BMD112 NEDSS 1.1.3 Foutcome The outcome of the fetus if the patient was pregnant or post-partum at the time of first positive culture. CE 0 1 PHVS_OUTCOME_L_BIRTH
BMD113 NEDSS 1.1.3 Under1Mnth Is the patient less than one month of age? CE 0 1 PHVS_YNU
BMD114 NEDSS 1.1.3 Gestage The gestational age of the infant. (include units) PQ 0 1 PHVS_AGE_UNIT
BMD115 NEDSS 1.1.3 BWght The birth weight of the infant (include units) PQ 0 1 PHVS_WeightUnit_UCUM
BMD118 NEDSS 1.1.3 Syndrm The types of infection that are caused by the organism. This is a multi-select field. CE 0 N PHVS_BM_INFEC_TYPE
BMD119 NEDSS 1.1.3 SpecSyn Other infection that is caused by the organism. (free text) ST 0 N
BMD120 NEDSS 1.1.3 Species The bacterial species that was isolated from any normally sterile site. CE 0 1 PHVS_BM_SPEC_ISOL
BMD121 NEDSS 1.1.3 OthBug1 Other bacterial species that was isolated from any normally sterile site. CE 0 1 PHVS_BM_OTHER_BAC_SP
BMD122 NEDSS 1.1.3 SterSite The sterile sites from which the organism was isolated. This is a multi-select field. CE 0 N PHVS_BM_ORG_ISO_S1
BMD123 NEDSS 1.1.3 OthSter Other sterile site from which the organism was isolated. (free text) ST 0 1
BMD124 NEDSS 1.1.3 FirstPosCultDate The date the first positive culture was obtained. (Diagnosis date) DATE 0 1
BMD124a NEDSS 1.1.3 POSITIVECULTURE Was there a positive culture? CE 0 1 PHVS_YNU
BMD125 NEDSS 1.1.3 NonSter The nonsterile sites from which the organism was isolated. This is a multi-select field. CE 0 N PHVS_BM_ORG_ISO_S2
BMD126 NEDSS 1.1.3 UnderCond Did the patient have any underlying conditions? CE 0 1 PHVS_YNU
BMD127 NEDSS 1.1.3 Cond The underlying conditions that the subject has. This is a multi-select field. CE 0 N PHVS_BM_UNDERL_CAUSE
BMD128 NEDSS 1.1.3 OthMalig Other malignancy that the subject had as an underlying condition. (free text) ST 0 1
BMD129 NEDSS 1.1.3 OthOrgan Detail of the organ transplant that the subject had as an underlying condition. (free text) ST 0 1
BMD130 NEDSS 1.1.3 OthIll Other prior illness that the subject had as an underlying condition. (free text) ST 0 1
BMD150 NEDSS 1.1.3 AUDIT Was the case first identified through audit? CE 0 1 PHVS_YNU
BMD151 NEDSS 1.1.3 RELAPSE Does this case have recurrent disease with the same pathogen? CE 0 1 PHVS_YNU
BMD152 NEDSS 1.1.3 PREVID The state ID of the previous ABCS case. ID 0 1
BMD267 NEDSS 1.1.3 BIRTHTIME The baby's time of birth. TS 0 1
BMD268 NEDSS 1.1.3 OTHOTHSPC Another Bacterial Species not listed in the Other Bacterial Species drop-down list. ST 0 1
BMD269 NEDSS 1.1.3 STATUS The status of the case report. CE 0 1 PHVS_BM_CRF_STS
BMD277 NEDSS 1.1.3 TransferHospital Name The name of the initial hospital, if the patient was transferred from another hospital. ST 0 1
BMD279 NEDSS 1.1.3 Hospital Name Culture The hospital or lab name where the culture was identified. ST 0 1
BMD292 NEDSS 1.1.3 Other Non-ABCs Bacterial Species If polymicrobial ABCS case, select other non-ABCS bacterial species isolated from any normally sterile site. This is a multi-select field. CE 0 N PHVS_BM_OTHER_BAC_SP
BMD293 NEDSS 1.1.3 Other Bacterial Species 1 Allows text entry of a bacterial species not included in the other non-ABCS multi-select list. ST 0 1
BMD294 NEDSS 1.1.3 Other Bacterial Species 2 Allows text entry of another bacterial species not included in the other non-ABCS multi-select list. ST 0 1
BMD295 NEDSS 1.1.3 Internal Body Site Specifies the Internal Body Site where the organism was located. CE 0 1 PHVS_BM_ORG_ISO_S3
BMD296 NEDSS 1.1.3 Other Prior Illness 2 Other prior illness as an underlying subject condition. (free text) ST 0 1
BMD297 NEDSS 1.1.3 Other Prior Illness 3 Other prior illness as an underlying subject condition. (free text) ST 0 1
BMD298 NEDSS 1.1.3 Other Nonsterile Site Other nonsterile site from which the organism was isolated (free text). ST 0 1
















































































































































































































































































































































Sheet 4: Grp A Strept
UID AppVer Label Description Fmt Min Max VSName
BMD145 NEDSS 1.1.3 SURGERY Did the patient have surgery? CE 0 1 PHVS_YNU
BMD146 NEDSS 1.1.3 SURGDATE The date of the surgery. DATE 0 1
BMD147 NEDSS 1.1.3 DELIVERY Did the patient have a baby (vaginal or C-section)? CE 0 1 PHVS_YNU
BMD148 NEDSS 1.1.3 BABYDATE The date of the baby's delivery. DATE 0 1
BMD149 NEDSS 1.1.3 GASCOND Did the patient have other prior conditions? This is a multi-select field. CE 0 N PHVS_BM_GAS_COND
























































































































































































































































































































































































































































































































































































































































Sheet 5: H. Influenzae
UID AppVer Label Description Fmt Min Max VSName
BMD131 NEDSS 1.1.3 Serotype The serotype of the culture. CE 0 1 PHVS_BM_SERO_TYPE
BMD132 NEDSS 1.1.3 HIBVacc If <15 years of age and serotype is 'b' or 'unk', did the patient receive Haemophilus Influenzae b vaccine? CE 0 1 PHVS_YNU
BMD171 NEDSS 1.1.3 MEDINS The type of medical insurance that the family has. CE 0 1 PHVS_MED_INS_TYPE
BMD172 NEDSS 1.1.3 OTHINS Other medical insurance type. ST 0 1
BMD175 NEDSS 1.1.3 HIBCON Is there a known previous contact with Hib disease within the preceding two months? CE 0 1 PHVS_YNU
BMD176 NEDSS 1.1.3 CONTYPE Type of previous contact with Hib disease within the preceding two months. ST 0 1
BMD177 NEDSS 1.1.3 SIGHIST The patient's significant past medical history. CE 0 N PHVS_BM_MED_HIST
BMD178 NEDSS 1.1.3 PREWEEKS The number of weeks of a preterm birth (less than 37 weeks). PQ 0 1 PHVS_AGE_UNIT
BMD179 NEDSS 1.1.3 SPECHIV Specify immunosupression/HIV. ST 0 1
BMD180 NEDSS 1.1.3 OTHSIGHIST Specify other prior condition. ST 0 1
BMD208 NEDSS 1.1.3 ACUTESER Is acute serum available? CE 0 1 PHVS_YNU
BMD209 NEDSS 1.1.3 ACUTESERDT Date of acute serum availability. DATE 0 1
BMD210 NEDSS 1.1.3 CONVSER Is convalescent serum available? CE 0 1 PHVS_YNU
BMD211 NEDSS 1.1.3 CONVSERDT Date of convalescent serum availability. DATE 0 1
BMD276 NEDSS 1.1.3 BIRTHCTRY The person's country of birth. CE 0 1 PHVS_Country_ISO_3166-1
BMD299 NEDSS 1.1.3 Other Serotype Allows free text entry of a serotype not included in the serotype dropdown list. ST 0 1
BMD300 NEDSS 1.1.3 LT 15 Years Indicates if the patient was less than 15 years of age at the time of first positive culture. CE 0 1 PHVS_YNU
























































































































































































































































































































































































































































































































































Sheet 6: Neis. Mening.
UID AppVer Label Description Fmt Min Max VSName
BMD133 NEDSS 1.1.3 Serogroup The serogroup of the culture. CE 0 1 PHVS_BM_SERO_GRP
BMD134 NEDSS 1.1.3 OthSero Other serogroup of the culture. ST 0 1
BMD135 NEDSS 1.1.3 College Is patient currently attending college? This question is only applicable if the patient is 15-24 years of age. CE 0 1 PHVS_YNU
BMD161 NEDSS 1.1.3 CASEID How was the case identified? CE 0 1 PHVS_BM_CASE_DET_M
BMD162 NEDSS 1.1.3 OTHSTRST Other sterile site from which species was isolated. (text) ST 0 1
BMD163 NEDSS 1.1.3 OTHID Other case identification method. ST 0 1
BMD164 NEDSS 1.1.3 SCHOOLYR The patient's year in college. (Freshman, Sophomore, etc.) CE 0 1 PHVS_YR_IN_SCHOOL
BMD165 NEDSS 1.1.3 STUDTYPE The patient's status in college as defined by the university. CE 0 1 PHVS_STUDENT_TYPE
BMD166 NEDSS 1.1.3 HOUSE The patient's current living situation. CE 0 1 PHVS_HOUSING_TYPE
BMD167 NEDSS 1.1.3 OTHHOUSE Other housing option. ST 0 1
BMD168 NEDSS 1.1.3 SCHOOLNM The full name of the college or university the patient is currently attending. ST 0 1
BMD169 NEDSS 1.1.3 POLYVAC Has patient received the polysaccharide meningococcal vaccine? CE 0 1 PHVS_YNU
BMD271 NEDSS 1.1.3 SECCASE Is this case of Neisseria meningitidis a secondary case. CE 0 1 PHVS_YNU
BMD272 NEDSS 1.1.3 SECCASETY Type of secondary contact for a case of Neisseria meningitidis. CE 0 1 PHVS_BM_SEC_CASE_TY
BMD273 NEDSS 1.1.3 OTHSECCASE Other field available if the secondary case type selected is other. ST 0 1
BMD274 NEDSS 1.1.3 NMSULFRES Neisseria meningitidis resistance to Sulfa. CE 0 1 PHVS_YNU
BMD275 NEDSS 1.1.3 NMRIFARES Neisseria meningitidis resistance to Rifampin. CE 0 1 PHVS_YNU
























































































































































































































































































































































































































































































































































Sheet 7: Strept. Pneumo
UID AppVer Label Description Fmt Min Max VSName

BMD136 NEDSS 1.1.3 Oxazone The oxacillin zone size for cases of Streptococcus pneumoniae. PQ 0 1 PHVS_UnitsOfMeasure_UCUM

BMD137 NEDSS 1.1.3 OxaScrn The oxacillin interpretation for cases of Streptococcus pneumoniae. CE 0 1 PHVS_BM_OXA_RSLT

BMD138 NEDSS 1.1.3 PNEUVACC Has patient received 23-valent pneumococcal polysaccharide vaccine? CE 0 1 PHVS_YNU

BMD139 NEDSS 1.1.3 PNEUCONJ If less than fifteen years of age, did the patient receive pneumococcal conjugate vaccine? CE 0 1 PHVS_YNU

BMD140 NEDSS 1.1.3 PERSIST Does the patient have persistent disease as defined by positive sterile site isolates 2-7 days after the first positive isolate? CE 0 1 PHVS_YNU

BMD141 NEDSS 1.1.3 SPCULT1 The date the first additional specimen was collected. DATE 0 1


BMD142 NEDSS 1.1.3 SPSITE1 The sites from which the first Streptococcus pneumoniae culture was isolated. This is a multi-select field. CE 0 N PHVS_BM_ORG_ISO_S1

BMD143 NEDSS 1.1.3 SPCULT2 The date the second additional specimen was collected. DATE 0 1


BMD144 NEDSS 1.1.3 SPSITE2 The sites from which the second Streptococcus pneumoniae culture was isolated. This is a multi-select field. CE 0 N PHVS_BM_ORG_ISO_S1















































































































































































































































































































































































































































































































































































































































































































































































Sheet 8: Anim. Rabies
UID AppVer Label Description Fmt Min Max VSName
ARI100 NEDSS 1.1.3 Species Species of animal that transmitted rabies. CE 0 1 PHVS_SPECIES_RABIES
ARI101 NEDSS 1.1.3 Other Species Other species of animal that transmitted rabies (free text) ST 0 1
















































































































































































































































































































































































































































































































































































































































































Sheet 9: CRS
UID AppVer Label Description Fmt Min Max VSName
CRS002 NEDSS 1.1.3 Last Evaluation Date The date the patient was last evaluated by a healthcare provider. DATE 0 1
CRS005 NEDSS 1.1.3 Primary Death Cause The primary cause of death, as noted on the death certificate. ST 0 1
CRS006 NEDSS 1.1.3 Secondary Death Cause The secondary cause of death, as noted on the death certificate. ST 0 1
CRS007 NEDSS 1.1.3 AutopsyPerformed Was an autopsy performed on the body? CE 0 1 PHVS_YNU
CRS008 NEDSS 1.1.3 Final Diagnosis Death The final anatomical cause of death ST 0 1
CRS009 NEDSS 1.1.3 Infant Birth State Allows selection of the state where the patient was born CE 0 1 PHVS_State_FIPS_5-2
CRS010 NEDSS 1.1.3 Infant Gestational Age Birth - Weeks The patient's gestational age at birth. (include age units) PQ 0 1 PHVS_AgeUnit_UCUM
CRS011 NEDSS 1.1.3 Infant Age Diagnosis The infant's age at the time of CRS diagnosis. (include units) PQ 0 1 PHVS_AgeUnit_UCUM
CRS013 NEDSS 1.1.3 Infant Birth Weight The infant's birth weight (include units) PQ 0 1 PHVS_WeightUnit_UCUM
CRS015 NEDSS 1.1.3 Cataracts Did/does the infant have cataracts? (Group A) CE 0 1 PHVS_YNU
CRS016 NEDSS 1.1.3 Hearing Impairment Did/does the infant have hearing impairment (loss)? (Group A) CE 0 1 PHVS_YNU
CRS017 NEDSS 1.1.3 Congenital Heart Disease Did the infant have a congenital heart disease? (Group A) CE 0 1 PHVS_YNU
CRS018 NEDSS 1.1.3 Patent Ductus Arteriosus Did the infant have patent ductus arteriosus? (Group A) CE 0 1 PHVS_YNU
CRS019 NEDSS 1.1.3 Peripheral Pulmonic Stenosis Did the infant have peripheral pulmonic stenosis? (Group A) CE 0 1 PHVS_YNU
CRS020 NEDSS 1.1.3 Other Congenital Heart Disease Did the infant have another congenital heart disease? (Group A) CE 0 1 PHVS_YNU
CRS021 NEDSS 1.1.3 Other Type If the infant had another congenital heart disease, what was it? (Group A) ST 0 1
CRS022 NEDSS 1.1.3 Mother Rash Did the mother have a maculopapular rash? CE 0 1 PHVS_YNU
CRS022a NEDSS 1.1.3 Mothers Rash Onset Date What was the rash onset date? DATE 0 1
CRS024 NEDSS 1.1.3 Mother Fever Did the mother have a fever? CE 0 1 PHVS_YNU
CRS027 NEDSS 1.1.3 Mother ArthralgiaArthritis Did the mother have arthralgia/arthritis? CE 0 1 PHVS_YNU
CRS028 NEDSS 1.1.3 Mother Lymphadenopathy Did the mother have lymphadenopathy? CE 0 1 PHVS_YNU
CRS030 NEDSS 1.1.3 Congenital Glaucoma Did the infant have congenital glaucoma? (Group A) CE 0 1 PHVS_YNU
CRS031 NEDSS 1.1.3 Pigmentary Retinopathy Did the infant have pigmentary retinopathy? (Group A) CE 0 1 PHVS_YNU
CRS032 NEDSS 1.1.3 Developmental Delay Did/does the infant have developmental delay or mental retardation? (Group B) CE 0 1 PHVS_YNU
CRS033 NEDSS 1.1.3 Meningoencephalitis Did the infant have meningoencephalitis? (Group B) CE 0 1 PHVS_YNU
CRS034 NEDSS 1.1.3 Microencephaly Did the infant have microencephaly? (Group B) CE 0 1 PHVS_YNU
CRS035 NEDSS 1.1.3 Purpura Did the infant have purpura? (Group B) CE 0 1 PHVS_YNU
CRS036 NEDSS 1.1.3 Enlarged Spleen Did/does the infant have an enlarged spleen? (Group B) CE 0 1 PHVS_YNU
CRS037 NEDSS 1.1.3 Enlarged Liver Did/does the infant have an enlarged liver? (Group B) CE 0 1 PHVS_YNU
CRS038 NEDSS 1.1.3 Radiolucent Bone Disease Did the infant have radiolucent bone disease? (Group B) CE 0 1 PHVS_YNU
CRS039 NEDSS 1.1.3 Neonatal Jaundice Did the infant have jaundice? (Group B) CE 0 1 PHVS_YNU
CRS040 NEDSS 1.1.3 Low Platelets Did the infant have low platelets? (Group B) CE 0 1 PHVS_YNU
CRS041 NEDSS 1.1.3 Dermal Erythropoieses Did infant have dermal erythropoisesis? (Group B) CE 0 1 PHVS_YNU
CRS042 NEDSS 1.1.3 Other Abnormalities Did the infant have any other abnormalities? (Group B) CE 0 1 PHVS_YNU
CRS043 NEDSS 1.1.3 Other Abnormalities 1 If the infant had other abnormalities, what was the first other abnormality? ST 0 1
CRS044 NEDSS 1.1.3 Other Abnormalities 2 If the infant had other abnormalities, what was the second other abnormality? ST 0 1
CRS045 NEDSS 1.1.3 Other Abnormalities 3 If the infant had other abnormalities, what was the third other abnormality? ST 0 1
CRS046 NEDSS 1.1.3 Other Abnormalities 4 If the infant had other abnormalities, what was the fourth other abnormality? ST 0 1
CRS049 NEDSS 1.1.3 Laboratory Testing Was laboratory testing done for rubella on this infant? CE 0 1 PHVS_YNU
CRS050 NEDSS 1.1.3 Rubella IgM EIA Test Was a rubella IgM EIA test done? CE 0 1 PHVS_YNU
CRS051 NEDSS 1.1.3 Date Rubella IgM EIA Test Date of the rubella IgM EIA test (non-capture) DATE 0 1
CRS052 NEDSS 1.1.3 Result Rubella IgM EIA Test Result of rubella IgM EID test (non-capture) CE 0 1 PHVS_NIP_RSLT_QUAL
CRS053 NEDSS 1.1.3 Rubella IgM EIA Capture Was a rubella IgM EIA capture test done? CE 0 1 PHVS_YNU
CRS054 NEDSS 1.1.3 Date Rubella IgM EIA capture Date of rubella IgM EIA capture test? DATE 0 1
CRS055 NEDSS 1.1.3 Result of Rubella IgM EIA capture Result of rubella IgM EIA capture test? CE 0 1 PHVS_NIP_RSLT_QUAL
CRS056 NEDSS 1.1.3 Rubella IgM other Test Was another rubella IgM test done? CE 0 1 PHVS_YNU
CRS057 NEDSS 1.1.3 Other Rubella IgM Specify the other IgM test ST 0 1
CRS058 NEDSS 1.1.3 Date Rubella IgM other Date of other rubella IgM test DATE 0 1
CRS059 NEDSS 1.1.3 Result Rubella IgM other Result of other rubella IgM test CE 0 1 PHVS_NIP_RSLT_QUAL
CRS060 NEDSS 1.1.3 Rubella IgG Test-1 Was rubella IgG test #1 done? CE 0 1 PHVS_YNU
CRS061 NEDSS 1.1.3 Date Rubella IgG Test -1 Date of rubella IgG test #1 DATE 0 1
CRS062 NEDSS 1.1.3 Rubella IgG Test -2 Was rubella IgG test #2 done? CE 0 1 PHVS_YNU
CRS063 NEDSS 1.1.3 Date Rubella IgG Test-2 Date of rubella IgG test #2 DATE 0 1
CRS064 NEDSS 1.1.3 Test Difference Difference between IgG test #1 and test #2 CE 0 1 PHVS_NIP_IGG_DIFF
CRS065 NEDSS 1.1.3 Virus Isolation Was a virus isolation done? CE 0 1 PHVS_YNU
CRS066 NEDSS 1.1.3 Date Virus Isolation Date of virus isolation DATE 0 1
CRS067 NEDSS 1.1.3 Source Virus Isolation Source of virus isolation specimen CE 0 1 PHVS_CRS_SPECMN_SRC
CRS068 NEDSS 1.1.3 Other Virus Isolation source If another source, specify the other source ST 0 1
CRS069 NEDSS 1.1.3 Result Virus Isolation Result of the virus isolation CE 0 1 PHVS_RUB_VIR_RSLT
CRS070 NEDSS 1.1.3 RT-PCR Test Was a RT-PCR test done? CE 0 1 PHVS_YNU
CRS071 NEDSS 1.1.3 Date RT-PCR Date of RT-PCR test DATE 0 1
CRS072 NEDSS 1.1.3 Source RT-PCR Source of RT-PCR specimen CE 0 1 PHVS_CRS_SPECMN_SRC
CRS073 NEDSS 1.1.3 Result RT-PCR Result of RT-PCR test CE 0 1 PHVS_RUB_VIR_RSLT
CRS074 NEDSS 1.1.3 Other laboratory Test Was other laboratory testing done for rubella? CE 0 1 PHVS_YNU
CRS075 NEDSS 1.1.3 Other Rubella Lab Test Specify the other rubella lab test ST 0 1
CRS076 NEDSS 1.1.3 Result Other Rubella Lab Test Result of the other rubella lab test ST 0 1
CRS077 NEDSS 1.1.3 CDC Genotyping Were clinical specimens sent to CDC for genotyping (molecular typing)? CE 0 1 PHVS_YNU
CRS080 NEDSS 1.1.3 Mother Birth Country The mother's country of birth CE 0 1 PHVS_Country_ISO_3166-1
CRS081 NEDSS 1.1.3 Mother Delivery Age The age of the mother when this infant was delivered PQ 0 1 PHVS_AgeUnit_UCUM
CRS082 NEDSS 1.1.3 Mother Occupation The mother's occupation at time of this conception ST 0 1
CRS083 NEDSS 1.1.3 Time Mother In US Length of time (in years) the mother has been in the US PQ 0 1 PHVS_DurationUnit_UCUM
CRS084 NEDSS 1.1.3 Children LT 18 In Household The number of children less then 18 years of age living in household during this pregnancy INT 0 1
CRS085 NEDSS 1.1.3 Children Household Immunized Were any of the children less than 18 years of age immunized with the rubella vaccine? CE 0 1 PHVS_YNU
CRS086 NEDSS 1.1.3 Number Children Household Immunized The number of children less than 18 years of age immunized with the rubella vaccine INT 0 1
CRS087 NEDSS 1.1.3 Attend Family Planning Did the mother attend a family planning clinic prior to conception of this infant? CE 0 1 PHVS_YNU
CRS088 NEDSS 1.1.3 Prenatal Care Was prenatal care obtained for this pregnancy? CE 0 1 PHVS_YNU
CRS089 NEDSS 1.1.3 Date First Prenatal Visit Date of the first prenatal visit for this pregnancy DATE 0 1
CRS090 NEDSS 1.1.3 Prenatal Care Location Where was the prenatal care for this pregnancy obtained? CE 0 1 PHVS_RUB_PRE_CARE_T
CRS091 NEDSS 1.1.3 Rubella-Like Illness Was there a rubella-like illness during this pregnancy? CE 0 1 PHVS_YNU
CRS092 NEDSS 1.1.3 Month Pregnancy First symptoms The month of pregnancy that rubella-like symptoms appeared INT 0 1
CRS093 NEDSS 1.1.3 Rubella Diagnosed By MD Was rubella diagnosed by a physician at time of illness? CE 0 1 PHVS_YNU
CRS094 NEDSS 1.1.3 Non-MD Dx If rubella was not diagnosed by a physician, then diagnosed by whom? ST 0 1
CRS095 NEDSS 1.1.3 Serologically Confirmed Was rubella serologically confirmed at time of illness? CE 0 1 PHVS_YNU
CRS096 NEDSS 1.1.3 Known Exposure Did the mother know where she might have been exposed to rubella? CE 0 1 PHVS_YNU
CRS097 NEDSS 1.1.3 Where Acquired General location of where the mother acquired rubella CE 0 1 PHVS_PHC_IMPRT
CRS098 NEDSS 1.1.3 Imported Country The country in which the mother acquired rubella CE 0 1 PHVS_Country_ISO_3166-1
CRS099 NEDSS 1.1.3 Imported City The city in which the mother acquired rubella ST 0 1
CRS100 NEDSS 1.1.3 Mother Travel Outside US If the rubella exposure is unknown, did the mother travel outside the US during the 1st trimester of pregnancy? CE 0 1 PHVS_YNU
CRS101 NEDSS 1.1.3 Date Mother Left US Travel-1 The date the mother left US for travel (first trip) DATE 0 1
CRS102 NEDSS 1.1.3 Date Mother Returned US Travel-1 The date the mother returned to US from travel (first trip) DATE 0 1
CRS103 NEDSS 1.1.3 Date Mother Left US Travel-2 The date the mother left the US for travel (second trip) DATE 0 1
CRS104 NEDSS 1.1.3 Date Mother Returned US Travel-2 The date the mother returned to US from travel (second trip) DATE 0 1
CRS105 NEDSS 1.1.3 Mother Directly Exposed Was the mother directly exposed to a confirmed rubella case? CE 0 1 PHVS_YNU
CRS106 NEDSS 1.1.3 Direct Exposure Relationship The mother's relationship to the confirmed rubella case CE 0 1 PHVS_PER_REL_TY
CRS107 NEDSS 1.1.3 Date Direct Exposure The mother's exposure date to the confirmed rubella case DATE 0 1
CRS139 NEDSS 1.1.3 Result Rubella IgG Test-1 Result rubella IgG test #1 CE 0 1 PHVS_NIP_RSLT_QUAL
CRS140 NEDSS 1.1.3 Result Rubella IgG Test-2 Result of rubella IgG test #2 CE 0 1 PHVS_NIP_RSLT_QUAL
CRS141 NEDSS 1.1.3 Date Other Rubella Test Date of other rubella lab test DATE 0 1
CRS142 NEDSS 1.1.3 Non-CRS Reason The reason this was not a case of CRS. Note: This is a follow-up question if user enters "Not a Case" for Case Status CE 0 1 PHVS_CRS_NO_CASE_RSN
CRS143 NEDSS 1.1.3 Date Sent Genotyping Date the specimen was sent to the CDC for genotyping DATE 0 1
CRS144 NEDSS 1.1.3 Rubella IgG Test-1 Result Result value of test #1 ST 0 1
CRS145 NEDSS 1.1.3 Rubella IgG Test -2 Result Result value of test #2 ST 0 1
CRS147 NEDSS 1.1.3 Mother Immunized Was the mother immunized with rubella vaccine? CE 0 1 PHVS_YNU
CRS148 NEDSS 1.1.3 Date Mother Vaccinated Date the mother was immunized with rubella vaccine DATE 0 1
CRS149 NEDSS 1.1.3 Source Mother Vaccine Information Source of mother's rubella immunization information R CE 0 1 PHVS_CRS_VAC_INFO
CRS150 NEDSS 1.1.3 Other Source Mother Vaccine Information Other source of mother's rubella immunization information ST 0 1
CRS151 NEDSS 1.1.3 Source Mother Vaccine Source of mother's rubella vaccine CE 0 1 PHVS_RUB_PRE_CARE_T
CRS152 NEDSS 1.1.3 Other Clinical Features Mother's other clinical features of maternal illness ST 0 1
CRS153 NEDSS 1.1.3 Previous US Birth Has mother given birth in the US previously? CE 0 1 PHVS_YNU
CRS154 NEDSS 1.1.3 Dates Previous Births List years in which mother has given birth in US previously ST 0 1
CRS157 NEDSS 1.1.3 Specify Other RT-PCR Specimen Source Specify other specimen source of RT-PCR ST 0 1
CRS158 NEDSS 1.1.3 Number Previous Pregnancies Mother's number of previous pregnancies INT 0 1
CRS159 NEDSS 1.1.3 Number Live Births-Total Mother's total number of live births INT 0 1
CRS160 NEDSS 1.1.3 Number US Births Mother's number of births delivered in US INT 0 1
CRS161 NEDSS 1.1.3 Mother Serological Testing Did the mother have serological testing prior to this pregnancy? CE 0 1 PHVS_YNU
CRS162 NEDSS 1.1.3 Imported State The state in which the mother acquired rubella CE 0 1 PHVS_State_FIPS_5-2
CRS163 NEDSS 1.1.3 Imported County The county in which the mother acquired rubella CE 0 1 PHVS_County_FIPS_6-4
CRS164 NEDSS 1.1.3 Mother Country Travel-1 The country in which the mother traveled (first trip) CE 0 1 PHVS_Country_ISO_3166-1
CRS165 NEDSS 1.1.3 Mother Country Travel-2 The country in which the mother traveled (second trip) CE 0 1 PHVS_Country_ISO_3166-1
CRS166 NEDSS 1.1.3 Exposure Relationship Specify mother's other relationship to confirmed rubella case ST 0 1
CRS167 NEDSS 1.1.3 IgM EIA-1st Test Value The test result value for IgM EIA (1st) test. ST 0 1
CRS168 NEDSS 1.1.3 IgM EIA-2nd Test Value The test result value for IgM EIA (2nd) test. ST 0 1
CRS169 NEDSS 1.1.3 ImG Other Test Value The test result value for IgM, other test. ST 0 1
CRS170 NEDSS 1.1.3 RT PCR Test Value The test result value for RT-PCR test. ST 0 1
CRS171 NEDSS 1.1.3 Other Rubella Test Value The test result value for other rubella test. ST 0 1
CRS172 NEDSS 1.1.3 Rubella Specimen Type The specimen type that was sent to the CDC for genotyping. CE 0 1 PHVS_CRS_SPECMN_SRC
CRS173 NEDSS 1.1.3 Other Rubella Specimen Type The specimen type (other) that was sent to the CDC for genotyping. ST 0 1
CRS174 NEDSS 1.1.3 Serologically Confirmed Date The date rubella was serologically confirmed. DATE 0 1
CRS175 NEDSS 1.1.3 Serologically Confirmed Result The result of the rubella serological confirmation. CE 0 1 PHVS_NIP_RSLT_QUAL
CRS176 NEDSS 1.1.3 Rubella Lab Testing Mother Was rubella lab testing performed for the mother in conjunction with this pregnancy? CE 0 1 PHVS_YNU
CRS177 NEDSS 1.1.3 Mother Reported Rubella Case Has the mother ever been reported as a rubella case? CE 0 1 PHVS_YNU
CRS178 NEDSS 1.1.3 IgM EIA-1st Method Used The method used for the IgM EIA test (1st). CE 0 1 PHVS_CRS_TEST_METHOD
CRS179 NEDSS 1.1.3 IgM EIA-2nd Method Used The method used for the IgM EIA test (2nd). CE 0 1 PHVS_CRS_TEST_METHOD
CRS180 NEDSS 1.1.3 Infant Death From CRS Did the infant die from CRS or complications associated with CRS? CE 0 1 PHVS_YNU

Sheet 10: Measles
UID AppVer Label Description Fmt Min Max VSName
MEA001 NEDSS 1.1.3 Rash Did the person being reported in this investigation have a rash? CE 0 1 PHVS_YNU
MEA002 NEDSS 1.1.3 Rash Onset Date What was the onset date of the person's rash? DATE 0 1
MEA003 NEDSS 1.1.3 Rash Duration How many days did the rash being reported in this investigation last? PQ 0 1 PHVS_DurationUnit_UCUM
MEA004 NEDSS 1.1.3 Generalized Rash Was the rash generalized? (Occurring on more than one or two parts of the body?) CE 0 1 PHVS_YNU
MEA005 NEDSS 1.1.3 Fever Did the person have a fever? (i.e., a measured temperature >2 degrees above normal) CE 0 1 PHVS_YNU
MEA006 NEDSS 1.1.3 Highest Measured Temperature What was the person's highest measured temperature during this illness? (Include units) PQ 0 1 PHVS_TemperatureUnits_UCUM
MEA008 NEDSS 1.1.3 Cough Did the person develop a cough during this illness? CE 0 1 PHVS_YNU
MEA009 NEDSS 1.1.3 Croup Did the person develop croup as a complication of measles? CE 0 1 PHVS_YNU
MEA010 NEDSS 1.1.3 Coryza Did the person develop coryza (runny nose) during this illness? CE 0 1 PHVS_YNU
MEA011 NEDSS 1.1.3 Hepatitis Did the person develop hepatitis after contracting measles? CE 0 1 PHVS_YNU
MEA012 NEDSS 1.1.3 Conjunctivitis Did the person develop conjunctivitis during this illness? CE 0 1 PHVS_YNU
MEA013 NEDSS 1.1.3 Otitis Media Did the person develop otitis media as a complication of this illness? CE 0 1 PHVS_YNU
MEA014 NEDSS 1.1.3 Diarrhea Did the person develop diarrhea as a complication of this illness? CE 0 1 PHVS_YNU
MEA015 NEDSS 1.1.3 Pneumonia Did the person develop pneumonia as a complication of this illness? CE 0 1 PHVS_YNU
MEA016 NEDSS 1.1.3 Encephalitis Did the person develop encephalitis as a complication of this illness? CE 0 1 PHVS_YNU
MEA017 NEDSS 1.1.3 Thrombocytopenia Did the person develop thrombocytopenia as a complication of this illness? CE 0 1 PHVS_YNU
MEA018 NEDSS 1.1.3 Other Complications Did the person develop an other conditions as a complication of this illness? CE 0 1 PHVS_YNU
MEA019 NEDSS 1.1.3 Specified Other Complication Please specify the other complication the person developed, during or as a result of this illness. ST 0 1
MEA027 NEDSS 1.1.3 Lab Test Performed Was laboratory testing done to confirm a diagnosis of measles? CE 0 1 PHVS_YNU
MEA028 NEDSS 1.1.3 Date IgM Specimen Date the IgM specimen was taken DATE 0 1
MEA029 NEDSS 1.1.3 IgM Test Result Result of the IgM test CE 0 1 PHVS_NIP_RSLT_QUAL
MEA030 NEDSS 1.1.3 Date IgG Acute Specimen Date the acute IgG specimen was taken DATE 0 1
MEA031 NEDSS 1.1.3 Date IgG Convalescent Specimen Date the convalescent IgG specimen was taken DATE 0 1
MEA032 NEDSS 1.1.3 Acute-Convalescent IgG Test Result The interpretative result of the difference between the values for the acute and convalescent IgG tests. CE 0 1 PHVS_NIP_IGG_DIFF
MEA033 NEDSS 1.1.3 Other Laboratory Tests Was other laboratory testing done to confirm a diagnosis of measles? CE 0 1 PHVS_YNU
MEA034 NEDSS 1.1.3 Specific Other Testing Specify the other test that was performed to confirm a diagnosis of measles. ST 0 1
MEA035 NEDSS 1.1.3 Date Other Testing Date other testing was done to confirm a diagnosis of measles. DATE 0 1
MEA036 NEDSS 1.1.3 Other Laboratory Results Laboratory test results for other testing that was done to confirm a diagnosis of measles. ST 0 1
MEA038 NEDSS 1.1.3 CDC Genotyping Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)? CE 0 1 PHVS_YNU
MEA039 NEDSS 1.1.3 MeaslesContainingVaccine Did the person receive a measles-containing vaccine? CE 0 1 PHVS_YNU
MEA040 NEDSS 1.1.3 ReasonNoMeaslesContainingVaccine If the person did not receive a measles-containing vaccine, what was the reason? CE 0 1 PHVS_VAC_NOTG_RSN
MEA042 NEDSS 1.1.3 Number of Doses Before 1st Birthday The number of doses of measles-containing vaccine the person received before their first birthday. INT 0 1
MEA043 NEDSS 1.1.3 Number of Doses From 1st Birthday The number of measles-containing vaccine doses the patient received on or after their first birthday. INT 0 1
MEA044 NEDSS 1.1.3 Reason Vaccinating Before Birthday If the person was vaccinated with measles-containing vaccine before the first birthday, but did not receive a vaccine dose after their first birthday, state the reason. CE 0 1 PHVS_VAC_NOTG_RSN
MEA045 NEDSS 1.1.3 Reason Never Received 2nd Dose If the person received one dose of measles-containing vaccine ON or AFTER their first birthday, but did not receive a second dose after the first birthday, what was the reason? CE 0 1 PHVS_VAC_NOTG_RSN
MEA059 NEDSS 1.1.3 Age Setting Verified Does the age of the case match or make sense for the transmission setting listed (i.e. a person aged 80 probably would not have a transmission setting of child day care center.)? CE 0 1 PHVS_YNU
MEA060 NEDSS 1.1.3 USA Resident Does the person currently reside in the USA? CE 0 1 PHVS_YNU
MEA067 NEDSS 1.1.3 Epi-linked Specify if this case is epidemiologically-linked to another confirmed or probable case of measles? CE 0 1 PHVS_YNU
MEA068 NEDSS 1.1.3 Traceable Internationally A yes answer to this questions denotes that the person in this case knows that they acquired measles from another person who acquired the disease internationally. It does not denote that the person in this case traveled or lived internationally. CE 0 1 PHVS_YNU
MEA069 NEDSS 1.1.3 Confirmation Method What method was used to classify the case status? CE 0 1 PHVS_NIP_CONF_M
MEA071 NEDSS 1.1.3 Date Fever Onset Date of fever onset. DATE 0 1
MEA072 NEDSS 1.1.3 Date Sent Genotyping The date the specimens were sent to the CDC laboratories for genotyping. DATE 0 1
MEA073 NEDSS 1.1.3 IgM Testing Performed Was IgM testing performed to confirm a diagnosis of measles? CE 0 1 PHVS_YNU
MEA074 NEDSS 1.1.3 IgG Acute-Convalescent Testing This is a series test. The first test is called the acute test;the second, the convalescent test. An interpretive analysis is made for the difference between the values resulting from the two tests. CE 0 1 PHVS_YNU
MEA075 NEDSS 1.1.3 Rash Onset Within 18 Days Did rash onset occur within 18 days of entering the USA, following any travel or living outside the USA? CE 0 1 PHVS_YNU
MEA076 NEDSS 1.1.3 Infection Source What was the source of the measles infection? ST 0 1
MEA077 NEDSS 1.1.3 Measles Specimen Type Measles testing specimen type. ST 0 1








































































































































































































































































































Sheet 11: Mumps
UID AppVer Label Description Fmt Min Max VSName
MUM100 NEDSS 1.1.3 Parotitis Indicates whether the patient had parotitis. CE 0 1 PHVS_YNU
MUM101 NEDSS 1.1.3 Meningitis Indicates whether the patient had meningitis. CE 0 1 PHVS_YNU
MUM102 NEDSS 1.1.3 Deafness Indicates whether the patient had deafness as a result of the condition. CE 0 1 PHVS_YNU
MUM103 NEDSS 1.1.3 Orchitis Indicates whether the patient had orchitis (complication). CE 0 1 PHVS_YNU
MUM104 NEDSS 1.1.3 Encephalitis Indicates whether the patient had encephalitis (complication). CE 0 1 PHVS_YNU
MUM105 NEDSS 1.1.3 Other complications Indicates whether the patient had any other complications. CE 0 1 PHVS_YNU
MUM106 NEDSS 1.1.3 Specific Other Complication Free text field to specify other complications from Mumps. ST 0 1
MUM108 NEDSS 1.1.3 Laboratory Testing Done Indicates whether the patient had testing done for mumps. CE 0 1 PHVS_YNU
MUM109 NEDSS 1.1.3 IgM Testing Indicates whether an IgM test was performed for the patient. CE 0 1 PHVS_YNU
MUM110 NEDSS 1.1.3 IgM Specimen Date Specifies the date the IgM test was performed. DATE 0 1
MUM111 NEDSS 1.1.3 IgM Specimen Result Specifies the result of the IgM test. CE 0 1 PHVS_NIP_RSLT_QUAL
MUM112 NEDSS 1.1.3 IgG AcuteConvalescent Testing Indicates whether IgG Acute/Convalescent testing was performed for this patient. CE 0 1 PHVS_YNU
MUM113 NEDSS 1.1.3 IgG Acute Specimen Date Specifies the date the IgG Acute specimen was taken. DATE 0 1
MUM114 NEDSS 1.1.3 IgG Convalescent Specimen Date Specifies the date the IgG Convalescent specimen was taken. DATE 0 1
MUM115 NEDSS 1.1.3 IgG AcuteConvalescent Test Result Specifies the result of the Acute/Convalescent IgG tests. CE 0 1 PHVS_NIP_IGG_DIFF
MUM116 NEDSS 1.1.3 Other Lab Testing Indicates whether other laboratory testing was done. CE 0 1 PHVS_YNU
MUM117 NEDSS 1.1.3 Other Test Specifies the other test that was done. ST 0 1
MUM118 NEDSS 1.1.3 Other Test Date Specifies the date that the other testing was done. DATE 0 1
MUM119 NEDSS 1.1.3 Other Test Results Specifies the other laboratory test results. ST 0 1
MUM120 NEDSS 1.1.3 Genotyping Specimens Sent Indicates whether the clinical specimens were sent to the CDC for genotyping (molecular typing). CE 0 1 PHVS_YNU
MUM121 NEDSS 1.1.3 Genotyping Date Specifies the date that the clinical specimens were sent for genotyping. DATE 0 1
MUM122 NEDSS 1.1.3 Receive Mumps Vaccine Did the patient receive mumps-containing vaccine? CE 0 1 PHVS_YNU
MUM123 NEDSS 1.1.3 Reason No Vaccine If no mumps-containing vaccine, select reason. CE 0 1 PHVS_VAC_NOTG_RSN
MUM124 NEDSS 1.1.3 Number Doses Received Number of doses received ON or AFTER first birthday INT 0 1
MUM125 NEDSS 1.1.3 Time In US Length of time in the U.S (years) PQ 0 1 PHVS_DurationUnit_UCUM
MUM126 NEDSS 1.1.3 Birth Country Country of Birth CE 0 1 PHVS_Country_ISO_3166-1
MUM127 NEDSS 1.1.3 Transmission Setting Transmission Setting CE 0 1 PHVS_PHC_TRAN_SETNG
MUM128 NEDSS 1.1.3 Age Setting Verified Were age and setting verified? CE 0 1 PHVS_YNU
MUM129 NEDSS 1.1.3 Infection Source Source of Infection (i.e. person ID, country,) ST 0 1
MUM130 NEDSS 1.1.3 Epi-linked To Another Case Is this case epi-linked to another confirmed or probable case? CE 0 1 PHVS_YNU
















































































































































































































































































































































































































































Sheet 12: Pertussis
UID AppVer Label Description Fmt Min Max VSName
PRT001 NEDSS 1.1.3 Cough Did the patient's illness include the symptom of cough? CE 0 1 PHVS_YNU
PRT002 NEDSS 1.1.3 Cough Onset Date Cough onset date DATE 0 1
PRT003 NEDSS 1.1.3 Paroxysmal Cough Did the patient's illness include the symptom of paroxysmal cough? CE 0 1 PHVS_YNU
PRT004 NEDSS 1.1.3 Whoop Did the patient's illness include the symptom of whoop? CE 0 1 PHVS_YNU
PRT005 NEDSS 1.1.3 Post-Tussive Vomiting Did the patient's illness include the symptom of post-tussive vomiting? CE 0 1 PHVS_YNU
PRT006 NEDSS 1.1.3 Apnea Did the patient's illness include the symptom of apnea? CE 0 1 PHVS_YNU
PRT007 NEDSS 1.1.3 Date Final Interview Date of the patient's final interview DATE 0 1
PRT008 NEDSS 1.1.3 Cough At Final Interview Was there a cough at the patient's final interview? CE 0 1 PHVS_YNU
PRT009 NEDSS 1.1.3 Total Cough Duration What was the duration (in days) of the patient's cough? PQ 0 1 PHVS_DurationUnit_UCUM
PRT011 NEDSS 1.1.3 Result Chest X-Ray For Pneumonia Result of chest x-ray for pneumonia CE 0 1 PHVS_PER_CHEST_XRAY
PRT012 NEDSS 1.1.3 Pertussis Seizures Did the patient have generalized or focal seizures due to pertussis? CE 0 1 PHVS_YNU
PRT013 NEDSS 1.1.3 Pertussis Encephalopathy Did the patient have acute encephalopathy due to pertussis? CE 0 1 PHVS_YNU
PRT020 NEDSS 1.1.3 Antibiotics Given Were antibiotics given to the patient? CE 0 1 PHVS_YNU
PRT021 NEDSS 1.1.3 Antibiotic Name What antibiotic did the patient receive? CE 0 1 PHVS_PER_ANTIBIOTIC
PRT023 NEDSS 1.1.3 Antibiotic Start Date Date the patient first started taking the antibiotic DATE 0 1
PRT024 NEDSS 1.1.3 Days Antibiotic Taken Number of days the patient actually took the antibiotic referenced. PQ 0 1 PHVS_DurationUnit_UCUM
PRT029 NEDSS 1.1.3 Pertussis Testing Was laboratory testing done for pertussis? CE 0 1 PHVS_YNU
PRT030 NEDSS 1.1.3 Bordetella Pertussis Culture Date Date that the bordetella pertussis culture was taken DATE 0 1
PRT031 NEDSS 1.1.3 Bordetella Pertussis Culture Result Bordetella pertussis culture result CE 0 1 PHVS_PER_LAB_RSLT
PRT033 NEDSS 1.1.3 Bordetella Pertussis Serology-1 Date Bordetella pertussis serology #1 date DATE 0 1
PRT034 NEDSS 1.1.3 Bordetella Pertussis Serology-1 Result Bordetella pertussis serology #1 result CE 0 1 PHVS_PER_LAB_RSLT
PRT037 NEDSS 1.1.3 Bordetella Pertussis Serology-2 Date Bordetella pertussis serology #2 date DATE 0 1
PRT038 NEDSS 1.1.3 Bordetella Pertussis Serology-2 Result Bordetella pertussis serology #2 result CE 0 1 PHVS_PER_LAB_RSLT
PRT040 NEDSS 1.1.3 Bordetella Pertussis PCR Specimen Date Bordetella pertussis PCR specimen date DATE 0 1
PRT041 NEDSS 1.1.3 Bordetella Pertussis PCR Result Bordetella pertussis PCR result CE 0 1 PHVS_PER_LAB_RSLT
PRT044 NEDSS 1.1.3 Pertussis-Containing Vaccine Did the patient ever receive a pertussis-containing vaccine? CE 0 1 PHVS_YNU
PRT045 NEDSS 1.1.3 Pertussis-Containing Vaccine Date Date of last pertussis-containing vaccine before illness DATE 0 1
PRT046 NEDSS 1.1.3 Doses Pertussis-Containing Vaccine Given 2 Weeks Prior Number of doses of pertussis-containing vaccine given CE 0 1 PHVS_P_VAC_DOSE_NUM
PRT047 NEDSS 1.1.3 Reason Not Vaccinated 3 Doses Give reason if not vaccinated with 3 or more doses of pertussis-containing vaccine CE 0 1 PHVS_VAC_NOTG_RSN
PRT060 NEDSS 1.1.3 Epi-Linked Confirmed Case Is this case epi-linked to a laboratory-confirmed case? CE 0 1 PHVS_YNU
PRT067 NEDSS 1.1.3 Documented Transmission Was there documented transmission (outside of the household) for transmission from this case? CE 0 1 PHVS_YNU
PRT068 NEDSS 1.1.3 New Setting What is the setting for spread of this case outside the household? CE 0 1 PHC_TRAN_SETNG
PRT069 NEDSS 1.1.3 Other Setting Other setting for spread of this case outside the household ST 0 1
PRT070 NEDSS 1.1.3 One Or More Suspected Sources Were there one or more suspected sources of infection? A suspected source is another person with a cough who was in contact with the case 7-20 days before the case's cough. CE 0 1 PHVS_YNU
PRT071 NEDSS 1.1.3 Number Suspected Sources Number of suspected sources of infection INT 0 1
PRT074 NEDSS 1.1.3 Suspected Source Age Suspected source of infection's age (include units) PQ 0 1 PHVS_AgeUnit_UCUM
PRT076 NEDSS 1.1.3 Suspected Source Sex Suspected source of infection's sex CE 0 1 PHVS_AdministrativeGender_CDC
PRT077 NEDSS 1.1.3 Suspected Source Relationship Suspected source of infection's relationship to case CE 0 1 PHVS_PER_REL_TY
PRT078 NEDSS 1.1.3 Suspected Source Relation To Case-Other Suspected source of infection's relationship to case (Other) ST 0 1
PRT080 NEDSS 1.1.3 Contacts To Receive Prophylaxis Number of contacts of this case recommended to receive antibiotic prophylaxis INT 0 1
PRT081 NEDSS 1.1.3 Other Laboratory Testing Was other laboratory testing done? CE 0 1 PHVS_YNU
PRT082 NEDSS 1.1.3 Specific Other Test Specify other laboratory test ST 0 1
PRT083 NEDSS 1.1.3 Other Test Date Date of other laboratory test TS 0 1
PRT084 NEDSS 1.1.3 Other Laboratory Results Other laboratory test results ST 0 1
PRT085 NEDSS 1.1.3 Confimation Method Method of confirming a case of pertussis. CE 0 N PHVS_NIP_CONF_M
PRT087 NEDSS 1.1.3 Number Doses Pertussis-Containing Vaccine How many doses of pertussis-containing vaccine has the suspected source received? CE 0 1 PHVS_P_VAC_DOSE_NUM
PRT088 NEDSS 1.1.3 Estimated Cough Onset Date Estimated cough onset date of suspected source of infection DATE 0 1
PRT089 NEDSS 1.1.3 Bordetella Pertussis Culture Was Bordetella Pertussis culture taken? CE 0 1 PHVS_YNU
PRT090 NEDSS 1.1.3 Bordetella Pertussis Serology-1 Was Bordetella Pertussis Serology #1 done? CE 0 1 PHVS_YNU
PRT091 NEDSS 1.1.3 Bordetella Pertussis Serology-2 Was Bordetella Pertussis Serology #2 done? CE 0 1 PHVS_YNU
PRT092 NEDSS 1.1.3 Bordetella Pertussis PCR Specimen Was Bordetella Pertussis PCR specimen taken? CE 0 1 PHVS_YNU
PRT093 NEDSS 1.1.3 CDC Genotyping Were clinical specimens sent to CDC for genotyping (molecular typing)? CE 0 1 PHVS_YNU
PRT094 NEDSS 1.1.3 Date Specimens Sent Date clinical specimens sent to CDC for genotyping DATE 0 1
PRT096 NEDSS 1.1.3 Serology-1 Lab Where Performed The lab where serology #1 was performed. CE 0 1 PHVS_PER_LAB_LOC
PRT097 NEDSS 1.1.3 Serology-1 Lab Name The name of the lab where serology #1 was performed. ST 0 1
PRT098 NEDSS 1.1.3 Serology-2 Lab Where Performed The lab where serology #2 was performed. CE 0 1 PHVS_PER_LAB_LOC
PRT099 NEDSS 1.1.3 Serology -2 Lab Name The name of the lab where serology #2 was performed. ST 0 1
PRT100 NEDSS 1.1.3 PCR Lab Where Performed The lab where PCR was performed. CE 0 1 PHVS_PER_LAB_LOC
PRT101 NEDSS 1.1.3 PCR Lab Name The name of the lab where PCR was performed. ST 0 1
PRT102 NEDSS 1.1.3 Genotyping Specimen Type The type of specimen that was sent to the CDC for genotyping. ST 0 1
PRT104 NEDSS 1.1.3 Not Vaccinated Reason If the patient was not vaccinated with pertussis-vaccine, give reason. CE 0 1 PHVS_VAC_NOTG_RSN
PRT105 NEDSS 1.1.3 Doses Pertussis Vaccine 2 Weeks Before Illness How many doses of pertussis-containing vaccine were given 2 weeks or more before illness onset? CE 0 1 PHVS_P_VAC_DOSE_NUM
















































































































































































Sheet 13: Rubella
UID AppVer Label Description Fmt Min Max VSName
RUB001 NEDSS 1.1.3 Time In US Length of time the patient has been in the US (Include units) PQ 0 1 PHVS_DurationUnit_UCUM
RUB003 NEDSS 1.1.3 Maculopapular Rash Did the patient have a maculopapular rash? CE 0 1 PHVS_YNU
RUB004 NEDSS 1.1.3 Rash Onset Date Maculopapular rash onset date DATE 0 1
RUB005 NEDSS 1.1.3 Rash Duration How many days did the maculopapular rash last? PQ 0 1 PHVS_DurationUnit_UCUM
RUB006 NEDSS 1.1.3 Patient Fever Did the patient have a fever? CE 0 1 PHVS_YNU
RUB007 NEDSS 1.1.3 Highest Temperature Highest measured temperature of the patient (include units) PQ 0 1 PHVS_TemperatureUnits_UCUM
RUB009 NEDSS 1.1.3 Arthralgia-Arthritis Did the patient have arthralgia/arthritis (symptom)? CE 0 1 PHVS_YNU
RUB010 NEDSS 1.1.3 Lymphadenopathy Did the patient have lymphadenopathy (symptom)? CE 0 1 PHVS_YNU
RUB011 NEDSS 1.1.3 Conjunctivitis Did the patient have conjunctivitis (symptom)? CE 0 1 PHVS_YNU
RUB019 NEDSS 1.1.3 Encephalitis Did the patient have encephalitis (complication)? CE 0 1 PHVS_YNU
RUB020 NEDSS 1.1.3 Thrombocytopenia Did the patient have thrombocytopenia (complication)? CE 0 1 PHVS_YNU
RUB021 NEDSS 1.1.3 Other Complications Did the patient have other complications? CE 0 1 PHVS_YNU
RUB022 NEDSS 1.1.3 Specific Other Complications Did the patient have other complications (Other)? ST 0 1
RUB028 NEDSS 1.1.3 Cause Death Cause of patient's death ST 0 1
RUB033 NEDSS 1.1.3 Rubella Testing Was laboratory testing done for rubella? CE 0 1 PHVS_YNU
RUB034 NEDSS 1.1.3 Rubella IgM EIA Rubella IgM EIA test? CE 0 1 PHVS_YNU
RUB035 NEDSS 1.1.3 Date Rubella IgM EIA Date of rubella IgM EIA test DATE 0 1
RUB036 NEDSS 1.1.3 Rubella IgM EIA Result Result of rubella IgM EIA test CE 0 1 PHVS_NIP_RSLT_QUAL
RUB037 NEDSS 1.1.3 Rubella IgM EIA Capture Rubella Igm EIA capture? CE 0 1 PHVS_YNU
RUB038 NEDSS 1.1.3 Date Rubella IgM EIA Capture Date of rubella IgM EIA capture DATE 0 1
RUB039 NEDSS 1.1.3 Rubella IgM EIA Capture Result Result of rubella IgM EIA capture CE 0 1 PHVS_NIP_RSLT_QUAL
RUB040 NEDSS 1.1.3 Other Rubella IgM Test Other rubella IgM test done? CE 0 1 PHVS_YNU
RUB041 NEDSS 1.1.3 Specific Other Rubella IgM Test Specify other rubella IgM test done ST 0 1
RUB042 NEDSS 1.1.3 Date Other Rubella IgM Test Date of other rubella IgM test DATE 0 1
RUB043 NEDSS 1.1.3 Other Rubella IgM Result Result of other rubella IgM test CE 0 1 PHVS_NIP_RSLT_QUAL
RUB044 NEDSS 1.1.3 Rubella IgG EIA-Acute Rubella IgG, EIA - acute? CE 0 1 PHVS_YNU
RUB045 NEDSS 1.1.3 Date Rubella IgG EIA-Acute Date of rubella IgG, EIA - acute DATE 0 1
RUB046 NEDSS 1.1.3 Rubella IgG EIA-Convalescent Rubella IgG, EIA - convalescent? CE 0 1 PHVS_YNU
RUB047 NEDSS 1.1.3 Date Rubella IgG EIA-Convalescent Date of rubella IgG, EIA - convalescent DATE 0 1
RUB048 NEDSS 1.1.3 Difference Acute-Convalescent IgG EIA Tests Difference between acute/convalescent IgG EIA tests CE 0 1 PHVS_NIP_IGG_DIFF
RUB049 NEDSS 1.1.3 Hemagglutination Inhibition Test-Acute Hemagglutination inhibition test- acute? CE 0 1 PHVS_YNU
RUB050 NEDSS 1.1.3 Date Hemagglutination Inhibition Test-Acute Date of hemagglutination inhibition test- acute DATE 0 1
RUB051 NEDSS 1.1.3 Hemagglutination Inhibition Test-Convalescent Hemagglutination inhibition test - convalescent? CE 0 1 PHVS_YNU
RUB052 NEDSS 1.1.3 Date Hemagglutination Inhibition Test-Convalescent Date hemagglutination inhibition test-convalescent DATE 0 1
RUB053 NEDSS 1.1.3 Difference Acute-Convalescent Hemagglutination Inhibition Tests Difference between acute/convalescent hemagglutination inhibition tests CE 0 1 PHVS_NIP_IGG_DIFF
RUB054 NEDSS 1.1.3 Complement Fixation Test-Acute Complement fixation test- acute? CE 0 1 PHVS_YNU
RUB055 NEDSS 1.1.3 Date Complement Fixation Test-Acute Date of complement fixation test - acute DATE 0 1
RUB056 NEDSS 1.1.3 Complement Fixation Test-Convalescent Complement fixation test - convalescent? CE 0 1 PHVS_YNU
RUB057 NEDSS 1.1.3 Date Complement Fixation Test-Convalescent Date of complement fixation test - convalescent DATE 0 1
RUB058 NEDSS 1.1.3 Difference Acute-Convalescent Complement Fixation Tests Difference between acute/complement fixation tests CE 0 1 PHVS_NIP_IGG_DIFF
RUB059 NEDSS 1.1.3 Other Rubella IgG Test-1 Other Rubella IgG test? (#1) CE 0 1 PHVS_YNU
RUB060 NEDSS 1.1.3 Specific Other Rubella IgG Test-1 Specify other Rubella IgG test (#1) ST 0 1
RUB061 NEDSS 1.1.3 Date Other Rubella IgG Test-1 Date of other Rubella IgG test (#1) DATE 0 1
RUB062 NEDSS 1.1.3 Other Rubella IgG Result-1 Result of other Rubella IgG test (#1) CE 0 1 PHVS_NIP_RSLT_QUAL
RUB063 NEDSS 1.1.3 Other Rubella IgG Test-2 Other Rubella IgG test? (#2) CE 0 1 PHVS_YNU
RUB064 NEDSS 1.1.3 Specific Other Rubella IgG Test-2 Specify other Rubella IgG test (#2) ST 0 1
RUB065 NEDSS 1.1.3 Date Other Rubella IgG Test-2 Date of other Rubella IgG test (#2) DATE 0 1
RUB066 NEDSS 1.1.3 Other Rubella IgG Result-2 Result of other Rubella IgG test (#2) CE 0 1 PHVS_NIP_RSLT_QUAL
RUB067 NEDSS 1.1.3 Other Rubella IgG Test-3 Other Rubella IgG test? (#3) CE 0 1 PHVS_YNU
RUB068 NEDSS 1.1.3 Specific Other Rubella IgG Test-3 Specify other Rubella IgG test (#3) ST 0 1
RUB069 NEDSS 1.1.3 Date Other Rubella IgG Test-3 Date of other Rubella IgG test (#3) DATE 0 1
RUB070 NEDSS 1.1.3 Other Rubella IgG Result-3 Result of other Rubella IgG test (#3) CE 0 1 PHVS_NIP_RSLT_QUAL
RUB071 NEDSS 1.1.3 Virus Isolation Performed Virus Isolation performed? CE 0 1 PHVS_YNU
RUB072 NEDSS 1.1.3 Date Virus Isolation Date of Virus Isolation DATE 0 1
RUB073 NEDSS 1.1.3 Source Virus Isolation Source of Virus Isolation specimen CE 0 1 PHVS_NIP_SPECMN_SRC
RUB074 NEDSS 1.1.3 Other source Virus Isolation If other Virus Isolation specimen source, please specify ST 0 1
RUB075 NEDSS 1.1.3 Virus Isolation Result Virus Isolation result CE 0 1 PHVS_RUB_VIR_RSLT
RUB076 NEDSS 1.1.3 RT-PCR Performed RT-PCR performed? CE 0 1 PHVS_YNU
RUB077 NEDSS 1.1.3 Date RT-PCR Date of RT-PCR DATE 0 1
RUB078 NEDSS 1.1.3 Source RT-PCR Source of RT-PCR CE 0 1 PHVS_NIP_SPECMN_SRC
RUB078a NEDSS 1.1.3 Other Source RT-PCR Other source of RT-PCR ST 0 1
RUB079 NEDSS 1.1.3 RT-PCR Result Result of RT-PCR CE 0 1 PHVS_RUB_VIR_RSLT
RUB080 NEDSS 1.1.3 Latex Agglutination Test Latex Agglutination test performed? CE 0 1 PHVS_YNU
RUB081 NEDSS 1.1.3 Date Latex Agglutination Test Date of Latex Agglutination test DATE 0 1
RUB083 NEDSS 1.1.3 Latex Agglutination Result Result of latex agglutination test CE 0 1 PHVS_NIP_RSLT_QUAL
RUB084 NEDSS 1.1.3 Immunofluorescent Antibody Assays Immunofluorescent Antibody Assay performed? CE 0 1 PHVS_YNU
RUB085 NEDSS 1.1.3 Date Immunofluorescent Antibody Assays Date of immunofluorescent Antibody Assay DATE 0 1
RUB086 NEDSS 1.1.3 Source Immunofluorescent Antibody Assays Source of Immunofluorescent Antibody Assay CE 0 1 PHVS_NIP_SPECMN_SRC
RUB086a NEDSS 1.1.3 Other Source Immunofluorescent Antibody Assays Other source of Immunofluorescent Antibody Assay ST 0 1
RUB087 NEDSS 1.1.3 Immunofluorescent Antibody Assays Result Result of Immunofluorescent Antibody Assay CE 0 1 PHVS_NIP_RSLT_QUAL
RUB088 NEDSS 1.1.3 Other Laboratory Rubella Tests Other laboratory testing done for rubella? CE 0 1 PHVS_YNU
RUB089 NEDSS 1.1.3 Specific Other Rubella Test Specify other rubella laboratory test ST 0 1
RUB089a NEDSS 1.1.3 Date Other Rubella Test Date of other rubella laboratory test DATE 0 1
RUB089b NEDSS 1.1.3 Result Other Rubella Test Result of other rubella laboratory test ST 0 1
RUB091 NEDSS 1.1.3 CDC Genotyping Were clinical specimens sent to CDC for genotyping (molecular typing)? CE 0 1 PHVS_YNU
RUB091a NEDSS 1.1.3 Specimen Type CDC Genotyping Specimen type sent to CDC for genotyping CE 0 1 PHVS_NIP_SPECMN_SRC
RUB092 NEDSS 1.1.3 Other Specimen Type CDC Genotyping Other specimen type sent to CDC for genotyping ST 0 1
RUB093 NEDSS 1.1.3 Patient Rubella-Containing Vaccine Did the patient receive rubella-containing vaccine? CE 0 1 PHVS_YNU
RUB094 NEDSS 1.1.3 Reason No Rubella-Containing Vaccine If patient was never vaccinated, what was the reason? CE 0 1 PHVS_VAC_NOTG_RSN
RUB096 NEDSS 1.1.3 Doses patient Received From 1st Birthday Number of rubella-containing vaccine doses patient received ON or AFTER first birthday INT 0 1
RUB112 NEDSS 1.1.3 Epi-Linked Is this case epi-linked to another laboratory confirmed case? CE 0 1 PHVS_YNU
RUB118 NEDSS 1.1.3 Expected Delivery Date What is the expected delivery date of this pregnancy? DATE 0 1
RUB119 NEDSS 1.1.3 Expected Delivery Place Expected place of delivery ST 0 1
RUB120 NEDSS 1.1.3 Weeks Gestation Number of weeks gestation at time of rubella disease PQ 0 1 PHVS_DurationUnit_UCUM
RUB121 NEDSS 1.1.3 Trimester Trimester of gestation at time of rubella disease CE 0 1 PHVS_PREG_TRIMESTER
RUB122 NEDSS 1.1.3 Previous Rubella Immunity Testing Is there documentation of previous rubella immunity testing? CE 0 1 PHVS_YNU
RUB123 NEDSS 1.1.3 Result Immunity Testing Result of immunity testing CE 0 1 PHVS_NIP_RSLT_QUAL
RUB124 NEDSS 1.1.3 Year Immunity Testing Year (YYYY) of immunity testing DATE 0 1
RUB125 NEDSS 1.1.3 Age Immunity Testing Age of woman at time of immunity testing PQ 0 1 PHVS_AgeUnit_UCUM
RUB126 NEDSS 1.1.3 Prior Rubella Disease Did the woman ever have rubella disease prior to this pregnancy? CE 0 1 PHVS_YNU
RUB127 NEDSS 1.1.3 Serological Confirmation Prior Rubella Disease Was previous rubella disease serologically confirmed by physician? CE 0 1 PHVS_YNU
RUB128 NEDSS 1.1.3 Year Previous Disease What was the year of the previous disease? DATE 0 1
RUB129 NEDSS 1.1.3 Age Previous Disease Age of the woman at time of previous disease? PQ 0 1 PHVS_AgeUnit_UCUM
RUB130 NEDSS 1.1.3 Outcome Current Pregnancy What was the outcome of the current pregnancy? CE 0 1 PHVS_OUTCOME_PREG
RUB132 NEDSS 1.1.3 Live Birth Outcome Type If the outcome of the current pregnancy is "Live birth" choose the type CE 0 1 PHVS_RUB_BIRTH_OUTCM
RUB133 NEDSS 1.1.3 Non-Live Birth Outcome Type If the outcome of the current pregnancy is "Not a live birth" choose the type CE 0 1 PHVS_OUTCOME_NLB
RUB134 NEDSS 1.1.3 Age Fetus Cessation At the time of cessation of pregnancy what was the age of the fetus (include units)? PQ 0 1 PHVS_AgeUnit_UCUM
RUB135 NEDSS 1.1.3 Autopysy-Pathology Conducted If the outcome of the current pregnancy is "Not a live birth", was an autopsy/pathology study conducted? CE 0 1 PHVS_YNU
RUB136 NEDSS 1.1.3 Autopsy-Pathology Result Result of the autopsy/pathology study ST 0 1
RUB137 NEDSS 1.1.3 Confimation Method Gives the method for confirming the case of Rubella. CE 0 1 PHVS_NIP_CONF_M
RUB139 NEDSS 1.1.3 Date CDC Genotyping Date clinical specimen sent to CDC for genotyping DATE 0 1
RUB140 NEDSS 1.1.3 Rubella IgG EIA-Acute Value EIA - Acute Test Result Value ST 0 1
RUB141 NEDSS 1.1.3 Rubella IgG EIA-Convalescent Value EIA - Convalescent Test Result Value ST 0 1
RUB142 NEDSS 1.1.3 Hemagglutination Inhibition Test-Acute Value Hemagglutination Inhibition - Acute Test Result Value ST 0 1
RUB143 NEDSS 1.1.3 Hemagglutination Inhibition Test-Convalescent Value Hemagglutination Inhibition - Convalescent Test Result Value ST 0 1
RUB144 NEDSS 1.1.3 Complement Fixation Test-Acute Value Complement Fixation - Acute Test Result Value ST 0 1
RUB145 NEDSS 1.1.3 Complement Fixation Test-Convalescent Value Complement Fixation - Convalescent Test Result Value ST 0 1
RUB146 NEDSS 1.1.3 Birth Country Patient's country of birth CE 0 1 PHVS_Country_ISO_3166-1
RUB147 NEDSS 1.1.3 Arthralgia-Arthritis Complication Did patient have arthralgia/arthritis (complication)? CE 0 1 PHVS_YNU
RUB148 NEDSS 1.1.3 IgM EIA-1st Test Value The test result value for IgM EIA (1st). ST 0 1
RUB149 NEDSS 1.1.3 IgM EIA-2nd Test Value The test result value for IgM EIA (2nd). ST 0 1
RUB150 NEDSS 1.1.3 Other IgM Test Value The test result value for IgM test, other. ST 0 1
RUB151 NEDSS 1.1.3 IgG Other-1 Test Value The test result value for IgG, other (#1). ST 0 1
RUB152 NEDSS 1.1.3 IgG Other-2 Test Value The test result value for IgG, other (#2). ST 0 1
RUB153 NEDSS 1.1.3 IgG Other-3Test Value The test result value for IgG, other (#3). ST 0 1
RUB154 NEDSS 1.1.3 RT-PCR Test Value The test result value for the RT-PCR test. ST 0 1
RUB155 NEDSS 1.1.3 Latex Agg Test Value The test result value for the latex aggluntination test. ST 0 1
RUB156 NEDSS 1.1.3 Assay Test Value The test result value for the Immunofluorescent Antibody Assay test. ST 0 1
RUB157 NEDSS 1.1.3 Other Rubella Test Value The test result value for rubella lab test, other. ST 0 1
RUB158 NEDSS 1.1.3 Infection Source The source of the rubella infection (i.e. person ID, country, etc) ST 0 1
RUB159 NEDSS 1.1.3 Rash Onset Entering USA Did rash onset occur 14-23 days after entering USA, following any travel or living outside the USA? CE 0 1 PHVS_YNU
RUB160 NEDSS 1.1.3 IgM EIA-1st Method Used The method used for IgM EIA (#1). CE 0 1 PHVS_CRS_TEST_METHOD
RUB161 NEDSS 1.1.3 IgM EIA-2nd Method Used The method used for IgM EIA (#2). CE 0 1 PHVS_CRS_TEST_METHOD

Sheet 14: Tetanus
UID AppVer Label Description Fmt Min Max VSName
TET100 NEDSS 1.1.3 Intensive Care Unit Was this patient in the Intensive Care Unit (ICU)? CE 0 1 PHVS_YNU
TET101 NEDSS 1.1.3 Intensive Care Unit Days Number of days patient was in ICU PQ 0 1 PHVS_DurationUnit_UCUM
TET102 NEDSS 1.1.3 Mechanical Ventilation Was this case mechanically ventilated? CE 0 1 PHVS_YNU
TET103 NEDSS 1.1.3 Mechanical Ventilation Days Number of days patient received mechanical ventilation: PQ 0 1 PHVS_DurationUnit_UCUM
TET104 NEDSS 1.1.3 Tetanus symptom Onset Date Date of tetanus symptom onset DATE 0 1
TET105 NEDSS 1.1.3 Tetanus Type Type of tetanus CE 0 1 PHVS_NIP_TET_TYPE
TET106 NEDSS 1.1.3 Acute Wound Was there an acute wound or injury? CE 0 1 PHVS_YNU
TET107 NEDSS 1.1.3 Acute Wound Date Date acute wound or injury occurred DATE 0 1
TET108 NEDSS 1.1.3 Acute Wound Work Related Was the acute wound or injury work related? CE 0 1 PHVS_YNU
TET109 NEDSS 1.1.3 Acute Wound Environment What was the environment where acute wound or injury occurred? CE 0 1 PHVS_NIP_TET_ENV
TET110 NEDSS 1.1.3 Acute Wound Circumstances Circumstances of acute wound or injury (e.g., stepped on a nail) ST 0 1
TET111 NEDSS 1.1.3 Acute Wound Anatomic Site Principle anatomic site of acute wound or injury CE 0 1 PHVS_NIP_TET_SITE
TET112 NEDSS 1.1.3 Acute Wound Type Principle acute wound or injury type CE 0 1 PHVS_NIP_TET_INJURY
TET114 NEDSS 1.1.3 Acute Wound Medical Care Was medical care obtained for this acute wound or injury before tetanus symptom onset? CE 0 1 PHVS_YNU
TET115 NEDSS 1.1.3 Acute Wound Medical Care Date Date of wound care DATE 0 1
TET116 NEDSS 1.1.3 Acute Wound Tetanus Toxoid Administered Was tetanus toxoid (Td, TT, DT, DTaP) administered for the acute wound or injury before tetanus symptom onset? CE 0 1 PHVS_YNU
TET117 NEDSS 1.1.3 Acute Wound Tetanus Toxoid Administered Date Date patient received tetanus toxoid (Td, TT, DT, DTaP) DATE 0 1
TET118 NEDSS 1.1.3 TIG Given Before Symptom Onset Was tetanus immune globulin (TIG) prophylaxis given as part of wound care before tetanus symptom onset? CE 0 1 PHVS_YNU
TET119 NEDSS 1.1.3 TIG Given Before Symptom Onset Date Date patient received TIG prophylaxis DATE 0 1
TET120 NEDSS 1.1.3 TIG Given Before Symptom Onset Dosage Prophylactic TIG dosage (include units) PQ 0 1
TET121 NEDSS 1.1.3 Acute Wound Infection Signs Were there signs of infection at the time of care for the acute wound or injury? CE 0 1 PHVS_YNU
TET122 NEDSS 1.1.3 Non-Acute Condition Associated With Tetanus If there was no acute wound or injury, was there one or more non-acute conditions associated with the tetanus illness? CE 0 1 PHVS_YNU
TET123 NEDSS 1.1.3 Abcess-Cellulitus Abcess/Cellulitus CE 0 1 PHVS_YNU
TET124 NEDSS 1.1.3 Ulcer Ulcer CE 0 1 PHVS_YNU
TET125 NEDSS 1.1.3 Blister Blister CE 0 1 PHVS_YNU
TET126 NEDSS 1.1.3 Gangrene Gangrene CE 0 1 PHVS_YNU
TET127 NEDSS 1.1.3 Cancer Cancer CE 0 1 PHVS_YNU
TET128 NEDSS 1.1.3 Dental Infection-Gingivitis Dental Infection/Gingivitis CE 0 1 PHVS_YNU
TET129 NEDSS 1.1.3 Ear Infection Ear infection CE 0 1 PHVS_YNU
TET130 NEDSS 1.1.3 Injection Drug Use Injection drug use CE 0 1 PHVS_YNU
TET131 NEDSS 1.1.3 Other Non-Acute Condition Other Non-Acute Condition Present? CE 0 1 PHVS_YNU
TET132 NEDSS 1.1.3 Specific Other Non-Acute Condition Specify other ST 0 1
TET133 NEDSS 1.1.3 Non-Acute Condition Medical Care Was medical care obtained for the non-acute condition before tetanus symptom onset? CE 0 1 PHVS_YNU
TET134 NEDSS 1.1.3 Non-Acute Condition Medical Care Date Date of medical care DATE 0 1
TET135 NEDSS 1.1.3 Non-Acute Condition Tetanus Toxoid Was tetanus toxoid (Td, TT, DT, DTaP) administered for the non-acute condition before tetanus symptom onset? CE 0 1 PHVS_YNU
TET136 NEDSS 1.1.3 Non-Acute Condition Tetanus Toxoid Date Date patient received tetanus toxoid (Td, TT, DT, DTaP) DATE 0 1
TET137 NEDSS 1.1.3 Infected Wound Was the wound infected at the time of tetanus diagnosis? CE 0 1 PHVS_YNU
TET138 NEDSS 1.1.3 TIG Given After Symptom Onset Was tetanus immune globulin (TIG) therapy given after symptom onset? CE 0 1 PHVS_YNU
TET139 NEDSS 1.1.3 TIG Given After Symptom Onset Date Date of TIG therapy DATE 0 1
TET140 NEDSS 1.1.3 TIG Given After Symptom Onset Dosage Total therapeutic TIG dosage (units) PQ 0 1
TET141 NEDSS 1.1.3 Final Outcome Final outcome CE 0 1 PHVS_NIP_TET_RXOUTCOME
TET143 NEDSS 1.1.3 Tetanus Antibody Test Was a tetanus antibody test performed? CE 0 1 PHVS_YNU
TET144 NEDSS 1.1.3 Tetanus Antibody Test Date Date of tetanus antibody test DATE 0 1
TET145 NEDSS 1.1.3 Tetanus Antibody Test Result Result of tetanus antibody test: (IU/mL) PQ 0 1 UCUM
TET146 NEDSS 1.1.3 Tetanus Toxid Received Has the patient ever received tetanus toxid (Td, TT, DT, DTaP)? CE 0 1 PHVS_YNU
TET147 NEDSS 1.1.3 Total Number Tetanus Toxid Doses Total # doses: CE 0 1 PHVS_NIP_TET_NUMDOSE
TET148 NEDSS 1.1.3 Years Since Last Tetanus Dose Number of years since the patient's last tetanus dose INT 0 1
TET149 NEDSS 1.1.3 Date Last Tetanus Dose Date of patient's last tetanus dose DATE 0 1
TET150 NEDSS 1.1.3 Year Last Tetanus Dose Year of patient's last tetanus dose DATE 0 1
TET151 NEDSS 1.1.3 Childhood Immunizations Immunizations in childhood CE 0 1 PHVS_TF
TET152 NEDSS 1.1.3 School Immunizations Immunizations for school CE 0 1 PHVS_TF
TET153 NEDSS 1.1.3 Work Immunizations Immunizations for work CE 0 1 PHVS_TF
TET154 NEDSS 1.1.3 Military Immunizations Immunizations for military CE 0 1 PHVS_TF
TET155 NEDSS 1.1.3 Travel Immunizations Immunizations for travel CE 0 1 PHVS_TF
TET156 NEDSS 1.1.3 Immigration Immunizations Immunizations for immigration CE 0 1 PHVS_TF
TET157 NEDSS 1.1.3 Other Reasons Immunizations Immunizations for other reasons CE 0 1 PHVS_TF
TET158 NEDSS 1.1.3 Never Received Tetanus Vaccination Reason If patient never received tetanus vaccination, give reason CE 0 1 PHVS_NIP_TET_VAC_NOTG_RSN
TET159 NEDSS 1.1.3 Primary Occupation Patient's primary occupation ST 0 1
TET160 NEDSS 1.1.3 Diabetes Does the patient have diabetes? CE 0 1 PHVS_YNU
TET161 NEDSS 1.1.3 Insulin Dependence Is the diabetic insulin dependent? CE 0 1 PHVS_YNU
TET162 NEDSS 1.1.3 Injection Drug Use History Is there a history of injection drug use? CE 0 1 PHVS_YNU
TET163 NEDSS 1.1.3 Born In US Was the patient born in the U.S.? CE 0 1 PHVS_YNU
TET164 NEDSS 1.1.3 Birth Country Patient's birth country ST 0 1
TET165 NEDSS 1.1.3 Patient LT 2 Months At Time Tetanus Was this patient less than 2 months old at time of tetanus illness? CE 0 1 PHVS_YNU
TET166 NEDSS 1.1.3 Mother Age Mother's age in years PQ 0 1 AGE_UNIT
TET167 NEDSS 1.1.3 Mother DOB Mother's date of birth DATE 0 1
TET168 NEDSS 1.1.3 Mother Primary Occupation Mother's primary occupation ST 0 1
TET169 NEDSS 1.1.3 Mother Born In US Was the mother born in the U.S. CE 0 1 PHVS_YNU
TET170 NEDSS 1.1.3 Mother Birth Country Mother's birth country ST 0 1
TET171 NEDSS 1.1.3 Date Mother First US Resident Date mother first resided in the U.S. DATE 0 1
TET172 NEDSS 1.1.3 Year Mother First US Resident Year mother first resided in the U.S. DATE 0 1
TET173 NEDSS 1.1.3 Years Mother Has Been In US Length of time mother has been in the US: (value) years PQ 0 1 DUR_UNIT
TET174 NEDSS 1.1.3 Mother Tetanus Vacc Prior To Infants Birth Had the mother ever received tetanus vaccination prior to the infant's (case's) birth? CE 0 1 PHVS_YNU
TET175 NEDSS 1.1.3 Mother Tetanus Vacc Number Known Doses If Yes, then give the number of known doses. CE 0 1 PHVS_NIP_TET_NUMDOSE
TET176 NEDSS 1.1.3 Last Mother Received Tetanus Vacc How long has it been since mother received her last tetanus vaccination? PQ 0 1 PHVS_NIP_TET_DUR_UNIT
TET178 NEDSS 1.1.3 Reason Mother Never Received Tetanus Vaccination If never vaccinated, select a reason. CE 0 1 PHVS_NIP_TET_VAC_NOTG_RSN
TET179 NEDSS 1.1.3 Number Previous Pregnancies Number of previous pregnancies INT 0 1
TET180 NEDSS 1.1.3 Total Number Live Births Number of live births (total) INT 0 1
TET181 NEDSS 1.1.3 Mother Given Birth Previously In US Has mother given birth previously in the US? CE 0 1 PHVS_YNU
TET182 NEDSS 1.1.3 Dates Previous Births In US If Yes, list the dates (years) ST 0 1
TET183 NEDSS 1.1.3 Prenatal Care Was prenatal care obtained during the pregnancy with the neonatal tetanus case? CE 0 1 PHVS_YNU
TET184 NEDSS 1.1.3 Number Prenatal Visits Number of prenatal visits INT 0 1
TET185 NEDSS 1.1.3 Infants Birth Place Location Infant's (case) birth place location CE 0 1 PHVS_NIP_TET_BIRTH_LOC
TET186 NEDSS 1.1.3 Specific Other Birth Place Specify other birth place ST 0 1
TET187 NEDSS 1.1.3 Birth Attendees Birth attendees CE 0 1 PHVS_NIP_TET_BIRTH_ROLE
TET188 NEDSS 1.1.3 Number Births Delivered In US Number of births delivered in the US INT 0 1

Sheet 15: GEN. HEP.
UID AppVer Label Description Fmt Min Max VSName
HEP100 NEDSS 1.1.3 TESTRX The reason the patient was tested for hepatitis. This is a multi-select field. CE 0 N PHVS_H_RSN_FOR_TEST
HEP101 NEDSS 1.1.3 OTHREASON Other reason the patient was tested for hepatitis. ST 0 1
HEP102 NEDSS 1.1.3 SYMPTOM Is the patient symptomatic? CE 0 1 PHVS_YNU
HEP103 NEDSS 1.1.3 SYMTDT The onset date of symptoms. DATE 0 1
HEP104 NEDSS 1.1.3 JAUNDICED Was the patient jaundiced? CE 0 1 PHVS_YNU
HEP107 NEDSS 1.1.3 DUEDT The patient's pregnancy due date. DATE 0 1
HEP110 NEDSS 1.1.3 TOTANTIHAV Total antibody to hepatitis A virus [total anti-HAV] CE 0 1 PHVS_PNU
HEP111 NEDSS 1.1.3 IGMHAV IgM antibody to hepatitis A virus [IgM anti-HAV] CE 0 1 PHVS_PNU
HEP112 NEDSS 1.1.3 HBSAG Hepatitis B surface antigen [HBsAg] CE 0 1 PHVS_PNU
HEP113 NEDSS 1.1.3 TOTANTIHBC Total antibody to hepatitis B core antigen [Total anti-HBc] CE 0 1 PHVS_PNU
HEP114 NEDSS 1.1.3 IGMHBC IgM antibody to hepatitis B core antigen [IgM anti-HBc] CE 0 1 PHVS_PNU
HEP115 NEDSS 1.1.3 ANTIHCV Antibody to hepatitis C virus [anti-HCV] CE 0 1 PHVS_PNU
HEP116 NEDSS 1.1.3 ANTIHCVSIG anti-HCV signal to cut-off ratio ST 0 1
HEP117 NEDSS 1.1.3 SUPANTIHCV Supplemental anti-HCV assay [e.g. RIBA] CE 0 1 PHVS_PNU
HEP118 NEDSS 1.1.3 HCVRNA HCV RNA [e.g. PCR] CE 0 1 PHVS_PNU
HEP119 NEDSS 1.1.3 ANTIHDV Antibody to hepatitis D virus [anti-HDV] CE 0 1 PHVS_PNU
HEP120 NEDSS 1.1.3 ANTIHEV Antibody to hepatitis E virus [anti-HEV] CE 0 1 PHVS_PNU
HEP121 NEDSS 1.1.3 ALTSGPT ALT (SGPT) Result (include units) PQ 0 1
HEP122 NEDSS 1.1.3 ALTSGPTUP ALT (SGPT) Result Upper Limit Normal (include units) PQ 0 1
HEP123 NEDSS 1.1.3 ASTSGOT AST (SGOT) Result (include units) PQ 0 1
HEP124 NEDSS 1.1.3 ASTSGOTUP AST (SGOT) Result Upper Limit Normal (include units) PQ 0 1
HEP125 NEDSS 1.1.3 ALTDT The date of the ALT result. DATE 0 1
HEP126 NEDSS 1.1.3 ASTDT The date of the AST result DATE 0 1
HEP127 NEDSS 1.1.3 EPILINK If this case has a diagnosis of hepatitis A that has not been serologically confirmed, is there an epidemiologic link between this patient and a laboratory-confirmed hepatitis A case? CE 0 1 PHVS_YNU
HEP128 NEDSS 1.1.3 DX The disease diagnosis. CE 0 1 PHVS_PHC_TYPE
HEP255 NEDSS 1.1.3 BIRTHPLACE The patient's country of birth. CE 0 1 PHVS_Country_ISO_3166-1
















































































































































































































































































































































































































































































Sheet 16: Hep A, Acute
UID AppVer Label Description Fmt Min Max VSName
HEP129 NEDSS 1.1.3 CONTACTA During the two to six weeks prior to the onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis A virus infection? CE 0 1 PHVS_YNU
HEP130 NEDSS 1.1.3 ATYPE The type of contact the patient had with a person with confirmed or suspected hepatitis A virus infection during the two to six weeks prior to symptom onset. CE 0 1 PHVS_H_CONTACT_TY
HEP131 NEDSS 1.1.3 AOTHCON Other type of contact the patient had with a person with confirmed or suspected hepatitis A virus infection during the two to six weeks prior to symptom onset. ST 0 1
HEP132 NEDSS 1.1.3 ADAYCARE1 Was the patient a child or employee in day care center, nursery, or preschool? CE 0 1 PHVS_YNU
HEP133 NEDSS 1.1.3 ADAYCARE2 Was the patient a household contact of a child or employee in a day care center, nursery, or preschool? CE 0 1 PHVS_YNU
HEP134 NEDSS 1.1.3 ADAYCAREAID Was there an identified hepatitis A case in the child care facility? CE 0 1 PHVS_YNU
HEP135 NEDSS 1.1.3 ASEXMALE The number of male sex partners the person had in the two to six weeks before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP136 NEDSS 1.1.3 ASEXFEMALE The number of female sex partners the person had in the two to six weeks before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP137 NEDSS 1.1.3 AIVDRUGS Did the patient inject street drugs in the two to six weeks before symptom onset? CE 0 1 PHVS_YNU
HEP138 NEDSS 1.1.3 ADRUGS Did the patient use street drugs but not inject in the two to six weeks before symptom onset? CE 0 1 PHVS_YNU
HEP139 NEDSS 1.1.3 ATRAVEL Did the patient travel outside of the U.S.A. or Canada in the two to six weeks before symptom onset? CE 0 1 PHVS_YNU
HEP140 NEDSS 1.1.3 AWHERE The countries to which the patient traveled (outside of the U.S.A. or Canada) in the two to six weeks before symptom onset? CE 0 N PHVS_Country_ISO_3166-1
HEP141 NEDSS 1.1.3 AHHTRAVEL Did anyone in the patient's household travel outside of the U.S.A. or Canada in the three months before symptom onset? CE 0 1 PHVS_YNU
HEP142 NEDSS 1.1.3 AHHWHERE The countries to which anyone in the patient's household traveled (outside of the U.S.A. or Canada) in the three months before symptom onset? CE 0 N PHVS_Country_ISO_3166-1
HEP145 NEDSS 1.1.3 AFOODITEM The food item with which the foodborne outbreak is associated. ST 0 1
HEP146 NEDSS 1.1.3 AHANDLER Was the patient employed as a food handler during the two weeks prior to onset of symptoms or while ill? CE 0 1 PHVS_YNU
HEP147 NEDSS 1.1.3 HEPAVAC Has patient ever received the hepatitis A vaccine? CE 0 1 PHVS_YNU
HEP148 NEDSS 1.1.3 HEPAVACDOS The number of doses of hepatitis A vaccine the patient received. CE 0 1 PHVS_H_VAC_DOSE_NUM
HEP149 NEDSS 1.1.3 HEPAVACYR The year that the patient received the last dose of hepatitis A vaccine. DATE 0 1
HEP150 NEDSS 1.1.3 IMMUGLOB Has the patient ever received immune globulin? CE 0 1 PHVS_YNU
HEP151 NEDSS 1.1.3 IMMUGLOBYR The date that the patient received the last dose of immune globulin. DATE 0 1
























































































































































































































































































































































































































































































































Sheet 17: Hep B, Acute
UID AppVer Label Description Fmt Min Max VSName
HEP152 NEDSS 1.1.3 CONTACTB During the six weeks to six months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected acute or chronic hepatitis B virus infection? Required Attribute: No CE 0 1 PHVS_YNU
HEP153 NEDSS 1.1.3 BTYPE The type of contact the patient had with a person with confirmed or suspected acute or chronic hepatitis B virus infection during the two to six weeks prior to symptom onset. Required Attribute: No CE 0 N PHVS_H_CONTACT_TY
HEP154 NEDSS 1.1.3 BOTHCON Other type of contact the patient had with a person with confirmed or suspected acute or chronic hepatitis B virus infection during the two to six weeks prior to symptom onset. Required Attribute: No ST 0 1
HEP155 NEDSS 1.1.3 BMALESEX The number of male sex partners the person had in the six months before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP156 NEDSS 1.1.3 BFEMALESEX The number of female sex partners the person had in the six months before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP157 NEDSS 1.1.3 BSTD Was patient ever treated for a sexually-transmitted disease? CE 0 1 PHVS_YNU
HEP158 NEDSS 1.1.3 BSTDYR The year that the patient received the most recent treatment for a sexually-transmitted disease. DATE 0 1
HEP159 NEDSS 1.1.3 BIVDRUGS Did the patient inject street drugs not prescribed by a doctor in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP160 NEDSS 1.1.3 BDRUGS Did the patient use street drugs but not inject in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP161 NEDSS 1.1.3 BDIALYSIS Did the patient undergo hemodialysis in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP162 NEDSS 1.1.3 BSTICK Did the patient have an accidental stick or puncture with a needle or other object contaminated with blood in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP163 NEDSS 1.1.3 BTRANS Did the patient receive blood or blood products (transfusion) in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP164 NEDSS 1.1.3 BTRANSDT The date the patient received blood or blood products (transfusion) in the six weeks to six months before symptom onset. DATE 0 1
HEP165 NEDSS 1.1.3 BBLOOD Did the patient have other exposure to someone else's blood in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP166 NEDSS 1.1.3 BBLOODTYPE The patient's blood exposure in the six weeks to six months before symptom onset other than through transfusion or an accidental stick or puncture. ST 0 1
HEP167 NEDSS 1.1.3 BMEDEMP Was the patient employed in a medical or dental field involving direct contact with human blood in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP168 NEDSS 1.1.3 BFREQ1 The patient's frequency of blood contact as an employee in a medical or dental field involving direct contact with human blood in the six weeks to six months before symptom onset. CE 0 1 PHVS_H_BLDCNTC_FREQ
HEP169 NEDSS 1.1.3 BPUBSAFEMP was the patient employed as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP170 NEDSS 1.1.3 BFREQ2 The patient's frequency of blood contact as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood in the six weeks to six months before symptom onset. CE 0 1 PHVS_H_BLDCNTC_FREQ
HEP171 NEDSS 1.1.3 BTATTOO Did the patient receive a tattoo in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP172 NEDSS 1.1.3 BTATTOOLOC The location where the patient received a tattoo in the six weeks to six months before symptom onset. CE 0 N PHVS_H_PIERC_LOC_TY
HEP173 NEDSS 1.1.3 BTATTOOOTH Other location where the patient received a tattoo in the six weeks to six months before symptom onset. ST 0 1
HEP174 NEDSS 1.1.3 BPIERCE Did the patient have any part of their body pierced (other than ear) in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP175 NEDSS 1.1.3 BPIERCELOC The location where the patient received a piercing in the six weeks to six months before symptom onset. CE 0 N PHVS_H_PIERC_LOC_TY
HEP176 NEDSS 1.1.3 BPEIRCEOTH Other location where the patient received a piercing in the six weeks to six months before symptom onset. ST 0 1
HEP177 NEDSS 1.1.3 BDENTAL Did the patient have dental work or oral surgery in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP178 NEDSS 1.1.3 BSURGERY Did the patient have surgery (other than oral surgery) in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP179 NEDSS 1.1.3 BHOSP Was the patient hospitalized in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP180 NEDSS 1.1.3 BNURSHOME Was the patient a resident of a long term care facility in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP181 NEDSS 1.1.3 BINCAR Was the patient incarcerated for longer than 24 hours in the six weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP182 NEDSS 1.1.3 BINCARTYPE The type of facility where the patient was incarcerated for longer than 24 hours in the six weeks to six months before symptom onset. CE 0 N PHVS_H_INCAR_TY
HEP183 NEDSS 1.1.3 BEVERINCAR Was the patient ever incarcerated for longer than 6 six months during his or her lifetime? CE 0 1 PHVS_YNU
HEP184 NEDSS 1.1.3 INCARYR The year that the patient was most recently incarcerated for longer than six months. DATE 0 1
HEP185 NEDSS 1.1.3 INCARDUR The length of time that the patient was most recently incarcerated for longer than six months. (include units) PQ 0 1 PHVS_DUR_UNIT
HEP187 NEDSS 1.1.3 BVACCINE Did the patient ever receive hepatitis B vaccine? CE 0 1 PHVS_YNU
HEP188 NEDSS 1.1.3 BVACCINENO The number of shots of hepatitis B vaccine that the patient received. CE 0 1 PHVS_H_VAC_DOSE_NUM
HEP189 NEDSS 1.1.3 BVACCINEYR The year in which the patient received the last shot of hepatitis B vaccine. DATE 0 1
HEP190 NEDSS 1.1.3 BANTIBODY Was the patient tested for antibody to HBsAg (anti-HBs) within 1-2 months after the last dose? CE 0 1 PHVS_YNU
HEP191 NEDSS 1.1.3 BRESULT Was the serum anti-HBs >= 10ml U/ml? (Answer 'yes' if lab result reported as positive or reactive) CE 0 1 PHVS_YNU
HEP252 NEDSS 1.1.3 BIVOUTPT Did the patient receive any IV infusions and/or injections in the outpatient setting during the six weeks to six months prior to onset of symptoms. CE 0 1 PHVS_YNU
































































































































































































































































































































































Sheet 18: Hep C, Acute
UID AppVer Label Description Fmt Min Max VSName
HEP192 NEDSS 1.1.3 CCONTACT Was the patient a contact of a person with confirmed or suspected acute or chronic hepatitis C infection in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP193 NEDSS 1.1.3 CTYPE The type of contact the patient had with a person with confirmed or suspected acute or chronic hepatitis C infection in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_CONTACT_TY
HEP194 NEDSS 1.1.3 COTHCON Other type of contact the patient had with a person with confirmed or suspected acute or chronic hepatitis C infection in the two weeks to six months before symptom onset. ST 0 1
HEP195 NEDSS 1.1.3 CMALESEC The number of male sex partners the person had in the six months before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP196 NEDSS 1.1.3 CFEMALESEX The number of female sex partners the person had in the six months before symptom onset. CE 0 1 PHVS_H_NUM_SEX_PART
HEP197 NEDSS 1.1.3 CSTD Was patient ever treated for a sexually-transmitted disease? CE 0 1 PHVS_YNU
HEP198 NEDSS 1.1.3 CSTDYR The year that the patient received the most recent treatment for a sexually-transmitted disease. DATE 0 1
HEP199 NEDSS 1.1.3 CMEDEMP Was the patient employed in a medical or dental field involving direct contact with human blood in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP200 NEDSS 1.1.3 CFREQ1 The patient's frequency of blood contact as an employee in a medical or dental field involving direct contact with human blood in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_BLDCNTC_FREQ
HEP201 NEDSS 1.1.3 CPUBSAFEMP was the patient employed as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP202 NEDSS 1.1.3 CFREQ2 The patient's frequency of blood contact as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_BLDCNTC_FREQ
HEP203 NEDSS 1.1.3 CTATTOO Did the patient receive a tattoo in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP204 NEDSS 1.1.3 CTATTOOLOC The location where the patient received a tattoo in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_PIERC_LOC_TY
HEP205 NEDSS 1.1.3 CTATTOOOTH Other location where the patient received a tattoo in the two weeks to six months before symptom onset. ST 0 1
HEP206 NEDSS 1.1.3 CPIERCE Did the patient have any part of their body pierced (other than ear) in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP207 NEDSS 1.1.3 CPIERCELOC The location where the patient received a piercing in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_PIERC_LOC_TY
HEP208 NEDSS 1.1.3 CPIERCEOTH Other location where the patient received a piercing in the two weeks to six months before symptom onset. ST 0 1
HEP209 NEDSS 1.1.3 CIVDRUGS Did the patient inject street drugs not prescribed by a doctor in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP210 NEDSS 1.1.3 CDRUGS Did the patient use street drugs but not inject in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP211 NEDSS 1.1.3 CDIALYSIS Did the patient undergo hemodialysis in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP212 NEDSS 1.1.3 CSTICK Did the patient have an accidental stick or puncture with a needle or other object contaminated with blood in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP213 NEDSS 1.1.3 CTRANSF Did the patient receive blood or blood products (transfusion) in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP214 NEDSS 1.1.3 CTRANSDT The date the patient received blood or blood products (transfusion) in the two weeks to six months before symptom onset. DATE 0 1
HEP215 NEDSS 1.1.3 CBLOOD Did the patient have other exposure to someone else's blood in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP216 NEDSS 1.1.3 CBLOODEX The patient's blood exposure in the two weeks to six months before symptom onset other than through transfusion or an accidental stick or puncture. ST 0 1
HEP217 NEDSS 1.1.3 CDENTAL Did the patient have dental work or oral surgery in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP218 NEDSS 1.1.3 CSURGEY Did the patient have surgery (other than oral surgery) in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP219 NEDSS 1.1.3 CHOSP Was the patient hospitalized in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP220 NEDSS 1.1.3 CNURSHOME Was the patient a resident of a long term care facility in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP221 NEDSS 1.1.3 CINCAR Was the patient incarcerated for longer than 24 hours in the two weeks to six months before symptom onset? CE 0 1 PHVS_YNU
HEP222 NEDSS 1.1.3 CINCARTYPE The type of facility where the patient was incarcerated for longer than 24 hours in the two weeks to six months before symptom onset. CE 0 1 PHVS_H_INCAR_TY
HEP223 NEDSS 1.1.3 CEVERINCAR Was the patient ever incarcerated for longer than 6 six months during his or her lifetime? CE 0 1 PHVS_YNU
HEP224 NEDSS 1.1.3 CINCARYR The year that the patient was most recently incarcerated for longer than six months. DATE 0 1
HEP225 NEDSS 1.1.3 CINCARDUR The length of time that the patient was most recently incarcerated for longer than six months. (Include units) PQ 0 1 PHVS_DUR_UNIT
HEP253 NEDSS 1.1.3 CIVOUTPT Did the patient receive any IV infusions and/or injections in the outpatient setting during the two weeks to six months prior to onset of symptoms. CE 0 1 PHVS_YNU








































































































































































































































































































































































































Sheet 19: Hep C, Chronic
UID AppVer Label Description Fmt Min Max VSName
HEP227 NEDSS 1.1.3 HAVTRANSF Did the patient receive a blood transfusion prior to 1992? CE 0 1 PHVS_YNU
HEP228 NEDSS 1.1.3 HACTRANSP Did the patient receive an organ transplant prior to 1992? CE 0 1 PHVS_YNU
HEP229 NEDSS 1.1.3 HCVCLOT Did the patient receive clotting factor concentrates prior to 1987? CE 0 1 PHVS_YNU
HEP230 NEDSS 1.1.3 HCVDIAL Was the patient ever on long term hemodialysis? CE 0 1 PHVS_YNU
HEP231 NEDSS 1.1.3 HCVIVDRUGS Has the patient ever injected drugs not prescribed by doctor even if only once or a few times? CE 0 1 PHVS_YNU
HEP232 NEDSS 1.1.3 HCVNUMPART How many sex partners has patient had (approximate lifetime)? ST 0 1
HEP233 NEDSS 1.1.3 HCVINCAR Was the patient ever incarcerated? CE 0 1 PHVS_YNU
HEP234 NEDSS 1.1.3 HCVSTD Was the patient ever treated for a sexually-transmitted disease? CE 0 1 PHVS_YNU
HEP235 NEDSS 1.1.3 HCVCONTACT Was the patient ever a contact of person who had hepatitis? CE 0 1 PHVS_YNU
HEP236 NEDSS 1.1.3 HCVTYPE The type of contact the patient had with a person with hepatitis. CE 0 1 PHVS_H_CONTACT_TY
HEP237 NEDSS 1.1.3 HCVOTHCON Other type of contact the patient had with a person with hepatitis. ST 0 1
HEP238 NEDSS 1.1.3 HCVMEDEMP Was the patient ever employed in a medical or dental field involving direct contact with human blood? CE 0 1 PHVS_YNU
































































































































































































































































































































































































































































































































































































Sheet 20: HBV, Perinatal
UID AppVer Label Description Fmt Min Max VSName
HEP239 NEDSS 1.1.3 HBVMOMRACE The race of the patient's mother. CE 0 N PHVS_Race_CDC_CAT
HEP240 NEDSS 1.1.3 HBVMOMETH The ethnicity of the patient's mother. CE 0 1 PHVS_Ethnicity_CDC_GRP
HEP241 NEDSS 1.1.3 HBVMOMBORN Was mother born outside of the U.S.A.? CE 0 1 PHVS_YNU
HEP242 NEDSS 1.1.3 HBVMOMCTRY The mother's birth country (other than the US). CE 0 1 PHVS_Country_ISO_3166-1
HEP243 NEDSS 1.1.3 HBVCONF Was the mother confirmed HBsAg positive prior to or at time of delivery? CE 0 1 PHVS_YNU
HEP244 NEDSS 1.1.3 HBVCONFDEL Was the mother confirmed HBsAg positive after delivery? CE 0 1 PHVS_YNU
HEP245 NEDSS 1.1.3 HBVCONFDT The date of HBsAg positive test result. DATE 0 1
HEP246 NEDSS 1.1.3 HBVVACDOSE How many doses of hepatitis B vaccine did the child receive? CE 0 1 PHVS_VAC_DOSE_NUM
HEP247 NEDSS 1.1.3 HBVVACDT1 The date the child received the first dose of hepatitis B vaccine. DATE 0 1
HEP248 NEDSS 1.1.3 HBVVACDT2 The date the child received the second dose of hepatitis B vaccine. DATE 0 1
HEP249 NEDSS 1.1.3 HBVVACDT3 The date the child received the third dose of hepatitis B vaccine. DATE 0 1
HEP250 NEDSS 1.1.3 HBIG Did the child receive hepatitis B immune globulin (HBIG)? CE 0 1 PHVS_YNU
HEP251 NEDSS 1.1.3 HBIGDT The date the child received HBIG. DATE 0 1
HEP256 NEDSS 1.1.3 HBVMRACECD The mother's detailed race category. CE 0 N PHVS_Race_CDC
HEP257 NEDSS 1.1.3 HBVMETHCD The mother's detailed ethnicity category. CE 0 N PHVS_Ethnicity_CDC
HEP258 NEDSS 1.1.3 HBVMOMRDES The mother race - if other than the provided race categories. ST 0 1
































































































































































































































































































































































































































































































































































Sheet 21: Isolate Tracking
UID AppVer Label Description Fmt Min Max VSName
FDD_Q_276 NBS 1.1.4 specimenTrackingInd Is specimen tracking being captured? CE 0 1 PHVS_YN
FDD_Q_71 NBS 1.1.4 patientStatusAtSpecimenCollectionCd Patient’s status at time of isolate collection? CE 0 1 PHVSFB_SPCMNPTSTATUS
FDD_Q_291 NBS 1.1.4 isolateBeingTracked Isolate being tracked START OF REPEATING BLOCK CE 0 1 PHVS_YN
FDD_Q_66 NBS 1.1.4 isolateToPublicHealthLabInd Was an isolate received at the state public health lab? REPEATING BLOCK CE 0 1 PHVS_YNU
FDD_Q_67 NBS 1.1.4 specNotReceivedCd If an isolate wasn't received at the state public health lab, what is the reason? REPEATING BLOCK CE 0 1 PHVSFB_SPECFORW
FDD_Q_246 NBS 1.1.4 specNotReceivedOther If "Other", please specify: REPEATING BLOCK ST 0 1
FDD_Q_68 NBS 1.1.4 specReceivedDate If “Yes”, please specify date received in state public health lab: REPEATING BLOCK DATE 0 1
FDD_Q_69 NBS 1.1.4 statePublicHHealthLabID State public health lab isolate ID number: REPEATING BLOCK II 0 1
FDD_Q_70 NBS 1.1.4 statePublicHealthLabConfirmed Was the case confirmed at the state public health lab? REPEATING BLOCK (LAST ELEMENT) CE 0 1 PHVS_YNU
FDD_Q_288 NBS 1.1.4 PulseNet_ind Are PulseNet Isolates being tracked? CE 0 1 PHVS_YN
FDD_Q_366 NBS 1.1.4 pulsenetIsolateInd PulseNet Isolate: START OF REPEATING BLOCK CE 0 1 PHVS_YN
FDD_Q_49 NBS 1.1.4 pfgeToPulseNetInd Has isolate PFGE pattern been sent to central PulseNet database? REPEATING BLOCK ELEMENT CE 0 1 PHVS_YNU
FDD_Q_50 NBS 1.1.4 pulsenetPfgeEnzyme1 PulseNet PFGE Designation Enzyme 1: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_51 NBS 1.1.4 statePfgeEnzyme1 State Health Department Lab PFGE Designation Enzyme 1: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_52 NBS 1.1.4 pulsenetPfgeEnzyme2 PulseNet PFGE Designation Enzyme 2: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_53 NBS 1.1.4 statePfgeEnzyme2 State Health Department Lab PFGE Designation Enzyme 2: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_54 NBS 1.1.4 pulsenetPfgeEnzyme3 PulseNet PFGE Designation Enzyme 3: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_55 NBS 1.1.4 statePfgeEnzyme3 State Health Department Lab PFGE Designation Enzyme 3: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_271 NBS 1.1.4 NARMSCaseInd Is this a NARMS case? CE 0 1 PHVS_YN
FDD_Q_47 NBS 1.1.4 isolateToNARMSIind Has isolate been sent to NARMS? REPEATING BLOCK START CE 0 1 PHVS_YNU
FDD_Q_298 NBS 1.1.4 stateNARMSId State-assigned NARMS ID number: REPEATING BLOCK II 0 1
FDD_Q_299 NBS 1.1.4 NARMSExpectedShipDate Expected Ship Date: REPEATING BLOCK ELEMENT DATE 0 1
FDD_Q_300 NBS 1.1.4 NARMSActualShipDate Actual Ship Date: REPEATING BLOCK ELEMENT DATE 0 1
FDD_Q_302 NBS 1.1.4 noNARMSSpecReasonCd If an isolate was not sent to NARMS, what is the reason? REPEATING BLOCK ELEMENT CE 0 1 PHVSFB_ISOLATNO
FDD_Q_68 NBS 1.1.4 specReceivedDate If “Yes”, please specify date received in state public health lab: REPEATING BLOCK DATE 0 1
FDD_Q_69 NBS 1.1.4 statePublicHHealthLabID State public health lab isolate ID number: REPEATING BLOCK ELEMENT II 0 1
FDD_Q_70 NBS 1.1.4 statePublicHealthLabConfirmed Was the case confirmed at the state public health lab? REPEATING BLOCK (LAST ELEMENT) CE 0 1 PHVS_YNU
FDD_Q_289 NBS 1.1.4 EIP_isolate_tracking_ind If EIP Isolates are being tracked, then display the following questions: CE 0 1 PHVS_YN
FDD_Q_363 NBS 1.1.4 EIPIsolateInd EIP Isolate: START OF REPEATING BLOCK CE 0 1 PHVS_YN
FDD_Q_247 NBS 1.1.4 EIPAvailableCd Is this specimen available for further EIP testing? REPEATING BLOCK ELEMENT CE 0 1 PHVSFB_ISOLATAV
FDD_Q_251 NBS 1.1.4 EIPNotAvailableCd If a specimen is not available for further EIP testing, what is the reason? REPEATING BLOCK ELEMENT CE 0 1 PHVSFB_SPECAVAL
FDD_Q_252 NBS 1.1.4 EIPNotAvailableOther If "Other", please specify other reason why specimen is not available: REPEATING BLOCK ELEMENT ST 0 1 PHVSFB_SPECFORW
FDD_Q_248 NBS 1.1.4 EIPShipToCd If “Yes”, where will the specimen the shipped? CE 0 1 PHVSFB_CDCLABSH
FDD_Q_249 NBS 1.1.4 EIPExpectedShipDate Expected Ship Date: REPEATING BLOCK ELEMENT DATE 0 1
FDD_Q_250 NBS 1.1.4 EIPActualShipDate Actual Ship Date: REPEATING BLOCK ELEMENT DATE 0 1
FDD_Q_290 NBS 1.1.4 EIPReshipRequestedInd Was specimen requested for reshipment? REPEATING BLOCK ELEMENT CE 0 1 PHVS_YN
FDD_Q_253 NBS 1.1.4 EIPReshipReasonCd If a specimen was requested for reshipment for further EIP testing, what is the reason? REPEATING BLOCK ELEMENT CE 0 1 PHVSFB_CONTAMIN
FDD_Q_254 NBS 1.1.4 EIPReshipReasonOther If “Other”, please specify other reason for reshipment: REPEATING BLOCK ELEMENT ST 0 1
FDD_Q_255 NBS 1.1.4 EIPExpectedReshipDate Expected Reship Date: REPEATING BLOCK ELEMENT DATE 0 1
FDD_Q_256 NBS 1.1.4 EIPActualReshipDate Actual Reship Date: REPEATING BLOCK ELEMENT DATE 0 1
































































































































































































































































































































































Sheet 22: Foodborne Questions
UID AppVer Label Description Fmt Min Max VSName
FDD_Q_31 NBS 1.1.4 animalContactInd Did patient come in contact with an animal? CE 0 1 YNU
FDD_Q_32 NBS 1.1.4 animalTypeCd Type of animal: (MULTISELECT) CE 0 N PHVSFB_ANIMALST
FDD_Q_243 NBS 1.1.4 animalTypeOther If “Other”, please specify other type of animal: ST 0 1
FDD_Q_295 NBS 1.1.4 animalAmphibianOther If “Other Amphibian”, please specify other type of amphibian: ST 0 1
FDD_Q_296 NBS 1.1.4 animalReptileOther If “Other Reptile”, please specify other type of reptile: ST 0 1
FDD_Q_374 NBS 1.1.4 animalMammalOther If "Other Mammal", please specify other type of mammal: ST 0 1
FDD_Q_33 NBS 1.1.4 animalContactLocation Name or Location of Animal Contact: ST 0 1
FDD_Q_34 NBS 1.1.4 acquireNewPet Did the patient acquire a pet prior to onset of illness? CE 0 1 YNU
FDD_Q_244 NBS 1.1.4 applicableIncubationPeriod Applicable incubation period for this illness is (Incubation.PDF): ST 0 1
FDD_Q_259 NBS 1.1.4 botulismFoodborneInd Does the patient have Foodborne Botulism? CE 0 1 YN
FDD_Q_114 NBS 1.1.4 botulismLabConfirmedInd Was botulism laboratory confirmed from patient specimen? CE 0 1 PHVS_YNU
FDD_Q_115 NBS 1.1.4 cBotulinumIsolatedInd Was C. botulinum isolated in culture from patient specimen? CE 0 1 PHVS_YNU
FDD_Q_113 NBS 1.1.4 botulismFoodSourceCd If food is known or thought to be the source, please specify food type: CE 0 1 PHVSFB_COOKMETH
FDD_Q_112 NBS 1.1.4 botulismFoodSourceOther If “Other”, please specify other food type: ST 0 1
FDD_Q_116 NBS 1.1.4 foodTestedInd Was food tested? CE 0 1 PHVS_YNU
FDD_Q_117 NBS 1.1.4 foodBotulismPositiveInd Was food positive for botulism? CE 0 1 PHVS_YNU
FDD_Q_118 NBS 1.1.4 foodToxinTypeCd If food was positive, what was its toxin type? CE 0 1 PHVSFB_BOTOXTYPE
FDD_Q_119 NBS 1.1.4 foodToxinTypeOther If “Other”, please specify other toxin type: ST 0 1
FDD_Q_263 NBS 1.1.4 botulismOtherInd Did the patient have Other Clinical based Botulism? CE 0 1 YN
FDD_Q_286 NBS 1.1.4 botulismLabConfirmed Was botulism laboratory confirmed from patient specimen? CE 0 1 PHVS_YNU
FDD_Q_287 NBS 1.1.4 cBotulinumIsolated Was C. botulinum isolated in culture from patient specimen? CE 0 1 PHVS_YNU
FDD_Q_264 NBS 1.1.4 choleraInd Did the patient have Cholera? CE 0 1 YN
FDD_Q_196 NBS 1.1.4 choleraOnsetTime Time of onset of illness: TS 0 1 PHVSFB_AMPMAMPM
FDD_Q_197 NBS 1.1.4 diarrheaInd Did the patient have diarrhea? CE 0 1 PHVS_YNU
FDD_Q_198 NBS 1.1.4 maxStools24hrs If "Yes”, please specify maximum number of stools per 24 hours: INT 0 1
FDD_Q_199 NBS 1.1.4 feverInd Did patient have a fever? CE 0 1 PHVS_YNU
FDD_Q_200 NBS 1.1.4 temperature If “Yes”, please specify temperature: PQ 0 1 PHVS_TEMP_UNIT
FDD_Q_202 NBS 1.1.4 cellulitisInd Did the patient have Cellulitis? CE 0 1 PHVS_YNU
FDD_Q_203 NBS 1.1.4 cellulitisSourceCd If “Yes”, please specify the location: CE 0 1 PHVSFB_ANATOMYS
FDD_Q_204 NBS 1.1.4 cellulitisSourceOther If “Other”, please specify other type of location: ST 0 1
FDD_Q_205 NBS 1.1.4 bullaeInd Did the patient have Bullae? CE 0 1 PHVS_YNU
FDD_Q_206 NBS 1.1.4 bullaeLocationCd If “Yes”, please specify the location: CE 0 1 PHVSFB_ANATOMYS
FDD_Q_207 NBS 1.1.4 bullaeLocationOther If “Other”, please specify other type of location: ST 0 1
FDD_Q_208 NBS 1.1.4 choleraSymptomCd Did patient have any of the following signs or symptoms? MULTISELECT FIELD CE 0 N PHVSFB_COLERASX
FDD_Q_209 NBS 1.1.4 choleraSymptomOther If “Other”, please specify other signs or symptoms: ST 0 1
FDD_Q_210 NBS 1.1.4 choleraSequelaeCd Did the patient have any sequelae? MULTISELECT FIELD CE 0 N PHVSFB_COLERASQ
FDD_Q_211 NBS 1.1.4 choleraSequelaeCd If “Other”, please specify other sequelae: ST 0 1
FDD_Q_214 NBS 1.1.4 antibioticTreatmentInd Did the patient take an antibiotic as treatment for this illness? CE 0 1 PHVS_YNU
FDD_Q_213 NBS 1.1.4 organismsOtherThanVibrioInd Were other organisms isolated from the same specimen that yielded Vibrio? CE 0 1 PHVS_YNU
FDD_Q_212 NBS 1.1.4 treatmentPrevious30days Was the patient receiving any of the following treatments or taking any of the following medications in the 30 days before this Vibrio illness began? MULTISELECT FIELD CE 0 N PHVSFB_MEDTREAT
FDD_Q_215 NBS 1.1.4 skinExposurePrevious7days In the 7 days before illness began, was patient’s skin exposed to any of the following? CE 0 1 PHVSFB_SEAFCONT
FDD_Q_217 NBS 1.1.4 skinExposureDatetime If patient's skin was exposed, please specify date patient's skin was exposed: TS 0 1 PHVSFB_AMPMAMPM
FDD_Q_219 NBS 1.1.4 skinExposureActivityCd In the 7 days prior to onset of illness, please specify the activity that resulted in patient’s skin exposure: CE 0 1 PHVSFB_SEAFACTN
FDD_Q_220 NBS 1.1.4 skinExposureActivityOther If “Other”, please specify other activity: ST 0 1
FDD_Q_221 NBS 1.1.4 bodyOfWaterTypeCd If patient was exposed to a body of water, please specify body of water type CE 0 1 PHVSFB_SALINITY
FDD_Q_222 NBS 1.1.4 bodyOfWaterTypeOther If “Other”, please specify other body of water type: ST 0 1
FDD_Q_216 NBS 1.1.4 bodyOfWaterLocation If patient was exposed to a body of water, please specify body of water location: ST 0 1
FDD_Q_224 NBS 1.1.4 woundDuringExposureCd If skin was exposed, did the patient sustain a wound during this exposure or have a pre-existing wound? CE 0 1 PHVSFB_WOUNDTYP
FDD_Q_225 NBS 1.1.4 woundDuringExposureDetails If “Yes”, please specify how wound occurred and site on patient’s body: ST 0 1
FDD_Q_226 NBS 1.1.4 choleraRiskFactorsCd If patient was infected with V. Cholerae O1 or O139, to which of the following risks was the patient exposed in the 4 days prior to onset of illness? MULTISELECTION FIELD CE 0 N PHVSFB_CHOLERAR
FDD_Q_227 NBS 1.1.4 choleraRiskFactorsOther If “Other”, please specify other V. Cholerae O1 or O139 risk: ST 0 1
FDD_Q_228 NBS 1.1.4 foreignTravelEducationCd If “Foreign Travel”, had the patient been educated in Cholera prevention measure prior to travel? CE 0 1 PHVSFB_TRAVELRR
FDD_Q_229 NBS 1.1.4 foreignTravelEducationOther If “Other”, please specify other source of Cholera prevention education: ST 0 1
FDD_Q_230 NBS 1.1.4 choleraVaccineInd Has patient ever received a Cholera vaccine? CE 0 1 PHVS_YNU
FDD_Q_265 NBS 1.1.4 cyclosporiasisInd Does the patient have Cyclosporiasis? CE 0 1 PHVS_YN
FDD_Q_160 NBS 1.1.4 diarrheaInd Did the patient have diarrhea? CE 0 1 PHVS_YNU
FDD_Q_161 NBS 1.1.4 maxStools24hrs If "Yes”, please specify maximum number of stools per 24 hours: INT 0 1
FDD_Q_162 NBS 1.1.4 weightLossInd Did patient experience weight loss? CE 0 1 PHVS_YNU
FDD_Q_163 NBS 1.1.4 baselineWeight If “Yes”, please specify baseline weight: PQ 0 1 PHVS_WEIGHT_UNIT
FDD_Q_164 NBS 1.1.4 weightLost Specify how much weight was lost: PQ 0 1 PHVS_WEIGHT_UNIT
FDD_Q_167 NBS 1.1.4 feverInd Did patient have a fever? CE 0 1 PHVS_YNU
FDD_Q_168 NBS 1.1.4 temperature If "Yes", please specify temperature: PQ 0 1 PHVS_TEMP_UNIT
FDD_Q_170 NBS 1.1.4 cycloSymptomsCd Did the patient have any of the following signs or symptoms of Cyclosporiasis? MULTISELECTION FIELD CE 0 N PHVSFB_CYCLOSYX
FDD_Q_171 NBS 1.1.4 cycloSymptomsOther If “Other”, please specify other signs or symptoms of Cyclosporiasis: ST 0 1
FDD_Q_172 NBS 1.1.4 cycloConfirmedByCDCInd Was the case confirmed at the CDC lab? CE 0 1 PHVS_YNU
FDD_Q_173 NBS 1.1.4 treatedForCycloInd Was the patient treated for Cyclosporiasis? CE 0 1 PHVS_YNU
FDD_Q_174 NBS 1.1.4 sulfaAllergyInd Does the patient have a sulfa allergy? CE 0 1 PHVS_YNU
FDD_Q_176 NBS 1.1.4 freshBerriesCd What fresh berries were eaten in the 14 days prior to onset of illness? MULTISELECTION FIELD CE 0 N PHVSFB_BERRYTYP
FDD_Q_177 NBS 1.1.4 freshBerriesOther If “Other”, please specify other type of fresh berries: ST 0 1
FDD_Q_178 NBS 1.1.4 freshHerbsCd What fresh herbs were eaten in the 14 days prior to onset of illness? MULTISELECTION FIELD CE 0 N PHVSFB_HERBTYPE
FDD_Q_179 NBS 1.1.4 freshHerbsOther If “Other”, please specify other type of fresh herbs: ST 0 1
FDD_Q_180 NBS 1.1.4 lettuceLast14DaysCd What fresh lettuce was eaten in the 14 days prior to onset of illness? MULTISELECTION FIELD CE 0 N PHVSFB_LETTUCET
FDD_Q_181 NBS 1.1.4 lettuceLast14DaysOther If “Other”, please specify other type of fresh lettuce: ST 0 1
FDD_Q_182 NBS 1.1.4 produceLast14DaysCd What other types of fresh produce were eaten in the 14 days prior to onset of illness? MULTISELECTION FIELD CE 0 N PHVSFB_PRODUCET
FDD_Q_183 NBS 1.1.4 produceLast14DaysOther If “Other”, please specify other type of fresh produce: ST 0 1
FDD_Q_373 NBS 1.1.4 fruitOtherThanBerriesSpecify If "Fruit, other than berries", please specify type of fruit other than berries: ST 0 1
FDD_Q_184 NBS 1.1.4 eventTast14DaysInd Did patient attend any events in the 14 days prior to onset of illness? CE 0 1 PHVS_YNU
FDD_Q_185 NBS 1.1.4 eventSpecify If “Yes”, please specify the event: ST 0 1
FDD_Q_186 NBS 1.1.4 eventDate Date of event: DATE 0 1
FDD_Q_187 NBS 1.1.4 restaurantInd Did patient eat at restaurant(s) in the 14 days prior to onset of illness? CE 0 1 PHVS_YNU
FDD_Q_188 NBS 1.1.4 restaurantSpecify If “Yes”, please specify the name of the restaurant(s): ST 0 1
FDD_Q_245 NBS 1.1.4 daycareInd Is the Patient associated with a day care center? CE 0 1 PHVS_YN
FDD_Q_1 NBS 1.1.4 dayCareAttendInd Attend a day care center? CE 0 1 PHVS_YNU
FDD_Q_2 NBS 1.1.4 dayCareWorkInd Work at a day care center? CE 0 1 PHVS_YNU
FDD_Q_3 NBS 1.1.4 dayCareLiveInd Live with a day care center attendee? CE 0 1 PHVS_YNU
FDD_Q_4 NBS 1.1.4 dayCareTypeCd What type of day care facility? CE 0 1 PHVSFB_CAREGIVE
FDD_Q_5 NBS 1.1.4 dayCareFacilityName What is the name of the day care facility? ST 0 1
FDD_Q_6 NBS 1.1.4 foodPrepInd Is food prepared at this facility? CE 0 1 PHVS_YNU
FDD_Q_7 NBS 1.1.4 diaperedInfantsInd Does this facility care for diapered persons? CE 0 1 PHVS_YNU
FDD_Q_266 NBS 1.1.4 drinkingWaterExposureInd Does the patient have Drinking Water exposure? CE 0 1 PHVS_YN
FDD_Q_21 NBS 1.1.4 homeWaterSourceCd What is the source of tap water at home? CE 0 1 PHVSFB_WATERSRC
FDD_Q_22 NBS 1.1.4 homeWellTreatCd If “Private Well”, how was the well water treated at home? CE 0 1 PHVSFB_WATERTRT
FDD_Q_23 NBS 1.1.4 homeWaterSourceOther If “Other”, specify other source of tap water at home: ST 0 1
FDD_Q_93 NBS 1.1.4 schoolWorkWaterSourceCd What is the source of tap water at school/work? CE 0 1 PHVSFB_WATERSRC
FDD_Q_94 NBS 1.1.4 schoolWorkWellTreatCd If “Private Well”, how was the well water treated at school/work? CE 0 1 PHVSFB_WATERTRT
FDD_Q_92 NBS 1.1.4 schoolWorkWaterSourceOther If “Other”, specify other source of tap water at school/work: ST 0 1
FDD_Q_24 NBS 1.1.4 drinkUntreatedWaterIind Did patient drink untreated water 7 days prior to onset of illness? CE 0 1 PHVS_YNU
FDD_Q_267 NBS 1.1.4 ehecExposureInd Does the patient have EHEC exposure? CE 0 1 PHVS_YN
FDD_Q_128 NBS 1.1.4 eColiIsolatedInd Was the isolate biochemically identified as E. coli? CE 0 1 PHVS_YNUNT
FDD_Q_129 NBS 1.1.4 shigaToxinPositiveInd Was isolate Shiga toxin positive? CE 0 1 PHVS_YNU
FDD_Q_268 NBS 1.1.4 foodHandlerInd Is the patient a Food Handler? CE 0 1 PHVS_YN
FDD_Q_8 NBS 1.1.4 foodHandlerAfterOnsetInd Did patient work as a food handler after onset of illness? CE 0 1 PHVS_YNU
FDD_Q_9 NBS 1.1.4 foodHandlerLastWorkedDate What was last date worked as a food handler after onset of illness? DATE 0 1
FDD_Q_10 NBS 1.1.4 foodHandlerLocation Where was patient a food handler? ST 0 1
FDD_Q_269 NBS 1.1.4 foodnetJurisdictionInd Is the patient within a FoodNet jurisdiction? CE 0 1 PHVS_YN
FDD_Q_257 NBS 1.1.4 foodnetCaseInd FoodNet Case: CE 0 1 PHVS_YN
FDD_Q_80 NBS 1.1.4 transferredInd Was patient transferred from one hospital to another? CE 0 1 PHVS_YNU
FDD_Q_81 NBS 1.1.4 transferredFromHospName If "Yes", specify name of the hospital to which the patient was transferred: ST 0 1
FDD_Q_82 NBS 1.1.4 hospInfosourceCd How was the information about patient’s hospitalization obtained? CE 0 1 PHVSFB_INFOSOURCE
FDD_Q_83 NBS 1.1.4 hospInfosourceOther If “Other”, specify other source of patient’s hospitalization: ST 0 1
FDD_Q_84 NBS 1.1.4 outcomeInfosourceCd How was the information about the patient’s outcome obtained? CE 0 1 PHVSFB_INFOSOURCE
FDD_Q_85 NBS 1.1.4 outcomeInfosourceOther If “Other”, specify other source of patient’s outcome: ST 0 1
FDD_Q_90 NBS 1.1.4 internationalInterviewCd Was the patient interviewed for international travel history? CE 0 1 PHVSFB_INTERVEW
FDD_Q_86 NBS 1.1.4 caseStudyIndicator In case-control study? CE 0 1 PHVS_YN
FDD_Q_87 NBS 1.1.4 caseStudyIdNumber If “Yes”, case control study id number: ST 0 1
FDD_Q_88 NBS 1.1.4 cdcEFORSNumber If transmission mode is “Foodborne”, what is the CDC EFORS Number? ST 0 1
FDD_Q_89 NBS 1.1.4 caseIdentifiedByAuditInd Was case found during an audit? CE 0 1 PHVS_YN
FDD_Q_272 NBS 1.1.4 pregnancyQuestionInd Is this a condition where the pregnancy questions should be answered? CE 0 1 PHVS_YN
FDD_Q_97 NBS 1.1.4 pregnancyRelatedCaseInd Is this a pregnancy related case? CE 0 1 PHVS_YNU
FDD_Q_98 NBS 1.1.4 pregnantInfectionTypeCd Type of infection in mother: CE 0 1 PHVSFB_PREGINFTYPE
FDD_Q_99 NBS 1.1.4 pregnantInfectionTypeOther If "Other", please specify other type of infection in mother: ST 0 1
FDD_Q_100 NBS 1.1.4 pregnantInfectionComments Comments on infection in mother: ST 0 1
FDD_Q_101 NBS 1.1.4 pregnancyOutcomeCd Outcome of pregnancy: CE 0 1 PHVSFB_PREGOUTCOME
FDD_Q_102 NBS 1.1.4 pregnancyOutcomeOther If "Other", please specify other outcome of pregnancy: ST 0 1
FDD_Q_103 NBS 1.1.4 deliveryDate If delivered, date of delivery: DATE 0 1
FDD_Q_104 NBS 1.1.4 pregnancyOutcomeComments Comments on pregnancy outcome: ST 0 1
FDD_Q_282 NBS 1.1.4 fetalListeriaConfirmed Confirmed listeria in neonate or fetus: CE 0 1 PHVS_YNU
FDD_Q_106 NBS 1.1.4 fetalSpecimenSourceCd Source of specimen collected from fetus/neonate: CE 0 1 PHVSFB_NNSPECMNSRC
FDD_Q_107 NBS 1.1.4 fetalSpecimenSourceOther If "Other", please specify other specimen collection source: ST 0 1
FDD_Q_108 NBS 1.1.4 fetalSpecimenDate Fetus/neonate specimen collection date: DATE 0 1
FDD_Q_109 NBS 1.1.4 fetalInfectionTypeCd Type of infection in fetus/neonate: CE 0 1 PHVSFB_NNINFTYPE
FDD_Q_110 NBS 1.1.4 fetalInfectionTypeOther If "Other", please specify other fetus/neonate infection type: ST 0 1
FDD_Q_111 NBS 1.1.4 fetalInfectionComments Comments on infection in fetus/neonate: ST 0 1
FDD_Q_273 NBS 1.1.4 recreationalWaterInd Did patient have recreational water exposure? CE 0 1 PHVS_YN
FDD_Q_25 NBS 1.1.4 recwaterExposureInd Was there recreational water exposure in the 7 days prior to illness? CE 0 1 PHVS_YNU
FDD_Q_26 NBS 1.1.4 recwaterExposureTypeCd What was the recreational water exposure type? MULTISELECT FIELD CE 0 N PHVSFB_RECWATER
FDD_Q_27 NBS 1.1.4 recwaterExposureOther If "Other", please specify other recreational water exposure type: ST 0 1
FDD_Q_28 NBS 1.1.4 swimmingPoolTypeCd If "Swimming Pool", please specify swimming pool type: MULTISELECT FIELD CE 0 N PHVSFB_POOLTYPE
FDD_Q_29 NBS 1.1.4 swimmingPoolTypeOther If "Other", please specify other swimming pool type: ST 0 1
FDD_Q_30 NBS 1.1.4 recwaterLocationName Name or location of water exposure: ST 0 1
FDD_Q_274 NBS 1.1.4 relatedCaseInd Are there related cases associated to this case? CE 0 1 PHVS_YN
FDD_Q_77 NBS 1.1.4 otherIllPersonsInd Does the patient know of any similarly ill persons? CE 0 1 PHVS_YNU
FDD_Q_78 NBS 1.1.4 otherIllnessInfoCollectedInd If "Yes", did the health department collect contact information about other similarly ill persons and investigate further? CE 0 1 PHVS_YNU
FDD_Q_79 NBS 1.1.4 otherRelatedCasesCd Are there other cases related to this one? CE 0 1 PHVSFB_EPIDEMGY
FDD_Q_275 NBS 1.1.4 seafoodExposureInd Did patient have seafood exposure? CE 0 1 PHVS_YN
FDD_Q_35 NBS 1.1.4 seafoodLast14DaysInd Has the patient eaten seafood in the last 14 days? CE 0 1 PHVS_YNU
FDD_Q_36 NBS 1.1.4 seafoodUndercookedInd Was the seafood eaten undercooked? CE 0 1 PHVS_YNU
FDD_Q_37 NBS 1.1.4 seafoodRawIind Was the seafood eaten raw? CE 0 1 PHVS_YNU
FDD_Q_38 NBS 1.1.4 rawSeafoodTypeCd If “Yes”, type of raw seafood: MULTISELECTION FIELD CE 0 N PHVSFB_SEAFDTYP
FDD_Q_39 NBS 1.1.4 otherShellfishSpecify If "Other Shellfish", specify type of other shellfish: ST 0 1
FDD_Q_40 NBS 1.1.4 otherFishSpecify if "Other Fish", specify type of other fish: ST 0 1
FDD_Q_41 NBS 1.1.4 rawSeafoodConsumptionDatetime Date and time raw seafood consumed: TS 0 1 PHVSFB_AMPMAMPM
FDD_Q_43 NBS 1.1.4 rawSeafoodObtainedCd Where was raw seafood obtained? MULTISELECTION FIELD CE 0 N PHVSFB_SEAFOODS
FDD_Q_44 NBS 1.1.4 rawSeafoodObtainedOther If “Other”, specify other source where raw seafood was obtained: ST 0 1
FDD_Q_45 NBS 1.1.4 rawOystersTagAvailableInd If type of raw seafood was "Oysters", are shipping tags available from suspect lot? CE 0 1 PHVS_YNU
FDD_Q_46 NBS 1.1.4 rawOystersShipperSpecify If shipping tags are available, name of shippers who handled suspected raw oysters: ST 0 1
FDD_Q_277 NBS 1.1.4 toxoplasmosisInd Does the patient have toxoplasmosis? CE 0 1 PHVS_YN
FDD_Q_231 NBS 1.1.4 congenitalToxoplasmosisInd Is this a case of congenital toxoplasmosis? CE 0 1 PHVS_YNU
FDD_Q_232 NBS 1.1.4 toxoplasmicEncephalitisInd Is this a case of toxoplasmic encephalitis? CE 0 1 PHVS_YNU
FDD_Q_279 NBS 1.1.4 trichinellosisInd Does the patient have trichnellosis? CE 0 1 PHVS_YN
FDD_Q_131 NBS 1.1.4 eosinophiliaInd Did patient have Eosinophilia? CE 0 1 PHVS_YNU
FDD_Q_132 NBS 1.1.4 eosinAbsolute If "Yes", please specify absolute number or percentage: PQ 0 1 PHVSFB_PERCNUME
FDD_Q_134 NBS 1.1.4 feverInd Did patient have a fever? CE 0 1 PHVS_YNU
FDD_Q_135 NBS 1.1.4 temperature If "Yes", please specify temperature: PQ 0 1 PHVS_TEMP_UNIT
FDD_Q_137 NBS 1.1.4 trichinellosisSxCd Did patient have any of the following signs or symptoms of Trichinellosis? CE 0 1 PHVSFB_TRICHSYX
FDD_Q_138 NBS 1.1.4 trichinellosisSxOther If "Other", please specify other signs or symptoms of Trichinellosis: ST 0 1
FDD_Q_139 NBS 1.1.4 suspectedFoodCd What suspect foods did the patient eat? CE 0 1 PHVSFB_PORKONOT
FDD_Q_140 NBS 1.1.4 porkTypeCd Please specify type of pork: CE 0 1 PHVSFB_PORKTYPE
FDD_Q_141 NBS 1.1.4 porkTypeOther If “Other”, please specify other type of pork: ST 0 1
FDD_Q_142 NBS 1.1.4 porkConsumeDate Date suspect food was consumed: DATE 0 1
FDD_Q_143 NBS 1.1.4 porkLarvaeFoundCd Was larvae found in suspect food? CE 0 1 PHVSFB_ABPRSUNE
FDD_Q_144 NBS 1.1.4 porkSourceCd Where was the suspect meat obtained? CE 0 1 PHVSFB_SOURCEMT
FDD_Q_145 NBS 1.1.4 porkSourceOther If “Other”, please specify where suspect meat was obtained: ST 0 1
FDD_Q_146 NBS 1.1.4 porkPrepCd How was suspect food prepared or further processed after purchase? CE 0 1 PHVSFB_FOODPROC
FDD_Q_147 NBS 1.1.4 porkPrepOther If “Other”, please specify other type of processing: ST 0 1
FDD_Q_148 NBS 1.1.4 porkCookMethodCd What was the method of cooking the suspect food? CE 0 1 PHVSFB_FOODCOOK
FDD_Q_149 NBS 1.1.4 porkCookMethodOther If “Other”, please specify other type of cooking method: ST 0 1
FDD_Q_150 NBS 1.1.4 nonporkTypeCd Please specify type of non-pork: CE 0 1 PHVSFB_NONPORKT
FDD_Q_151 NBS 1.1.4 nonporkTypeOther If “Other”, please specify other type of non-pork: ST 0 1
FDD_Q_152 NBS 1.1.4 nonporkConsumeDate Date suspect food was consumed: DATE 0 1
FDD_Q_153 NBS 1.1.4 nonporkLarvaeFoundCd Was larvae found in suspect food? CE 0 1 PHVSFB_ABPRSUNE
FDD_Q_154 NBS 1.1.4 nonporkSourceCd Where was the suspect meat obtained? CE 0 1 PHVSFB_SOURCEMT
FDD_Q_155 NBS 1.1.4 nonporkSourceOther If “Other”, please specify where suspect meat was obtained: ST 0 1
FDD_Q_156 NBS 1.1.4 nonporkPrepCd How was suspect food prepared or further processed after purchase? CE 0 1 PHVSFB_FOODPROC
FDD_Q_157 NBS 1.1.4 nonporkPrepOther If “Other”, please specify other type of processing: ST 0 1
FDD_Q_158 NBS 1.1.4 nonporkMethodCd What was the method of cooking the suspect food? CE 0 1 PHVSFB_FOODCOOK
FDD_Q_159 NBS 1.1.4 nonporkMethodOther If “Other”, please specify other type of cooking method: ST 0 1
FDD_Q_278 NBS 1.1.4 travelInd Did the patient travel? CE 0 1 PHVS_YN
FDD_Q_11 NBS 1.1.4 travelPriorToOnsetInd Did patient travel prior to onset of illness? CE 0 1 PHVS_YNU
FDD_Q_12 NBS 1.1.4 incubationPeriod Applicable incubation period for this illness is (Incubation PDF): ST 0 1
FDD_Q_13 NBS 1.1.4 travelPurposeCd What was the purpose of the travel? MUTISELECTION FIELD CE 0 N PHVSFB_TRAVELTT
FDD_Q_14 NBS 1.1.4 travelPurposeOther If “Other”, please specify other purpose of travel: ST 0 1
FDD_Q_15 FDD_Q_56 FDD_Q_61 NBS 1.1.4 destinationTypeCd Destination 1 Type: Destination 2 Type: Destination 3 Type: (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) CE 0 1 PHVSFB_DOMINTNL
FDD_Q_16 FDD_Q_57 FDD_Q_62 NBS 1.1.4 domesticDestinationCd (Domestic) Destination 1: (Domestic) Destination 2: (Domestic) Destination 3: (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) CE 0 1 PHVS_STATE_CCD_ALPH
FDD_Q_292 FDD_Q_293 FDD_Q_294 NBS 1.1.4 internationalDestinationCd (International) Destination 1: (International) Destination 2: (International) Destination 3: (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) CE 0 1 PHVS_PSL_CNTRY
FDD_Q_17 FDD_Q_58 FDD_Q_63 NBS 1.1.4 travelModeCd Mode of Travel: (1) Mode of Travel: (2) Mode of Travel: (3) (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) CE 0 1 PHVSFB_TRANSPRT
FDD_Q_18 FDD_Q_59 FDD_Q_64 NBS 1.1.4 dateOfArrival Date of Arrival: (1) Date of Arrival: (2) Date of Arrival: (3) (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) DATE 0 1
FDD_Q_19 FDD_Q_60 FDD_Q_65 NBS 1.1.4 dateOfDeparture Date of Departure (1): Date of Departure (2): Date of Departure (3): (PROBABLY WILL TREAT THIS AS A REPEATING BLOCK AND USE ONLY THE FIRST ELEMENT) DATE 0 1
FDD_Q_20 NBS 1.1.4 otherDestinationTxt If more than 3 destinations, specify details here: ST 0 1
FDD_Q_280 NBS 1.1.4 typhoidInd Does the patient have typhoid? CE 0 1 PHVS_YN
FDD_Q_189 NBS 1.1.4 usCitizenInd Is patient a U. S. Citizen? CE 0 1 PHVS_YNU
FDD_Q_190 NBS 1.1.4 typhoidSymptomInd Was the patient symptomatic for Typhoid Fever? CE 0 1 PHVS_YNU
FDD_Q_191 NBS 1.1.4 typhoidSymptomCd If “Yes”, did the patient have any of the following signs or symptoms of Typhoid Fever? CE 0 N PHVS_TBMAJSITE_2
FDD_Q_192 NBS 1.1.4 typhoidSymptomOther If “Other”, please specify other signs or symptoms of Typhoid: ST 0 1
FDD_Q_193 NBS 1.1.4 antibioticTestingInd Was antibiotic sensitivity testing performed on the isolate? CE 0 1 PHVS_YNU
FDD_Q_194 NBS 1.1.4 typhoidVaccineInd Did the patient receive Typhoid vaccination? CE 0 1 PHVS_YNU
FDD_Q_195 NBS 1.1.4 typhoidCarrierTracedInd Was the case traced to a Typhoid carrier? CE 0 1 PHVS_TBMAJSITE_1
FDD_Q_281 NBS 1.1.4 underlyingConditionsInd Does the patient have underlying conditions? CE 0 1 PHVS_YN
FDD_Q_233 NBS 1.1.4 underlyingConditionCd Did patient have any of the following underlying conditions? MULTISELECT FIELD CE 0 N PHVSFB_DISEASES
FDD_Q_234 NBS 1.1.4 otherPriorIllnessSpecify If “Other Prior Illness”, please specify: INT 0 1
FDD_Q_235 NBS 1.1.4 insulinDependentInd If “Diabetes Mellitus”, specify whether on insulin: CE 0 1 PHVS_YNU
FDD_Q_236 NBS 1.1.4 organTransplantSpecify If “Organ Transplant”, please specify organ: CE 0 1
FDD_Q_237 NBS 1.1.4 gastricSurgerySpecify If “Gastric Surgery”, please specify type: INT 0 1
FDD_Q_238 NBS 1.1.4 hematologicDiseaseSpecify If “Hematologic Disease”, please specify type: CE 0 1
FDD_Q_239 NBS 1.1.4 immunodeficiencySpecify If “Immunodeficiency”, please specify type: CE 0 1
FDD_Q_240 NBS 1.1.4 otherLiverSpecify If “Other Liver Disease”, please specify type: ST 0 1
FDD_Q_241 NBS 1.1.4 otherMalignancySpecify If “Other Malignancy”, please specify type: CE 0 1
FDD_Q_242 NBS 1.1.4 otherRenalSpecify If “Other Renal Disease”, please specify type: CE 0 1

Sheet 23: Lyme Disease
UID AppVer Label Description Fmt Min Max VSName
LYM100 NBS 1.1.4 ErythemaMigrans ErythemaMigrans CE 0 1 YNU
LYM101 NBS 1.1.4 Swelling Swelling CE 0 1 YNU
LYM102 NBS 1.1.4 BellsPalsy BellsPalsy CE 0 1 YNU
LYM103 NBS 1.1.4 Radiculoneuropathy Radiculoneuropathy CE 0 1 YNU
LYM104 NBS 1.1.4 LymphocyticMeningitis LymphocyticMeningitis CE 0 1 YNU
LYM105 NBS 1.1.4 Encephalitis Encephalitis CE 0 1 YNU
LYM106 NBS 1.1.4 CSFTestedForBBurgdorferi CSFTestedForBBurgdorferi CE 0 1 YNU
LYM107 NBS 1.1.4 AntibodyInCSFHigherThanSerum AntibodyInCSFHigherThanSerum CE 0 1 YNU
LYM108 NBS 1.1.4 2or3DegreeAVBlock 2or3DegreeAVBlock CE 0 1 YNU
LYM109 NBS 1.1.4 OtherClinical OtherClinical ST 0 1
















































































































































































































































































































































































































































































































































































































File Typeapplication/vnd.ms-office
AuthorCrystal Decisions
Last Modified Bywsb2
File Modified2007-09-14
File Created2005-08-19
© 2024 OMB.report | Privacy Policy