Attachment 5
National Violent Death Reporting System
Incident Information
Date of addition/change
Version of software
Case status
Number of source documents in incident
Number of persons in incident
Number of weapons in incident
Number of victim-suspect relationship records in incident
Number of person-weapon relationship records in incident
Date supervisor checked incident
Date supervisor rechecked incident
Supervisor note field
Number of non-fatally shot persons in incident
Narrative of the incident
Re-abstraction from data year
Re-abstraction of incident number
Document notes
Document notes field
Document type
Source agency requested from
Source agency’s internal record number
Person who entered record
Date record requested/expected/sought
Date record re-requested/re-searched
Date record received
Date record abstracted/imported
Date entered data checked
Document determined to be unavailable
Person Information (Victim and Suspect)
Death type
Person type
Last name
First name
Middle name
Person’s sex
Social Security #
Date of birth
Age
Age unit
Address
City
County
State
ZIP code
Country
White
Black
Asian
Pacific Islander
American Indian
Other
Unspecified
Hispanic/Latino/Spanish
Country
US Census tract
US Census block group
Person Information (Victim only)
Death Certificate Variables
Death Certificate number
Birth place
Country of birth if not listed
Veteran status
Marital status
Place of death
Place of death if other
Date pronounced dead
State of death
Date of death
Immediate cause of death text
Cause leading to immediate cause text
Next antecedent cause of death text
Underlying cause of death text
Underlying cause of death code
ICD 4th
ICD 5th
Date of injury
Time of injury
Type of location where injured
Injured at work
Street and number of injury site
Country of birth if not listed
County of injury
City of injury FIPS code
State of injury FIPS code
US Census block group of injury
US Census tract of injury
Survival time no. of units
Unit of time used in survival time
Education
Number year’s education
Usual occupation code
Usual occupation text
Kind of business/industry code
Usual industry text
Multiple conditions on death certificate 1-20
Victim in custody when injured
Manner of death
Person attempted suicide after incident
ZIP code of injury
At persons home
EMS at scene
Person was pregnant
Homeless status
Current occupation
Autopsy performed
Toxicology Variables
Date specimens were collected
Time specimens were collected
Alcohol use suspected
Blood alcohol concentration results
Alcohol test results
Testing for alcohol
Amphetamine test results
Testing for amphetamines
Antidepressant test results
Testing for antidepressants
Cocaine test results
Testing for cocaine
Marijuana test results
Testing for marijuana
Opiate test results
Testing for opiate(s)
Other drug test results
Other substance test results
Type of other substance
Wound location variables
Number of wounds
Number of bullets that hit victim
Wound to the head
Wound to the face
Wound to the neck
Wound to the upper extremity
Wound to the spine
Wound to the thorax
Wound to the abdomen
Wound to the lower extremity
SHR circumstance
SHR situation
SHR homicide type
SHR justifiable homicide circumstance
Emergency Department and Hospital
Victim seen in ED
Victim admitted to inpatient care
First external cause of injury code from hospital
Second external cause of injury code from hospital
Victim-Suspect Relationship
History of abuse
Caretaker of victim
Victim to suspect relationship 1 and 2
Type of VS violence relationship
Circumstance Variables (see next page)
Suicide Circumstances
Homicide Circumstances
Unintentional Firearm Injury Circumstances
Weapon Variables
Weapon type
Other weapon information
Gun recovered
Bullet recovered
Casing recovered
Firearm information known
Firearm type
Other firearm type text
Make or NCIC code
Other firearm make text
Firearm model
Firearm model text
Cartridge specification
Firearm caliber
Firearm gauge
Firearm serial number
Firearm stolen
Firearm trace attempted
Date of firearm first purchase
City of firearm first purchase
State of firearm first purchase
Firearm importer’s name
Firearm importer’s city
Firearm importer’s state
Gun owner
Gun stored loaded
Gun stored locked
Youth gun access narrative
Type of poison
Name of poison if other
Code for poison
Patient drug obtained for
Size of pill (mg)
Lower bound, number of pills ingested
Upper bound, number of pills ingested
Estimated amount of liquid poison ingested (ml)
Carbon monoxide source, if CO
(Identifies which weapon killed the victim and which suspect used the weapon)
First purchaser
Weapon killed this person
Person used this weapon to kill
National Violent Death Reporting System
Current depressed mood
Current mental health problem
Type of first metal illness diagnosed
Type of second metal illness diagnosed
Other mental health diagnosis
Current treatment for mental illness
Ever treated for mental illness
Alcohol problem
Other substance problem
Person left a suicide note
Disclosed intent to commit suicide
History of suicide attempts
Crisis in past 2 wks
Physical health problem
Intimate partner problem
Other relationship problem
Job problem
School problem
Financial problem
Suicide of friend or family in past 5 yr
Other death of friend or family
Recent criminal legal problem
Other legal problems
Perpetrator of interpersonal violence past mo.
Victim of interpersonal violence past mo.
Other suicide circumstance
Argument over money/property
Jealousy (lovers` triangle)
Intimate partner violence related
Other argument, abuse, conflict
Drug involvement
Gang related
Precipitated by another crime
Nature of first other crime
First other crime in progress
Nature of second other crime
Hate crime
Brawl (mutual physical fight)
Terrorist attack
Victim was a bystander
Victim was a police officer on duty
Justifiable self defense/law enforcement
Victim used weapon
Victim was intervener assisting crime victim
Mercy killing
Other homicide circumstance (specify)
Unintentional Circumstance (Firearm death)
Context
Hunting
Target shooting
Self-defensive shooting
Celebratory firing
Loading/unloading gun
Cleaning gun
Showing gun to others
Playing with gun
Other context of injury
Thought safety was engaged
Thought unloaded magazine disengaged
Thought gun was unloaded, other
Unintentionally pulled trigger
Bullet ricochet
Gun defect or malfunction
Fired while holstering/un-holstering
Dropped gun
Fired while operating safety/lock
Gun mistaken for toy
Other mechanism of injury
National Violent Death Reporting System
Scene investigation by the C/ME
Scene investigation by law enforcement
Witness (es) to fatal incident
If yes, child witness
CFR records available on victim
Household Information
Type of residence in which victim lived
Length of time in residence
Unrelated adult living in household
Other children <18 yrs in household
Marital relationship of victim’s biological parents
Domestic Violence and Substance abuse
Intimate partner violence in victims household
Substance abuse in victims household
Intimate partner violence in victim’s foster home
Substance abuse in victim’s foster home
Perpetrator was supervisor
Supervisor’s relationship to victim
Supervisor’s age
Supervisor’s sex
Quality of supervision a factor
No supervision
Supervisor drug/alcohol impaired
Supervisor distracted or asleep
Other supervisory factor
Primary caregiver a victim or suspect in the incident
If yes, caregivers ID in the incident
Relationship to victim
Age at time of incident
Sex
Had legal custody of victim at time of death
Had documented history of maltreating
Had a previous child die in his/her care
Physical illness or disability
Victim had a physical illness at time of injury
If yes, specify diagnosis
Victim had disability at time of injury
If yes, disability was physical
If yes, disability was developmental
If yes, disability was sensory
Prenatal history
Infants: Prenatal care prior to 3rd trimester
Infants: maternal recreational drug use
Infants: maternal alcohol use
Infants: maternal tobacco use
Infants: victim born prematurely
CPS Contacts
Prior CPS report on the victim’s household
If yes, CPS report filed on whom
If yes, report substantiated
Physical abuse substantiated
Sexual abuse substantiated
Neglect substantiated
CPS case opened on other kids due to this death
Other Prior System Contacts by Victim
Victim contact with police
Households contact with police
Victim contact with juvenile justice system
Victim contact with the health care system
Victim contact with mental health services
Victim/ primary caregiver contact with social services
Primary caregiver on welfare/financial assistance
Victim/primary caregiver contact with WIC
Victim/primary caregiver contact with Medicaid
Data Sources Used by CFR
C/ME records
SS/CPS records
Police/Law Enforcement records
School records
EMS records
Health Provider/Hospital records
Public Health Department records
Mental Health Records
Juvenile Justice Records
Death certificate
Other records
Specify (what other records)
CFR conclusion matches death certificate
If no, manner the CFR designated
Text to specify other manner
Action taken to change the official manner
Result of action
CFR determination of preventability
CFR Suicide Circumstances
History of inpatient psychiatric treatment
Taking psychiatric med. at time of death
Barriers to accessing mental health care
Specific person suspected
Suspect arrested as perp in this death
Suspect charged as perp in this death
Suspect prosecuted
Suspect convicted
Convicted of original charge
CPS report or referral ever filed on the suspect
Suspect ever charged with a prior homicide
__________________________________________________________________________
. Goodin J, Hanzlick R. Mind your manners: part II: general results from the National Association of Medical Examiners Manner of Death Questionnaire, 1995. Am J Foren Med Path 1997;18:224-227.
. www.cdc.gov/epo/dphsi/mecisp/index.htm. Accessed on 2/25/2003.
| File Type | application/msword |
| File Title | Attachment 5 |
| Author | fmc7 |
| Last Modified By | fmc7 |
| File Modified | 2009-05-11 |
| File Created | 2009-05-11 |