Territories - Weekly automated

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Overview

General
Animal Rabies
Anthrax
Arboviral
Babesiosis
Botulism
Brucellosis
Campylobacter
Candida auris
Carbon Monoxide Poisoning
Cholera
Congenital Rubella Syndrome
Congenital Syphilis
CP-CRE
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Giardia
Haemophilus Influenzae
Hansen's
Hantavirus Pulmonary Syndrome
Hepatitis
Hemolytic Uremic Syndrome
Human Rabies
Invasive Pneumococcal Disease
Legionellosis
Leptospirosis
Listeria
Latent TB Infection
Lyme
Malaria
Measles
Melioidosis
Mumps
Neisseria meningitidis
Novel Influenza A
Ped Flu Deaths
Pertussis
Plague
Polio
Polio Nonparalytic
Psittacosis
QFever
STSS
Rubella
Salmonellosis
S.Paratyphi Infection
S. Typhi Infection
SARS
Shigella
STD (not congenital)
STEC
TBRD
Tetanus
Trichinellosis
Tuberculosis
Tularemia
Varicella
Vibriosis

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Sheet 1: General

Subsequent tabs in this workbook describe the disease-specific data elements that are requested from each program area.
CDC Priority:	Indicates whether the program specifies the field as:
	R - Required - Mandatory for sending the message.  If data element is not present, the message will error out.
	P - Preferred - This is an optional variable and there is no requirement to send this information to CDC.  However, if this variable is already being collected by the state/territory, or if the state/territory is planning to collect this information because it is deemed important for your own programmatic needs, CDC would like this information sent.  CDC preferred variables are the most important of the optional variables to be earmarked for CDC analysis/assessment, even if sent from a small number of states.
	O - Optional - This is an optional variable and there is no requirement to send this information to CDC.  This variable is considered nice-to-know if the state/territory already collects this information or is planning to collect this information, but has a lower level of importance to CDC than the preferred classification of optional data elements.

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Sheet 2: Animal Rabies

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
AnimalID	Unique ID for animal submitted for rabies diagnosis
Date Collected	Date animal collected for rabies diagnosis
Species	Species of animal submitted for rabies diagnosis	PHVS_AnimalSpecies_AnimalRabies
Sex	Sex of animal	PHVS_Sex_MFU
Age	Age category of animal	PHVS_AnimalAgeCategory_NND
Vax Status	Rabies vaccination status of animal submitted for rabies diagnosis	PHVS_YesNoUnknown_CDC
Human Exposure	Was there a potential human exposure to the animal submitted	PHVS_YesNoUnknown_CDC
Animal Exposure	Was there a potential domestic animal exposure ot the animal submitted	PHVS_YesNoUnknown_CDC
Latitude	Latitutde of Animal Collection
Longitude	Longitude of animal collection
Address	Street Address of animal collection
City	City of animal collection	PHVS_City_USGS_GNIS
County	County of animal collection	PHVS_County_FIPS_6-4
State	State of animal collection	PHVS_State_FIPS_5-2
ZipCode	Zip Code of animal collection
DFAResult	Results of direct flourescent antibody test	PHVS_PosNegUnk_CDC
Date DFA	Date tested by DFA
DRIT Result	Results of direct rapid immunohistochemistry test	PHVS_PosNegUnk_CDC
Date DRIT	Date tested by DRIT
Variant	Rabies virus variant if typed	PHVS_VirusVariantType_AnimalRabies
DateTyped	Date rabies virus typed

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Sheet 3: Anthrax

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
Case Status Determined	How was the case status determined, from "Laboratory Results", "Clinical Presentation", "Epi Link"
State	State reporting case	PHVS_State_FIPS_5-2
State Case ID	States use this field to link NEDSS investigations back to their own state investigations.
Date State Notified	Date State Notified
County reporting the case	County reporting the case	PHVS_County_FIPS_6-4
Date local health department notified	Date local health department notified
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Treating HCP	Name of the treating health care provider of the subject
HCP Phone	Telephone number of the treating health care provider of the subject
MMWR year	MMWR year of report
Event date	Event Date ( earliest date associated with case)
Event Type	Event Type from "Date Onset", "Date Diagnosis", "Date State Notified", "Date LHD notified", "Date Laboratory diagnosis"
Subject’s Sex	Subject’s current sex	PHVS_Sex_MFU
Pregnancy status	Indicates whether the subject was pregnant at the time of the event.	PHVS_YesNoUnknown_CDC
Date of Birth	Birth Date (mm/yyyy)
Age at case investigation	Subject age at time of case investigation
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Country of usual residence	Country of usual residence	PHVS_CountryofBirth_CDC
Occupation	Provide the subject's occupation
Date Onset	Date Onset
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Date Diagnosis	Date Diagnosis
Clinical presentation	Clinical Presentation (Cutaneus, Inhalation, Meningitis, GI/Oroph, Injection)
Hospitalized	Was subject hospitalized because of this event?	PHVS_YesNoUnknown_CDC
Final treatment place	List the place of final treatment (only to be sent during a bioterrorism event)
Admission Date	Subject’s first admission date to the hospital for the condition covered by the investigation.
ICU	Was the subject admitted to Intensive Care Unit for any length of time?	PHVS_YesNoUnknown_CDC
Mechanical ventilation	Was the subject on mechanical ventilation for any length of time?	PHVS_YesNoUnknown_CDC
AIG	Did the subject receive Anthrax anti-toxin?	PHVS_YesNoUnknown_CDC
Raxibacumab	Did the subject receive raxibacumab?	PHVS_YesNoUnknown_CDC
Outcome	Clinical outcome of the patient ("Still hospitalized"; "Discharged"; "Died";"Other")
Discharge Date	Subject's first discharge date from the hospital for the condition covered by the investigation.
Deceased Date	If the subject died from this illness or complications associated with this illness, indicate the date of death
Autopsy	If the subject died, was an autopsy performed?	PHVS_YesNoUnknown_CDC
Reporting Lab Name	Name of Laboratory that reported test result.
Date Laboratory diagnosis	Date Laboratory diagnosis
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Date of Acute Specimen Collection	The date the acute specimen was collected.
Date of Convalscent Specimen Collection	The date the convalscent specimen was collected.
Resulted Test Name	The lab test that was run on the specimen	PHVS_LabTestName_CDC
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_PosNegUnk_CDC
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Specimens to CDC	Were specimens or isolates sent to CDC for testing?	PHVS_YesNoUnknown_CDC
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	PHVS_AbnormalFlag_HL7_2x
Exposure event	If participated in a documented exposure event, give the name or location
Exposure response	Participated in exposure response?	PHVS_YesNoUnknown_CDC
Exposure to animals	Exposure to livestock/ wild mammals/ their body fluids?	PHVS_YesNoUnknown_CDC
Exposure to animals products	Exposure to animal products?	PHVS_YesNoUnknown_CDC
Contact with undercooked meat	Consumed or contact with undercooked or raw meat?	PHVS_YesNoUnknown_CDC
Gardened	Gardened or other work with soil?	PHVS_YesNoUnknown_CDC
Bone meal	If yes, was bone meal fertilizer or similar used?	PHVS_YesNoUnknown_CDC
Laboratory work	Worked in a clinical or microbiological laboratory?	PHVS_YesNoUnknown_CDC
Unknown powder	Exposed to unknown powder?	PHVS_YesNoUnknown_CDC
Suspicious mail	Handled suspicious mail?	PHVS_YesNoUnknown_CDC
Similar illness	Undiagnosed similar illness in friends, family, coworkers, or other contacts?	PHVS_YesNoUnknown_CDC
Similar food contact	Consumed same food/drink as lab-confirmed anthrax case?	PHVS_YesNoUnknown_CDC
Similar exposures	Exposed to the same environment, animal, or objects as a lab-confirmed anthrax case?	PHVS_YesNoUnknown_CDC
Illicit drugs	Contact with illicit drugs?	PHVS_YesNoUnknown_CDC
Received injection	Received an injection?	PHVS_YesNoUnknown_CDC
Took public transportation	Took public transportation?	PHVS_YesNoUnknown_CDC
Transportation type	If Took public transportation is "Yes", what form of transportation did the subject take ("Bus"; "Train";"Light rail"; "Subway"; "Ferry"; "Other")
Other transportation	If the patient took Other form of public transportation, describe
Attended gathering	Attended a large gathering (e.g., concert, sporting event)?	PHVS_YesNoUnknown_CDC
Congregate	Attended a place where people congregate (e.g., shopping mall, relgious services)?	PHVS_YesNoUnknown_CDC
Travel	Traveled out of county, state, or country?	PHVS_YesNoUnknown_CDC
Latitude	Latitude of suspected exposure location (only to be sent during a bioterrorism event)
Longitude	Longitude of suspected exposure location (only to be sent during a bioterrorism event)
Vaccine	Was anthrax vaccine received?	PHVS_YesNoUnknown_CDC
Vaccine received	If anthrax vaccine received is "Yes", specify what was received from "Post-exposure vaccine (1,2,or 3 doses)", "Partial series of pre-exposure vaccine", "Full series of pre-exposure vaccine"
Vaccine dose	If anthrax vaccine received is "Yes" specify the number of doses received or vaccination status, from "1", "2", "3", "<5", "Outdated on annual boosters", "Fully updated on annual boosters", "Unknown"
Post exposure antibiotics	Received Post-Exposure Antibiotics	PHVS_YesNoUnknown_CDC
Antibiotics not taken	Antibiotics not taken or discontinued?	PHVS_YesNoUnknown_CDC
Antibiotics not taken specify	If Antibiotics were not taken or were discontinued is "Yes", select the primary reason why they were not taken "Low perceived risk", "Adverse events", "Fear of side effects", "Other", "Unknown"

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Sheet 4: Arboviral

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
StateID	State-assigned investigation identification code
Year	Current year (new)
State	State of residence
County	County of residence
Week	Week of report (new)
OnsetDate	Date of onset of symptoms consistent with arboviral infection
ImportedFrom	Likely location of acquisition of arboviral infection
CountryOfOrigin	Country in which infection was likely acquired
StateOfOrigin	State in which infection was likely acquired
ForeignResident	(New)
Arbovirus	Type of arboviral infection
CaseStatus	Case classification according to CDC/CSTE surveillance case definitions
Age	Age at time of case investigation
AgeUnit	Age units
BirthDate	Date of Birth
Sex	Current sex
Race	Race
Ethnicity	Ethnicity
ClinicalSyndrome	General clinical presentation
Fever	Clinical Sign/Symptom
Headache	Clinical Sign/Symptom
Rash	Clinical Sign/Symptom
NauseaVomiting	Clinical Sign/Symptom
Diarrhea	Clinical Sign/Symptom
Myalgia	Clinical Sign/Symptom
ArthralgiaArthritis	Clinical Sign/Symptom
ParesisParalysis	Clinical Sign/Symptom
StiffNeck	Clinical Sign/Symptom
AlteredMentalStatus	Clinical Sign/Symptom
Seizures	Clinical Sign/Symptom
StateLocalPublicHealthLab	Testing performed at:
CDCLab	Testing performed at:
CommercialLab	Testing performed at:
Serum1Collected	Was Serum1 collected?
Serum1CollectedDate	When was Serum1 collected?
Serum2Collected	Was Serum2 collected?
Serum2CollectedDate	When was Serum2collected?
CSFCollected	Was CSF collected?
CSFCollectedDate	When was CSF collected?
CSFPLeocytosis
SerumIgM
SerumPRNT
SerumPCRorNAT
SerumPairedAntibody
CSFIgM
CSFPRNT
CSFPCRorNAT
Hospitalized	Patient was hospitalized as a result of arboviral illness
Fatality	Patient died as a result of arboviral infection
DateOfDeath	Date of death
LabAcquired	Patient likely acquired infection due to occupational exposure in a laboratory setting
NonLabAcquired	Patient likely acquired infection due to occupational exposure in a non-laboratory setting
BloodDonor	Patient donated blood within 30 days prior to illness onset
BloodTransfusion	Patient received a blood transfusion within 30 days prior to illness onet
OrganDonor	Patient donated a solid organ within 30 days prior to illness onset
OrganTransplant	Patient received a solid organ transplant within 30 days prior to illness onset
BreastFedInfant	Patient was a breastfed infant at time of illness onset
InfectedInUteroOrPerinatal	Patient likely acquired infection in utero or perinatal
Pregnant	Patient acquired infection during pregnancy
AFP	Patient suffered acute flaccid paralysis
IdentifiedByBloodDonorScreening	Infection identified through blood donor screening
DateOfDonation	Date of blood donation
LabTestingBy	Source of diagnostic testing
TransmissionOrigin
TransmissionMode
BloodTissueBorneTransmission
DomesticTravelDestinationLast
DomesticTravelDestination2ndLast
DomesticTravelDestination3rdLast
ForeignTravelDestinationLast
ForeignTravelDestination2ndLast
ForeignTravelDestination3rdLast
DateUSReturn
DurationDaysTravelOutsideUS
ReasonTravel
PreTravelHealthConsultation
CountryBirth
ResidenceStatus
DurationMonthsVisitOrLiveUS
MilitaryStatus
ClinicalSyndrome2
DurationDaysHospitalized
ICUAdmission
SevereEncephalitis
SevereSeizure
SevereMeningitis
SevereAcuteFlaccidParalysis
SevereGuillainBarreSyndrome
SevereHemorrhageShock
SeverePlasmaLeakage
SevereAcuteLiverFailure
SevereAcuteMyocarditis
SevereMultiSystemOrganFailure
SevereOtherSevereSigns
SevereUnknown
PreExistingAsthma
PreExistingChronicHeart
PreExistingChronicLiver
PreExistingChronicRenal
PreExistingDiabetesMellitus
PreExistingSickleCell
PreExistingHyperlipidemia
PreExistingHypertension
PreExistingObesity
PreExistingPregnancy
PreExistingThyroidDisease
PreExistingOther
PreExistingUnknown
S1DENVCollected
S1DENVCollectedDate
S1IgMAntiDENV
S1MolecularDENV
S1OtherDENVMethod
S1OtherDENVResult
S2DENVCollected
S2DENVCollectedDate
S2IgMAntiDENV
S2MolecularDENV
S2OtherDENVMethod
S2OtherDENVResult
OtherSpecCollected
OtherSpecType
OtherSpecCollectedDate
OtherSpecDENVMethod
OtherSpecDENVResult
DENVSeroType
Published
FeverMedication	Did patient receive medication for fever?
ImmuneSuppressTreatment	Is patient on immunosuppressive therapy?
ImmuneSuppressCondition	Does patient have an immunosuppressive condition?
ImmuneSuppressDesc	Description of immunosuppressive condition
OtherAfebrileCause	Other afebrile causes
ChillsRigors	Did patient have chills or rigors?
FatigueMalaise	Did patient exhibit fatigue or malaise?
Ataxia	Did patient have ataxia?
ParkinsonismCogwheel	Was Parkinsonism cogwheel rigidity present?
SevereShock	Did patient exhibit severe shock?
SevereHemorrhage	Did patient have severe hemorrhaging?
OtherSymptoms	Other symptoms of interest
Arthralgia	Did patient exhibit arthralgia?
Arthritis	Did patient exhibit arthritis?
Conjunctivitis	Did the patient have conjunctivitis?
RetroOrbitalPain	Did the patient have retro orbital pain?
TourniquetTestPositive	Did the patient have a tourniquet test positive?
Leukopenia	Did the patient have leukopenia?
AbdominalPainTenderness	Did the patient have abdominal pain tenderness?
PersistingVomiting	Did the patient have persisting vomiting?
ExtravascularFluidAccumulation	Did the patient have extravascular fluid accumulation?
MucosalBleeding	Did the patient have mucosal bleeding?
LiverEnlargement	Did the patient have liver enlargement?
IncreasingHematocritDecPLT	Did the patient have increasing hematocrit dec PLT?
SevereBleeding	Did the patient have severe bleeding?
SevereOrganInvolvement	Did the patient have severe organ involvement?
Mother-Infant Case ID Linkage	Mother and infant case IDs
Mother's Last Menstrual Period Before Delivery	Mother's last menstrual period (LMP) before delivery
Pregnancy Complications	Complications of pregnancy
Pregnancy Outcome	Pregnancy outcomes
Newborn Complications	Compliations for newborn
Other Arboviral Disease Transmission Mode	Other Arboviral unusual and rare disease transmission modes

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Sheet 5: Babesiosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Date Submitted	Date the case report form (extended variables) was submitted to CDC
Clinician Name	Name of treating clinician
Clinician Phone	Phone number for treating clinician
Symptomatic	Was the case-patient symptomatic?	PHVS_YesNoUnknown_CDC
ClinicalManifestation	Did the case-patient have any clinical manifestations of babesiosis?	PHVS_YesNoUnknown_CDC
Asplenic	Is the case-patient asplenic?	PHVS_YesNoUnknown_CDC
Reason for Splenectomy	Why was the case-patient's spleen removed?
Date of Splenectomy	Date of splenectomy
Symptoms	Indicate case-patient's signs and symptoms
Symptom Fever	Did the case-patient have a fever?	PHVS_YesNoUnknown_CDC
Temperature	If fever was indicated, specify temperature (observation includes units)
Temperature Units	If fever was indicated, specify Fahrenheit or Celsius	PHVS_TemperatureUnit_UCUM
Symptom Headache	Did the case-patient have a headache?	PHVS_YesNoUnknown_CDC
Symptom Myalgia	Did the case-patient have myalgia?	PHVS_YesNoUnknown_CDC
Symptom Anemia	Did the case-patient have anemia?	PHVS_YesNoUnknown_CDC
Symptom Chills	Did the case-patient have chills?	PHVS_YesNoUnknown_CDC
Symptom Arthralgia	Did the case-patient have arthralgia?	PHVS_YesNoUnknown_CDC
Symptom Thrombocytopenia	Did the case-patient have thrombocytopenia?	PHVS_YesNoUnknown_CDC
Symptom Sweats	Did the case-patient have sweats?	PHVS_YesNoUnknown_CDC
Symptom Nausea	Did the case-patient have nausea?	PHVS_YesNoUnknown_CDC
Symptom Hepatomegaly	Did the case-patient have hepatomegaly?	PHVS_YesNoUnknown_CDC
Symptom Splenomegaly	Did the case-patient have splenomegaly?	PHVS_YesNoUnknown_CDC
Symptom Cough	Did the case-patient have a cough?	PHVS_YesNoUnknown_CDC
Symptoms Other	Indicate any additional symptoms or clinical manifestations
Complications	Select all complications
Risk Factor Immunosuppressed	At the time of diagnosis, was the case-patient immunosuppressed?	PHVS_YesNoUnknown_CDC
Risk Factor Immune Condition	If the case-patient reported being immunosuppressed, what was the cause?
Hospitalization	If the case-patient was hospitalized, indicate the length in days of the hospitalization.
Death Related to Babesiosis	Was the case-patient's death related to the Babesia infection?	PHVS_YesNoUnknown_CDC
Treatment	Did the case-patient receive antimicrobial treatment for Babesia infection?	PHVS_YesNoUnknown_CDC
Treatment Medications	If the case-patient was treated, specify which drugs were administered.
Transfusion Associated Recipient	Was the case-patient’s infection transfusion associated?	PHVS_YesNoUnknown_CDC
Transfusion Associated Donor	Was the case-patient a blood donor identified during a transfusion investigation?	PHVS_YesNoUnknown_CDC
Outdoor Activities	In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient engage in outdoor activities?	PHVS_YesNoUnknown_CDC
Outdoor Activities Type	Specify outdoor activities
Occupation	Indicate case-patient's occupation
Wooded Areas	In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient spend time outdoors in or near wooded or brushy areas?	PHVS_YesNoUnknown_CDC
History of Babesiosis	Does the case-patient have a previous history of babesiosis in the last 12 months (prior to this report)?	PHVS_YesNoUnknown_CDC
Date of Previous Babesiosis	Date of previous babesiosis diagnosis
Tick Bite	In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient notice any tick bites?	PHVS_YesNoUnknown_CDC
Tick Bite Date	When did the tick bite occur (approximate dates accepted)?
Tick Bite Place	Where (geographic location) did the tick bite occur (city, state, country)?
Travel	In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient travel (check all that apply)?
Travel Date	When did the travel occur?
Travel Place	Where did the case-patient travel (city, state, country)?
Infected In Utero	Was the case-patient an infant born to a mother who had babesiosis or Babesia infection during pregnancy?	PHVS_YesNoUnknown_CDC
Mother Test Positive After Delivery	Did the case-patient's mother test positive for babesiosis after delivery?	PHVS_YesNoUnknown_CDC
Mother Test Positive Before Delivery	Did the case-patient's mother test positive for babesiosis before or at the time of delivery?	PHVS_YesNoUnknown_CDC
Mother Confirmed Positive Date	Date of mother's earliest positive test result
Blood Donor Screening	Donors who have been identified as having a Babesia infection through routine blood donor screening (e.g., IND) by the blood collection agency. May or may not be symptomatic.	PHVS_YesNoUnknown_CDC
Blood Donor	Did the case-patient donate blood in the 8 weeks prior to onset?	PHVS_YesNoUnknown_CDC
Date of Donation	Date of blood donation(s)
Linked Recipient	Was a transfusion recipient(s) identified for the case-patient's donation?	PHVS_YesNoUnknown_CDC
Blood Recipient	Did the case-patient receive a blood transfusion in the 8 weeks prior to onset?	PHVS_YesNoUnknown_CDC
Date of Transfusion	Date of blood transfusion(s)
Implicated Product	If a blood product was implicated, specify which type of product.
Linked Donor	Was a blood donor identified for the case-patient's transfusion?	PHVS_YesNoUnknown_CDC
Organ Donor	Did the case-patient donate an organ in the 30 days prior to onset?	PHVS_YesNoUnknown_CDC
Organ Transplant	Did the case-patient receive an organ in the 30 days prior to onset?	PHVS_YesNoUnknown_CDC
Lab Test	Indicate each test performed (repeat variables as necessary).	PHVS_LabTestName_Babesiosis
Date of Specimen Collection	Provide the date the specimen was collected
Lab	Information on whether the specimen was tested in public health labs or exclusively in commercial laboratories.
Coded Result	Coded qualitative result value (e.g., positive, negative).	PHVS_PosNegUnkNotDone_CDC
Numeric Result	Results expressed as numeric value/quantitative result (e.g., titer).
Babesia Species	Provide species identified by the laboratory test (if applicable).	PHVS_LabResult_Babesiosis
Parasitemia	Estimated number of infected erythrocytes expressed as a percentage of the total erythrocytes.
Confirmed SPHL	Was the diagnosis confirmed at the state public health laboratory?	PHVS_YesNoUnknown_CDC
Date of Onset Approx	If exact date of illness onset is not known, provide approximate date (mm/yyyy).
Date of Death Approx	If exact date of death is not known, provide approximate date (mm/yyyy).
Date Approx	Is the date provided an approximation?	PHVS_YesNoUnknown_CDC
Case Classification	Indicate the case classification status (confirmed, probable, suspect, unknown)
Blood Recipient/Blood Transfusion	In the year before symptom onset or diagnosis, did the subject receive a blood transfusion?	PHVS_YesNoUnknown_CDC
Blood Donor	In the year before symptom onset or diagnosis, did the subject donate blood?	PHVS_YesNoUnknown_CDC

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Sheet 6: Botulism

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Botulism Lab Confirmed	Was botulism laboratory confirmed from patient specimen?	PHVS_YesNoUnknown_CDC
C. Botulinum Isolated	Was C. botulinum/ C. baratii/ or C. butyricum isolated in culture from patient specimen?	PHVS_YesNoUnknown_CDC
Botulinum toxin Isolated	Was botulinum toxin confirmed from patient specimen?	PHVS_YesNoUnknown_CDC
Toxin Type Clin	If clinical specimen positive, what was its toxin type?
Transmission Category	What was the transmission category (e.g., foodborne, wound, infant, other/unknown)?
Botulism Food Source Code	If food is known or thought to be the source, please specify food type:	PHVS_BotulismFoodSourceType_FDD
Botulism Food Source Other	If “Other,” please specify other food type:
Food Tested	Was food tested?	PHVS_YesNoUnknown_CDC
Food Tested Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	Should include mouse bioassay, PCR, ELISA, Culture
Food Botulism Positive	Was food positive for botulism?	PHVS_YesNoUnknown_CDC
Food Bot Positive_Specify	If food positive, what was the food item?
Food Toxin Type Code	If food was positive, what was its toxin type?	PHVS_BotulinumToxinType_FDD
Food Toxin Type Other	If “Other,” please specify other toxin type:
Non-food Vehicle	If not foodborne botulism, what was the vehicle/exposure (e.g., black tar heroin)
Botulism Other Indicator	Does the patient have Other Clinical based Botulism?	PHVS_YesNo_HL7_2x
Botulism Laboratory Confirmed	Was botulism laboratory confirmed from patient specimen?	PHVS_YesNoUnknown_CDC
Epi-linked	If botulism not laboratory confirmed from patient specimen or food, was case epi-linked to a confirmed botulism case?
Comments	Space to add in general comments
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification.
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	PHVS_BodySite_CDC
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	PHVS_Specimen_CDC
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	PHVS_ResultStatus_HL7_2x
Resulted Test Name	The lab test that was run on the specimen.	PHVS_LabTestName_CDC
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_LabTestResultQualitative_CDC
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	PHVS_AbnormalFlag_HL7_2x
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	PHVS_LabTestMethods_CDC Should include mouse bioassay, PCR, ELISA, Culture
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Track Isolate	Track Isolate functionality indicator	PHVS_TrueFalse_CDC
Patient status at specimen collection	Patient status at specimen collection	PHVS_PatientLocationStatusAtSpecimenCollection
Isolate received in state public health lab	Isolate received in state public health lab	PHVS_YesNoUnknown_CDC
Reason isolate not received	Reason isolate not received	PHVS_IsolateNotReceivedReason_NND
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	PHVS_YesNoUnknown_CDC
Case confirmed at CDC lab	Case confirmed at CDC lab

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Sheet 7: Brucellosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Date First Submitted	Date/time the notification was first sent to CDC. This value does not change after the original notification.
Case Outbreak indicator	Denotes whether the reported case was associated with an identified outbreak.	PHVS_YesNoUnknown_CDC
Source of Infection	What is the source of infection from list "naturally-acquired", "lab-aquired", "bioterrorism"
Outbreak source	If case outbreak indicator is "Yes", what was the common exposure source, including "Food consumption", "Occupational exposure", "Recreational exposure", "Family", "Close contact", "Sexual contact"
State Case ID	States use this field to link NEDSS investigations back to their own state investigations.
Health care provider	Health care provider name
Local Subject ID	The local ID of the subject/entity.
Health care provider	Health care provider phone number
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Subject Address State	State of residence of the subject	PHVS_State_FIPS_5-2
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Age at case investigation	Subject age at time of case investigation
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Subject’s Sex	Subject’s current sex	PHVS_Sex_MFU
Pregnancy status	Indicates whether the subject was pregnant at the time of the event.	PHVS_YesNoUnknown_CDC
Country of Birth	Country of Birth	PHVS_CountryofBirth_CDC
Ethnic Group Code	Based on the self-identity of the subject as Hispanic or Latino	PHVS_EthnicityGroup_CDC_Unk
Race Category	Field containing one or more codes that broadly refer to the subject’s race(s).	PHVS_RaceCategory_CDC
Occupation	Occupation of the case patient, from list "Animal Research", "Medical Research", "Dairy", "Laboratory", "Wildlife", "Rancher", "Slaughterhouse", "Tannery/rendering", "Veterinarian/Vet Tech", "Lives w/person of with an occupation listed here", "Other"
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
Stage of disease	Stage of disease, inlcuding "Acute", "Subacute", "Chronic", "Unknown"
Fever	Did patient have a fever?	PHVS_YesNoUnknown_CDC
Fever onset date	Onset date of fatigue
Maximum temperature	Maximum temperature reported
Temperature Units	Specify fahrenheit or celsius	PHVS_TemperatureUnit_UCUM
Sweats	Experienced sweats	PHVS_YesNoUnknown_CDC
Sweats onset date	Onset date of sweats
arthralgia	Experienced arthralgia?	PHVS_YesNoUnknown_CDC
arthragia onset date	Onset date of arthralgia
headache	Experienced headache	PHVS_YesNoUnknown_CDC
headache onset date	Onset date of headache
Fatigue	Experienced fatigue	PHVS_YesNoUnknown_CDC
Fatigue date of onset	Onset date of fatigue
Anorexia	Experienced anorexia	PHVS_YesNoUnknown_CDC
Anorexia Onset date	Onset date of anorexia
Myalgia	Experienced myalgia	PHVS_YesNoUnknown_CDC
Myalgia onset date	Onset date of myalgia
weight loss	Experienced weight loss	PHVS_YesNoUnknown_CDC
weight loss onset date	Onset date of weight loss
endocarditis	Experienced endocarditis?	PHVS_YesNoUnknown_CDC
endocarditis onset date	Onset date of endocarditis
Orchitis	Experienced orchitis	PHVS_YesNoUnknown_CDC
Orchitis onset date	Onset date of orchitis
Epididymitis	Experienced epididymitis?	PHVS_YesNoUnknown_CDC
Epididymitis onset date	Onset date of epididymitis
Hepatomegaly	Experienced hepatomegaly	PHVS_YesNoUnknown_CDC
Hepatomegaly onset date	Onset date of hepatomegaly
splenomegaly	Experienced splenomegaly	PHVS_YesNoUnknown_CDC
splenomegaly onset date	Onset date of splenomegaly
Arthritis	Experienced athritis?	PHVS_YesNoUnknown_CDC
Arthritis onset date	Onset date of arthritis
Meningitis	Experienced meningitis	PHVS_YesNoUnknown_CDC
Meningitis onset date	Onset date of meningitis
spondylitis	Experienced spondylitis	PHVS_YesNoUnknown_CDC
spondylitis onset date	Onset date of spondylitis
Symptoms Other	Were other symptoms or signs experienced	PHVS_YesNoUnknown_CDC
Symptoms Other details	Describe other symptoms or signs experienced
Symptoms Other onset date	Details of other symptoms experienced
Hospitalized	Was subject hospitalized because of this event?	PHVS_YesNoUnknown_CDC
Admission Date	Subject’s first admission date to the hospital for the condition covered by the investigation.
Discharge Date	Subject's first discharge date from the hospital for the condition covered by the investigation.
Subject Died	Did the subject die from this illness or complications of this illness?	PHVS_YesNoUnknown_CDC
Deceased Date	If the subject died from this illness or complications associated with this illness, indicate the date of death
Treatment status	Status of treatment at time of case notification ("Currently under treatment", "Completed treatment", "Not treated", "No Response")
Treated doxycycline	treated with doxycycline?	PHVS_YesNoUnknown_CDC
Dose of doxycycline	dosage of doxycycline prescribed
Days of doxycycline	days of doxycycline prescribed
Treated with rifampin	treated with rifampin?	PHVS_YesNoUnknown_CDC
dosage of rifampin	dosage of rifampin prescribed
days of rifampin	days of rifampin prescribed
Treated with streptomycin	treated with streptomycin?	PHVS_YesNoUnknown_CDC
dosage of streptomycin	dosage of streptomycin prescribed
days of streptomycin	days of streptomycin prescribed
treated with other drug 1	treated with other drug 1?	PHVS_YesNoUnknown_CDC
name of other drug 1	If Other drug 1 is "Yes", list name of the drug
dose of other drug 1	If Other drug 1 is "Yes", list the prescribed dosage of this drug
Days other drug 1	If Other drug 1 is "Yes", list the prescribed duration of this drug
treated with other drug 2	treated with other drug 2?	PHVS_YesNoUnknown_CDC
name of other drug 2	If Other drug 2 is "Yes", list name of the drug
dose of other drug 2	If Other drug 2 is "Yes", list the prescribed dosage of this drug
Days other drug 2	If Other drug 2 is "Yes", list the prescribed duration of this drug
treated with other drug 3	treated with other drug 3?	PHVS_YesNoUnknown_CDC
name of other drug 3	If Other drug 3 is "Yes", list name of the drug
dose of other drug 3	If Other drug 3 is "Yes", list the prescribed dosage of this drug
Days other drug 3	If Other drug 3 is "Yes", list the prescribed duration of this drug
Travel	In the 6 months prior to illness onset did the subject travel outside of the state of residence?	PHVS_YesNoUnknown_CDC
travel location 1	Location of travel 1
Travel departure date 1	If traveled, departure date to first destination
Travel return date 1	If traveled, return date from first destination
travel location 2	Location of travel 2
Travel departure date 2	If traveled, departure date to second destination
Travel return date 2	If traveled, return date from second destination
Animal Contact	In the 6 months prior to illness onset, did the subject have animal contact?	PHVS_YesNoUnknown_CDC
Birthing product animal	Which animal(s) did case patient have contact with birthing products ("Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other")
Birthing product animal other	Other animal with which case patient had contact with birthing products
Skinning contact with animal	Which animal did case patient have contact with skinning/slaughtering ("Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other")?
Skinning contact with other animal	If animal skinned/slaughtered is "Other", describe which animal(s) the case patient had contact with
Hunt animal contact	Which animal(s) did case patient hunt, from list "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Hunt other animal	If type of animal hunted is "Other", specify the type(s) of animal(s) hunted
Animal Other Contact Type	If Type of animal contact is "Other" describe the contact
Other Animal Contact	If Type of animal contact is "Other", which animal did case patient have this type of contact including "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Other animal contact	If Type of animal contact is "Other" and animal is "Other" which animal did case patient have this type of contact
Birthing product own animal	If case patient had contact with birthing products, who owned the animal ("Case", " Private", " Wild", " Commercial", " Unknown")
Skinning contact owned	Who owned the animal which the case patient had contact with skinning/slaughter ("Case", " Private", " Wild", " Commercial", " Unknown")
Hunt own animal	Who owned the animal which the case patient had contact with hunting from list "Case", " Private", " Wild", " Commercial", " Unknown"
Other animal owned	If animal contact type was "Other", describe who owned the animal from this contact, from list "Case", " Private", " Wild", " Commercial", " Unknown"
Consumed meat or dairy	In the 6 months prior to illness onset, did the subject consume unpasteurized dairy or undercooked meat?	PHVS_YesNoUnknown_CDC
Milk animal source	If the subject consumed unpasteurized milk from which animal(s) "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Milk Animal other	If milk animal source is "Other", describe which animal this milk product was from
Cheese	Consumed fresh or soft cheese from which animal(s), including "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Other animal source of cheese	If animal source of cheese is "Other", which animal(s) was the source of cheese
Meat animal source	Consumed undercooked meat from which animal(s) "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Meat animal other	If animal source of meat is "Other", list the animal source(s) from which the case patient consumed meat
Food product other	If food product is "Other", describe other food consumed
Food product animal source	If food product is "Other", select the animal sources of this food from list "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"
Food Animal other	If food product and animal are "Other", describe which animal this other food was from
Milk source country	Country milk was from, "U.S.", "Other"
Milk source other 1	If milk source country is "Other", list country	PHVS_CountryofBirth_CDC
Milk source other 2	If milk source country is "Other", list country	PHVS_CountryofBirth_CDC
Cheese source country	Country where the cheese product was from. Notification types include "U.S.", "Other"
Country cheese was from 1	If cheese source country is "Other", list country	PHVS_CountryofBirth_CDC
Country cheese was from 2	If cheese source country is "Other", list country	PHVS_CountryofBirth_CDC
Meat source country	Country meat was from, "U.S.", "Other"
Meat source other 1	If meat source country is "Other", list country	PHVS_CountryofBirth_CDC
Meat source other 2	If meat source country is "Other", list country	PHVS_CountryofBirth_CDC
Food product source country	Country where the food product was from. Notification types include "U.S.", "Other"
Food source other 1	If food source country is "Other", list country	PHVS_CountryofBirth_CDC
Food source other 2	If food source country is "Other", list country	PHVS_CountryofBirth_CDC
Is this case epi-linked to a laboratory-confirmed case?	Is this case epi-linked to a laboratory-confirmed case?	PHVS_YesNoUnknown_CDC
Similar illness	Similar illness in contact of the subject?	PHVS_YesNoUnknown_CDC
Close contact	If epi-link to a laboratory-confirmed case or similar illness in a close contact are "Yes", then select the relationship of the contact ("Household", "Neighbor", "Co-worker", "Other")
Close contact Other	If Close Contact is "Other", then describe the relationship of the contact
Exposure to Brucella	Was the case patient exposed to Brucella, from the list "Clinical specimen", "Isolate", "Vaccine", "Unknown"
Location of Exposure	If Brucella exposure is selected, where did exposure occur, from list "Clinical", "Laboratory", "Farm/ranch", "Surgery", "Unknown", "Other"
Location of Exposure, other	If location of exposure to Brucella is "Other", specify exposure location
Risk of exposure	Exposure risk classificaiton ("high", "low", "Unknown")
Exposure to Brucella vaccine	If case patient was exposed to "Vaccine", choose which vaccine patient was exposed to, from list "S19", "RB51", "Rev1", "Other"
PEP received	Did the subject receive post exposure prophylaxis?	PHVS_YesNoUnknown_CDC
no PEP was taken	If the case-patient had a known eposure to Brucella and PEP was not taken, why not, from list "Unaware of exposure", "Unavailable", "Allergic", "Pregnant", "Unknown", "Other"
no PEP was taken other	If no PEP taken reason was "Other", desribe the reason PEP was not taken
Complete PEP	Did the patient complete PEP regimen ("Yes","No", "Unknown", "Partial"?
Partial PEP	If PEP completed is "Partial", Explain why partial pep was taken
Earliest Date Reported to State	Earliest date reported to state public health system
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab City	City location of Laboratory that reported test result.
Reporting Lab State	State Laboratory that reported test result.	PHVS_State_FIPS_5-2
Reporting Lab Zip	Zip code of Laboratory that reported test result.
Received from	Received from (e.g., lab name, clinician, etc)
Received city	Received from city
Received state	Received from state	PHVS_State_FIPS_5-2
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Agglutination test name	Name of agglutination test used
Acute total titer	Acute Total antibody titer
Convalscent total titer	Convalscent Total antibody titer
Positive Result	Based on the acute and covalscent titers for the agglutination test used, what is the result of the paired total antibody titers (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Agglutination cut off	Cut off value of a positive result for the Agglutination test used
Acute IgG titer Agglutination	Acute IgG agglutination titer
Convalscent IgG titer Agglutination	Convalscent IgG agglutination titer
Agglutination Positive Result	Based on the acute and covalscent titers for the agglutination test used, what is the result of the paired IgG titers (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
ELISA test name	Name of the ELISA test used
Acute IgG ELISA titer	Acute IgG ELISA titer
Convalscent IgG ELISA titer	Convalscent IgG ELISA titer
ELISA IgG Positive Result	Based on the acute and covalscent titers for the IgG ELISA test used, what is the result of the paired IgG titers (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Acute IgM ELISA titer	Acute IgM ELISA titer
Convalscent IgM ELISA titer	Convalscent IgM ELISA titer
ELISA IgM Positive Result	Based on the acute and covalscent titers for the IgM ELISA test used, what is the result of the paired IgM titers (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
ELISA test cut off	ELISA test cut off
Date of Acute Serum Specimen Collection	The date the acute serum specimen was collected.
Date of Convalscent Serum Specimen Collection	The date the convalscent serum specimen was collected.
Rose Bengal titer	Rose Bengal titer
Rose Bengal positive result	Result of Rose Bengal test (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Rose Bengal test cut off	Cut off value of a positive result for the Rose Bengal test
Coombs Titer	Coombs Titer
Coombs Titer positive result	Result of Coombs test (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Coombs test cut off	Cut off value of a positive result for the Coombs test
Other serologic test name 1	Name of other serologic test used 1
Other serologic test titer or value 1	Titer or value of other serologic test 1
Other serologic test 1 positive	Result of other serologic test 1 (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Other serologic test 1 cut off	Cut off value of a positive result for the Other test used 1
Other serologic test name 2	Name of other serologic test used 2
Other serologic test value 2	Value of other serologic test 2
Other serologic test 2 positive	Result of other serologic test 2 (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Other serologic test 2 cut off	Cut off value of a positive result for the Other test used 2
PCR	If PCR was done, select on which specimens it was used ("Blood", "Abscess/wound", "Bone marrow", "CSF", "Other")
PCR other specimen	Describe the specimen if specimen tested by PCR was "Other"
Date specimen for PCR collected	The date the specimen was collected for PCR
PCR positive	Result of PCR (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
PCR Species identified	What Brucella species were identified as a result of PCR ("abortus", "canis", "melitensis", "suis", "ceti", "inopinata", "microti", "neotomae", "pinnipedalis")
Culture	If culture was done, which specimens were used ("Blood", "Abscess/wound", "Bone marrow", "CSF", "Other")
Culture other specimen	Describe the specimen if specimen tested by culture was "Other"
Date specimen for culture was collected	The date the specimen was collected for culture
Culture positive	Result of culture (e.g., Positive, Negative, Unknown)?	PHVS_YesNoUnknown_CDC
Culture Species identified	What Brucella species were identified as a result of culture ("abortus", "canis", "melitensis", "suis", "ceti", "inopinata", "microti", "neotomae", "pinnipedalis")
Pre antimicrobials	Were specimens collected before antimicrobials were taken	PHVS_YesNoUnknown_CDC
Select Agent Reporting	Was the select agent reported to CDC	PHVS_YesNoUnknown_CDC
Lab exposure	Did a laboratory exposure occur during manipulation of an isolate?	PHVS_YesNoUnknown_CDC
Exposure reported	If a laboratory exposure is "Yes", was it reported?	PHVS_YesNoUnknown_CDC
Specimens to CDC	Were specimens or isolates sent to CDC for testing?	PHVS_YesNoUnknown_CDC
Specimens still available	are clinical specimens or isolates still available for further testing?	PHVS_YesNoUnknown_CDC

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Sheet 8: Campylobacter

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Reported  symptoms and signs of illness	Symptoms and signs associated with illness
Travel in 10 days prior to illness	Did the case have travel outside of the U.S. in the 10 days before the illness began?
Consumption of undercooked/ raw meat	Did the case eat undercooked or raw meat before the illness began?
Consumption of undercooked/ raw poultry	Did the case eat undercooked or raw poultry before the illness began?
Drinking untreated water	Did the case drink untreated water before the illness began?
Contact with untreated recreational water	Did the case have contact with untreated recreational water before the illness began?
Consumption of raw milk or unpasteurized dairy	Did the case consume raw milk or unpasteurized dairy before the illness began?
Contact with pets, farm animals with Campylobacter species	Did the case have contact with pets or farm animals from which Campylobacter species were isolated?
Contact with confirmed/probable case of Campylobacteriosis	Did the case have contact with another probable or confirmed case of Campylobacteriosis?
Consumption or exposure to implicated vehicle	Did the case consume or have exposure to a vehicle implicated in an outbreak or a location in which an implicated food vehicle was prepared or eaten?
WGS (Whole-Genome Sequencing) ID	The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case
Probable – Laboratory Diagnosed	Probable case is laboratory diagnosed	PHVS_YesNo_HL7_2x	P
Probable – Epi Linked	Probable case is epi linked	PHVS_YesNo_HL7_2x	P

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Sheet 9: Candida auris

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Previously Counted Case	Was patient previously counted as a colonization/screening case?	PHVS_YesNoUnknown_CDC	P
Previously Reported State Case Number	If patient was previously counted as a colonization/screening case or a CP-CRE case, please provide the related case ID(s)	N/A	P
Tracheostomy Tube at Specimen Collection	Did patient have a tracheostomy tube at the time of specimen collection?	PHVS_YesNoUnknown_CDC	P
Ventilator Use at Specimen Collection	Was patient on a ventilator at the time of specimen collection?	PHVS_YesNoUnknown_CDC	P
Long-term Care Resident	Did the patient have a stay in a long-term care facility in the 90 days before specimen collection date?	PHVS_YesNoUnknown_CDC	P
Type of Long-term Care Facility	If patient had a stay in a long-term care facility in the 90 days before specimen collection date, indicate the type of long-term care facility.	PHVS_LongTermCareFacilityType_C.auris	P
Healthcare Outside Resident State	Indicate if the patient received overnight healthcare within the United States, but outside of the patient's resident state in the year prior to the date of specimen collection.	PHVS_YesNoUnknown_CDC	P
Travel Outside USA Prior to Illness Onset within Program Specific Timeframe	Did the patient travel internationally in the past 1 year from the date of specimen collection?	PHVS_YesNoUnknown_CDC	P
International Destination(s) of Recent Travel	List the names of the country(ies) outside of the United States the patient traveled to in the year prior to the date of specimen collection, if the patient traveled outside of the United States during that time.	PHVS_Country_ISO_3166-1	P
Healthcare Outside USA	Indicate if the patient received overnight healthcare outside of the United States in the year prior to the date of specimen collection.	PHVS_YesNoUnknown_CDC	P
Country(ies) of Healthcare Outside USA	List the names of the country(ies) outside of the United States where the patient received overnight healthcare in the year prior to the date of specimen collection, if the patient received overnight healthcare outside of the United States during that time.	PHVS_Country_ISO_3166-1	P
Type of Location Where Specimen Collected	Indicate the physical location type of the patient when the specimen was collected	PHVS_SpecimenCollectionSettingType_C.auris	P
County of Facility	County of facility where specimen was collected	PHVS_County_FIPS_6-4	P
State of Facility	State of facility where specimen was collected	PHVS_State_FIPS_5-2	P
Infection with Another MDRO	Does the patient have infection or colonization with another MDRO?	PHVS_YesNoUnknown_CDC	P
Co-infection Type	If patient has infection or colonization with another MDRO, indicate the MDRO.	PHVS_TypeCoInfection_C.auris	P
State Lab specimen ID	State lab specimen ID	N/A	P
WGS ID Number	NCBI SRA Accession number (SRX#) We would describe this as: The accession number generated by NCBI’s Sequence Read Archive when sequence data are uploaded to NCBI. This provides both the sequence data and metadata on how the sample was sequenced.	N/A	P

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Sheet 10: Carbon Monoxide Poisoning

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Smoking status	Current smoker (yes, no, unknown)	https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7749	P
Source of data for case ascertainment	·         Hospital/emergency department	https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7891	P
	·         Poison control center
	·         Laboratory report
	·         Death certificate
	·         Provider/medical examiner report
Carboxyhemoglobin (COHb) level	Laboratory test result (%)	N/A	P
Intent	·         Intentional	https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7876	P
	·         Unintentional

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Sheet 11: Cholera

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
AGEMM	Age in months
AGEYY	Age in years
CDCNUM	CDC Number
CITY	City
COUNTY	County
DATECOMP	Date completing form
DOB	Date of birth
ETHNICITY	Hispanic or Latino origin?
FDANUM	FDA Number
FNAME	First 3 letters of first name
LNAME	First 3 letters of last name
OCCUPAT	Occupation
RACE	Race
SEX	Sex
STATE	State of exposure (usually reporting state)
STEPINUM	State Number
STLABNUM	State Lab Number
FEVER	Fever
NAUSEA	Nausea
VOMIT	Vomiting
DIARRHEA	Diarrhea
VISBLOOD	Bloody stool
CRAMPS	Abdominal cramps
HEADACHE	Headache
MUSCPAIN	Muscle Pain
CELLULIT	Cellulitis
BULLAE	Bullae
SHOCK	Shock
OTHER	Other
MAXTEMP	Symptom: Maximum temp of fever
CENFAR	Fever measured in units of C or F
NUMSTLS	Symptom: # of stools/24 hours
CELLSITE	Symptom: Site of cellulitis
BULLSITE	Symtom: Site of Bullae
OTHSPEC2	Symptom: Specify other Symptoms
AMPMSYMP	Seafood Investigation: Onset in am or pm
ANTIBYN	Did patient receive antibiotics?
Descant1	Name of 1st Antibiotic
Descant2	Name of 2nd Antibiotic
Descant3	Name of 3rd Antibiotic
ANTNAM01	Name of 1st Antibiotic (old)
ANTNAM02	Name of 2nd Antibiotic (old)
ANTNAM03	Name of 3rd Antibiotic (old)
ANTNAM04	Name of 4th Antibiotic (old)
BEGANT1	Date began Antibiotic #1
BEGANT2	Date began Antibiotic #2
BEGANT3	Date began Antibiotic #3
BEGANT4	Date began Antibiotic #4
CDCISOL	CDC Isolate No.
DATEADMN	Date admitted to hospital
DATEDIED	Date of death
DATEDISC	Date of discharge from hospital
DATESYMP	Date of symptom onset
DURILL	# days ill
ENDANT1	Date ended Antibiotic #1
ENDANT2	Date ended Antibiotic #2
ENDANT3	Date ended Antibiotic #3
ENDANT4	Date ended Antibiotic #4
GSURGTYP	Pre-existing: Type of gastric surgery
HEMOTYPE	Pre-exisiting: Type of hemotological disease
HHSYMP	Hour of symptom onset
HOSPYN	Hospitalized?
IMMTYPE	Pre-exisiting: Type of Immunodeficiency
LIVTYPE	Pre-exisiting: type of liver disease
MALTYPE	Pre-existing: Type of Malignancy
MISYMP	Minute of symptom exposure
OTHCONSP	Pre-existing: Type of Other condition
PATDIE	Did patient die?
PEPULCER	Pre-existing: Peptic ulcer
ALCOHOL	Pre-existing: Alcoholism
DIABETES	Pre-existing: Diabetes
INSULIN	Pre-existing: on insulin?
GASSURG	Pre-existing: Gastric surgery
HEART	Pre-existing: Heart disease
HEARTFAL	Pre-existing: Heart failure?
HEMOTOL	Pre-existing: Hematologic disease
IMMUNOD	Pre-existing: Immunodeficiency
LIVER	Pre-existing: Liver disease
MALIGN	Pre-existing: Malignancy
RENAL	Pre-existing: Renal disease
RENTYPE	Pre-existing: Type of renal disease
OTHCOND	Pre-existing: Other
TRTANTI	Type of treatment received: antibiotics
TRTCHEM	Type of treatment received: chemotherapy
TRTRADIO	Type of treatment received: radiotherapy
TRTSTER	Type of treatment received: systemic steroids
TRTIMMUN	Type of treatment received: immunosuppressants
TRTACID	Type of treatment received: antacids
TRTULCER	Type of treatment received: H2 Blocker or other ulcer medication
SEQDESC	Describe Sequelae
SEQUELAE	Sequelae?
TRTACISP	If previously treated with Antacids, specifiy
TRTANTSP	If previously treated with Antibiotics, specifiy
TRTCHESP	If previously treated with chemotherapy, specifiy
TRTIMMSP	If previously treated with immunosuppressants, specifiy
TRTRADSP	If previously treated with radiotherapy, specifiy
TRTSTESP	If previously treated with steroids, specifiy
TRTULCSP	If treated with ulcer meds, specifiy
DATESPEC	Date specimen collected
SPECIESNAME	Species
SITE	If other source, specify site from which Vibrio was isolated
STATECON	Was Species confirmed at State PH Lab?
SOURCE	Specimen source
OTHORGAN	Other organism isolated from specimen?
SPECORGAN	Specify other organism isolated
AMBTEMFC	Seafood Investigation: Maximum ambient temp units - F or C
AMNTCONS	Seafood Investigation: Amount of shellfish consumed
AMPMCONS	Seafood Investigation: Shellfish consumed in am or pm
DATEAMBT	Seafood investigation: Date ambient temp measured
DATEFECL	Seafood Investigation: Date of fecal count
DATEH2O	Seafood Investigation: Date water temp measured
DATEHAR1	Seafood Investigation: Date of harvest #1
DATEHAR2	Seafood Investigation: Date of harvest #2
DATERAIN	Seafood Investigation: Date total rain fall recorded
DATESALN	Seafood Investigation: Date salinity measured
DATESEAR	Seafood Investigation: Date restaurant rec'd seafood
FECALCNT	Seafood Investigation: Fecal Coliform Count
H2OSALIN	Seafood Investigation: Results of Salinity test
HARVSIT1	Seafood Investigation: Harvest Site #1
HARVSIT2	Seafood Investigation: Harvest Site #2
HARVST01	Seafood Investigation: Status of Harvest Site #1
HARVST02	Seafood Investigation: Status of Harvest Site #2
HARVSTS1	Seafood Investigation: Specify if Status for Harvest Site #1 = other
HARVSTS2	Seafood Investigation: Specify if Status for Harvest Site #2 = other
HHCONSUM	Seafood Investigation: Hour of seafood consumption
IMPROPER	Seafood Investigtaion: Improper Storage?
MAMTEMP	Seafood Investigation: Maximum ambient temp
MICONSUM	Seafood Investigation: Minute of seafood consumption
RAINFALL	Seafood Investigation: Total rainfall in Inches
RESTINV	Seafood Investigation: Investigation of Restaurant?
SEADISSP	Seafood Investigation: Specify how shellfish distributed
SEADIST	Seafood Investigation: How is shellfish distributed?
SEAHARV	Seafood Investigation: Was shellfish harvested by patient or friend?
SEAIMPOR	Seafood Investigation: Was seafood imported?
SEAIMPSP	Seafood Investigation: Specify country of Import
SEAOBT	Seafood Investigation: where was seafood obtained?
SEAOBTSP	Seafood Investigation: Specify from where seafood was obtained
SEAPREP	Seafood Investigation: How was seafood prepared?
SEAPRSP	Seafood Investigation: Specify how seafood was prepared (if other)
SH2OTEMP	Seafood Investigation: Surface water temperature
SH2OTMFC	Surface water temp units in F or C?
SOURCES	Sources of seafood
SHIPPERS	Shippers who handled suspected seafood (certification numbers)
TAGSAVA	Seafood investigation: Are tags available from suspect lot?
TYPESEAF	Seafood investigation: Type of shellfish consumed
HARVESTSTATE	State in which seafood was harvested
HARVESTREGION	Region in which seafood was harvested
BIOTYPE	Cholera Only: biotype?
CHOLVACC	Cholera Only: Patient ever received cholera vaccine
DATEVACC	Cholera Only: Date cholera vaccine received
ORALVACC	Cholera Only: Oral cholera vaccine received
PAREVACC	Cholera Only: Parenteral cholera vaccine received
ELISA	Cholera Only: Elisa test performed for Cholera toxin testing?
LATEX	Cholera Only: Latex Agglut. performed for Cholera toxin testing?
RISKRAW	Cholera Only: Raw seafood
RISKCOOK	Cholera Only: Cooked seafood
RISKTRAV	Cholera Only: Foreign travel
RISKPERS	Cholera Only: Other person(s) with cholera or cholera-like illness
RISKVEND	Cholera Only: Stree-vended food
RISKOTHER	Cholera Only: Other
RISKSPEC	Cholera Only: Other risk specified
SEROTYPE	Cholera Only: Cholera Serotype
SPECTOXN	Cholera Only: Specify other toxin test used for Cholera (if other)
TOXGENIC	Cholera Only: is it toxigenic?
TRVOTHR	Cholera prevention education: specify other source of education
TRVPREV	Cholera prevention education prior to travel?
TRVPREV1	Cholera prevention: Pre-travel clinic
TRVPREV2	Cholera prevention: Airport
TRVPREV3	Cholera prevention: Newspaper
TRVPREV4	Cholera prevention: Friends
TRVPREV5	Cholera prevention: Private physician
TRVPREV6	Cholera prevention: Health department
TRVPREV7	Cholera prevention: Travel agency
TRVPREV8	Cholera prevention: CDC travelers' hotline
TRVPREV9	Cholera prevention: Other
TRVREAS1	Reason for travel: Visit friends/relatives
TRVREAS2	Reason for travel: Business
TRVREAS3	Reason for travel: Tourism
TRVREAS4	Reason for travel: Military
TRVREAS5	Reason for travel: Other
TRVREAS6	Reason for travel: Unknown
TRVROTHR	Cholera, reason for travel: specify if other
AMPMEXP	Seafood Investigation: Exposure to seawater in am or pm
HANDLING	Exposure: handing/cleaning seafood
SWIMMING	Exposure: Swimming/diving/wading
WALKING	Exposure: Walking on beach/shore/fell on rocks/shells
BOATING	Exposure: Boating/skiing/surfing
CONSTRN	Exposure: Construction/repairs
BITTEN	Exposure: Bitten/stung
ANYWLIFE	Exposure: Contact with other marine/freshwater life
BODYH2O	Exposure: Exposure to a body of water
CONSTRN	Exposure to water via construction
DATEEXPO	Exposure: Date of exposure to seawater
DATEWHI1	Date traveled/entered destination #1
DATEWHI2	Date traveled/entered destination #2
DATEWHI3	Date traveled/entered destination #3
DATEWHO1	Date left/returned home #1
DATEWHO2	Date left/returned home #2
DATEWHO3	Date left/returned home #3
FISHSP	Type of fish
H2OCOMM	Exposure: Comments on water exposure
H2OTYPE	Exposure: Type of water exposure
HHEXPOS	Exposure: Hour of seawater exposure
LOCEXPOS	Exposure: location of water exposure
MIEXPOS	Exposure: Minute of seawater exposure
OTHEREXP	Exposure: Other exposure
OTHERH2O	Exposure: Exposed to other water not listed?
OTHSHSP	Specify other shellfish consumed
OUTBREAK	Is case part of outbreak?
OUTBRKSP	If part of an outbreak, Specify outbreak
CLAMS	Consumption: clams
CRAB	Consumption: crab
LOBSTER	Consumption: lobster
MUSS	Consumption: mussels
OYSTER	Consumption: oysters
SHRIMP	Consumption: shrimp
CRAY	Consumption: crawfish
OTHSH	Consumption: other shellfish
FISH	Consumption: other fish
RCLAM	Raw consumption: clams
RCRAB	Raw consumption: crab
RLOBSTER	Raw consumption: lobster
RMUSS	Raw consumption: muss
ROYSTER	Raw consumption: oyster
RSHRIMP	Raw consumption: shrimp
RCRAY	Raw consumption: crawfish
ROTHSH	Raw consumption: other shellfish
RFISH	Raw consumption: other fish
DATECLAM	Date of seafood consumption: clams
DATECRAB	Date of seafood consumption: crab
DATELOBS	Date of seafood consumption: lobster
DATEMUSS	Date of seafood consumption: mussels
DATEOYSTER	Date of seafood consumption: oysters
DATESHRI	Date of seafood consumption: shrimp
DATECRAY	Date of seafood consumption: crawfish
DATEOTHSH	Date of seafood consumption: other shellfish
DATEFISH	Date of seafood consumption: other fish
SPECEXPO	Specify other seawater/shellfish dripping exposure (if other)
STRESID	State of residence
TRAVEL	Exposure to travel outside home state in previous 7 days?
WHERE01	Travel destination #1
WHERE02	Travel destination #2
WHERE03	Travel destination #3
WOUNDEXP	Did patient incur a wound before/during exposure?
WOUNDSP	If patient incurred wound before/during exposure, describe wound
Specify Different Exposure Window	If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P

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Sheet 12: Congenital Rubella Syndrome

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Date of Last Evaluation by a Healthcare Provider	The date the patient was last evaluated by a healthcare provider
Primary cause of death from death certificate	The primary cause of subject's death, as noted on the death certificate
Secondary cause of death from death certificate	The secondary cause of subject's death, as noted on the death certificate.
Was an autopsy performed?	Was an autopsy performed on the subject's body?	PHVS_YesNoUnknown_CDC
Final Anatomical Diagnosis of Death from Autopsy Report	The final anatomical cause of subject's death
If not a case of CRS, select reason	The reason this was not a case of CRS.	PHVS_NoCaseReason_CRS
Gestational Age at Birth (in weeks)	The subject's gestational age (in weeks) at birth
Age at Diagnosis	The subject's age at the time of diagnosis.
Age (unit) at Diagnosis	The age units at the time of diagnosis	PHVS_AgeUnit_UCUM
Birth Weight	The subject's birth weight
Birth Weight (unit)	The subject's birth weight units	PHVS_WeightUnit_UCUM
Cataracts (Complication)	Did/does the subject have cataracts?	PHVS_YesNoUnknown_CDC
Hearing Impairment (loss) (Complication)	Did/does the subject have hearing impairment (loss)?	PHVS_YesNoUnknown_CDC
Congenital Heart Disease (Complication)	Did the subject have a congenital heart disease?	PHVS_YesNoUnknown_CDC
Patent Ductus Arteriosus (Complication)	Did/does the subject have patent ductus arteriosus?	PHVS_YesNoUnknown_CDC
Peripheral Pulmonic Stenosis (Complication)	Did/does the subject have peripheral pulmonic stenosis?	PHVS_YesNoUnknown_CDC
Congenital Glaucoma (Complication)	Did/does the subject have congenital glaucoma?	PHVS_YesNoUnknown_CDC
Pigmentary Retinopathy (Complication)	Did/does the subject have pigmentary retinopathy?	PHVS_YesNoUnknown_CDC
Developmental Delay or Mental Retardation (Complication)	Did/does the subject have developmental delay or mental retardation?	PHVS_YesNoUnknown_CDC
Meningoencephalitis (Complication)	Did the subject have meningoencephalitis?	PHVS_YesNoUnknown_CDC
Microencephaly (Complication)	Did the subject have microencephaly?	PHVS_YesNoUnknown_CDC
Purpura (Complication)	Did the subject have purpura?	PHVS_YesNoUnknown_CDC
Enlarged Spleen (Complication)	Did/does the subject have an enlarged spleen?	PHVS_YesNoUnknown_CDC
Enlarged Liver (Complication)	Did/does the subject have an enlarged liver?	PHVS_YesNoUnknown_CDC
Radiolucent Bone Disease (Complication)	Did the subject have radiolucent bone disease?	PHVS_YesNoUnknown_CDC
Neonatal Jaundice (Complication)	Did the subject have jaundice?	PHVS_YesNoUnknown_CDC
Low Platelets (Complication)	Did/does the subject have low platelets?	PHVS_YesNoUnknown_CDC
Dermal Erythropoieses (Blueberry Muffin Syndrome) (Complication)	Did subject have dermal erythropoisesis?	PHVS_YesNoUnknown_CDC
Other Complication(s)	Did the subject develop other conditions as a complication of this illness?	PHVS_YesNoUnknown_CDC
Specify Other Complication(s)	Please specify the other complication(s) the subject developed, during or as a result of this illness.
Was laboratory testing done for Rubella on this subject?	Was laboratory testing done for Rubella on this subject?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case	PHVS_LabTestProcedure_Rubella
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_VPD
Sample Analyzed Date	The date the lab test was performed
Test Method	The technique or method used to perform the test and obtain the test results.	PHVS_LabTestMethod_CDC
Date Collected	Date of specimen collection
Specimen Source	The medium from which the specimen originated.	PHVS_SpecimenSource_VPD
Was CRS virus genotype sequenced?	Identifies whether the CRS virus was genotype sequenced	PHVS_YesNoUnknown_CDC
Was Rubella genotype sequenced?	Identifies whether the Rubella virus was genotype sequenced	PHVS_YesNoUnknown_CDC
Were the specimens sent to CDC for genotyping (molecular typing)?	Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Specimen type sent to CDC for genotyping	Specimen type sent to CDC for genotyping	PHVS_SpecimenSource_VPD
Date sent for genotyping	The date the specimens were sent to the CDC laboratories for genotyping.
Type of Genotype Sequence	Identifies the genotype sequence of the Rubella virus	PHVS_Genotype_Rubella
Did the mother have a rash?	Did the mother have a maculopapular rash?	PHVS_YesNoUnknown_CDC
What was the mother's rash onset date?	What was the mother's rash onset date?
Mother's Rash Duration (in days)	How many days did the mother's rash being reported in this investigation last?
Did the mother have a fever?	Did the mother have a fever?	PHVS_YesNoUnknown_CDC
What was the mother's fever onset date?	What was the mother's rash onset date?
Mother's Fever Duration (in days)	How many days did the mother's rash being reported in this investigation last?
Did the mother have arthralgia/arthritis?	Did the mother have arthralgia/arthritis?	PHVS_YesNoUnknown_CDC
Did the mother have lymphadenopathy?	Did the mother have lymphadenopathy?	PHVS_YesNoUnknown_CDC
Other clinical features of maternal illness	Mother's other clinical features of maternal illness
Mother's birth country	The mother's country of birth	PHVS_Country_ISO_3166-1
Length of time mother has been in the US	Length of time (in years) the mother has been in the U.S.
Mother's age at delivery	The age of the mother when the infant (subject) was delivered
Mother's occupation at time of conception	The mother's occupation at time of this conception	PHVS_Occupation_CDC
Did the mother attend a family planning clinic prior to conception of this infant?	Did the mother attend a family planning clinic prior to conception of this infant?	PHVS_YesNoUnknown_CDC
Number of children less than 18 years of age living in household during this pregnancy?	The number of the mother's children less then 18 years of age living in household during this pregnancy
Were any of the children living in the household immunized with Rubella-containing vaccine?	Were any of the mother's children less than 18 years of age immunized with the rubella vaccine?	PHVS_YesNoUnknown_CDC
Number of children less than 18 years of age immunized with the rubella vaccine	The number of the mother's children less than 18 years of age immunized with the rubella vaccine
Was prenatal care obtained for this pregnancy?	Was prenatal care obtained for this pregnancy?	PHVS_YesNoUnknown_CDC
Date of first prenatal visit for this pregnancy	Date of the first prenatal visit for this pregnancy
Where was prenatal care for this pregnancy obtained?	Where was the prenatal care for this pregnancy obtained?	PHVS_PrenatalCareProvider_Rubella
Did the mother have serological testing prior to this pregnancy?	Did the mother have serological testing prior to this pregnancy?	PHVS_YesNoUnknown_CDC
Was there a rubella-like illness during this pregnancy?	Was there a rubella-like illness during this pregnancy?	PHVS_YesNoUnknown_CDC
Month of pregnancy in which symptoms first occurred	The month of pregnancy that Rubella-like symptoms appeared
Rubella Lab Testing Mother	Was Rubella lab testing performed for the mother in conjunction with this pregnancy?	PHVS_YesNoUnknown_CDC
Was Rubella diagnosed by a physician at time of illness?	Was the mother diagnosed with Rubella by a physician at time of illness?	PHVS_YesNoUnknown_CDC
If Rubella was not diagnosed by a physician, diagnosed by whom?	If the mother was not diagnosed with Rubella by a physician, then diagnosed by whom?
Was Rubella serologically confirmed at time of illness?	Was Rubella serologically confirmed (mother) at time of illness?	PHVS_YesNoUnknown_CDC
Serologically Confirmed Date	The date Rubella was serologically confirmed (mother)
Serologically Confirmed Result	The result of the Rubella serological confirmation (mother)	PHVS_LabTestInterpretation_VPD
Mother Reported Rubella Case	Has the mother ever been reported as a Rubella case?	PHVS_YesNoUnknown_CDC
Does the mother know where she might have been exposed to Rubella?	Did the mother know where she might have been exposed to Rubella?	PHVS_YesNoUnknown_CDC
If location of exposure is unknown, did the mother travel outside the US during the first trimester of pregnancy	If the Rubella exposure is unknown, did the mother travel outside the US during the first(1st) trimester of pregnancy?	PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel	List any international destinations of recent travel	PHVS_Country_ISO_3166-1
Date left for travel	The date the mother left for all international travel
Date returned from travel	The date the mother returned to United States from travel
Was the mother directly exposed to a confirmed case?	Was the mother directly exposed to a confirmed Rubella case?	PHVS_YesNoUnknown_CDC
If mother directly exposed to a confirmed Rubella case, specify the relationship	The mother's relationship to the confirmed Rubella case	PHVS_Relationship_VPD
Mother's date of exposure to a confirmed rubella case	The mother's exposure date to the confirmed rubella case
Has mother given birth in the US previously?	Has mother given birth in the US previously?	PHVS_YesNoUnknown_CDC
If mother has given birth in US, list dates (years)	List years in which mother has given birth in US previously
Number of previous pregnancies	Mother's number of previous pregnancies
Number of live births (total)	Mother's total number of live births
If mother has given birth in US, number of births delivered in U.S.	Mother's number of births delivered in U.S.
Mother immunized with rubella-containing vaccine?	Was the mother immunized with Rubella vaccine?	PHVS_YesNoUnknown_CDC
Source of mother's Rubella-containing vaccine information	Source of mother's Rubella immunization information	PHVS_ImmunizationInformationSource_CRS
Source of mother's rubella-containing vaccine	Source of mother's Rubella vaccine	PHVS_PrenatalCareProvider_Rubella
Vaccine Administered	The type of vaccine administered, (e.g., Varivax, MMRV). First question of a repeating group of vaccine questions.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine. Second question of a repeating group of vaccine questions.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered. Third question of a repeating group of vaccine questions.
Vaccine Administered Date	The date that the vaccine was administered. Fourth question of a repeating group of vaccine questions.
US Acquired	Sub-classification of disease or condition acquired in the US	PHVS_CaseClassificationExposureSource_NND
Specimen from mother or infant	Is the specimen from the mother or infant?
At the time of cessation of pregnancy, what was the age of the fetus (in weeks)?	If applicable, at the time of cessation of pregnancy, what was the age of the fetus (in weeks)?
Birth State	State where the subject was born
Mother's Country of Residence	What is the mother's country of residence?
Mother's pre-pregnancy serological test date.	If pre-pregnancy serological testing was performed, what was the date of mother's pre-pregnancy serological test?
Mother's pre-pregnancy serological test interpretation.	If pre-pregnancy serological testing was performed, what was the interpretation of mother's pre-pregnancy serological test?
Pregnancy outcome	What was the outcome of the current pregnancy
Number of doses received on or after 1st birthday	The number of vaccine doses against this disease which the mother received on or after their first birthday
Date of last dose prior to illness onset	Date of mother's last vaccine dose against this disease prior to illness onset

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Sheet 13: Congenital Syphilis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
RECTYPE	Record type will determine how the record is handled when it arrives at CDC.	Value for case data: M=MMWR report
UPDATE	Currently not implemented.	(Pad with a 9)
STATE	Reporting State FIPS code - (e.g., "06", "13").
YEAR	MMWR Year (2-digits) for which case information reported to CDC.
CASEID	Unique Case ID (numeric only) assigned by the state.
SITE	Location code used by the state to indicate where report originated and who has responsibility for maintaining the record. (NOTE: STD*MIS software substitutes a '#' for the leading 'S' in codes listed).	S01=State epidemiologist S02=State STD Program S03=State Chronic Disease Program S04-S99=Other state offices R01-R99=Regional or district offices 001-999=County health depts (FIPS codes) L01-L99=Laboratories within state CD1=Historical records (prior to new format) CD2=Entered at CDC (based on phone reports)
WEEK	MMWR Week on Surveillance Calendar, i.e., week for which case information reported to CDC.
EVENT	Event (disease) code for the disease being reported.	10316=Syphilis (congenital)
COUNT	For case records this field will always contain "00001".
COUNTY	FIPS code for reporting county (999=Unknown)
BIRTHDATE	Date of birth of infant in YYYYMMDD format (99999999=Unknown)
AGE	Estimated Gestational Age in weeks - (e.g., "038", "042") (999= Unknown)
AGETYPE	Indicates the units (weeks) for the AGE field.	2=0-52 Weeks 9=Gestational Age Unknown (AGE field should be 999)
RACE	Race of Mother.	1=American Indian/Alaskan Native 2=Asian or Pacific Islander 3=Black 5=White 8=Other 9=Unknown NOTE: Please use only one of the codes above if a single race was selected. If multiple races were selected, enter code 8=Other for Race and also select the appropriate race categories that apply in columns 238-244.
HISPANIC	Indicator for Mother's Hispanic ethnicity.	1=Hispanic/Latino 2=Non-Hispanic/Latino 9=Unknown
EVENTDATE	Date of Report to Health Department in YYMMDD format
DATETYPE	A code describing the type of date provided in EVENTDATE.	4=Date of first report to community health system
CASE STATUS	Recode of Case Classification.	1=Confirmed, Probable, or Syphilitic stillbirth 2=Not a case 9=Unknown
OUTBREAK	Indicates whether the case was associated with an outbreak.	1=Yes 2=No 9=Unknown
INFOSRCE	Information Source/Provider Codes (from Interview Record if available).	01=HIV Counseling and Testing Site 02=STD clinic 03=Drug Treatment 04=Family Planning 06=Tuberculosis clinic 07=Other Health Department clinic 08=Private Physician/HMO 10=Hospital-Emergency Room; Urgent Care Facility 11=Correctional Facility 12=Laboratory 13=Blood Bank 14=Labor and Delivery 15=Prenatal 16=National Job Training Program 17=School-based Clinic 18=Mental Health Provider 29=Hospital-Other 66=Indian Health Service 77=Military 88=Other 99=Unknown (if data not available)
DETECTED	Method of Case Detection (from Interview Record if available).	20=Screening 21=Self-referred 22=Patient referred partner 23=Health Department referred partner 24= Cluster related 88=Other 99=Unknown
MZIP	Zip Code for Mother's Residence	99999=Unknown (if data not available)
MSTATE	FIPS Code for Mother's State of Residence. Code 98 for Mexico and 97 for any other non-USA residence. (999=Unknown)
MCOUNTY	FIPS Code for Mother's County of Residence. Code 998 for Mexico and 997 for any other non-USA residence. (999=Unknown)
MBIRTH	Mother's Date of Birth in YYYYMMDD format. (99999999=Unknown)
MARITAL	Mother's Marital Status.	1=Single, never married 2=Married 3=Separated/Divorced 4=Widow 8=Other 9=Unknown
LMP	Date of Mother's Last Menstrual Period before delivery in YYYYMMDD format. (99999999=Unknown)
PRENATAL	Did mother have prenatal care?	0=No prenatal care 9=Unknown
PNCDATE1	Date of mother's first prenatal visit in YYYYMMDD format. (99999999=Unknown)
DATEA	Date of mother’s most recent non-treponemal test in YYYYMMDD format. (99999999=Unknown)
RESULTA	Result of mother’s most recent non-treponemal test.	1=Reactive 2=Nonreactive 9=Unknown
DATEB	Date of mother’s first non-treponemal test in YYYYMMDD format. (99999999=Unknown)
RESULTB	Result of mother’s first non-treponemal test.	1=Reactive 2=Nonreactive 9=Unknown
TITER	Titer of mother’s most recent non-treponemal test. (The titer for date b is in columns 214-217).	0=weakly reactive 9999=Unknown
VITAL	Vital status of infant/child.	1=Alive 2=Born alive, then died 3=Stillborn 9=Unknown
DEATHDAT	Date of death of infant/child in YYYYMMDD format.	(If alive, pad with 99999999) (99999999=Unknown)
BIRTHWT	Birthweight in grams (9999=Unknown)
REACSTS	Did infant/child have reactive non-treponemal test for syphilis?	1=Yes 2=No 3=No test 9=Unknown
REACDATE	Date of infant/child's first reactive non-treponemal test for syphilis in YYYYMMDD format. (99999999=Unknown)
DARKFLD	Did the infant/child, placenta, or cord have darkfield exam, DFA, or special stains?	1=Yes, positive 2=Yes, negative 3=No test 4=No lesions and no tissue to test 9=Unknown
XRAYS	Did infant/child have long bone x-rays?	1=Yes, changes consistent with CS 2=Yes, no signs of CS 3=No x-rays 9=Unknown
CSFVDRL	Did infant/child have a CSF-VDRL?	1= Yes, reactive 2=Yes, nonreactive 3=No test 9=unknown
TREATED	Was infant/child treated?	1=Yes, with Aqueous or Procaine Penicillin for 10 days 3=Yes, with Benzathine penicillin x 1 4=Yes, with other treatment 5=No treatment 9=Unknown
CLASS	Case Classification.	1=Not a case 2=Confirmed Case (laboratory confirmed identification of T.pallidum, e.g., darkfield or direct fluorescent antibody positive lesions) 3=Syphilitic stillbirth 4=Probable case (a case identified by the algorithm, which is not a confirmed case or syphilitic stillbirth)
ID126	CDC 73.126 form Case ID number (9999999=Unknown)
VERSION	CDC 73.126 Form Version.	41306
TITERB	Titer of mother’s first non-treponemal test b.	0=weakly reactive 9999=Unknown Note: All entries should be left justified (no preceding or trailing zeroes). Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.
INFTITER	Titer of infant/child’s first reactive non-treponemal test for syphilis.	0=weakly reactive 9999=Unknown Note: All entries should be left justified (no preceding or trailing zeroes). Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.
AMIND	American Indian/Alaskan Native:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
ASIAN	Asian:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
BLACK	Black:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
WHITE	White:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
NAHAW	Native Hawaiian or Other Pacific Islander:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
RACEOTH	Other Race:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
RACEUNK	Unknown Race:	If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.
MCOUNTRY	Mother’s country of residence. (XX=Unknown)
REACTREP	Did infant/child have reactive treponemal test?	1 = Yes 2 = No 3 = No test 9 = Unknown
RTDATE	Date of infant/child’s reactive treponemal test in YYYYMMDD format. (99999999=Unknown)
STD IMPORT	Was case imported? Was disease acquired elsewhere? Indicates probable location of disease acquisition relative to reporting state values.	N = Not an imported case C = Yes, imported from another country S = Yes, imported from another state J = Yes, imported from another county/jurisdiction in the state D = Yes, imported but not able to determine source state and/or country U = Unknown
GRAVIDA	Number of pregnancies (e.g. 01) (99=Unknown)
PARA	Number of live births (e.g. 03) (99=Unknown)
PNCTRI	Trimester of mother’s first prenatal visit.	1 = 1st trimester 2 = 2nd trimester 3 = 3rd trimester 9 = Unknown
TESTVISA	Did mother have non-treponemal or treponemal test at first prenatal visit?	1 = Yes 2 = No 9 = Unknown
TESTVISB	Did mother have non-treponemal or treponemal test at 28-32 weeks gestation?	1 = Yes 2 = No 9 = Unknown
TESTVISC	Did mother have non-treponemal or treponemal test at delivery?	1 = Yes 2 = No 9 = Unknown
TREPDTA	Date of mother’s first treponemal test in YYYYMMDD format. (99999999=Unknown)
TESTTYPA	Test type of mother’s first treponemal test.	1 = EIA or CLIA 2 = TP-PA 3 = Other 9 = Unknown
TREPRESA	Result of mother’s first treponemal test.	1 = Reactive 2 = Nonreactive 9 = Unknown
TREPDTB	Date of mother’s most recent treponemal test in YYYYMMDD format. (99999999=Unknown)
TESTTYPB	Test type of mother’s most recent treponemal test.	1 = EIA or CLIA 2 = TP-PA 3 = Other 9 = Unknown
TREPRESB	Result of mother’s most recent treponemal test.	1 = Reactive 2 = Nonreactive 9 = Unknown
HIVSTAT	What was mother’s HIV status during pregnancy?	P = Positive E = Equivocal test X = Patient not tested N = Negative U = Unknown
CLINSTAG	What clinical stage of syphilis did mother have during pregnancy?	1 =Primary 2 = Secondary 3 = Early latent 4 = Late or late latent 5 = Previously treated/serofast 8 = Other 9 = Unknown
SURVSTAG	What surveillance stage of syphilis did mother have during pregnancy?	1 = Primary 2 = Secondary 3 = Early latent 4 = Late or late latent 8 = Other 9 = Unknown
FIRSTDT	Date of mother’s first dose of benzathine penicillin in YYYYMMDD format. (99999999=Unknown)
FIRSTDOS	When did mother receive her first dose of benzathine penicillin?	1 = Before pregnancy 2 = 1st trimester 3 = 2nd trimester 4 = 3rd trimester 5 = No Treatment 9 = Unknown
MOMTX	What was mother’s treatment?	1 = 2.4 M units benzathine penicillin 2 = 4.8 M units benzathine penicillin 3 = 7.2 M units benzathine penicillin 8 = Other 9 = Unknown
RESPAPP2	Did mother have an appropriate serologic response?	1 = Yes, appropriate response 2 = No, inappropriate response: evidence of treatment failure or reinfection 3 = Response could not be determined from available non-treponemal titer information 4 = Not enough time for titer to change
CLINNO	No signs/asymptomatic?	1 = Yes; Otherwise pad with a 9.
CLINLATA	Condyloma lata?	1 = Yes; Otherwise pad with a 9.
CLINSNUF	Snuffles?	1 = Yes; Otherwise pad with a 9.
CLINRASH	Syphilitic skin rash?	1 = Yes; Otherwise pad with a 9.
CLINHEPA	Hepatosplenomegaly?	1 = Yes; Otherwise pad with a 9.
CLINJUAN	Jaundice/Hepatitis?	1 = Yes; Otherwise pad with a 9.
CLINPARA	Pseudo paralysis?	1 = Yes; Otherwise pad with a 9.
CLINEDEM	Edema?	1 = Yes; Otherwise pad with a 9.
CLINOTH	Other signs of CS?	1 = Yes; Otherwise pad with a 9.
CLINUNK	Unknown signs of CS?	1 = Yes; Otherwise pad with a 9.
CSFWBC	Did the infant/child have a CSF WBC count or CSF protein test?	1 = Yes, CSF WBC count elevated 2 = Yes, CSF protein elevated 3 = Both tests elevated 4 = Neither test elevated 5 = No test 9 = Unknown

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Sheet 14: CP-CRE

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Type of case	Type of case (i.e., was case identified based on testing of a clinical specimen or screening specimen)	N/A	P
State lab isolate id	Lab isolate identifier from public health lab for mechanism testing	N/A	P
Phenotypic Test Method	Phenotypic Test Name (phenotypic methods for carbapenemase production)	N/A	P
Phenotypic Test Result	Result of Phenotypic test	N/A	P
Genotypic Test Name	Test performed to identify carbapenemase  (molecular methods for resistance mechanism)	N/A	P
Genotypic Test Result	Result of test to identify carbapenemase	N/A	P
County of facility	County of facility where specimen was collected	PHVS_County_FIPS_6-4	O
State of facility	State of facility where specimen was collected	PHVS_State_FIPS_5-2	O
Travel Outside USA Prior to Illness Onset within Program Specific Timeframe	Did the patient travel internationally in the past 1 year from the date of specimen collection?	PHVS_YesNoUnknown_CDC	P
International Destination(s) of Recent Travel	This data element is used to capture the names of the country(ies) outside of the United States the patient traveled to in the year prior to the date of specimen collection, if the patient has traveled outside of the United States during that time.	PHVS_Country_ISO_3166-1	P
Healthcare Outside USA	This data element is used to capture if the patient received healthcare outside of the United States in the year prior to the date of specimen collection.	PHVS_YesNoUnknown_CDC	P
Country(ies) of Healthcare Outside USA	This data element is used to capture the names of the country(ies) outside of the United States where the patient received healthcare in the year prior to the date of specimen collection, if the patient traveled outside of the United States during that time.	PHVS_Country_ISO_3166-1	P
Gene Identifier	Gene identifier	PHVS_GeneName_CP-CRE	P
Previously Counted Case	Was patient previously counted as a colonization/screening case?	PHVS_YesNoUnknown_CDC	P
Previously Reported State Case Number	If patient was previously counted as colonization/screening case please provide related case ID(s)	N/A	P
WGS ID Number	NCBI SRA Accession number (SRX#) We would describe this as: The accession number generated by NCBI’s Sequence Read Archive when sequence data are uploaded to NCBI. This provides both the sequence data and metadata on how the sample was sequenced.	N/A	P

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Sheet 15: Cryptosporidiosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Animal Contact Questions Indicator	If contact with animal, then display the following questions	Yes No Indicator (HL7)
Animal Contact Indicator	Did patient come in contact with an animal?	Yes No Unknown (YNU)
Animal Type Code(s)	Type of animal: (MULTISELECT)	Animal Type (FDD)
Animal Type Other	If “Other,” please specify other type of animal:
Amphibian Other	If “Other Amphibian,” please specify other type of amphibian:
Reptile Other	If “Other Reptile,” please specify other type of reptile:
Mammal Other	If "Other Mammal," please specify other type of mammal:
Animal Contact Location	Name or Location of Animal Contact:
Acquired New Pet	Did the patient acquire a pet prior to onset of illness?	Yes No Unknown (YNU)
Applicable Incubation Period	Applicable incubation period for this illness is
Associated with Daycare Indicator	If Patient associated with a day care center:	Yes No Indicator (HL7)
Day Care Attendee	Attend a day care center?	Yes No Unknown (YNU)
Day Care Worker	Work at a day care center?	Yes No Unknown (YNU)
Live with Day Care Attendee	Live with a day care center attendee?	Yes No Unknown (YNU)
Day Care Type	What type of day care facility?	Day CareType (FDD)
Day Care Facility Name	What is the name of the day care facility?
Food Prepared at this Daycare	Is food prepared at this facility?	Yes No Unknown (YNU)
Diapered Infants at this Daycare	Does this facility care for diapered persons?	Yes No Unknown (YNU)
Drinking Water Exposure Indicator	If patient has had Drinking Water exposure, then display the following questions	Yes No Indicator (HL7)
Home Tap Water Source Code	What is the source of tap water at home?	Tap Water Source (FDD)
Home Well Treatment Code	If “Private Well,” how was the well water treated at home?	Well Water Treatment (FDD)
Home Tap Water Source Other	If “Other,” specify other source of tap water at home:
School/Work Tap Water Source Code	What is the source of tap water at school/work?	Tap Water Source (FDD)
SchoolWork Well Treatment Code	If “Private Well,” how was the well water treated at school/work?	Well Water Treatment (FDD)
School/Work Tap Water Source Other	If “Other,” specify other source of tap water at school/work:
Drink Untreated Water 14 days Prior to Onset	Did patient drink untreated water 14 days prior to onset of illness?	Yes No Unknown (YNU)
Food Handler	If patient is a Food Handler, then display the following questions	Yes No Indicator (HL7)
Food Handler after Illness Onset	Did patient work as a food handler after onset of illness?	Yes No Unknown (YNU)
Food HandlerLast Worked Date	What was the last date worked as a food handler after onset of illness?
Food Handler Location	Where was patient a food handler?
Recreational Water Exposure Questions Indicator	If patient has had recreational water exposure, then display the following	Yes No Indicator (HL7)
Recreational Water Exposure 14 Days Prior to Onset	Was there recreational water exposure in the 14 days prior to illness?	Yes No Unknown (YNU)
Recreational Water Exposure Type Code(s)	What was the recreational water exposure type? (MULTISELECT)	Recreational Water (FDD)
Recreational Water Exposure Type Other	If "Other," please specify other recreational water exposure type:
Swimming Pool Type Code(s)	If "Swimming Pool," please specify swimming pool type: (MULTISELECT)	Swimming Pool Type (FDD)
Swimming Pool Type Other	If "Other," please specify other swimming pool type:
Recreational Water Location Name	Name or location of water exposure:
Related Case Indicator	If related cases are associated to this case, then display the following questions	Yes No Indicator (HL7)
Patient Knows of Similarly Ill Persons	Does the patient know of any similarly ill persons?	Yes No Unknown (YNU)
Health Department Investigated	If "Yes," did the health department collect contact information about other similarly ill persons and investigate further?	Yes No Unknown (YNU)
Other Related Cases	Are there other cases related to this one?	Other Related Cases
Travel Questions Indicator	If patient has traveled, then display the following questions	Yes No Indicator (HL7)
Travel Prior To Onset	Did the patient travel prior to onset of illness?	Yes No Unknown (YNU)
Incubation Period	Applicable incubation period for this illness is 14 days
Travel Purpose Code(s)	What was the purpose of the travel? (MULTISELECT)	Travel Purpose
Travel Purpose Other	If “Other,” please specify other purpose of travel:
Destination 1 Type:	Destination 1 Type:	Travel Destination Type
(Domestic) Destination 1:	(Domestic) Destination 1:	State
(International) Destination 1	(International) Destination 1	Country
Mode of Travel: (1)	Mode of Travel: (1)	Travel Mode
Date Of Arrival (1)	Date of Arrival: (1)
Date of Departure (1)	Date of Departure (1)
Destination 2 Type	Destination 2 Type	Travel Destination Type
(Domestic) Destination 2	(Domestic) Destination 2	State
(International) Destination 2	(International) Destination 2	Country
Mode of Travel: (2)	Mode of Travel: (2)	Travel Mode
Date of Arrival: (2)	Date of Arrival: (2)
Date of Departure (2)	Date of Departure (2)
Destination 3 Type:	Destination 3 Type:	Travel Destination Type
(Domestic) Destination 3:	(Domestic) Destination 3:	State
(International) Destination 3	(International) Destination 3	Country
Mode of Travel: (3)	Mode of Travel: (3)	Travel Mode
Date of Arrival: (3)	Date of Arrival: (3)
Date of Departure (3)	Date of Departure (3)
Other Destination Txt	If more than 3 destinations, specify details here:
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it ap
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.	Ordered Test
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	Specimen
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	Specimen
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	Result Status (HL7)
Resulted Test Name	The lab test that was run on the specimen.	Lab Test Result Name (FDD)
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	Units Of Measure
Coded Result Value	Coded qualitative result value.	Lab Test Result Qualitative
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	Microorganism (FDD)
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	Observation Result Status (HL7)
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	Abnormal Flag (HL7)
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	Observation Method
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Lab Test Coded Comments	Explanation for missing result (e.g., clotting, quantity not sufficient, etc.)	Missing Lab Result Reason
Genotyping/ Subtyping	Indicate whether the specimens were genotyped and/or subtyped	Yes No Unknown (YNU)
Genotyping Sent Date	If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.
Genotype/Subtype location	Indicate where Genotype and/or subtype testing was performed
Genotype	If the specimen was sent for genotype identification, indicate the genotype
Subtype	If the specimen was sent for subtype idenfication, indicate the subtype
Track Isolate	Track Isolate functionality indicator	Yes No Indicator (HL7)
Patient status at specimen collection	Patient status at specimen collection	Patient Location Status at Specimen Collection
Isolate received in state public health lab	Isolate received in state public health lab	Yes No Unknown (YNU)
Reason isolate not received	Reason isolate not received	Isolate Not Received Reason
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	Yes No Unknown (YNU)
AgClinic	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory?
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
Immigrate	Did case-patient immigrate to the U.S.? (within 15 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Case-patient's medical record number
OtherCdcTest	What was the result of specimen testing using another test at CDC?
OtherClinicTest	What was the result of specimen testing using another test at a clinical laboratory?
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing using another test at a state public health laboratory?
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PcrClinic	What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SLabsID	State lab identification number
SpeciesClinic	What was the species result at clinical lab?
SpeciesSphl	What was the species result at SPHL?
SpecSite	Case patient's specimen collection source
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 15 days of onset)
Specify Different Exposure Window	If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P

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Sheet 16: Cyclosporiasis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Cabbage	Was fresh cabbage consumed in the 14 days prior to onset of illness?	PHVS_FreshProduce_FDD
Interview Status	Interview Status	PHVS_InterviewStatus_CDC
Travel Destination Type	Travel Destination Type	PHVS_TravelDestinationType_FDD
Travel Mode	Travel Mode	PHVS_TravelMode_CDC
Travel Purpose	Purpose of Travel	PHVS_TravelPurpose_FDD
Date of departure	Departure Date
Date of arrival	Arrival Date
Destination code	FIPS code assigned to city/state/country
Destination description	Name of city/state/country
Person Knows of Similarly Ill Persons	Does the patient know of any similarly ill persons?	FDD_Q_77 (PHIN_Questions_FDD)
Diarrhea Indicator	Did the patient have diarrhea?	PHVS_YesNoUnknown_CDC
Max Stools per 24 Hrs	If "Yes,” please specify maximum number of stools per 24 hours:
Weight Loss	Did patient experience weight loss?	PHVS_YesNoUnknown_CDC
Baseline Weight	If “Yes,” please specify baseline weight:
Baseline Weight Units	specify baseline weight in lbs or kgs	PHVS_WeightUnit_UCUM
Weight Lost	Specify how much weight was lost:
Weight Lost Units	Specify weight loss in lbs or kgs	PHVS_WeightUnit_UCUM
Fever	Did patient have a fever?	PHVS_YesNoUnknown_CDC
Temperature	If "Yes," please specify temperature (observation includes units)
Temperature Units	Specify temperature in fahrenheit or centigrade	PHVS_TemperatureUnit_UCUM
Cyclosporiasis Symptom Code(s)	Did the patient have any of the following signs or symptoms of Cyclosporiasis? (MULTISELECT)	PHVS_CyclosporiasisSignsSymptoms_FDD
Cyclosporiasis Symptoms Other	If “Other,” please specify other signs or symptoms of Cyclosporiasis:
Cyclosporiasis Confirmed By CDC	Was the case confirmed at the CDC lab?	PHVS_YesNoUnknown_CDC
Treated For Cyclosporiasis	Was the patient treated for Cyclosporiasis?	PHVS_YesNoUnknown_CDC
Sulfa Allergy	Does the patient have a sulfa allergy?	PHVS_YesNoUnknown_CDC
Fresh Berries Code(s)	What fresh berries were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshBerries_FDD
Fresh Berries Other	If “Other,” please specify other type of fresh berries:
Fresh Herbs Code(s)	What fresh herbs were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshHerbs_FDD
Fresh Herbs Other	If “Other,” please specify other type of fresh herbs:
Lettuce Last 14 Days Code(s)	What fresh lettuce was eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_LettuceType_FDD
Lettuce Last 14 Days Other	If “Other,” please specify other type of fresh lettuce:
Produce Last 14 Days Code(s)	What other types of fresh produce were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshProduce_FDD
Produce Last 14 Days Other	If “Other,” please specify other type of fresh produce:
Fruit Other Than Berries Specify	If "Fruit, other than berries," please specify type of fruit other than berries:
Attend Events 14 Days Prior to Onset	Did patient attend any events in the 14 days prior to onset of illness?	PHVS_YesNoUnknown_CDC
Event Specify	If “Yes,” please specify the event:
Event Date	Date of event:
Eat at Restaurant 14 Days Prior to Onset	Did patient eat at restaurant(s) in the 14 days prior to onset of illness?	PHVS_YesNoUnknown_CDC
Restaurant(s) Specify	If “Yes,” please specify the name of the restaurant(s):
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification.
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	PHVS_BodySite_CDC
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	PHVS_Specimen_CDC
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	PHVS_ResultStatus_HL7_2x
Resulted Test Name	The lab test that was run on the specimen.	PHVS_LabTestName_CDC
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_LabTestResultQualitative_CDC
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	PHVS_AbnormalFlag_HL7_2x
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	PHVS_LabTestMethods_CDC
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Lab Test Coded Comments	Explanation for missing result (e.g., clotting, quantity not sufficient, etc.)	PHVS_MissingLabResult_CDC
Sent to CDC for Genotyping	Indicate whether the specimens were sent to CDC for genotyping.	PHVS_YesNoUnknown_CDC
Genotyping Sent Date	If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.
Sent For Strain ID	Indicate whether the specimen was sent for strain identification.	PHVS_YesNoUnknown_CDC
Strain Type	If the specimen was sent for strain identification, indicate the strain.	PHVS_MicrobiologicalStrain_CDC
Track Isolate	Track Isolate functionality indicator	PHVS_TrueFalse_CDC
Patient status at specimen collection	Patient status at specimen collection	PHVS_PatientLocationStatusAtSpecimenCollection
Isolate received in state public health lab	Isolate received in state public health lab	PHVS_YesNoUnknown_CDC
Reason isolate not received	Reason isolate not received	PHVS_IsolateNotReceivedReason_NND
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	PHVS_YesNoUnknown_CDC
AgClinic	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory? Results from rapid card testing or EIA would be entered here.
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
Immigrate	Did case-patient immigrate to the U.S.? (within 15 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Ccase-patient's medical record number
OtherCdcTest	For other pathogens: What was the result of specimen testing using another test at CDC? Results from DFA, IFA or other tests would be entered here.
OtherClinicTest	What was the result of specimen testing using another test at a clinical laboratory? Results from DFA, IFA or other tests would be entered here.
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing using another test at a state public health laboratory? Results from DFA, IFA or other tests would be entered here.
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PcrClinic	What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SLabsID	State lab identification number
SpecSite	Case patient's specimen collection source
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 15 days of onset)
Travel	In the two weeks before onset of illness, did the case-patient travel out of their state or US?
Travel State	Domestic destination or state(s) the case-patient traveled to in the two weeks before onset of illness
Medication Administered	What treatment did the case-patient receive?
Performing Laboratory Type	Performing laboratory type
Other Organism from Specimen	If other non-Cyclospora organism(s) identified from stool specimen(s), indicate the organism
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P
Did The Case Travel Domestically Prior To Illness Onset?	Did the case patient travel domestically within program specific timeframe?	PHVS_YesNoUnknown_CDC	P
Specify Different Exposure Window	If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P

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Sheet 17: Diphtheria

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Childhood Primary Series?	Did the patient receive primary a vaccination series?
Number of Doses if <18 years old	If patient <18 years old, how many doses of vaccine were received?
Boosters as Adult?	Did the patient receive vaccine booster doses as an adult?
Last Dose	What is the date of patient's last dose of vaccine?
Clinical Description	Description of patient's clinical picture
Fever?	Did/does the patient have a fever?
If Yes, Temp	The units of measure of the highest measured temperature in Celsius.
Sore Throat?	Did/does the patient have a sore throat?
Difficulty Swallowing?	Did/does the patient have difficulty swallowing?
Membrane?	Did/does the patient have a pseudomembrane?
If Yes, Tonsils?	Were/are the tonsils the site of the membrane?
If Yes, Soft Palate?	Was/is the soft palate the site of the membrane?
If Yes, Hard Palate?	Was/is the hard palate the site of the membrane?
If Yes, Larynx?	Was/is the larynx the site of the membrane?
If Yes, Nares?	Were/are the nares the site of the membrane?
If Yes, Nasopharynx?	Was/is the nasopharynx the site of the membrane?
If Yes, Conjunctiva?	Was/is conjunctiva the site of the membrane?
If Yes, Skin?	Was/is the skin site of the membrane?
Change in Voice?	Did/does the patient experience shortness of breath?
Shortness of Breath?	Did/does the patient have voice change?
Weakness?	Did/does the patienthave weakness?
Fatigue?	Did/does the patient have fatique?
Other?	Did/does the patient have any other symptoms?
Soft Tissue Swelling?	Did/does the patient have soft tissue swelling?
Neck Edema?	Did/does the patient have neck edema?
If Yes	If neck edema, was it bilateral, left side only, or right side only?
If Yes, Extent	If neck edema, extent of the neck edema
Stridor?	Did/does the patient have stridor?
Wheezing?	Did/does the patient have wheezing?
Palatal Weakness?	Did/does the patient have weakness?
Tachycardia?	Did/does the patient have tachycardia?
EKG Abnormalities?	Did/does the patient have EKG abnormalities?
Complications?	Did/does the patient have complications due to this illness?
Airway Obstruction?	Did/does the patient have airway obstruction as a complication of this illness?
AO Onset Date	Patient's onset date for airway obstruction
Intubation Required?	Was intubation of the patient required?
Myocarditis?	Did/does the patient have myocarditis as a complication of this illness?
Myocarditis Onset Date	Patient's onset date for myocarditis
(Poly)neuritis?	Did/does the patient have (poly)neuritis as a complication of this illness?
(Poly)neuritis Onset date	Patient's onset date for (poly)neuritis
Other?	Did/does the patient experience any other complications due to this illness?
Describe	Description of other complications due to this illness.
Diphtheria Culture	Was a specimen for diphtheria culture obtained?
Culture Date	If yes, date culture specimen obtained
Culture Result	What is the result for culture specimen?
Lab Name	Specify laboratory performing culture
Biotype	If culture result positive, specify biotype
Toxigenicity Test	If culture positive, what is the result of toxigenicity testing?
Specimen Sent to CDC	Was a specimen sent to the CDC Diphtheria Lab for confirmation/molecular typing?
Specimen Type	Indicate type of specimen sent to CDC
Serum Specimen for Ab Testing	Was a serum specimen for diphtheria antitoxin antibodies obtained?
PCR Result	Specify the PCR result
Antibiotic Treatment	Was patient treated with antibiotics?
Outpatient Treatment	Did patient receive treatment as an outpatient?
Date Initiated	If yes, what is the date outpatient treatment initiated?
Antibiotic as Outpatient	What antibiotic did the patient receive?
OP Therapy Duration	What was the duration of therapy (in days)?
Antibiotic Therapy in Hospital	Was antibiotic therapy obtained in a hospital?
Inpatient Treatment	Did patient receive treatment as an inpatient?
Antibiotic as Inpatient	What antibiotic did the patient receive?
IP Therapy Duration	What was the duration of therapy (in days)?
Antibiotics Before Culture	Did patient receive antibiotics in the 24 hours before culture specimen taken?
Country of Residence	What is patient's country of residence?
Other Country	If other than US, what is the country?
US Arrival Date	What is the date of patient's arrivaal in the US?
International Travel	Did patient have history of international travel 2 weeks prior to symptom onset?
Country(s) Visited	What country(s) were visited?
International Departure Date	Date the patient left for international travel
International Return Date	Date the patient returned from international travel
Interstate Travel	Did patient have history of interstate travel 2 weeks prior to symptom onset?
State(s) Visited	What state(s) were visited?
Interstate Departure Date	Date the patient left for interstate travel
Interstate Return Date	Date the patient returned from intestate travel
Exposure to Case or Carrier?	Was patient exposed to a known case or carrier of diphtheria?
Exposure to International Travelers?	Did the patient have a known exposure to any international travelers?
Exposure to Immigrants?	Did the patient have a known exposure to any immigrants?
DAT Administered	Units of DAT administered
Final Diagnosis	What was the final clinical diagnosis for this patient?
Final Diagnosis Confirmation	How was the final diagnosis confirmed?

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Sheet 18: Giardia

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Animal Contact Questions Indicator	If contact with animal, then display the following questions	Yes No Indicator (HL7)
Animal Contact Indicator	Did patient come in contact with an animal?	Yes No Unknown (YNU)
Animal Type Code(s)	Type of animal: (MULTISELECT)	Animal Type (FDD)
Animal Type Other	If “Other,” please specify other type of animal:
Amphibian Other	If “Other Amphibian,” please specify other type of amphibian:
Reptile Other	If “Other Reptile,” please specify other type of reptile:
Mammal Other	If "Other Mammal," please specify other type of mammal:
Animal Contact Location	Name or Location of Animal Contact:
Acquired New Pet	Did the patient acquire a pet prior to onset of illness?	Yes No Unknown (YNU)
Applicable Incubation Period	Applicable incubation period for this illness is
Associated with Daycare Indicator	If Patient associated with a day care center:	Yes No Indicator (HL7)
Day Care Attendee	Attend a day care center?	Yes No Unknown (YNU)
Day Care Worker	Work at a day care center?	Yes No Unknown (YNU)
Live with Day Care Attendee	Live with a day care center attendee?	Yes No Unknown (YNU)
Day Care Type	What type of day care facility?	Day CareType (FDD)
Day Care Facility Name	What is the name of the day care facility?
Food Prepared at this Daycare	Is food prepared at this facility?	Yes No Unknown (YNU)
Diapered Infants at this Daycare	Does this facility care for diapered persons?	Yes No Unknown (YNU)
Drinking Water Exposure Indicator	If patient has had Drinking Water exposure, then display the following questions	Yes No Indicator (HL7)
Home Tap Water Source Code	What is the source of tap water at home?	Tap Water Source (FDD)
Home Well Treatment Code	If “Private Well,” how was the well water treated at home?	Well Water Treatment (FDD)
Home Tap Water Source Other	If “Other,” specify other source of tap water at home:
School/Work Tap Water Source Code	What is the source of tap water at school/work?	Tap Water Source (FDD)
SchoolWork Well Treatment Code	If “Private Well,” how was the well water treated at school/work?	Well Water Treatment (FDD)
School/Work Tap Water Source Other	If “Other,” specify other source of tap water at school/work:
Drink Untreated Water 14 days Prior to Onset	Did patient drink untreated water 14 days prior to onset of illness?	Yes No Unknown (YNU)
Food Handler	If patient is a Food Handler, then display the following questions	Yes No Indicator (HL7)
Food Handler after Illness Onset	Did patient work as a food handler after onset of illness?	Yes No Unknown (YNU)
Food HandlerLast Worked Date	What was the last date worked as a food handler after onset of illness?
Food Handler Location	Where was patient a food handler?
Recreational Water Exposure Questions Indicator	If patient has had recreational water exposure, then display the following	Yes No Indicator (HL7)
Recreational Water Exposure 14 Days Prior to Onset	Was there recreational water exposure in the 14 days prior to illness?	Yes No Unknown (YNU)
Recreational Water Exposure Type Code(s)	What was the recreational water exposure type? (MULTISELECT)	Recreational Water (FDD)
Recreational Water Exposure Type Other	If "Other," please specify other recreational water exposure type:
Swimming Pool Type Code(s)	If "Swimming Pool," please specify swimming pool type: (MULTISELECT)	Swimming Pool Type (FDD)
Swimming Pool Type Other	If "Other," please specify other swimming pool type:
Recreational Water Location Name	Name or location of water exposure:
Related Case Indicator	If related cases are associated to this case, then display the following questions	Yes No Indicator (HL7)
Patient Knows of Similarly Ill Persons	Does the patient know of any similarly ill persons?	Yes No Unknown (YNU)
Health Department Investigated	If "Yes," did the health department collect contact information about other similarly ill persons and investigate further?	Yes No Unknown (YNU)
Other Related Cases	Are there other cases related to this one?	Other Related Cases
Travel Questions Indicator	If patient has traveled, then display the following questions	Yes No Indicator (HL7)
Travel Prior To Onset	Did the patient travel prior to onset of illness?	Yes No Unknown (YNU)
Incubation Period	Applicable incubation period for this illness is 14 days
Travel Purpose Code(s)	What was the purpose of the travel? (MULTISELECT)	Travel Purpose
Travel Purpose Other	If “Other,” please specify other purpose of travel:
Destination 1 Type:	Destination 1 Type:	Travel Destination Type
(Domestic) Destination 1:	(Domestic) Destination 1:	State
(International) Destination 1	(International) Destination 1	Country
Mode of Travel: (1)	Mode of Travel: (1)	Travel Mode
Date Of Arrival (1)	Date of Arrival: (1)
Date of Departure (1)	Date of Departure (1)
Destination 2 Type	Destination 2 Type	Travel Destination Type
(Domestic) Destination 2	(Domestic) Destination 2	State
(International) Destination 2	(International) Destination 2	Country
Mode of Travel: (2)	Mode of Travel: (2)	Travel Mode
Date of Arrival: (2)	Date of Arrival: (2)
Date of Departure (2)	Date of Departure (2)
Destination 3 Type:	Destination 3 Type:	Travel Destination Type
(Domestic) Destination 3:	(Domestic) Destination 3:	State
(International) Destination 3	(International) Destination 3	Country
Mode of Travel: (3)	Mode of Travel: (3)	Travel Mode
Date of Arrival: (3)	Date of Arrival: (3)
Date of Departure (3)	Date of Departure (3)
Other Destination Txt	If more than 3 destinations, specify details here:
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it ap
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.	Ordered Test
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	Specimen
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	Specimen
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	Result Status (HL7)
Resulted Test Name	The lab test that was run on the specimen.	Lab Test Result Name (FDD)
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	Units Of Measure
Coded Result Value	Coded qualitative result value.	Lab Test Result Qualitative
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	Microorganism (FDD)
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	Observation Result Status (HL7)
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	Abnormal Flag (HL7)
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	Observation Method
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Lab Test Coded Comments	Explanation for missing result (e.g., clotting, quantity not sufficient, etc.)	Missing Lab Result Reason
Genotyping/ Subtyping	Indicate whether the specimens were genotyped and/or subtyped	Yes No Unknown (YNU)
Genotyping Sent Date	If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.
Genotype/Subtype location	Indicate where Genotype and/or subtype testing was performed
Genotype	If the specimen was sent for genotype identification, indicate the genotype
Subtype	If the specimen was sent for subtype idenfication, indicate the subtype
Track Isolate	Track Isolate functionality indicator	Yes No Indicator (HL7)
Patient status at specimen collection	Patient status at specimen collection	Patient Location Status at Specimen Collection
Isolate received in state public health lab	Isolate received in state public health lab	Yes No Unknown (YNU)
Reason isolate not received	Reason isolate not received	Isolate Not Received Reason
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	Yes No Unknown (YNU)
AgClinic	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory?
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
Immigrate	Did case-patient immigrate to the U.S.? (within 15 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Case-patient's medical record number
OtherCdcTest	What was the result of specimen testing using another test at CDC?
OtherClinicTest	What was the result of specimen testing using another test at a clinical laboratory?
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing using another test at a state public health laboratory?
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PcrClinic	What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SLabsID	State lab identification number
SpeciesClinic	What was the species result at clinical lab?
SpeciesSphl	What was the species result at SPHL?
SpecSite	Case patient's specimen collection source
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 15 days of onset)

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Sheet 19: Haemophilus Influenzae

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
DAYCARE	If <6 years of age, is the patient in daycare?	PHVS_YesNoUnknown_CDC
FACNAME	Name of the daycare facility.	PHVS_YesNoUnknown_CDC
NURSHOME	Does the patient reside in a nursing home or other chronic care facility?	PHVS_YesNoUnknown_CDC
NHNAME	Name of the nursing home or chronic care facility.
SYNDRM	Types of infection that are caused by the organism. This is a multi-select field.	TBD
SPECSYN	Other infection that is caused by the organism.
SPECIES	Bacterial species that was isolated from any normally sterile site.	TBD
OTHBUG1	Other bacterial species that was isolated from any normally sterile site.	TBD
STERSITE	Sterile sites from which the organism was isolated. This is a multi-select field.	TBD
OTHSTER	Other sterile site from which the organism was isolated.
DATE	Date the first positive culture was obtained. (This is considered diagnosis date.)
NONSTER	Nonsterile sites from which the organism was isolated. This is a multi-select field.	TBD
UNDERCOND	Did the patient have any underlying conditions?	PHVS_YesNoUnknown_CDC
COND	Underlying conditions that the subject has. This is a multi-select field.	TBD
OTHMALIG	Other malignancy that the subject had as an underlying condition.
OTHORGAN	Detail of the organ transplant that the subject had as an underlying condition.
OTHILL	Other prior illness that the subject had as an underlying condition.
OTHOTHSPC	Another Bacterial Species not listed in the Other Bacterial Species drop-down list.
Specify Internal Body Site	Internal Body Site where the organism was located.	TBD
Other Prior Illness 2	Other prior illness that the subject had as an underlying condition.
Other Prior Illness 3	Other prior illness that the subject had as an underlying condition.
Other Nonsterile Site	Other nonsterile site from which the organism was isolated.
INSURANCE	Patient's type of insurance (multi-selection).	TBD
INSURANCEOTH	Patient's other type of insurance.
WEIGHTLB	Weight of the patient in pounds.
WEIGHTOZ	Weight of the patient in ounces.
WEIGHTKG	Weight of the patient in kilograms.
HEIGHTFT	Height of the patient in feet.
HEIGHTIN	Height of the patient in inches.
HEIGHTCM	Height of the patient in centimeters.
WEIGHTUNK	Indicator that the weight of the patient is unknown.	PHVS_TrueFalse_CDC
HEIGHTUNK	Indicator that the height of the patient is unknown.	PHVS_TrueFalse_CDC
SEROTYPE	Serotype of the culture.	TBD
HIBVACC	If <15 years of age and serotype is 'b' or 'unk', did the patient receive Haemophilus Influenzae b vaccine?	PHVS_YesNoUnknown_CDC
MEDINS	Type of medical insurance the family has.	TBD
OTHINS	Other medical insurance type.
HIBCON	Is there a known previous contact with Hib disease within the preceding two months?	PHVS_YesNoUnknown_CDC
CONTYPE	Type of previous contact with Hib disease within the preceding two months.
SIGHIST	Patient's significant past medical history.	TBD
PREWEEKS	Number of weeks of a preterm birth (less than 37 weeks).
SPECHIV	Specify immunosupression/HIV.
OTHSIGHIST	Specify other prior condition.
ACUTESER	Is acute serum available?	PHVS_YesNoUnknown_CDC
ACUTESERDT	Date of acute serum availability.
CONVSER	Is convalescent serum available?	PHVS_YesNoUnknown_CDC
CONVSERDT	Date of convalescent serum availability.
BIRTHCTRY	Person's country of birth.	PHVS_Country_ISO_3166-1
Other Serotype	Another serotype not included in the serotype dropdown list.
Was the patient < 15 years of age at the time of first positive culture?	Indicator whether the patient was less than 15 years of age at the time of first positive culture.	PHVS_YesNoUnknown_CDC
Bacterial Infection Syndrome	Types of infection caused by organism	PHVS_InfectionType_RIBD	P
Pregnancy Status at the Time of First Positive Culture	At the time of first positive culture, was the patient pregnant or postpartum? (The postpartum period is defined as the 30 days following a delivery or miscarriage)	PHVS_PregnacyStatus_RIBD	P
Pregnancy Outcome	If pregnant or postpartum, what was the outcome of fetus?	PHVS_FetalOutcome_RIBD	P
Gestational Age	If patient <1 month of age, indicate gestational age (in weeks)	N/A	P
Birth Weight	If patient <1 month of age, indicate birth weight	N/A	P
Birth Weight Units	Birth Weight Units	PHVS_WeightUnit_UCUM	P
Previous Contact With Hib Disease	Is there a known previous contact(s) with Hib disease within the preceding two months?	PHVS_YesNoUnknown_CDC	P
Hib Contact Type	Type of previous contact(s) with Hib disease within the preceding two months.	PHVS_ContactType_RIBD	P
Previous Contact With Non-b or Nontypeable H. influenzae Case	Did patient have known previous contact(s) with a non-b or nontypeable case of H. influenzae disease within the preceding 2 months?	PHVS_YesNoUnknown_CDC	P
Non-b or Nontypeable Contact Type	Specify type of contact(s) with non-b or nontypeable case of H. influenzae	PHVS_ContactType_RIBD	P
Recurrent Disease with Same Pathogen	this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.)	PHVS_YesNoUnknown_CDC	P
Previous State ID (Recurrent Case)	StateID of 1st occurrence for this pathogen and person.	N/A	P
Case Report Form Status	Case Report Form Status	PHVS_FormStatus_RIBD	P
Illness Onset Age	Illness onset age	N/A	P
Illness Onset Age Units	Illness onset age units	PHVS_AgeUnit_UCUM	P
Residence	Where was the patient a resident at time of initial culture?	PHVS_ResidenceLocation_RIBD	P
Premature Infant	Premature at birth (for children ≤2 years old)	PHVS_YesNoUnknown_CDC	P
Epi-Linked to a Laboratory-Confirmed Case	Is this case epi-linked to a laboratory-confirmed case?	PHVS_YesNoUnknown_CDC	P
ABCs Case	ABCs case?	PHVS_YesNoUnknown_CDC	P
ABCs State ID	ABCs State ID	N/A	P
Laboratory Testing Performed	Was laboratory testing done to confirm the diagnosis?	PHVS_YesNoUnknown_CDC	P
Laboratory Confirmed	Was the case laboratory confirmed?	PHVS_YesNoUnknown_CDC	P
Test Manufacturer	Test Manufacturer	N/A	P
Lab Accession Number	Lab Accession Number (including CDC Lab ID)	N/A	P
Did the Subject Ever Receive a Vaccine Against This Disease	Did the subject ever receive a vaccine against this disease?	PHVS_YesNoUnknown_CDC	P
Date of Last Dose Prior to Illness Onset	Date of last vaccine dose against this disease prior to illness onset	N/A	P
Vaccination Doses Prior to Onset	Number of vaccine doses against this disease prior to illness onset	N/A	P
Vaccine History Comments	Vaccine History Comments	N/A	P
Age at Vaccination	The persons age at the time the vaccine was given	N/A	P
Age at Vaccination Units	The age units of the person at the time the vaccine was given	PHVS_AgeUnit_UCUM	P
Vaccine History Information Source	What sources were used for vaccination history?	PHVS_InformationSource_RIBD	P
Vaccine Information Source Indicator	Vaccination History Information Source Indicator	PHVS_YesNoUnknown_CDC	P
Susceptibility Test	Was any susceptibility data available?	PHVS_YesNoUnknown_CDC	P

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Sheet 20: Hansen's

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
State Case ID	States use this field to link NEDSS investigations back to their own state investigations.
Date of completion of Report	Date the initial leprosy surveillance form was completed by a reporting source (physician or lab reported to the local/county/state health department).
Date of First Report to CDC	Date the case was first reported to the CDC
Notification Result Status	Status of the notification.	PHVS_ResultStatus_NETSS
Condition Code	Condition or event that constitutes the reason the notification is being sent	PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
MMWR Week	MMWR Week for which case information is to be counted for MMWR publication.
MMWR Year	MMWR Year (YYYY) for which case information is to be counted for MMWR publication.
Reporting State	State reporting the notification.	PHVS_State_FIPS_5-2
Reporting County	County reporting the notification.	PHVS_County_FIPS_6-4
National Reporting Jurisdiction	National jurisdiction reporting the notification to CDC.	PHVS_NationalReportingJurisdiction_NND
Reporting Source Type Code	Type of facility or provider associated with the source of information sent to Public Health.	PHVS_ReportingSourceType_NND
Reporting Source ZIP Code	ZIP Code of the reporting source for this case.
Date First Reported PHD	Earliest date the case was reported to the public health department whether at the local, county, or state public health level.
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Title	Job title / description of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Affiliation	Affiliated Facility of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Type of leprosy	Classify the diagnosis based on one of the ICD-9-CM diagnosis codes	PHVS_TypeofLeprosy_CDC
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Subject Address State	State of residence of the subject	PHVS_State_FIPS_5-2
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Country of Birth	Country of Birth	PHVS_CountryofBirth_CDC
Time in U.S.	Length of time this subject has been living in the U.S. (if born out of the U.S.
Date first entered U.S.	Provide the date that subject first entered U.S. in YYYYMM format (if born out of the U.S.)
Subject’s Sex	Subject’s current sex	PHVS_Sex_MFU
Race Category	Field containing one or more codes that broadly refer to the subject’s race(s).	PHVS_RaceCategory_CDC
Ethnic Group Code	Based on the self-identity of the subject as Hispanic or Latino	PHVS_EthnicityGroup_CDC_Unk
Country of Usual Residence	Where does the person usually* live (defined as their residence) *For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf .	PHVS_CountryofBirth_CDC
Earliest Date Reported to County	Earliest date reported to county public health system
Earliest Date Reported to State	Earliest date reported to state public health system
Diagnosis Date	Earliest date of diagnosis (clinical or laboratory) of condition being reported to public health system
Case Disease Imported Code	Indication of where the disease/condition was likely acquired.	PHVS_DiseaseAcquiredJurisdiction_NETSS
Imported Country	If the disease or condition was imported, indicates the country in which the disease was likely acquired.	PHVS_Country_ISO_3166-1
Country of Exposure or Country Where Disease was Acquired Note: use exposure or acquired consistently across variables	Indicates the country in which the disease was potentially acquired.	PHVS_CountryofBirth_CDC
Date of Onset of symptoms	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 Leprosy first diagnosed	Provide month and year first diagnosis was made (if applicable)
Initial diagnosis	Was subject diagnosed in the U.S. or outside the U.S.
Diagnosis_Biopsy	Was biopsy performed in the U.S.?	PHVS_DiagnosisBiopsy_CDC
Diagnosis_SkinSmear	Was skin smear test performed	PHVS_DiagnosisSkinSmear_Leprosy
Date test performed	Provide date test was performed in YYYYMM format
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_Leprosy
Current antimicrobial Treatment	Indicate all antimicrobial drugs used to treat subject	PHVS_MedicationTreatment_Leprosy
Date current antimicrobial Treatment	Indicate the date antimicrobial treatment started	PHVS_MedicationTreatment_Date_Leprosy
Disability	Indicate any sensory abnormalities or deformities of the hands, feet or eyes	PHVS_HandsFeet_CDC
Armadillo exposure	Did subject ever had direct contact with an armadillo?	PHVS_YesNoUnknown_CDC

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Sheet 21: Hantavirus Pulmonary Syndrome

Label/Short Name	Description
Last Name	Patient's last name
First Name	Patient's first name
Middle Initial	Patient's middle initial
Occupation	Patient's occupation
History of rodent exposure 8 weeks prior to illness onset	Did patient have history of rodent exposure during 8 week period prior to illness onset?
If yes, type of rodent exposure	If rodent exposure occurred, what was the type of exposure?
Exposre occurred while cleaning	Did exposure occur while cleaning?
Exposure occurred while working	Did exposure occur while working?
Exposre during recreational activity (camping, hiking)	Did exposure occur during a recreational activity?
Other exposure? (explain below)	Other types of exposure? (Explain)
Fever >101F (38.3C)	Did patient have a fever >101F (38.3C)?
Thrombocytopenia (<150,000)	Did patient have thrombocytopenia (<150,000)?
Elevated hematocrit	Did patinent have elevated hematocrit?
Elevated creatinine	Did patinet have elevated creatinine?
Outcome of illness	What was the outcome of the illness?
Autopsy performed	If patient died, was autopsy performed?
Autopsy findings	Describe autopsy findings
Did patient seek care before admission	Did patient seek care before admission?
Date of pre-hospital treatment	Date of pre-hospital treatment
Outcome of treatment (sent home, diagnosed as flu, etc):	What was the outcome of treatment (sent home, diagnosed as flu, etc)?
Supplemental oxygen required	Did the patient require supplemental oxygen?
Was patient on ECMO	Was patient on extracorporeal membrane oxygenation (ECMO)?
Was patient intubated	Was the patient intubated?
CXR with unexplained bilateral interstitial infiltrates or suggestive of ARDS	Did patient have chest x-ray (CXR) with unexplained bilateral interstitial infiltrates or suggestive of acute respiratory distress syndrome (ARDS)?
Notes on clinical course of illness	Describe clinical course of illness
Specimen collection date	Specimen collection date
Type of specimen	Type of specimen collected
If specimen tested, at which laboratory	If specimen tested, at which laboratory?
Test results (i.e. titer, IgM, IgG)	Test results (i.e. titer, IgM, IgG)
Name of patient’s physician	Name of patient’s physician
Physician's email	Physician's email
Physician's phone number	Physician's phone number
Elevated Hematocrit (>50)	Was Elevated Hematocrit >50?
Elevated Creatinine (>1.2 mg/dL)	Was Elevated Creatinine >1.2 mg/dL?
Proteinuria	Was Proteinuria detected?
Hematuria	Was Hematuria detected?
Exposure occurred from pet rodent	Did exposure occur from a pet rodent?
Street address	What is the patient’s street address?

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Sheet 22: Hepatitis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Reason for Testing	Listing of the reason(s) the subject was tested for hepatitis.	PHVS_ReasonForTest_Hepatitis
Symptomatic	Was the subject symptomatic for hepatitis?	PHVS_YesNoUnknown_CDC
Date of Illness Onset	Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system
Jaundiced (Symptom)	Was the subject jaundiced?	PHVS_YesNoUnknown_CDC
Due Date	Subject's pregnancy due date
Previously Aware of Condition	Was the subject aware they had Hepatitis prior to lab testing?	PHVS_YesNoUnknown_CDC
Provider of Care for Condition	Does the subject have a provider of care for Hepatitis? This is any healthcare provider that monitors or treats the patient for viral hepatitis.	PHVS_YesNoUnknown_CDC
Liver Enzyme Test Type	Liver Enzyme Test Type	PHVS_LabTestTypeEnzymes_Hepatitis
Liver Enzyme Test Result Date	Liver Enzyme Test Result Date
Liver Enzyme Upper Limit Normal	Liver Enzyme Upper Limit Normal
Liver Enzyme Test Result	Liver Enzyme Test Result
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case.	PHVS_LabTestType_Hepatitis
Test Result	Epidemiologic interpretation of the results of the test(s) performed for this case.	PHVS_PosNegUnk_CDC
anti-HCV signal to cut-off ratio	Used to specify the anti-HCV signal to cut-off ratio if antibody to Hepatitis C virus was the test performed.
Is this case Epi-linked to another confirmed or probable case?	Specify if this case is Epidemiologically-linked to another confirmed or probable case of hepatitis?	PHVS_YesNoUnknown_CDC
Contact With Confirmed or Suspected Case	During the 2-6 weeks prior to the onset of symptoms, was the subject a contact of a person with confirmed or suspected hepatitis virus infection?	PHVS_YesNoUnknown_CDC
Contact Type	During the 2-6 weeks prior to the onset of symptoms, type of contact the subject had with a person with confirmed or suspected hepatitis virus infection	PHVS_ContactType_HepatitisA
Contact Type Indicator	During the 2-6 weeks prior to the onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis virus infection	PHVS_YesNoUnknown_CDC
In Day Care	During the 2-6 weeks prior to the onset of symptoms, was the subject a child or employee in daycare center, nursery, or preschool?	PHVS_YesNoUnknown_CDC
Day Care Contact	During the 2-6 weeks prior to the onset of symptoms, was the subject a household contact of a child or employee in a daycare center, nursery, or preschool?	PHVS_YesNoUnknown_CDC
Identified Day Care Case	Was there an identified hepatitis case in the childcare facility?	PHVS_YesNoUnknown_CDC
Sexual Preference	What is/was the subject's sexual preference?	PHVS_SexualPreference_NETSS
Number of Male Sexual Partners	During the 2-6 weeks prior to the onset of symptoms, number of male sex partners the person had.
Number of Female Sexual Partners	During the 2-6 weeks prior to the onset of symptoms, number of female sex partners the person had.
IV Drug Use	During the 2-6 weeks prior to the onset of symptoms, did the subject inject drugs not prescribed by a doctor?	PHVS_YesNoUnknown_CDC
Recreational Drug Use	During the 2-6 weeks prior to the onset of symptoms, did the subject use street drugs but not inject?	PHVS_YesNoUnknown_CDC
Travel or Live Outside U.S. or Canada	During the 2-6 weeks prior to the onset of symptoms, did the subject travel or live outside the U.S.A. or Canada?	PHVS_YesNoUnknown_CDC
Countries Traveled or Lived Outside U.S. or Canada	The country(s) to which the subject traveled or lived (outside the U.S.A. or Canada) prior to symptom onset.	PHVS_Country_ISO_3166-1
Principal reason for travel	What was the principal reason for travel?	PHVS_TravelReason_HepatitisA
Household Travel Outside U.S. or Canada	During the 3 months prior to the onset of symptoms, did anyone in the subject's household travel outside the U.S.A. or Canada?	PHVS_YesNoUnknown_CDC
Household Countries Traveled to Outside U.S. or Canada	The country(s) to which anyone in the subject's household traveled (outside the U.S.A. or Canada) prior to symptom onset.	PHVS_Country_ISO_3166-1
Common-Source Outbreak	Is the subject suspected as being part of a common-source outbreak?	PHVS_YesNoUnknown_CDC
Foodborne Outbreak- infected food handler	Subject is associated with a foodborne outbreak that is asscociated with an infected food handler.	PHVS_YesNoUnknown_CDC
Foodborne Outbreak - NOT an infected food handler	Subject is associated with a foodborne outbreak that is not associated with an infected food handler.	PHVS_YesNoUnknown_CDC
Food Item of Associated Outbreak	Food item with which the foodborne outbreak is associated.
Waterborne Outbreak	Subject is associated with a waterborne outbreak .	PHVS_YesNoUnknown_CDC
Unidentified Source Outbreak	Subject is associated with an outbreak that does not have an identifed source.	PHVS_YesNoUnknown_CDC
Food Handler	During the 2 weeks prior to the onset of symptoms or while ill, was the subject employed as a food handler?	PHVS_YesNoUnknown_CDC
Diabetes	Does subject have diabetes?	PHVS_YesNoUnknown_CDC
Diabetes Diagnosis Date	If subject has diabetes, date of diabetes diagnosis.
Ever Receive a Vaccine	Did the subject ever receive the hepatitis A vaccine?	PHVS_YesNoUnknown_CDC
Total Doses of Vaccine	Number of doses of hepatitis A vaccine the subject received.
Date of Last Dose	Year the subject received the last dose of hepatitis A vaccine.
Ever Receive Immune Globulin	Has the subject ever received immune globulin?	PHVS_YesNoUnknown_CDC
Date of Last IG Dose	Date the subject received the last dose of immune globulin.
Mother's Race	Race of the subject's mother.	PHVS_RaceCategory_CDC
Mother's Ethnicity	Ethnicity of the patient's mother.	PHVS_EthnicityGroup_CDC_Unk
Mother Born Outside U.S.	Was mother born outside of the United States of America?	PHVS_YesNoUnknown_CDC
Mother's Birth Country	What is the birth country of the mother?	PHVS_Country_CDC
Mother Confirmed Positive Prior To Delivery	Was the mother confirmed HBsAg positive prior to or at time of delivery?	PHVS_YesNoUnknown_CDC
Mother Confirmed Positive After Delivery	Was the mother confirmed HBsAg positive after delivery?	PHVS_YesNoUnknown_CDC
Mother Confirmed Positive Date	Date of mother's earliest HBsAg positive test result.
Total Doses of Vaccine	Number of doses of hepatitis vaccine the child received.
Ever Receive Immune Globulin	Has the child ever received immune globulin?	PHVS_YesNoUnknown_CDC
Date the child received HBIG	Date the child received the last dose of immune globulin.
Vaccine Dose Number	The vaccine dose number in series of vaccination for hepatitis.
Vaccine Administered Date	The date that the vaccine was administered.
Contact With Confirmed or Suspected Case	For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis B virus infection? For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis C virus infection?	PHVS_YesNoUnknown_CDC
Contact Type	For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis B virus infection? For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis C virus infection?	PHVS_ContactType_HepatitisBandC
Contact Type Indicator	For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection. For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection.	PHVS_YesNoUnknown_CDC
Sexual Preference	What is/was the subject's sexual preference?	PHVS_SexualPreference_NETSS
Number of Male Sexual Partners	Prior to the onset of symptoms, number of male sex partners the person had. For Acute Hep B, the time period prior to onset of symptoms is 6 months. For Acute Hep C, the time period prior to onset of symptoms is 6 months.
Number of Female Sexual Partners	Prior to the onset of symptoms, number of female sex partners the person had. For Acute Hep B, the time period prior to onset of symptoms is 6 months. For Acute Hep C, the time period prior to onset of symptoms is 6 months.
Number of Sex Partners	How many sex partners (approximately) has subject ever had?
Treated for STD	Was the subject ever treated for a sexually transmitted disease?	PHVS_YesNoUnknown_CDC
Year of Recent Treatment for STD	Year the patient received the most recent treatment for a sexually transmitted disease.
Ever IDU	Has the patient ever injected drugs not prescribed by a doctor, even if only once or a few times?	PHVS_YesNoUnknown_CDC
Ever Had Contact with Hepatitis	Was the patient ever a contact of a person who had hepatitis?	PHVS_YesNoUnknown_CDC
Ever Contact Type	If the patient was ever a contact of a person who had hepatitis, what was the type of contact?	PHVS_ContactType_HepatitisBandC
IV Drug Use	Prior to the onset of symptoms, did the patient inject drugs not prescribed by a doctor? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Recreational Drug Use	Prior to the onset of symptoms, did the patient use street drugs but not inject? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Long-Term Hemodialysis	Was the patient ever on long-term hemodialysis?	PHVS_YesNoUnknown_CDC
Hemodialysis	Prior to the onset of symptoms, did the patient udergo hemodialysis? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Contaminated Stick	Prior to the onset of symptoms, did the patient have an accidental stick or puncture with a needle or other object contaminated with blood? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Transfusion before 1992	Did the patient receive a blood transfusion prior to 1992?	PHVS_YesNoUnknown_CDC
Transplant before 1992	Did the patient receive an organ transplant prior to 1992?	PHVS_YesNoUnknown_CDC
Clotting Factor before1987	Did the patient receive clotting factor concentrates prior to 1987?	PHVS_YesNoUnknown_CDC
Blood Transfusion	Prior to the onset of symptoms, did the patient receive blood or blood products (transfusion)? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Blood Transfusion Date	Date the subject began receiving blood or blood products (transfusion) prior to symptom onset. For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
Outpatient IV Infusions and/or Injections	Prior to the onset of symptoms, did the patient receive any IV infusions and/or injections in an outpatient setting? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Other Blood Exposure	Prior to the onset of symptoms, did the patient have other exposure to someone else's blood? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Ever a Medical / Dental Blood Worker	Was the patient ever employed in a medical or dental field involving direct contact with human blood?	PHVS_YesNoUnknown_CDC
Medical / Dental Blood Worker	Prior to the onset of symptoms, was the patient employed in a medical or dental field involving direct contact with human blood? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Medical / Dental Blood Worker - Frequency of Blood Contact	Subject's frequency of blood contact as an employee in a medical or dental field involving direct contact with human blood. For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_BloodContactFrequency_Hepatitis
Public Safety Blood Worker	Prior to the onset of symptoms, was the subject employed as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Public Safety Blood Worker - Frequency of Blood Contact	Subject's frequency of blood contact as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood. For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_BloodContactFrequency_Hepatitis
Tattoo	Prior to the onset of symptoms, did the patient receive a tattoo? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Location Tattoo Received from	Location(s) where the patient received a tattoo	PHVS_TattooObtainedFrom_Hepatitis
Piercing	Prior to the onset of symptoms, did the patient receive a piercing (other than ear)? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Location Piercing Received from	Location(s) where the patient received a piercing (other than ear)	PHVS_TattooObtainedFrom_Hepatitis
Dental Work / Oral Surgery	Prior to the onset of symptoms, did the patient have dental work or oral surgery? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Surgery Other Than Oral	Prior to the onset of symptoms, did the patient have surgery (other than oral surgery)? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Tested for Hepatitis D	Was the patient tested for Hepatitis D	PHVS_YesNoUnknown_CDC
Hepatitis Delta Infection	Did patient have a co-infection with Hepatitis D?	PHVS_YesNoUnknown_CDC
Prior Negative Hepatitis Test	Did the patient have a negative hepatitis-related test in the previous 6 months? For Hep B: Did patient have a negative HBsAg test in the previous 6 months? For Hep C: Did patient have a negative HCV antibody test in the previous 6 months?	PHVS_YesNoUnknown_CDC
Verified Test Date	If patient had a negative hepatitis-related test test in the previous 6 months, please enter the test date.
Hospitalized	Prior to the onset of symptoms, was the patient hospitalized? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Long Term Care Resident	Prior to the onset of symptoms, was the patient a resident of a long-term care facility? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Ever Incarcerated	Was the patient ever incarcerated?	PHVS_YesNoUnknown_CDC
Incarcerated More Than 24 hours	Prior to the onset of symptoms, was the patient incarcerated for longer than 24 hours? For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months. For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.	PHVS_YesNoUnknown_CDC
Diabetes	Does subject have diabetes?	PHVS_YesNoUnknown_CDC
Diabetes Diagnosis Date	If subject has diabetes, date of diabetes diagnosis.
Type of Incarceration Facility	Type of facility where the patient was incarcerated for longer than 24 hours before symptom onset.	PHVS_IncarcerationType_Hepatitis
Incarceration Type Indicator		PHVS_YesNoUnknown_CDC
Incarcerated More Than 6 months	Was the patient ever incarcerated for longer than six months during his or her lifetime?	PHVS_YesNoUnknown_CDC
Year of Most Recent Incarceration	Year the patient was most recently incarcerated for longer than six months.
Length of Incarceration	Length of time the patient was most recently incarcerated for longer than six months.
Received Medication for Condition	Has the subject ever received medication for the type of Hepatitis being reported?	PHVS_YesNoUnknown_CDC
Mother's Birth Country	What is the birth country of the mother?	PHVS_Country_CDC
Did the subject ever receive a vaccine?	Did the subject ever receive a hepatitis B vaccine?	PHVS_YesNoUnknown_CDC
Total Doses of Vaccine	Number of doses of hepatitis B vaccine the patient received.
Date of Last Dose	Year the patient received the last dose of hepatitis B vaccine.
Tested for HBsAg Antibodies	Was the patient tested for antibody to HBsAg (anti-HBs) within one to two months after the last dose?	PHVS_YesNoUnknown_CDC
HBsAg Antibodies Positive	Was the serum anti-HBs >= 10ml U/ml? (Answer 'Yes' if lab result reported as positive or reactive.)	PHVS_YesNoUnknown_CDC
Maternal HBeAg result, date	Maternal HBeAg result, date
Maternal HBV DNA (or genotype), result, date	Maternal HBV DNA (or genotype), result, date
Maternal Alanine aminotransferase (ALT)	Maternal Alanine aminotransferase (ALT)
Maternal antiviral therapy, if any	Maternal antiviral therapy, if any
Maternal Coinfection with human immunodeficiency virus or hepatitis C virus	Maternal Coinfection with human immunodeficiency  virus or hepatitis C virus
Maternal State/Territory of residence at time of infant’s diagnosis	Maternal State/Territory of residence at time of infant’s diagnosis
Infant Birthweight	Infant Birthweight
Infant Time of birth (military time)	Infant Time of birth (military time)
Infant State/Territory of birth	Infant State/Territory of birth
HCV RNA (NAAT) test results	HCV RNA (NAAT) test results and timing of test performance
HCV genotype test results	HCV genotype test results and timing of test performance
HCV antigen test results	HCV antigen test results and timing of test performance
hepatitis A RNA	Nucleic acid amplification test (NAAT; such as PCR or genotyping) for hepatitis A virus RNA	PHVS_LabTestResultQualitative_CDC	P
Date of hepatitis A RNA test	Date of hepatitis A RNA test	N/A	P
Total bilirubin	Total bilirubin levels	N/A	P
Date of bilirubin test	Date of bilirubin test	N/A	P
Experienced homelessness	In the 2-6 weeks prior to symptom onset, was the patient homeless?	PHVS_YesNoUnknown_CDC	P

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Sheet 23: Hemolytic Uremic Syndrome

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
CASEID	Case patient's ID
FIRST_IDENT	How was patient's illness first identified by public health (state or local health department or EIP)?
DATE_AS	Date case entered into data system (Complete if FIRST_IDENT=1)
OTHR_IDENT_DESC	Describe other way patient's illness first identified by public health (Complete if FIRST_IDENT=4).
HDD	Was this case captured through Hospital Discharge Data?
HDD_DATE	Date case entered into data system (Complete if HDD=1)
DATEHUS	Date of HUS diagnosis
OUTBREAK	Is this case outbreak-related?
DIARRHEA	Did patient have diarrhea during the 3 weeks before HUS diagnosis?
DONSET	Date of diarrhea (Complete if DIARRHEA=1)
STOOLBLOOD	Did stools contain visible blood at any time? (Complete if DIARRHEA=1)
DTREATED	Was diarrhea treated with antimicrobial medications/ (Complete if DIARRHEA=1)
A1ANTI	Type of antimicrobial (Complete if DTREATED=1)
CONTACT	Did the patient have contact with another person with diarrhea or HUS during the 3 weeks before HUS diagnosis (include daycare, household, etc)? (Complete if DIARRHEA=2)
OTHREA	Was patient treated with an antimicrobial medication for any other reason than diarrhea during the 3 weeks before HUS diagnosis?
A3ANTI	Type of antimicrobial (Complete if OTHREA=1)
A4REAS	Reason for antimicrobial (Complete if OTHREA=1)
GASTRO	Was other gastrointestinal illness present during 3 weeks before HUS diagnosis?
UTI	Did patient have a urinary tract infection during 3 weeks before HUS diagnosis?
RTI	Did patient have a respiratory tract infection during 3 weeks before HUS diagnosis?
ACUTE	Did patient have other acute illness during 3 weeks before HUS diagnosis?
DACUTE	Describe other acute illness (Complete if ACUTE=1)
PREG	Was patient pregnant during 3 weeks before HUS diagnosis?
KIDN	Did patient have kidney disease during 3 weeks before HUS diagnosis?
IMMCOMP	Did patient have an ummunocompromising condition or was the patient taking medication during 3 weeks before HUS diagnosis?
MALIG	Did patient have a malignancy during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1)
TRANSPL	Did patient have transplanted organ or bone marrow during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1)
HIV	Did patient have HIV infection during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1)
STER	Was patient using steroids (parenteral or oral) during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1)
IMMOTHER	Describe other immunocompromising condition during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1)
CRE	Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum creatinine (expressed as mg/dL)
BUN	Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum BUN (expressed as mg/dL)
WBC	Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum WBC (expressed as K/mm3)
HGB	Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest hemoglobin (expressed as g/dL)
HCT	Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest hematocrit (expressed as %)
PLT	Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest platelet count (expressed as K/mm3)
RCFRAG	Were there microangiopathic changes (i.e., schistocytes, helmet cells or red cell fragments) at any time within 7 days before HUS diagnosis to hospital discharge (if patient was not hospitalized or discharged within 3 days of HUS diagnosis, then outpatient lab results from 7 days before to 3 days after diagnosis should be used, if available)
BURINE	Other laboratory findings within 7 days before and 3 days after HUS diagnosis: Blood (or heme) in urine
PURINE	Other laboratory findings within 7 days before and 3 days after HUS diagnosis: Protein in urine
RBCURINE	Other laboratory findings within 7 days before and 3 days after HUS diagnosis: RBC in urine by microscopy
STOOLSPEC	Was a stool specimen obtained from this patient?
TESTSHIGA	Was stool tested for Shiga toxin at any clinical laboratory?
N11BRESULT	Result of Shiga toxin testing (Complete if TESTSHIGA=1)
STSPEC	Collection date of first specimen tested (Complete if TESTSHIGA=1)
STECPOS	Collection date of first positive specimen (Complete if TESTSHIGA=1)
CULTO157	Was stool cultured for E. coli O157 (on selective or differential media e.g. SMAC, CHROMagar O157, CTSMAC) at any CLINICAL laboratory?
DATEO157	Date stool cultured for E. coli O157 (Complete if CULTO157=1)
O157ISOL	Was E.coli O157 isolated? (Complete if CULTO157=1)
DATEO157POS	Collection date 1st positive specimen culture for O157 (Complete if O157POS=1)
HANT	Result of H antigen testing (Complete if O157ISOL=1)
HANT_OTHER	Other H antigen (Complete if HANT=5)
STOOL_CDC_PHL	Was a stool sample, or any type of specimen or isolate originating from stool sent to a public health laboratory (state or CDC)?
SPEC_DATEPHLSTEC	Date of specimen collection (Complete if STOOL_CDC_PHL=1)
STEC_ISOL	Was E.coli or non-O157 STEC identified? (Complete if STOOL_CDC_PHL=1)
O	What was the O antigen for strain 1? (Complete if STEC_ISOL=1)
H	What was the H antigen for strain 1? (Complete if STEC_ISOL=1)
O2	What was the O antigen for strain 2? (Complete if STEC_ISOL=1)
H2	What was the H antigen for strain 2? (Complete if STEC_ISOL=1)
IMS	Was immunomagnetic separation (IMS) used to identify common STEC serogroups?
IMS_SERO	What serogroup(s) did the IMS procedure target? (Complete if IMS=1)
OTHERPATH	Was another pathogen isolated from stool (at PHL or clinical lab)?
PATH1	Name pathogen isolated from stool (Complete if OTHERPATH=1)
PATH1D	Date other pathogen isolated from stool
PATH2	Name of second pathogen isolated from stool (Complete if OTHERPATH=1)
PATH2D	Date second other pathogen isolated from stool
PATHNOS	Was pathogen isolated from source other than stool (at PHL or clinical lab)?
DESPATH	Name pathogen isolated from source other than stool (Complete if PATHNOS=1)
SPECPATH	Specimen source of pathogen isolated from source other than stool (Complete if PATHNOS=1)
DATEPATH	First date of isolation of pathogen from source other than stool (Complete if PATHNOS=1)
STATELAB	If O157 or other STEC was isolated, was the isolate sent to state laboratory?
F9MENUREF	If isolate sent to state laboratory, what was the state laboratory ID (Complete if STATELAB=1)
CDC	If O157 or other STEC was isolated, was the isolate sent to CDC?
CDC_ID	If isolate sent to CDC, what was the CDC laboratory ID (Complete if CDC=1)
REFLAB	If O157 or other STEC was isolated, was the isolate sent to another reference lab?
SPECIFY_REFLAB	If isolate sent to reference lab, what was the name of the reference lab? (Complete if REFLAB=1)
FNCATCH	Is the patient a resident of the FoodNet catchment area?
PERSONID	What is the FoodNet PERSONID? (Complete if FNCATCH=1)
ANTIO157	Has patient serum or plasma been sent to CDC for testing for antibodies to O157 or other STEC?
SLABID_SERUM	What is the state laboratory ID or the serum? (Complete if ANTIO157=1)
OTHERSLABSID_SERUM	Other laboratory ID numbers for serum sent to CDC (Complete if ANTIO157=1)
LPS_TYPE1	LPS type
IGG_1	IgG titer
IGG_INTERP	Interpretation of IgG titer
IGM_1	IgM titer
IGM1_INTERP	Interpretation of IgM titer
LPS_TYPE2	Second LPS type
IGG_2	Second IgG titer
IGG_INTERP2	Interpretation of second IgG titer
IGM_2	Second IgM titer
IGM1_INTERP2	Interpretation of second IgM titer
LPS_TYPE3	Third LPS type
IGG_3	Third IgG titer
IGG_INTERP3	Interpretation of third IgG titer
IGM_3	Third IgM titer
IGM1_INTERP3	Interpretation of third IgM titer
ADMISR	Date of first hospital admission
DISCHR	Date of last hospital discharge
PNE	Did pneumonia occur as a complication during this hospital admission?
DPNE	Date of onset of pneumonia (Complete if PNE=1)
SZR	Did seizure occur as a complication during this hospital admission?
DSZR	Date of onset of seizure (Complete if SZR=1)
PAR	Did paralysis or hemiparesis occur as a complication during this hospital admission?
DPAR	Date of onset of paralysis or hemiparesis (Complete if PAR=1)
BLN	Did blindness occur as a complication during this hospital admission?
DBLN	Date of onset of blindness (Complete if BLN=1)
NER	Did other major neurologic sequelae occur as a complication during this hospital admission?
DNER	Date of other major neurologic sequalae (Complete if NER=1)
DESCR1	Describe other major neurologic sequelae (Complete if NER=1)
PDIAL	Was peritoneal dialysis performed during hospital stay?
HDIAL	Was hemodialysis performed during hospital stay?
PRBC	Was packed RBC or whole blood used in dialysis? (Complete if PDIAL=1 or HDIAL=1)
PLTT	Were platelets used in dialysis? (Complete if PDIAL=1 or HDIAL=1)
FFPL	Was fresh frozen plasma used in dialysis? (Complete if PDIAL=1 or HDIAL=1)
PHRES	Was plasmapheresis performed during hospital stay?
SURG	Was laparotomy or other abdominal surgery performed during hospital stay? Do not include insertion of dialysis catheter.
SURGDES	Describe other abdominal surgery
CONDDC	Patient's condition at hospital discharge
DEAD	Date of death (Complete if CONDDC=1)
REQDIAL	Was patient discharged requiring dialysis? (Complete if CONDDC=2)
NEURODEF	Was patient discharged with neurologic deficits? (Complete if CONDDC=2)

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Sheet 24: Human Rabies

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
City	Patients City of Residence	PHVS_City_USGS_GNIS
State	Patients State of Residence	PHVS_State_FIPS_5-2
Country	Patients Country of Residence	PHVS_Country_ISO_3166-1
Occupation	Patients Occupation	PHVS_Occupation_CDC
Gender	Patients Gender	PHVS_Sex_MFU
Age	Patients Age
Race	Patients Race	PHVS_RaceCategory_CDC_Unk
Ethnicity	Patients Ethnicity	PHVS_EthnicityGroup_CDC_Unk
Animal Exposure	Did patient have a history of an animal exposure	PHVS_YesNoUnknown_CDC
Animal Species	What type of animal was involved in the Exposure	PHVS_AnimalSpecies_AnimalRabies
Animal State	What state did the animal exposure occur in	PHVS_State_FIPS_5-2
Animal Country	What country did the animal exposure occur in	PHVS_Country_ISO_3166-1
Type of Exposure	What type of exposure occurred
Vaccination status	Was the patient vaccinated for rabies prior to onset of symptoms	PHVS_YesNoUnknown_CDC
Travel	Did the patient have a recent (prior 12 months) history of travel?	PHVS_YesNoUnknown_CDC
Travel State	What state did the patient travel to	PHVS_State_FIPS_5-2
Travel Country	What country did the patient travel to	PHVS_Country_ISO_3166-1
Travel DateStart	When did the trip begin
Travel DateEnd	When did the trip end
Onset	Date Symptoms began
Hospitalized	Date patient hospitalized
Death	Date patient died
Variant	What rabies virus variant was responsible for the infection	PHVS_VirusVariantType_AnimalRabies

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Sheet 25: Invasive Pneumococcal Disease

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Long Term Care Facilty Resident	Does the patient reside in a long term care facility?	PHVS_YesNoUnknown_CDC
Culture Date	Date the first positive culture was obtained.
Bacterial Infection Syndrome	Types of infection(s) that are caused by the bacterial organism.	PHVS_BacterialInfectionSyndrome_IPD
Sterile Specimen Type	Sterile body site(s) from which the organism was isolated.	PHVS_SterileSpecimen_IPD
Did Underlying Condition(s) exist?	Did the subject have any pre-existing medical conditions before the start of the illness/condition?	PHVS_YesNoUnknown_CDC
Underlying Condition(s)	Listing of pre-existing conditions as related to the condition/illness	PHVS_UnderlyingConditions_IPD
Oxacillin Zone Size	Oxacillin zone size for cases of Streptococcus pneumoniae
Oxacillin Interpretation	Oxacillin interpretation for cases of Streptococcus pneumoniae	PHVS_OxacillinInterpretation_IPD
Antimicrobial Agent	Antimicrobial agent tested	PHVS_AntimicrobialAgent_IPD
Antimicrobial Susceptibility Test Method	Antimicrobial susceptibility testing method used	PHVS_AntimicrobialSuceptiblilityTestMethod_IPD
Antimicrobial Susceptibility Test Result	S/I/R/U result, indicating whether the microorganism is susceptible or not susceptible (intermediate or resistant) to the antimicrobial being tested.	PHVS_SusceptibilityResult_CDC
Minimum Inhibitory Concentration Range	MIC (minimum inhibitory concentration) range.
Serotyping Results Available	Are serotyping results available for S pneumoniae isolate?	PHVS_YesNoUnknown_CDC
Lab Result Coded Value	If Serotyping results are available for S pneumoniae isolate, please specify.	PHVS_SerotypeMethod_IPD
Serotype Method	Serotyping Method Used	PHVS_SerotypeMethod_IPD
23-Valent Pneumo Poly Vaccine	Has patient ≥2yrs received 23-valent pneumococcal polysaccharide vaccine (Pneumovax)?	PHVS_YesNoUnknown_CDC
7-Valent Pneumo Conjugate Vaccine	If less than eighteen years of age, did the patient receive 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar)?	PHVS_YesNoUnknown_CDC
13-Valent Pneumo Conjugate Vaccine	If less than eighteen years of age, did the patient receive 13-valent pneumococcal conjugate vaccine (PCV13)?	PHVS_YesNoUnknown_CDC
Vaccine Administered	The type of vaccine administered	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered
Vaccine Administered Date	The date that the vaccine was administered
Clinical syndrome	Clinical diagnoses associated with a case of IPD
Method(s) of laboratory testing	Type of laboratory test used to diagnose pneumococcal infection from a sterile site isolate
Name of CIDT test and manufacturer	Name of culture independent laboratory test used and manufacturer of the test
CLIA number of laboratory	CLIA number of the laboratory that conducted the testing
In Day Care	Does this patient attend a day care facility?	PHVS_YesNoUnknown_CDC	P
Underlying Condition(s)	Listing of underlying causes or prior illnesses	PHVS_UnderlyingConditions_RIBD	P
Underlying Conditions Indicator	Underlying Conditions Indicator	PHVS_YesNoUnknown_CDC	P
Illness Onset Age	Illness onset age	N/A	P
Illness Onset Age Units	Illness onset age units	PHVS_AgeUnit_UCUM	P
Hospital ICU	During any part of the hospitalization, did the subject stay in an Intensive Care Unit (ICU) or a Critical Care Unit (CCU)?	PHVS_YesNoUnknown_CDC	P
Residence	Where was the patient a resident at time of initial culture?	PHVS_ResidenceLocation_RIBD	P
Pregnancy Status at the Time of First Positive Culture	At the time of first positive culture, was the patient pregnant or postpartum? (The postpartum period is defined as the 30 days following a delivery or miscarriage)	PHVS_PregnacyStatus_RIBD	P
Pregnancy Outcome	If pregnant or postpartum, what was the outcome of fetus?	PHVS_FetalOutcome_RIBD	P
Gestational Age	If patient <1 month of age, indicate gestational age (in weeks)	N/A	P
Birth Weight	If patient <1 month of age, indicate birth Weight	N/A	P
Birth Weight Units	Birth Weight Units	PHVS_WeightUnit_UCUM	P
Premature Infant	Premature at birth (for children ≤2 years old)	PHVS_YesNoUnknown_CDC	P
Insurance	Insurance	PHVS_InsuranceType_RIBD	P
Epi-Linked to a Laboratory-Confirmed or Probable Case	Is this case Epi linked to a confirmed or probable case?	PHVS_YesNoUnknown_CDC	P
ABCs Case	ABCs case?	PHVS_YesNoUnknown_CDC	P
ABCs State ID	ABCs State ID	N/A	P
Recurrent Disease with Same Pathogen	Does this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.)	PHVS_YesNoUnknown_CDC	P
Previous State ID (Recurrent Case)	StateID of 1st occurrence for this pathogen and person.	N/A	P
Laboratory Testing Performed	Was laboratory testing done to confirm the diagnosis?	PHVS_YesNoUnknown_CDC	P
Laboratory Confirmed	Was the case laboratory confirmed?	PHVS_YesNoUnknown_CDC	P
Test Manufacturer	Test Manufacturer	N/A	P
Lab Accession Number	Lab Accession Number (including CDC Lab ID)	N/A	P
Did the Subject Ever Receive a Vaccine Against This Disease	Did the subject ever receive a vaccine against this disease?	PHVS_YesNoUnknown_CDC	P
Date of Last Dose Prior to Illness Onset	Date of last vaccine dose against this disease prior to illness onset	N/A	P
Vaccination Doses Prior to Onset	Number of vaccine doses against this disease prior to illness onset	N/A	P
Vaccine History Comments	Vaccine History Comments	N/A	P
Age at Vaccination	The persons age at the time the vaccine was given	N/A	P
Age at Vaccination Units	The age units of the person at the time the vaccine was given	PHVS_AgeUnit_UCUM	P
Vaccine History Information Source	What sources were used for vaccination history?	PHVS_InformationSource_RIBD	P
Vaccine Information Source Indicator	Vaccination History Information Source Indicator	PHVS_YesNoUnknown_CDC	P
Susceptibility Test	Was any susceptibility data available?	PHVS_YesNoUnknown_CDC	P

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Sheet 26: Legionellosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Diagnosis	Disease caused by a Legionella species
Hospitalization for treatment	Was patient hospitalized during treatment for legionellosis?
Admission date	Date of admission to hospital
Hospital name	Name of hospital to which admitted
Hospital address	City and state of hospital
Illness outcome	Outcome of illness
Nights away from home	In the 10 days before onset, did the patient spend any nights away from home (excluding healthcare settings)?
Accommodation name	Name of lodging where patient stayed other than usual resident
Accommodation address	Address of lodging away from home
Accommodation city	City of lodging away from home
Accommodation state	State of lodging away from home
Accommodation zip	Zipcode of lodging away from home
Accommodation country	Country of lodging away from home
Accommodation room number	Room number at lodging where patient stayed other than usual resident
Arrival Date	Date of stay arrival
Departure Date	Date of stay departure
Reported CDC	If yes, was this case reported to CDC at [email protected]? 1
Whirlpool/Spa vicinity	In the 10 days before onset, did the patient get in or spend time near a whirlpool spa (i.e., hot tub)?
Respiratory trherapy equipment use	In the 10 days before onset, did the patient use a nebulizer, CPAP, BiPAP or any other respiratory therapy equipment for the treatment of sleep apnea, COPD, asthma or for any other reason?
Humidifier use	If yes, does this device use a humidifier?
Water type	If yes, what type of water is used in the device? This is a multi-select field.
Healthcare setting visit/stay	In the 10 days before onset, did the patient visit or stay in a healthcare setting (e.g., hospital, long term care/rehab/skilled nursing facility, clinic)?
Healthcare setting/facility	Type of healthcare setting/facility
Exposure type	Type of exposure in HC setting/facility
Facility name	Name of healthcare facility
Transplant center	Is this a transplant center?
Visit reason	Reason for visit to HC facility
HC facility city	City of HC facility
HC facility state	State of HC facility
Admission date	Start date of HC facility admission/visit
End date	End date of HC facility admission/visit
Healthcare exposure	Was this case associated with a healthcare exposure?
Assisted living facility exposure	In the 10 days before onset, did the patient visit or stay in an assisted living facility or senior living facility?
AL facility type	Type of assisted living facility exposure
AL exposure type	Type of assisted living facility
AL facility name	Name of AL facility
AL city	Name of city of AL facility
AL state	Name of state of AL facility
AL start date	Start date of AL facility admission/visit
AL end date	End date of AL facility admission/visit
Urine Ag positive	Was the urine antigen positive?
Urine Ag collection date	Date urine antigen was collected
Culture positive	Was the culture positive?
Culture collection date	Date culture was collected
Culture site	Site of culture specimen
Culture species	Species isolated from culture
Culture serogroup	Serogroup of species from culture
Ab titer	Was there a fourfold rise in Ab titer?
Acute titer	Initial Ab titer to L. pneumophila serogroup 1
Acute collected	Initial Ab titer specimen collection date
Convalescent titer	Convalescent Ab titer to L. pneumophila serogroup 1
Convalescent collected	Convalescent Ab specimen collection date
Ab titer other	Was there a fourfold rise in Ab titer for other than L. pneumophila serogroup 1 or to multiple species or serogroups of Legionella using pooled antigen?
Acute titer other	Initial Ab titer to other than L. pneumophila serogroup 1
Acute collected other	Initial Ab titer specimen collection date for species other than L. pneumophila serogroup 1
Convalescent titer other	Convalescent Ab titer to species other than L. pneumophila serogroup 1
Convalescent collected other	Convalescent Ab specimen collection date for species other than L. pneumophila serogroup 1
Species other	Species identified for other than L. pneumophila serogroup 1
Serogroup other	Serogroup identified for other than L. pneumophila serogroup 1
DFA/IHC positive	Was the DFA or IHC positive?
DFA/IHC collection date	Date specimen for DFA/IHC collected
DFA/IHV specimen site	Site of DFA/IHC specimen
Species other - DFA/IHC	Species identified by DFA/IHC for other than L. pneumophila serogroup 1
Serogroup other - DFA/IHC	Serogroup identified by DFA/IHC for other than L. pneumophila serogroup 1
Nucleic Acid Assay - other	Was a nucleic acid assay (e.g., PCR) performed?
Nucleic Acid Assay collection date	Date nucleic acid assay specimen collected
Nucleic Acid Assay specimen site	Site of nucleic acid assay specimen
Species other - nucleic acid assay	Species identified by nucleic acid assay for other than L. pneumophila serogroup 1
Serogroup other - nucleic acid assay	Serogroup identified by nucleic acid assay for other than L. pneumophila serogroup 1
Whirlpool Spa, Location	If Yes, describe where
Whirlpool Spa, Dates	If Yes, list dates
Occupation	Subject’s Occupation
Interviewer’s Name	Interviewer’s Name
Interviewer’s Affiliation	Interviewer’s Affiliation
Interviewer’s telephone number	Interviewer’s telephone number
Name of State Health Department Official who reviewed this report	Name of State Health Department Official who reviewed this report
Title of State Health Department Official who reviewed this report	Title of State Health Department Official who reviewed this report
Telephone Number of State Health Department Official who reviewed this report	Telephone Number of State Health Department Official who reviewed this report
Illness Onset Age	Age at illness onset	N/A	P
Illness Onset Age Units	Age units at illness onset	PHVS_AgeUnit_UCUM	P
Accomodation Comments	Comments or information about nights away from home not collected elsewhere	N/A	P
Address of Healthcare Facility	Street Address of healthcare facility visited by the patient in the 10 days before onset	N/A	P
Zip Code of Healthcare Facility	Zip code of healthcare facility visited by the patient in the 10 days before onset	N/A	P
Healthcare Setting Exposure Comments	Comments or information about healthcare setting exposure not collected elsewhere	N/A	P
Healthcare Facility Water Management Program	Did the healthcare facility have a water management program to reduce the risk of Legionella growth and spread in place?	PHVS_YesNoUnknown_CDC	P
Street Address of Assisted/Senior Living Facility	Street address of assisted/senior living facility visited/lived in by the patient during exposure	N/A	P
Zip Code of Assisted/Senior Living Facility	Zip code of assisted/senior living facility visited/lived in by the patient during exposure	N/A	P
Assisted/Senior Living Facility Comments	Comments or information about assisted/senior living facility exposure not collected elsewhere	N/A	P
Assisted/Senior Living Facility Water Management Program	Did the assited/senior living facility have a water management program to reduce the risk of Legionella growth and spread in place?	PHVS_YesNoUnknown_CDC	P
Exposure	Was the patient exposed to any of the following during the 10 days prior to onset?	PHVS_LegionellaExposure_RIBD	P
Exposure Indicator	Exposure Indicator	PHVS_YesNoUnknown_CDC	P
Location of Exposure	Location of exposure (e.g. facility name, city , state)	N/A	P
Date(s) of Exposure	Date(s) of exposure	N/A	P
Recent Cruise Travel	In the 10 days before onset, did patient take a cruise?	PHVS_YesNoUnknown_CDC	P
Name of Cruiseline	Name of cruiseline patient sailed with	PHVS_CruiseLine_RIBD	P
Name of Ship	Name of ship patient sailed on	N/A	P
Cruise Departure City	Cruise departure city	N/A	P
Cruise Departure State	Cruise departure state	PHVS_State_FIPS_5-2	P
Cruise Departure Country	Cruise departure country	PHVS_Country_ISO_3166-1	P
Date of Cruise Departure	Cruise departure date	N/A	P
Cruise Return City	Cruise return city	N/A	P
Cruise Return State	Cruise return state	PHVS_State_FIPS_5-2	P
Cruise Return Country	Cruise return country	PHVS_Country_ISO_3166-1	P
Date of Cruise Return	Cruise return date	N/A	P
Cabin Number	Patient's cruise ship cabin number	N/A	P
Port of Call City	Port of call city	N/A	P
Port of Call Country	Port of call country	PHVS_Country_ISO_3166-1	P
Port of Call State	Port of call state	PHVS_State_FIPS_5-2	P
Port of Call Date	Date for port of call	N/A	P
CDC NORS Outbreak ID#	CDC National Outbreak Reporting System (NORS) Outbreak ID#	N/A	P
Did Underlying Condition(s) Exist	Did the patient have any underlying causes or prior illnesses?	PHVS_YesNoUnknown_CDC	P
Underlying Condition(s)	Listing of underlying causes or prior illnesses	PHVS_UnderlyingConditions_RIBD	P
Underlying Conditions Indicator	Underlying conditions indicator	PHVS_YesNoUnknown_CDC	P
Titer Test Type	If this is a titer, indicate if this is an initial/acute or convalescent titer (Titer Test Type)	PHVS_TiterTestType_RIBD	P
Test Manufacturer	Test Manufacturer	N/A	P
Test Brand Name	Test Brand Name	N/A	P

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Sheet 27: Leptospirosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Date First Submitted	Date/time the notification was first sent to CDC. This value does not change after the original notification.
State Case ID	States use this field to link NEDSS investigations back to their own state investigations.
Health care provider	Health care provider name
Health care provider phone	Health care provider phone number
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
Subject Address State	State of residence of the subject	PHVS_State_FIPS_5-2
Subject Address ZIP Code	ZIP Code of residence of the subject
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Subject’s Sex	Subject’s current sex
Date of Birth	Birth Date (mm/yyyy)
Age at case investigation	Subject age at time of case investigation
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Ethnic Group Code	Based on the self-identity of the subject as Hispanic or Latino	PHVS_EthnicityGroup_CDC_Unk
Race Category	Field containing one or more codes that broadly refer to the subject’s race(s).	PHVS_RaceCategory_CDC
Symptomatic	Was the case-patient symptomatic?	PHVS_YesNoUnknown_CDC
Date symptom onset	If Symptomatic was "Yes", provide the Date of Onset of symptoms
Symptoms	Select symptoms and signs reported or identified, from "Fever", "Myalgia", "Headache", "Jaundice ", "Hepatitis", "Conjunctival suffusion", "Rash (Maculopapular or petechial)", "Aseptic meningitis", "Gastrointestinal involvement", "Pulmonary complications", "Cardiac involvement", "Renal insufficiency/failure ", "Hemorrhage", "Other (specify)"
Hospitalization?	Was the case-patient hospitalized (at least overnight) for this Did the case-patient die? Yes No Unk infection?	PHVS_YesNoUnknown_CDC
Admission Date	Subject’s first admission date to the hospital for the condition covered by the investigation.
Number of days	If hospitalized, number of days.
Outcome	Clinical outcome of the patient ("Still hospitalized"; "Discharged"; "Died";"Other")
Discharge Date	Subject's first discharge date from the hospital for the condition covered by the investigation.
Deceased Date	If the subject died from this illness or complications associated with this illness, indicate the date of death
Antibiotics prescribed	Were Antibiotics prescribed for this infection?	PHVS_YesNoUnknown_CDC
Antibiotics start date	Date started taking antibiotics
Doxycycline	Was doxycycline prescribed for this infection?	PHVS_YesNoUnknown_CDC
Penicillin	Was penicillin prescribed for this infection?	PHVS_YesNoUnknown_CDC
Other antibiotics	List other antibiotics prescribed for this infection
Reporting Lab Name	Name of Laboratory that reported test result.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Date specimen collected	The date the specimen was collected.
Specimen Type	Type of specimen collected ("Blood", "Urine", "Tissue", "CSF", "Other", "Unknown", "Serum")
Date of Acute Specimen Collection	The date the acute specimen was collected.
Date of Convalscent Specimen Collection	The date the convalscent specimen was collected.
Resulted Test Name	The lab test that was run on the specimen ("Microscopic Agglutination Test (MAT)", "PCR", "Culture", "Immunofluorescence", "Darkfield microscopy", "ELISA (specify)", "IHC", "Other, specify")
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_PosNegUnk_CDC
Organism Name	The Organism (i.e., species and serovar) name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Specimens to CDC	Were specimens or isolates sent to CDC for testing?	PHVS_YesNoUnknown_CDC
Exposures	Describe exposures to water, animals, or wet soil which the subject had in the 30 days prior to illness onset
Animal contact	Select which animals the subject has had contact with in the 30 days prior to illness onset, if any ("Farm livestock", "Wildlife", "Dogs", "Rodents", "Other", "No known contact", "Unknown")
Livestock contact	If the subject had contact with livestock, specify the animal(s)
Wildlife contact	If the subject had contact with wildlife, specify the animal(s)
Animal contact other	If animal contact is "Other", describe the animal(s) with which the subject has had contact
Animal contact location	If the subject had contact with animals, specify the grographic location where the contact occurred
Water contact	Select which water sources the subject has had contact with in the 30 days prior to illness onset, if any ("Standing fresh water (lake, pond, run-off)", "Flood water", "River", "Wet soil", "Sewage","Water sports", "Other", "No known contact", "Unknown")
Water contact other	If water contact is "Other", describe the water source(s) which the subject has had contact
Water contact location	If the subject had contact with water, specify the grographic location where the contact occurred
Contact Type	If subject had contact with animals, fresh water, or wet soil in the 30 days prior to illness onset, describe the type of contact ("Occupational", "Recreational", "Avocational", "Other")
Occupational contact	If type of contact with animals or water is "Occupational", select the occupational group ("Farmer (land)", "Farmer (animals)", "Fish worker", "Other", "Unknown")
Occupational contact other	If the occupational group through which the subject had contact with animals or water is "Other", describe the occupation
Recreational contact	If type of contact with animals or water is "Recreational", select the recreational activity ("Swimming", "Boating", "Outdoor competition", "Camping/hiking", "Hunting", "Other", "Unknown")
Recreational contact other	If the recreational activity through which the subject had contact with animals or water is "Other", describe the recreational activity
Avocational contact	If type of contact with animals or water is "Avocational", select the activity ("Gardening", "Pet-ownership", "Other", "Unknown")
Avocational contact other	If the Avocational activity through which the subject had contact with animals or water is "Other", describe the avocational activity
Contact Type Other	If Contact Type is "Other", describe the type of contact with animals, wet soil, or standing water
Rodent infested housing	Did the patient stay in housing with evidence of rodents in the 30 days prior to illness onset	PHVS_YesNoUnknown_CDC
Rural residence	Residence in rural area in the 30 days prior to illness onset	PHVS_YesNoUnknown_CDC
Hisotry of leptospirosis	Does the subject have a hisotry of leptospirosis?	PHVS_YesNoUnknown_CDC
Travel	Did the subject travel out of the county, state, or country in the 30 days prior to symptom onset?	PHVS_YesNoUnknown_CDC
Travel location	If the travel is "Yes", provide location(s) of travel in the 30 days prior to symptom onset
Rainfall	Was there heavy rainfall near the subjects place of residence, worksite, activities, or travel in the 30 days prior to symptom onset?	PHVS_YesNoUnknown_CDC
Flooding	Was there flooding near the subjects place of residence, worksite, activities, or travel in the 30 days prior to symptom onset?	PHVS_YesNoUnknown_CDC
Similar illness	Did the patient have similar exposures as a contact diagnosed with leptospirosis in the 30 day period	PHVS_YesNoUnknown_CDC
Outbreak	Is this patient part of an outbreak?	PHVS_YesNoUnknown_CDC
Case Outbreak Name	A state-assigned name for an indentified outbreak.
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.

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Sheet 28: Listeria

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
CaseId	ID assigned by database
CdcId	ID assigned by CDC
ReportStatus	Status of report
FormVersion	Version of form
FoodNetID	The FoodNet ID for the imported report (if applicable)
CaseStateID	The State Epi ID to identify the report being imported.
CaseLocalID	The Local Epi ID to identify the report being imported.
Interviewer	The name of the interviewer.
SentLab	Was the isolate sent to the public health laboratory?
SentLabSpecify	If isolate not sent to state lab, why not and could it still be obtained?
DateCompletedBy	The date that the form was completed on.
Gender	Gender
City	The city of residence where the report/case originated.
ResidenceCounty	The county of residence where the report/case originated.
State of Residence	The state of residence where the report/case originated.
Age	Age of case-patient.
DateOfBirth	Date of birth
Ethnicity	Is the case-patient of Hispanic, Latino, or Spanish origin?
HispanicMexican	Mexican, Mexican American, Chicano
HispanicPuertoRican	Puerto Rican
HispanicCuban	Cuban
HispanicOther	Another Hispanic, Latino, or Spanish Origin
HispanicSpecify	If another Hispanic, Latino, or Spanish origin, specify.
HispanicUnknown	Unknown Hispanic ancestry/declined to specify
RaceAfricanAmerican_Black	African American/Black
RaceAsian	Asian
RaceAsianIndian	Asian Indian
RaceAsianChinese	Chinese
RaceAsianFilipino	Filipino
RaceAsianJapanese	Japanese
RaceAsianKorean	Korean
RaceAsianVietnamese	Vietnamese
RaceAsianOther	Other Asian
RaseAsianOtherSpecify	Other Asian, specify
RaceNativeHawaiian_OtherPacificIslander	Native Hawaiian or Other Pacific Islander
RacePacificIslanderHawaiian	Native Hawaiian
RacePacificIslanderGuamanian	Guamanian or Chamorro
RacePacificIslanderSomoan	Samoan
RacePacificIslanderOther	Other Pacific Islander
RaceNativeAmerican	Native American or Alaska Native
RaceWhite	White
RaceWhiteMidEast	Middle Eastern/North African
RaceWhiteNotMidEast	Not Middle Eastern/North African
RaceUnknown	Unknown Race
RaceOther	Other Race
RaceOtherSpecify	Other Race Specify
RaceDecline	Declined to answer race question(s)
Pregnancy	Is Listeria case associate with pregnancy?
BloodNP	Not Pregnant: Type of specimen that grew Listeria. - Blood
BloodNPDate	Not Pregnant: Specimen collection date. - Blood
BloodNPIDNumber	Not Pregnant: State public health lab isolate ID #. - Blood
CSFNP	Not Pregnant: Type of specimen that grew Listeria. - CSF
CSFNPDate	Not Pregnant: Specimen collection date. - CSF
CSFNPIDNumber	Not Pregnant: State public health lab isolate ID #. - CSF
OtherNP	Not Pregnant: Type of specimen that grew Listeria. - Other
OtherNPSpec	Not Pregnant: Specify other type of specimen that grew Listeria.
OtherNPDate	Not Pregnant: Specimen collection date. - Other
OtherNPIDNumber	Not Pregnant: State public health lab isolate ID #. - Other
OtherNP2	Not Pregnant: Type of specimen that grew Listeria. - Other
OtherNP2Spec	Not Pregnant: Specify other type of specimen that grew Listeria.
OtherNP2Date	Not Pregnant: Specimen collection date. - Other
OtherNP2IDNumber	Not Pregnant: State public health lab isolate ID #. - Other
NPSpecimenFlag	Not Pregnant: Other flag
BacteremiaNP	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Bloodstream infection/sepsis
MeningitisNP	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Meningitis
NpListeriaIllnessMeningo	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Meningoencephalitis
FebrileGastroenteritisNP	Type of illness-Febrile gastroenteritis, non-pregnant case
NpListeriaIllnessBrain	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Brain abscess
NpListeriaIllnessRhomb	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Rhombencephalitis
NpListeriaIllnessPer	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Peritonitis
NpListeriaIllnessPneu	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Pneumonia
NPListeriaIllnessWound	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Wound infection
NpListeriaIllnessJoint	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Joint infection/septic arthritis
NPListeriaIllnessBone	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Bone infection/osteomyelitis
OtherIllnessNP	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Other illness
OtherIllnessNPSpec	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Other illness specify
UnknownNP	Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Unknown
HospitalizedNP	Not Pregnant: Was patient hospitalized for listeriosis?
AdmitNP	Not Pregnant: If patient hospitalized for listeriosis, admit date.
DischargeNP	Not Pregnant: If patient hospitalized for listeriosis, discharge date.
StillhospitalizedNP	Not Pregnant: If patient hospitalized for listeriosis, still hospitalized?
NPHospitalizedListeriosisStillDate	Not Pregnant: If patient hospitalized for listeriosis, still hospitalized last date.
OutcomeNP	Not Pregnant: Did the patient survive?
NPOutcomeDied	Not Pregnant: If the patient died, what was the date?
NPOutcomeListeriosisDeathCert	Not Pregnant: If died, was listeriosis or Listeria infection listed on death certificate?
NPOutcomeLastAlive	Not Pregnant: If survived, last known date alive.
BloodMotherAP	Pregnant: Type of specimen that grew Listeria. - Blood from mother
BloodMotherAPDate	Pregnant: Specimen collection date. -Blood from mother
BloodMotherAPIDNumber	Pregnant: State public health lab isolate ID #. - Blood from mother
BloodNeonateAP	Pregnant: Type of specimen that grew Listeria. - Blood from neonate
BloodNeonateAPDate	Pregnant: Specimen collection date. - Blood from neonate
BloodNeonateAPIDNumber	Pregnant: State public health lab isolate ID #. - Blood from neonate
CSFMotherAP	Pregnant: Type of specimen that grew Listeria. - CSF from mother
CSFMotherAPDate	Pregnant: Specimen collection date. - CSF from mother
CSFMotherAPIDNumber	Pregnant: State public health lab isolate ID #. - CSF from mother
CSFNeonateAP	Pregnant: Type of specimen that grew Listeria. - CSF from neonate
CSFNeonateAPDate	Pregnant: Specimen collection date. - CSF from neonate
CSFNeonateAPIDNumber	Pregnant: State public health lab isolate ID #. - CSF from neonate
PlacentaAP	Pregnant: Type of specimen that grew Listeria. - Placenta
PlacentaAPDate	Pregnant: Specimen collection date. - Placenta
PlacentaAPIDNumber	Pregnant: State public health lab isolate ID #. - Placenta
AmnioticAP	Pregnant: Type of specimen that grew Listeria. - Amniotic Fluid
AmnioticAPDate	Pregnant: Specimen collection date. - Amniotic fluid
AmnioticAPIDNumber	Pregnant: State public health lab isolate ID #. - Amniotic fluid
PrSpecimenTypeFetal	Pregnant: Type of specimen that grew Listeria. -Fetal tissue
PrSpecimenCollectionFetal	Pregnant: Specimen collection date. - Fetal tissue
PrSpecimenIsolateIDFetal	Pregnant: State public health lab isolate ID #. - Fetal tissue
OtherAP	Pregnant: Type of specimen that grew Listeria. - Other
OtherAPSpec	Pregnant: Specify other type of specimen that grew Listeria. - Other
OtherAPDate	Pregnant: Specimen collection date. - Other
OtherAPIDNumber	Pregnant: State public health lab isolate ID #. - Other
Other2AP	Pregnant: Type of specimen that grew Listeria. - Other
Other2APSpec	Pregnant: Specify other type of specimen that grew Listeria. - Other
Other2APDate	Pregnant: Specimen collection date. -Other
Other2APIDNumber	Pregnant: State public health lab isolate ID #. - Other
APSpecimenFlag	Pregnant: Other flag
OutsideUSSpecify	If born outside of the US, specify where.
BornInUS	Denotes that the <case> was born inside the United States.
OutsideUS	Denotes that the <case> was born outside the United States.
PrimaryLanguage	Primary language of the <case>, either english, spanish, other (specify) or unknown.
PrimaryLanguageSpecify	Specify the primary language if it is not available in the original list.
YearCametoUS	If born outside of the US, specify the year <case> arrived.
CDC_EFORSID	CDC EFORS ID
BloodNPLab	Lab submitting blood specimen, non-pregnant case
CSFNPLab	Lab submitting CSF specimen, non-pregnant case
OtherNP2Lab	Lab submitting other specimen 2, non-pregnant case
OtherNPLab	Lab submitting other specimen, non-pregnant case
StoolNP	Stool specimen grew Listeria, non-pregnant case
StoolNPDate	Date stool specimen collected, non-pregnant case
StoolNPLab	Lab submitting stool specimen, non-pregnant case
StoolNPIDNumber	State public health isolate ID number, stool, non-pregnant case
BloodMotherAPLab	Lab submitting blood specimen from mother, pregnancy-associated case
BloodNeonateAPLab	Lab submitting blood specimen from neonate, pregnancy-associated case
CSFMotherAPLab	Lab submitting CSF specimen from mother, pregnancy-associated case
CSFNeonateAPLab	Lab submitting CSF specimen from neonate, pregnancy-associated case
StoolMotherAP	Stool specimen from mother grew Listeria, pregnancy-associated case
StoolMotherAPDate	Date stool specimen from mother collected, pregnancy-associated case
StoolMotherAPLab	Lab submitting stool specimen from mother, pregnancy-associated case
StoolMotherAPIDNumber	State public health isolate ID number, stool specimen from mother, pregnancy-associated case
PlacentaAPLab	Lab submitting placenta specimen, pregnancy-associated case
AmnioticAPLab	Lab submitting amniotic fluid specimen, pregnnacy-associated case
OtherAPLab	Lab submitting other specimen, pregnancy-associated case
None	Underlying conditions and treatments. - None
Cancer	Underlying conditions and treatments. - Cancer
Leukemia	If Cancer, Leukemia
Lymphoma	If Cancer, Lymphoma
Hodgkins	If Lymphoma, Hodgkins
NonHodgkins	If Lymphoma, Non-Hodgkins
MultipleMyeloma	If Cancer, Multiple Myeloma
Myeloproliferative	If Cancer, Myeloproliferative disorder
OtherCancer	If Cancer, Other cancer
OtherCancerSpecify	If Other Cancer, specify other cancer
KidneyDialysis	Underlying conditions and treatments. - Kidney dialysis
CirrhosisLiverDisease	Underlying conditions and treatments. - Cirrhosis/advanced liver disease
COPD	Underlying conditions and treatments. - Chronic Obstructive Pulmonary Disease
HeartDisease	Underlying conditions and treatments. - Heart Disease
HeartDiseaseSpecify	If Heart Disease, specify heart disease
OrganTransplant	Underlying conditions and treatments. - Organ transplant
OrganTransplantSpecify	If Organ Transplant, specify organ
Unknown	Underlying conditions and treatments. - Unknown
OtherConditions	Underlying conditions and treatments. - Other conditions
Crohns	Underlying conditions and treatments. - Crohn's
Diabetes	Underlying conditions and treatments. - Diabetes mellitus
DiabetesTypeI	If Diabetes mellitus, Type 1
DiabetesTypeII	If Diabetes mellitus, Type 2
GiantCell	Underlying conditions and treatments. - Giant cell arteritis
Hemochromatosis	Underlying conditions and treatments. - Hemochromatosis/iron overload
HIV_AIDS	Underlying conditions and treatments. - HIV/AIDS
HIV	If HIV/AIDS, HIV (no AIDS)
AIDS	If HIV/AIDS, AIDS
Lupus	Underlying conditions and treatments. - Lupus
RheumatoidArthritis	Underlying conditions and treatments. - Rheumatoid arthritis
Sarcoidosis	Underlying conditions and treatments. - Sarcoidosis
SickleCell	Underlying conditions and treatments. - Sickle cell disease
Splenectomy	Underlying conditions and treatments. - Splenectomy/asplenia
UlcerativeColitis	Underlying conditions and treatments. - Unlcerative colitis
Other1	Underlying conditions and treatments. - Other condition
Other1Spec	If Other Condition, specify other conditions
Cond_Pregnancy	Underlying conditions and treatments. - Pregnancy
ImmunosuppressiveMed	Underlying conditions and treatments. - Immunosuppressive medication
Steroids	If Immunosuppressive medication, Corticosteroids/steroids
CancerChemotherapy	If Immunosuppressive medication, Cancer chemotherapy
OtherImmunosuppresive	If Immunosuppressive medication, Other immunosuppressive therapy
OtherImmunoSpecify	If Other Immunosuppressive therapy, specify therapy
Alcohol	Underlying conditions and treatments. - Excessive alcohol use
IDU	Underlying conditions and treatments. - Injection drug user
Antacids	Underlying conditions and treatments. - Medications that suppress stomach acid
AntacidsSpecify	If Medications that suppress stomach acid, specify medications
InterviewPatientAble	Was patient or surrogate able to be interviewed?
InterviewPatientReason	If patient or surrogate was not interviewed, why not?
InterviewPatientReasonSpecify	Other reason patient or surrogate was not interviewed.
StomachUlcers	StomachUlcers
Arthritis	Arthritis
KidneyDisease	KidneyDisease
StomachSurgery	StomachSurgery
Hypertension	Hypertension
ESRD	ESRD
ChronicDiarrhea	ChronicDiarrhea
Comments	Comments
Underlying	Underlying
Radiation	Radiation
Antibiotics	Antibiotics
Other2	Other symptoms
Other3	Name of store/restaurant/other venue where soft white cheese purchased 3
Other4	Name of store/restaurant/other venue where soft white cheese purchased 4
Other5	Name of store/restaurant/other venue where soft white cheese purchased 5
Other2Spec	Other 2 specify
Other3Spec	Other 3 specify
Other4Spec	Other 4 specify
Other5Spec	Other 5 specify
PrInfant1PregnancyOutcome	Pregnant: Infant 1 pregnancy outcome.
PrInfant1GestationWeeks	Pregnant: Infant 1 weeks of gestation.
PrInfant1DeliveryType	Pregnant: Infant 1 delivery type.
PrInfant1PregnancyOutcomeDate	Pregnant: Infant 1 pregnancy outcome date.
PrInfant1PregnancyOutcomeOtherSpecify	Pregnant: Specify other outcome of pregnancy for infant 1?
PrInfant2PregnancyOutcome	Pregnant: Infant 1 pregnancy outcome.
PrInfant2GestationWeeks	Pregnant: Infant 1 weeks of gestation.
PrInfant2DeliveryType	Pregnant: Infant 1 delivery type.
PrInfant2PregnancyOutcomeDate	Pregnant: Infant 1 pregnancy outcome date.
PrInfant2PregnancyOutcomeOtherSpecify	Pregnant: Specify other outcome of pregnancy for infant 1?
PrMotherIllnessFever	Pregnant: Type(s) of illness in mother.-Fever
PrMotherIllnessBacteremia	Pregnant: Type(s) of illness in mother.-Bacteremia/sepsis
PrMotherIllnessMeningitis	Pregnant: Type(s) of illness in mother.-Meningitis
PrMotherIllnessAmnionitis	Pregnant: Type(s) of illness in mother.-Amnionitis
PrMotherIllnessFlu	Pregnant: Type(s) of illness in mother.-Non-specific flu-like illness
PrMotherIllnessNone	Pregnant: Type(s) of illness in mother.-None
PrMotherIllnessOther	Pregnant: Type(s) of illness in mother.-Other
PrMotherIllnessOtherSpecify	Pregnant: If Other Illness, specify
PrMotherIlnnessUnknown	Pregnant: Type(s) of illness in mother.-Unknown
PrMotherHospLst	Pregnant: Was mother hospitalized for listeriosis?
PrMotherHospListAdmit	Pregnant: If mother was hospitalized for listeriosis, admit date.
PrMotherHospDischarge	Pregnant: If mother was hospitalized for listeriosis, discharge date.
PrMotherHospListStill	Pregnant: If mother was hospitalized for listeriosis, still hopsitalized?
PrMotherHospListHospital	Pregnant: If mother was hospitalized for listeriosis, name of hospital.
PrMotherOutcomeSurvived	Pregnant: Did the mother survive?
PrMotherOutcomeLastAlive	Pregnant: If the mother survived, last known date alive.
PrMotherOutcomeDeathCert	Pregnant: If the mother died, was listeriosis or Listeria infection listed on death certificate?
PrInfant1IllnessBacteremia	Pregnant: Type(s) of illness in infant 1.-Bacteremia/sepsis
PrInfant1IllnessMeningitis	Pregnant: Type(s) of illness in infant 1.-Meningitis
PrInfant1IllnessPneumonia	Pregnant: Type(s) of illness in infant 1.-Pneumonia
PrInfant1IllnessNone	Pregnant: Type(s) of illness in infant 1.-None
PrInfant1IllnessOther	Pregnant: Type(s) of illness in infant 1.-Other
PrInfant1IllnessSpecify	Pregnant: Specify other type(s) of illness in infant 1.
PrInfant1IllnessUnknown	Pregnant: Type(s) of illness in infant 1.-Unknown
PrInfant1Delivered	Pregnant: Where was infant 1 delivered?
PrInfant1DeliveredAdmit	Pregnant: If infant 1 was delivered at a hospitalized, admit date.
PrInfant1DeliveredDischarge	Pregnant: If infant 1 was delivered at a hospitalized, discharge date.
PrInfant1DeliveredStill	Pregnant: If infant 1 was delivered at a hospitalized, still hopsitalized?
PrInfant1DeliveredHospital	Pregnant: If infant 1 was hospitalized for listeriosis, name of hospital.
PrInfant1OutcomeSpecify	Pregnant: Specify other location where infant 1 was delivered?
PrInfant1HospList	Pregnant: Was infant 1 hospitalized for listeriosis?
PrInfant1HospListAdmit	Pregnant: If infant 1 was hospitalized for listeriosis, admit date.
PrInfant1HospListDischarge	Pregnant: If infant 1 was hospitalized for listeriosis, discharge date.
PrInfant1HospStill	Pregnant: If infant 1 was hospitalized for listeriosis, still hopsitalized?
PrInfant1OutcomeSurvived	Pregnant: Did infant 1 survive?
PrInfant1OutcomeLastAlive	Pregnant: If infant 1 survived, last known date alive.
PrInfant1OutcomeDeathCert	Pregnant: If infant 1 died, was listeriosis or Listeria infection listed on death certificate?
PrInfant2IllnessBacteremia	Pregnant: Type(s) of illness in infant 2.-Bacteremia/sepsis
PrInfant2IllnessMeningitis	Pregnant: Type(s) of illness in infant 2.-Meningitis
PrInfant2IllnessPneumonia	Pregnant: Type(s) of illness in infant 2.-Pneumonia
PrInfant2IllnessNone	Pregnant: Type(s) of illness in infant 2.-None
PrInfant2IllnessOther	Pregnant: Type(s) of illness in infant 2.-Other
PrInfant2IllnessSpecify	Pregnant: Specify other type(s) of illness in infant 2.
PrInfant2IllnessUnknown	Pregnant: Type(s) of illness in infant 2.-Unknown
PrInfant2Delivered	Pregnant: Where was infant 2 delivered?
PrInfant2DeliveredAdmit	Pregnant: If infant 2 was delivered at a hospitalized, admit date.
PrInfant2DeliveredDischarge	Pregnant: If infant 2 was delivered at a hospitalized, discharge date.
PrInfant2DeliveredStill	Pregnant: If infant 2 was delivered at a hospitalized, still hopsitalized?
PrInfant2DeliveredHospital	Pregnant: If infant 2 was hospitalized for listeriosis, name of hospital.
PrInfant2OutcomeSpecify	Pregnant: Specify other location where infant 2 was delivered?
PrInfant2HospList	Pregnant: Was infant 2 hospitalized for listeriosis?
PrInfant2HospListAdmit	Pregnant: If infant 2 was hospitalized for listeriosis, admit date.
PrInfant2HospListDischarge	Pregnant: If infant 2 was hospitalized for listeriosis, discharge date.
PrInfant2HospListStill	Pregnant: If infant 2 was hospitalized for listeriosis, still hopsitalized?
PrInfant2OutcomeSurvived	Pregnant: Did infant 2 survive?
PrInfant2OutcomeLastAlive	Pregnant: If infant 2 survived, last known date alive.
PrInfant2OutcomeDeathCert	Pregnant: If infant 2 died, was listeriosis or Listeria infection listed on death certificate?
PrMotherIllnessGastroenteritis	Pregnant: Type(s) of illness in mother.-Gastroenteritis
PrInfant1IllnessGranulomatosis	Pregnant: Type(s) of illness in infant1.-Granulomatosis
PrInfant2IllnessGranulomatosis	Pregnant: Type(s) of illness in infant2.-Granulomatosis
InterviewDate	Date of patient interview.
Interviewee	Respondent of the patient interview.
Relationship	If respondent was surrogate, relationship to patient.
OtherRelationshipSpecify	If respondent was surrogate, relationship to patient specify other.
Onset	Date illness began.
IllnessBeginNotApplicable	Date illness began does not apply.
HospitalizedBefore	During the 4 weeks before illness/delivery date, was admitted to a hospital?
HAdmit	If admitted to a hospital, admission date.
HDischarge	If admitted to a hospital, discharge date.
Hname	If admitted to a hospital, hospital name.
StillHosp	If admitted to a hospital, still residing there?
NursingHomeBefore	During the 4 weeks before illness/delivery date, was admitted to a nursing home?
Admitdate	Date admitted to nursing home (if resident in 4 weeks prior to onset)
DischargeDate	Dicharge date from nursing home (if resident in 4 weeks prior to onset)
StillHosporNH	If admitted to a nursing home, still residing there?
NHName	If admitted to a nursing home, nursing home name.
TravelState	Did travel outside state of residence?
StatesVisited	If traveled outside state of residence, names of states.
TravelInternat	Did travel outside state of the U.S.?
Countries	If traveled outside U.S., names of countries.
DateDepart	If traveled outside U.S., departure date.
DateReturn	If traveled outside U.S., return date.
Fever	Patient symptom name associated with illness.-Fever
Chills	Patient symptom name associated with illness.-Chills
Diarrhea	Patient symptom name associated with illness.-Diarrhea
Vomiting	Patient symptom name associated with illness.-Vomitting
PretermLabor	Patient symptom name associated with illness.-Preterm labor
MuscleAches	Patient symptom name associated with illness.-Muscle Aches
Headache	Patient symptom name associated with illness.-Headache
StiffNeck	Patient symptom name associated with illness.-Stiff neck
AlteredMental	Patient symptom name associated with illness.-Altered mental status
OtherSx1	Patient symptom name associated with illness.-Other
OtherSx1Specify	Specify other patient symptom.
OtherSx2	Patient symptom name associated with illness.-Other
OtherSx2Specify	Specify other patient symptom.
OtherSxFlag	Other symptom flag
TestDelivered	Illness/delivery date
_4weeksbefore	4-week start date
SpecCollection	4-week end date
HasAllergies	Whether or not <case> had allergies that prevented <case> from eating certain foods.
Milk	The name of the food that <case> has allergies toward.-Milk
Eggs	The name of the food that <case> has allergies toward.-Eggs
Peanuts	The name of the food that <case> has allergies toward.-Peanuts
TreeNuts	The name of the food that <case> has allergies toward.-Tree Nuts
Fish	The name of the food that <case> has allergies toward.-Fish
Soy	The name of the food that <case> has allergies toward.-Soy
Wheat	The name of the food that <case> has allergies toward.-Wheat
Shellfish	The name of the food that <case> has allergies toward.-Shellfish
OtherAllergy	The name of the food that <case> has allergies toward.-Other
AllergySpecify	If Other (specify) was the given allergy, then specify allergy here.
HadVegetarianDiet	Whether or not <case> had a vegetarian or vegan diet.
Vegetarian	If yes to vegetarian or vegan diet, this denotes a vegetarian diet.
Vegan	If yes to vegetarian or vegan diet, this denotes a vegan diet.
HadRestrictedDiet	Whether or not <case> had a restricted diet.
DietDescription	A description of the restricted diet that <case> was on.
Grocery1	The name of the store from which the food was acquired
Grocery1Address	The location of the store from which the food was acquired.
Grocery2	The name of the store from which the food was acquired
Grocery2Address	The location of the store from which the food was acquired.
Grocery3	The name of the store from which the food was acquired
Grocery3Address	The location of the store from which the food was acquired.
Grocery4	The name of the store from which the food was acquired
Grocery4Address	The location of the store from which the food was acquired.
Grocery5	The name of the store from which the food was acquired
Grocery5Address	The location of the store from which the food was acquired.
Grocery6	The name of the store from which the food was acquired
Grocery6Address	The location of the store from which the food was acquired.
Grocery7	The name of the store from which the food was acquired
Grocery7Address	The location of the store from which the food was acquired.
GroceryFlag	Grocery strore flag
ShopperCardReleased	Whether or not <case> agreed to release shopper card information.
ShopperCardStoreName1	The name of the store associated with the shopper card information.
ShopperCardNumber1	The number and/or characters that uniquely identify the shopper card.
ShopperCardStoreName2	The name of the store associated with the shopper card information.
ShopperCardNumber2	The number and/or characters that uniquely identify the shopper card.
ShopperCardStoreName3	The name of the store associated with the shopper card information.
ShopperCardNumber3	The number and/or characters that uniquely identify the shopper card.
ShopperCardNameFlag	Shopper card name flag
Restaurant1	The name of the restaurant where <case> may have eaten.
Restaurant1Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte1	The food that <case> may have eaten at the restaurant.
Restaurant1Date_1	Restaurant 1 date 1
Restaurant1Date_2	Restaurant 1 date 2
Restaurant1Date_3	Restaurant 1 date 3
Restaurant1Date_4	Restaurant 1 date 4
Restaurant1Date_5	Restaurant 1 date 5
Restaurant2	The name of the restaurant where <case> may have eaten.
Restaurant2Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte2	The food that <case> may have eaten at the restaurant.
Restaurant2Date_1	Restaurant 2 date 1
Restaurant2Date_2	Restaurant 2 date 2
Restaurant2Date_3	Restaurant 2 date 3
Restaurant2Date_4	Restaurant 2 date 4
Restaurant2Date_5	Restaurant 2 date 5
Restaurant3	The name of the restaurant where <case> may have eaten.
Restaurant3Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte3	The food that <case> may have eaten at the restaurant.
Restaurant3Date_1	Restaurant 3 date 1
Restaurant3Date_2	Restaurant 3 date 2
Restaurant3Date_3	Restaurant 3 date 3
Restaurant3Date_4	Restaurant 3 date 4
Restaurant3Date_5	Restaurant 3 date 5
Restaurant4	The name of the restaurant where <case> may have eaten.
Restaurant4Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte4	The food that <case> may have eaten at the restaurant.
Restaurant4Date_1	Restaurant 4 date 1
Restaurant4Date_2	Restaurant 4 date 2
Restaurant4Date_3	Restaurant 4 date 3
Restaurant4Date_4	Restaurant 4 date 4
Restaurant4Date_5	Restaurant 4 date 5
Restaurant5	The name of the restaurant where <case> may have eaten.
Restaurant5Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte5	The food that <case> may have eaten at the restaurant.
Restaurant5Date_1	Restaurant 5 date 1
Restaurant5Date_2	Restaurant 5 date 2
Restaurant5Date_3	Restaurant 5 date 3
Restaurant5Date_4	Restaurant 5 date 4
Restaurant5Date_5	Restaurant 5 date 5
Restaurant6	The name of the restaurant where <case> may have eaten.
Restaurant6Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte6	The food that <case> may have eaten at the restaurant.
Restaurant6Date_1	Restaurant 6 date 1
Restaurant6Date_2	Restaurant 6 date 2
Restaurant6Date_3	Restaurant 6 date 3
Restaurant6Date_4	Restaurant 6 date 4
Restaurant6Date_5	Restaurant 6 date 5
Restaurant7	The name of the restaurant where <case> may have eaten.
Restaurant7Address	The location of the restaurant where <case> may have eaten.
RestaurantFoodsAte7	The food that <case> may have eaten at the restaurant.
Restaurant7Date_1	Restaurant 7 date 1
Restaurant7Date_2	Restaurant 7 date 2
Restaurant7Date_3	Restaurant 7 date 3
Restaurant7Date_4	Restaurant 7 date 4
Restaurant7Date_5	Restaurant 7 date 5
RestaurantFlag	Reastaurant flag
OtherVenue1	The name of the other location where <case> may have eaten.
OtherVenue1Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte1	The food that <case> may have eaten at the other location.
OtherVenue1Date_1	Other venue 1 date 1
OtherVenue1Date_2	Other venue 1 date 2
OtherVenue1Date_3	Other venue 1 date 3
OtherVenue1Date_4	Other venue 1 date 4
OtherVenue1Date_5	Other venue 1 date 5
OtherVenue2	The name of the other location where <case> may have eaten.
OtherVenue2Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte2	The food that <case> may have eaten at the other location.
OtherVenue2Date_1	Other venue 2 date 1
OtherVenue2Date_2	Other venue 2 date 2
OtherVenue2Date_3	Other venue 2 date 3
OtherVenue2Date_4	Other venue 2 date 4
OtherVenue2Date_5	Other venue 2 date 5
OtherVenue3	The name of the other location where <case> may have eaten.
OtherVenue3Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte3	The food that <case> may have eaten at the other location.
OtherVenue3Date_1	Other venue 3 date 1
OtherVenue3Date_2	Other venue 3 date 2
OtherVenue3Date_3	Other venue 3 date 3
OtherVenue3Date_4	Other venue 3 date 4
OtherVenue3Date_5	Other venue 3 date 5
OtherVenue4	The name of the other location where <case> may have eaten.
OtherVenue4Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte4	The food that <case> may have eaten at the other location.
OtherVenue4Date_1	Other venue 4 date 1
OtherVenue4Date_2	Other venue 4 date 2
OtherVenue4Date_3	Other venue 4 date 3
OtherVenue4Date_4	Other venue 4 date 4
OtherVenue4Date_5	Other venue 4 date 5
OtherVenue5	The name of the other location where <case> may have eaten.
OtherVenue5Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte5	The food that <case> may have eaten at the other location.
OtherVenue5Date_1	Other venue 5 date 1
OtherVenue5Date_2	Other venue 5 date 2
OtherVenue5Date_3	Other venue 5 date 3
OtherVenue5Date_4	Other venue 5 date 4
OtherVenue5Date_5	Other venue 5 date 5
OtherVenue6	The name of the other location where <case> may have eaten.
OtherVenue6Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte6	The food that <case> may have eaten at the other location.
OtherVenue6Date_1	Other venue 6 date 1
OtherVenue6Date_2	Other venue 6 date 2
OtherVenue6Date_3	Other venue 6 date 3
OtherVenue6Date_4	Other venue 6 date 4
OtherVenue6Date_5	Other venue 6 date 5
OtherVenue7	The name of the other location where <case> may have eaten.
OtherVenue7Address	The location of the other location where <case> may have eaten.
OtherLocationFoodsAte7	The food that <case> may have eaten at the other location.
OtherVenue7Date_1	Other venue 7 date 1
OtherVenue7Date_2	Other venue 7 date 2
OtherVenue7Date_3	Other venue 7 date 3
OtherVenue7Date_4	Other venue 7 date 4
OtherVenue7Date_5	Other venue 7 date 5
OtherVenueFlag	Other venue 7 date 6
OtherFoodDetails	Any other food items <case> ate that we didn't talk about already.
SeasonalFoodDetails	Any seasonal foods or special foods <case> ate during the last 4 weeks.
FarmersMarket1	Name of delicatessen, small local market, other small shop, or farmers markets 1
FarmersMarket1Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 1
FarmersMarket2	Name of delicatessen, small local market, other small shop, or farmers markets 2
FarmersMarket2Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 2
FarmersMarket3	Name of delicatessen, small local market, other small shop, or farmers markets 3
FarmersMarket3Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 3
FarmersMarket4	Name of delicatessen, small local market, other small shop, or farmers markets 4
FarmersMarket4Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 4
FarmersMarket5	Name of delicatessen, small local market, other small shop, or farmers markets 5
FarmersMarket5Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 5
FarmersMarket6	Name of delicatessen, small local market, other small shop, or farmers markets 6
FarmersMarket6Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 6
FarmersMarket7	Name of delicatessen, small local market, other small shop, or farmers markets 7
FarmersMarket7Address	Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 7
FarmersMarketPurchase	Did you eat food purchased from any delicatessens, small local markets, other small shops, or farmers' markets during the 4 week period?
GroceryPurchase	Did you eat food purchased from any grocery stores during the 4 week time period
OtherVenuePurchase	Did you eat food purchased or obtained from any other venues, such as school cafeteria, concession stands, street vendors, institutions (e.g., hospital food), local farms, or private vendors during the 4 week period?
RestaurantPurchase	Did you eat food from any restaurants, including sit-down, fast-food, and take-out restaurants during the 4 week period?
InterviewInitials	Initials of interviewer
FoodComments	Interviewer comments on food consumption history
InterviewComments	General interviewer comments
IfEatenHam	Ham
DeliSlicedHam	Ham
DetailsHam	Ham
VenueHam	Ham
IfEatenBologna	Bologna
DeliSlicedBologna	Bologna
DetailsBologna	Bologna
VenueBologna	Bologna
IfEatenTurkeyBreast	Turkey breast
DeliSlicedTurkeyBreast	Turkey breast
DetailsTurkeyBreast	Turkey breast
VenueTurkeyBreast	Turkey breast
IfEatenChicken	Chicken deli meat
DeliSlicedChicken	Chicken deli meat
DetailsChicken	Chicken deli meat
VenueChicken	Chicken deli meat
IfEatenRoastBeef	Roast beef
DeliSlicedRoastBeef	Roast beef
DetailsRoastBeef	Roast beef
VenueRoastBeef	Roast beef
IfEatenPastrami	Pastrami
DeliSlicedPastrami	Pastrami
DetailsPastrami	Pastrami
VenuePastrami	Pastrami
IfEatenLiver	Liverwurst or braunschweiger
DeliSlicedLiver	Liverwurst or braunschweiger
DetailsLiver	Liverwurst or braunschweiger
VenueLiver	Liverwurst or braunschweiger
IfEatenPate	Pate or meat spread that was not canned
DetailsPate	Pate or meat spread that was not canned
VenuePate	Pate or meat spread that was not canned
IfEatenHeadCheese	Head cheese
DeliSlicedHeadCheese	Head cheese
DetailsHeadCheese	Head cheese
VenueHeadCheese	Head cheese
IfEatenPepperoni	Pepperoni
DeliSlicedPepperoni	Pepperoni
DetailsPepperoni	Pepperoni
VenuePepperoni	Pepperoni
IfEatenItalian	Any other Italian-style meats
DeliSlicedItalian	Any other Italian-style meats
DetailsItalian	Any other Italian-style meats
VenueItalian	Any other Italian-style meats
IfEatenOtherDeli	Other deli/luncheon meat
DeliSlicedOtherDeli	Other deli/luncheon meat
SpecifyOtherDeli	Other deli/luncheon meat
DetailsOtherDeli	Other deli/luncheon meat
VenueOtherDeli	Other deli/luncheon meat
IfEatenDeliMeat	Anything from deli area where meat is sliced
DeliSlicedDeliMeat	Anything from deli area where meat is sliced
SpecifyDeliMeat	Anything from deli area where meat is sliced
DetailsDeliMeat	Anything from deli area where meat is sliced
VenueDeliMeat	Anything from deli area where meat is sliced
IfEatenSausage	Precooked sausage
DetailsSausage	Precooked sausage
VenueSausage	Precooked sausage
IfEatenCookedChicken	Precooked chicken
DetailsCookedChicken	Precooked chicken
VenueCookedChicken	Precooked chicken
IfEatenCookedMeat	Other precooked meat
DetailsCookedMeat	Other precooked meat
VenueCookedMeat	Other precooked meat
SpecifyCookedMeat	Other precooked meat
IfEatenCured	Cured or dried meat
DetailsCured	Cured or dried meat
VenueCured	Cured or dried meat
IfEatenHotDog	Hot dogs
HotDogsHeated	Hot dogs
DetailsHotDog	Was hot dog heated prior to being eaten?
VenueHotDog	Hot dogs
IfEatenFrozenPoultry	Frozen processed poultry
DetailsFrozenPoultry	Frozen processed poultry
VenueFrozenPoultry	Frozen processed poultry
SpecifyFrozenPoultry	Frozen processed poultry
IfEatenGroundPoultry	Grounch chicken or turkey
DetailsGroundPoultry	Grounch chicken or turkey
VenueGroundPoultry	Grounch chicken or turkey
SpecifyGroundPoultry	Grounch chicken or turkey
BolognaOften	If ate bologna, how often?
BolognaDeli	Was bologna purchased at a deli/small market?
BolognaGrocery	Was bologna purchased at grocery store?
BolognaOther	Was bologna purchased at an other venue?
BolognaRestaurant	BolognaRestaurant
VenueBologna2	VenueBologna2
VenueBologna3	VenueBologna3
VenueBologna4	VenueBologna4
DetailsBologna2	DetailsBologna2
DetailsBologna3	DetailsBologna3
DetailsBologna4	DetailsBologna4
ChickenOften	ChickenOften
ChickenDeli	ChickenDeli
ChickenGrocery	ChickenGrocery
ChickenOther	ChickenOther
ChickenRestaurant	ChickenRestaurant
VenueChicken2	VenueChicken2
VenueChicken3	VenueChicken3
VenueChicken4	VenueChicken4
DetailsChicken2	DetailsChicken2
DetailsChicken3	DetailsChicken3
DetailsChicken4	DetailsChicken4
HamOften	If ate ham, how often?
HamDeli	Was ham purchased at a deli/small market ?
HamGrocery	Was ham purchased at a grocery store?
HamOther	Was ham purchased at an other venue?
HamRestaurant	HamRestaurant
VenueHam2	VenueHam2
VenueHam3	VenueHam3
VenueHam4	VenueHam4
DetailsHam2	DetailsHam2
DetailsHam3	DetailsHam3
DetailsHam4	DetailsHam4
OtherDeliOften	If at other deli meat, how often?
OtherDeliDeli	Was other deli meat purchased at a deli/small market?
OtherDeliGrocery	Was other deli meat purchased at a grocery store?
OtherDeliOther	Was other deli meat purchased at an other venue?
OtherDeliRestaurant	OtherDeliRestaurant
VenueOtherDeli2	VenueOtherDeli2
VenueOtherDeli3	VenueOtherDeli3
VenueOtherDeli4	VenueOtherDeli4
DetailsOtherDeli2	DetailsOtherDeli2
DetailsOtherDeli3	DetailsOtherDeli3
DetailsOtherDeli4	DetailsOtherDeli4
IfEatenOtherTurkey	IfEatenOtherTurkey
OtherTurkeyOften	OtherTurkeyOften
OtherTurkeyDeli	OtherTurkeyDeli
OtherTurkeyGrocery	OtherTurkeyGrocery
OtherTurkeyOther	OtherTurkeyOther
OtherTurkeyRestaurant	OtherTurkeyRestaurant
VenueOtherTurkey	VenueOtherTurkey
VenueOtherTurkey2	VenueOtherTurkey2
VenueOtherTurkey3	VenueOtherTurkey3
VenueOtherTurkey4	VenueOtherTurkey4
DetailsOtherTurkey	DetailsOtherTurkey
DetailsOtherTurkey2	DetailsOtherTurkey2
DetailsOtherTurkey3	DetailsOtherTurkey3
DetailsOtherTurkey4	DetailsOtherTurkey4
DeliSlicedOtherTurkey	DeliSlicedOtherTurkey
PastramiOften	If ate pastrami, how often?
PastramiDeli	Was pastrami purchased at a deli/small market?
PastramiGrocery	Was pastrami purchased at a grocery store?
PastramiOther	Was pastrami purchased at an other venue?
PastramiRestaurant	PastramiRestaurant
VenuePastrami2	VenuePastrami2
VenuePastrami3	VenuePastrami3
VenuePastrami4	VenuePastrami4
DetailsPastrami2	DetailsPastrami2
DetailsPastrami3	DetailsPastrami3
DetailsPastrami4	DetailsPastrami4
PateOften	If yes, how often was pate eaten?
PateDeli	Was pate purchased at a deli/small market?
PateGrocery	Was pate purchased at a grocery store?
PateOther	Was pate purchased at an other venue?
PateRestaurant	PateRestaurant
VenuePate2	VenuePate2
VenuePate3	VenuePate3
VenuePate4	VenuePate4
DetailsPate2	DetailsPate2
DetailsPate3	DetailsPate3
DetailsPate4	DetailsPate4
DeliSlicedPate	DeliSlicedPate
TurkeyBreastOften	TurkeyBreastOften
TurkeyBreastDeli	TurkeyBreastDeli
TurkeyBreastGrocery	TurkeyBreastGrocery
TurkeyBreastOther	TurkeyBreastOther
TurkeyBreastRestaurant	TurkeyBreastRestaurant
VenueTurkeyBreast2	VenueTurkeyBreast2
VenueTurkeyBreast3	VenueTurkeyBreast3
VenueTurkeyBreast4	VenueTurkeyBreast4
DetailsTurkeyBreast2	DetailsTurkeyBreast2
DetailsTurkeyBreast3	DetailsTurkeyBreast3
DetailsTurkeyBreast4	DetailsTurkeyBreast4
DeliSlicedHotDog	DeliSlicedHotDog
HotDogOften	If yes, how often did you eat hot dogs?
HotDogDeli	Were hotdogs purchased at a deli/small market?
HotDogGrocery	Were hotdogs purchased at a grocery store?
HotDogOther	Were hotdogs purchased at an other venue?
HotDogRestaurant	HotDogRestaurant
VenueHotDog2	VenueHotDog2
VenueHotDog3	VenueHotDog3
VenueHotDog4	VenueHotDog4
DetailsHotDog2	DetailsHotDog2
DetailsHotDog3	DetailsHotDog3
DetailsHotDog4	DetailsHotDog4
IfEatenSprouts	IfEatenSprouts
DetailsSprouts	DetailsSprouts
VenueSprouts	VenueSprouts
IfEatenBean	Sprouts: Bean
DetailsBean	Sprouts: Bean
VenueBean	Sprouts: Bean
IfEatenAlfalfa	Sprouts:Alfalfa
DetailsAlfalfa	Sprouts:Alfalfa
VenueAlfalfa	Sprouts:Alfalfa
IfEatenClover	Sprouts:Clover
DetailsClover	Sprouts:Clover
VenueClover	Sprouts:Clover
IfEatenRadish	Sprouts:Radish
DetailsRadish	Sprouts:Radish
VenueRadish	Sprouts:Radish
IfEatenBroccoli	Sprouts:Broccoli
DetailsBroccoli	Sprouts:Broccoli
VenueBroccoli	Sprouts:Broccoli
IfEatenMixed	Sprouts:Mixed
DetailsMixed	Sprouts:Mixed
VenueMixed	Sprouts:Mixed
IfEatenOtherSprout	Sprouts:Other
DetailsOtherSprout	Sprouts:Other
VenueOtherSprout	Sprouts:Other
SpecifyOtherSprout	Sprouts:Other
IfEatenCucumber	Cucumber
DetailsCucumber	Cucumber
VenueCucumber	Cucumber
IfEatenPea	Pea pods/snap peas/snow peas
DetailsPea	Pea pods/snap peas/snow peas
VenuePea	Pea pods/snap peas/snow peas
IfEatenSweetPepper	Sweet peppers
DetailsSweetPepper	Sweet peppers
VenueSweetPepper	Sweet peppers
IfEatenHotPepper	Hot chili peppers
DetailsHotPepper	Hot chili peppers
VenueHotPepper	Hot chili peppers
IfEatenScallion	Green onions or scallions
DetailsScallion	Green onions or scallions
VenueScallion	Green onions or scallions
IfEatenCelery	Celery
DetailsCelery	Celery
VenueCelery	Celery
IfEatenCarrot	Mini-carrots
DetailsCarrot	Mini-carrots
VenueCarrot	Mini-carrots
IfEatenMushroom	Fresh mushrooms
DetailsMushroom	Fresh mushrooms
VenueMushroom	Fresh mushrooms
IfEatenPreCutVeg	Pre-cut raw vegetables or vegetabel mixes
SpecifyPreCutVeg	Pre-cut raw vegetables or vegetabel mixes
DetailsPreCutVeg	Pre-cut raw vegetables or vegetabel mixes
VenuePreCutVeg	Pre-cut raw vegetables or vegetabel mixes
IfEatenBasil	Fresh basil
DetailsBasil	Fresh basil
VenueBasil	Fresh basil
IfEatenCilantro	Fresh cilantro
DetailsCilantro	Fresh cilantro
VenueCilantro	Fresh cilantro
IfEatenParsley	Fresh parsely
DetailsParsley	Fresh parsely
VenueParsley	Fresh parsely
IfEatenHerbs	Other fresh herbs
SpecifyHerbs	Other fresh herbs
DetailsHerbs	Other fresh herbs
VenueHerbs	Other fresh herbs
IfEatenTomato	Fresh tomatoes
DetailsTomato	Fresh tomatoes
VenueTomato	Fresh tomatoes
IfEatenRedRound	Tomatoes: Red round
DetailsRedRound	Tomatoes: Red round
VenueRedRound	Tomatoes: Red round
IfEatenRoma	Tomatoes: Roma
DetailsRoma	Tomatoes: Roma
VenueRoma	Tomatoes: Roma
IfEatenCherryTom	Tomatoes: Cherry/grape
DetailsCherryTom	Tomatoes: Cherry/grape
VenueCherryTom	Tomatoes: Cherry/grape
IfEatenVineTom	Tomatoes: Vine-ripe, sold on vine
DetailsVineTom	Tomatoes: Vine-ripe, sold on vine
VenueVineTom	Tomatoes: Vine-ripe, sold on vine
IfEatenOtherTom	Tomatoes: Other
SpecifyOtherTom	Tomatoes: Other
DetailsOtherTom	Tomatoes: Other
VenueOtherTom	Tomatoes: Other
IfEatenLettuce	Any lettuce
BagLettuce	Was lettuce prepackaged or bagged?
BagLettuceSpecify	Specify type and brand of bagged lettuce
DetailsLettuce	Any lettuce
VenueLettuce	Any lettuce
IfEatenIceburg	Lettuce:Iceburg
DetailsIceburg	Lettuce:Iceburg
VenueIceburg	Lettuce:Iceburg
IfEatenRomaine	Lettuce:Romaine
DetailsRomaine	Lettuce:Romaine
VenueRomaine	Lettuce:Romaine
IfEatenMesclun	Lettuce:Mesclun
DetailsMesclun	Lettuce:Mesclun
VenueMesclun	Lettuce:Mesclun
IfEatenRadishLettuce	Lettuce:Radish
DetailsRadishLettuce	Lettuce:Radish
VenueRadishLettuce	Lettuce:Radish
IfEatenLeafLettuce	Lettuce:Any other leaf lettuce
SpecifyLeafLettuce	Lettuce:Any other leaf lettuce
DetailsLeafLettuce	Lettuce:Any other leaf lettuce
VenueLeafLettuce	Lettuce:Any other leaf lettuce
IfEatenPackedLeafy	Other prepackaged leafy green
SpecifyPackedLeafy	Other prepackaged leafy green
DetailsPackedLeafy	Other prepackaged leafy green
VenuePackedLeafy	Other prepackaged leafy green
IfEatenSalad	Premade green salad
DetailsSalad	Premade green salad
VenueSalad	Premade green salad
IfEatenProduce	Other produce
SpecifyProduce	Other produce
DetailsProduce	Other produce
VenueProduce	Other produce
SproutsOften	SproutsOften
SproutsDeli	SproutsDeli
SproutsGrocery	SproutsGrocery
SproutsOther	SproutsOther
SproutsRestaurant	SproutsRestaurant
VenueSprouts2	VenueSprouts2
VenueSprouts3	VenueSprouts3
VenueSprouts4	VenueSprouts4
DetailsSprouts2	DetailsSprouts2
DetailsSprouts3	DetailsSprouts3
DetailsSprouts4	DetailsSprouts4
DeliCounterSprouts	DeliCounterSprouts
IfEatenFeta	If eaten feta
DetailsFeta	Details feta
RawMilkFeta	Raw milk feta
VenueFeta	Venue feta
IfEatenGoat	If eaten goat
DetailsGoat	Details goat
RawMilkGoat	Raw milk goat
VenueGoat	Venue goat
IfEatenBlue	If eaten blue
DetailsBlue	Details blue
RawMilkBlue	Raw milk blue
VenueBlue	Venue blue
IfEatenBrie	If eaten brie
DetailsBrie	Details brie
RawMilkBrie	Raw milk brie
VenueBrie	Venue brie
IfEatenGouda	If eaten gouda
DetailsGouda	Details gouda
RawMilkGouda	Raw milk gouda
VenueGouda	Gouda
IfEatenShred	IfEatenShred
DetailsShred	DetailsShred
RawMilkShred	RawMilkShred
VenueShred	VenueShred
IfEatenMozz	IfEatenMozz
DetailsMozz	DetailsMozz
RawMilkMozz	RawMilkMozz
VenueMozz	VenueMozz
IfEatenCottage	IfEatenCottage
DetailsCottage	DetailsCottage
RawMilkCottage	RawMilkCottage
VenueCottage	VenueCottage
IfEatenRicotta	IfEatenRicotta
DetailsRicotta	DetailsRicotta
RawMilkRicotta	RawMilkRicotta
VenueRicotta	VenueRicotta
DetailsGourmet	DetailsGourmet
IfEatenGourmet	IfEatenGourmet
RawMilkGourmet	RawMilkGourmet
VenueGourmet	VenueGourmet
IfEatenCheeseDeli	IfEatenCheeseDeli
DetailsCheeseDeli	DetailsCheeseDeli
RawMilkCheeseDeli	RawMilkCheeseDeli
VenueCheeseDeli	VenueCheeseDeli
IfEatenMiddleEast	IfEatenMiddleEast
DetailsMiddleEast	DetailsMiddleEast
RawMilkMiddleEast	RawMilkMiddleEast
VenueMiddleEast	VenueMiddleEast
IfEatenMexican	IfEatenMexican
DetailsMexican	DetailsMexican
RawMilkMexican	RawMilkMexican
VenueMexican	VenueMexican
IfEatenFresco	IfEatenFresco
DetailsFresco	DetailsFresco
RawMilkFresco	RawMilkFresco
VenueFresco	VenueFresco
IfEatenBlanco	IfEatenBlanco
DetailsBlanco	DetailsBlanco
RawMilkBlanco	RawMilkBlanco
VenueBlanco	VenueBlanco
IfEatenCasero	IfEatenCasero
DetailsCasero	DetailsCasero
RawMilkCasero	RawMilkCasero
VenueCasero	VenueCasero
IfEatenCuajada	IfEatenCuajada
DetailsCuajada	DetailsCuajada
RawMilkCuajada	RawMilkCuajada
VenueCuajada	VenueCuajada
IfEatenAsadero	IfEatenAsadero
DetailsAsadero	DetailsAsadero
RawMilkAsadero	RawMilkAsadero
VenueAsadero	VenueAsadero
IfEatenCotija	IfEatenCotija
DetailsCotija	DetailsCotija
RawMilkCotija	RawMilkCotija
VenueCotija	VenueCotija
IfEatenPanella	IfEatenPanella
DetailsPanella	DetailsPanella
RawMilkPanella	RawMilkPanella
VenuePanella	VenuePanella
IfEatenRanchero	IfEatenRanchero
DetailsRanchero	DetailsRanchero
RawMilkRanchero	RawMilkRanchero
VenueRanchero	VenueRanchero
IfEatenRequeson	IfEatenRequeson
DetailsRequeson	DetailsRequeson
RawMilkRequeson	RawMilkRequeson
VenueRequeson	VenueRequeson
IfEatenOaxaca	IfEatenOaxaca
DetailsOaxaca	DetailsOaxaca
RawMilkOaxaca	RawMilkOaxaca
VenueOaxaca	VenueOaxaca
IfEatenOtherMex	IfEatenOtherMex
DetailsOtherMex	DetailsOtherMex
RawMilkOtherMex	RawMilkOtherMex
VenueOtherMex	VenueOtherMex
SpecifyOtherMex	SpecifyOtherMex
IfEatenOtherCheese	IfEatenOtherCheese
DetailsOtherCheese	DetailsOtherCheese
RawMilkOtherCheese	RawMilkOtherCheese
VenueOtherCheese	VenueOtherCheese
SpecifyOtherCheese	SpecifyOtherCheese
IfEatenRawCheese	IfEatenRawCheese
DetailsRawCheese	DetailsRawCheese
RawMilkRawCheese	RawMilkRawCheese
VenueRawCheese	VenueRawCheese
IfEatenCheese	IfEatenCheese
DetailsCheese	DetailsCheese
RawMilkCheese	RawMilkCheese
VenueCheese	VenueCheese
SpecifyCheese	SpecifyCheese
BlueOften	BlueOften
BlueDeli	BlueDeli
BlueGrocery	BlueGrocery
BlueOther	BlueOther
BlueRestaurant	BlueRestaurant
VenueBlue2	VenueBlue2
VenueBlue3	VenueBlue3
VenueBlue4	VenueBlue4
DetailsBlue2	DetailsBlue2
DetailsBlue3	DetailsBlue3
DetailsBlue4	DetailsBlue4
DeliCounterBlue	DeliCounterBlue
IfEatenBrie_Old	IfEatenBrie_Old
Brie_OldOften	Brie_OldOften
Brie_OldDeli	Brie_OldDeli
Brie_OldGrocery	Brie_OldGrocery
Brie_OldOther	Brie_OldOther
Brie_OldRestaurant	Brie_OldRestaurant
VenueBrie_Old1	VenueBrie_Old1
VenueBrie_Old2	VenueBrie_Old2
VenueBrie_Old3	VenueBrie_Old3
VenueBrie_Old4	VenueBrie_Old4
DetailsBrie_Old1	DetailsBrie_Old1
DetailsBrie_Old2	DetailsBrie_Old2
DetailsBrie_Old3	DetailsBrie_Old3
DetailsBrie_Old4	DetailsBrie_Old4
DeliCounterBrie_Old	DeliCounterBrie_Old
IfEatenCamembert	IfEatenCamembert
CamembertOften	CamembertOften
CamembertDeli	CamembertDeli
CamembertGrocery	CamembertGrocery
CamembertOther	CamembertOther
CamembertRestaurant	CamembertRestaurant
VenueCamembert1	VenueCamembert1
VenueCamembert2	VenueCamembert2
VenueCamembert3	VenueCamembert3
VenueCamembert4	VenueCamembert4
DetailsCamembert1	DetailsCamembert1
DetailsCamembert2	DetailsCamembert2
DetailsCamembert3	DetailsCamembert3
DetailsCamembert4	DetailsCamembert4
DeliCounterCamembert	DeliCounterCamembert
IfEatenFarmers	IfEatenFarmers
FarmersOften	FarmersOften
FarmersDeli	FarmersDeli
FarmersGrocery	FarmersGrocery
FarmersOther	FarmersOther
FarmersRestaurant	FarmersRestaurant
VenueFarmers1	VenueFarmers1
VenueFarmers2	VenueFarmers2
VenueFarmers3	VenueFarmers3
VenueFarmers4	VenueFarmers4
DetailsFarmers1	DetailsFarmers1
DetailsFarmers2	DetailsFarmers2
DetailsFarmers3	DetailsFarmers3
DetailsFarmers4	DetailsFarmers4
DeliCounterFarmers	DeliCounterFarmers
FetaOften	If ate feta, how often?
FetaDeli	Was feta purchased from a deli/small market?
FetaGrocery	Was feta purchased from a grocery store?
FetaOther	Was feta purchased at an other venue?
FetaRestaurant	FetaRestaurant
VenueFeta2	VenueFeta2
VenueFeta3	VenueFeta3
VenueFeta4	VenueFeta4
DetailsFeta2	DetailsFeta2
DetailsFeta3	DetailsFeta3
DetailsFeta4	DetailsFeta4
DeliCounterFeta	DeliCounterFeta
GoatOften	If ate goat cheese, how often?
GoatDeli	Was goat cheese purchased at a deli?
GoatGrocery	Was goat cheese purchased at a grocery store?
GoatOther	Was goat cheese purchased at an other venue?
GoatRestaurant	GoatRestaurant
VenueGoat2	VenueGoat2
VenueGoat3	VenueGoat3
VenueGoat4	VenueGoat4
DetailsGoat2	DetailsGoat2
DetailsGoat3	DetailsGoat3
DetailsGoat4	DetailsGoat4
DeliCounterGoat	DeliCounterGoat
MexicanOften	MexicanOften
MexicanDeli	MexicanDeli
MexicanGrocery	MexicanGrocery
MexicanOther	MexicanOther
MexicanRestaurant	MexicanRestaurant
VenueMexican2	VenueMexican2
VenueMexican3	VenueMexican3
VenueMexican4	VenueMexican4
DetailsMexican2	DetailsMexican2
DetailsMexican3	DetailsMexican3
DetailsMexican4	DetailsMexican4
DeliCounterMexican	DeliCounterMexican
OtherCheeseOften	OtherCheeseOften
OtherCheeseDeli	OtherCheeseDeli
OtherCheeseGrocery	OtherCheeseGrocery
OtherCheeseOther	OtherCheeseOther
OtherCheeseRestaurant	OtherCheeseRestaurant
VenueOtherCheese2	VenueOtherCheese2
VenueOtherCheese3	VenueOtherCheese3
VenueOtherCheese4	VenueOtherCheese4
DetailsOtherCheese2	DetailsOtherCheese2
DetailsOtherCheese3	DetailsOtherCheese3
DetailsOtherCheese4	DetailsOtherCheese4
DeliCounterOtherCheese	DeliCounterOtherCheese
RawCheeseOften	RawCheeseOften
RawCheeseDeli	RawCheeseDeli
RawCheeseGrocery	RawCheeseGrocery
RawCheeseOther	RawCheeseOther
RawCheeseRestaurant	RawCheeseRestaurant
VenueRawCheese2	VenueRawCheese2
VenueRawCheese3	VenueRawCheese3
VenueRawCheese4	VenueRawCheese4
DetailsRawCheese2	DetailsRawCheese2
DetailsRawCheese3	DetailsRawCheese3
DetailsRawCheese4	DetailsRawCheese4
DeliCounterRawCheese	DeliCounterRawCheese
IfEatenMilk	IfEatenMilk
DetailsMilk	DetailsMilk
VenueMilk	VenueMilk
RawUnpasteurizedMilk	RawUnpasteurizedMilk
IfEatenWholeMilk	IfEatenWholeMilk
DetailsWholeMilk	DetailsWholeMilk
VenueWholeMilk	VenueWholeMilk
IfEaten2Milk	IfEaten2Milk
Details2Milk	Details2Milk
Venue2Milk	Venue2Milk
IfEaten1Milk	IfEaten1Milk
Details1Milk	Details1Milk
Venue1Milk	Venue1Milk
IfEatenSkimMilk	IfEatenSkimMilk
DetailsSkimMilk	DetailsSkimMilk
VenueSkimMilk	VenueSkimMilk
IfEatenOtherMilk	IfEatenOtherMilk
DetailsOtherMIlk	DetailsOtherMIlk
VenueOtherMilk	VenueOtherMilk
SpecifyOtherMilk	SpecifyOtherMilk
IfEatenNonDairyMilk	IfEatenNonDairyMilk
DetailsNonDairyMilk	DetailsNonDairyMilk
VenueNonDairyMilk	VenueNonDairyMilk
SpecifyNonDairyMilk	SpecifyNonDairyMilk
IfEatenFrozenYogurt	IfEatenFrozenYogurt
DetailsFrozenYogurt	DetailsFrozenYogurt
VenueFrozenYogurt	VenueFrozenYogurt
IfEatenYogurt	IfEatenYogurt
RawUnpasteurizedYogurt	RawUnpasteurizedYogurt
SpecifyYogurt	SpecifyYogurt
DetailsYogurt	DetailsYogurt
VenueYogurt	VenueYogurt
IfEatenYogurtDrink	IfEatenYogurtDrink
DetailsYogurtDrink	DetailsYogurtDrink
VenueYogurtDrink	VenueYogurtDrink
IfEatenButter	IfEatenButter
DetailsButter	DetailsButter
VenueButter	VenueButter
IfEatenCream	IfEatenCream
DetailsCream	DetailsCream
VenueCream	VenueCream
IfEatenIceCreamBars	IfEatenIceCreamBars
DetailsIceCreamBars	DetailsIceCreamBars
VenueIceCreamBars	VenueIceCreamBars
IfEatenIceCream	IfEatenIceCream
DetailsIceCream	DetailsIceCream
VenueIceCream	VenueIceCream
SoftServeIceCream	Was any ice cream soft serve?
IfEatenSourCream	IfEatenSourCream
DetailsSourCream	DetailsSourCream
VenueSourCream	VenueSourCream
IfEatenShrimp	IfEatenShrimp
DetailsShrimp	DetailsShrimp
VenueShrimp	VenueShrimp
IfEatenShellfish	IfEatenShellfish
SpecifyShellfish	SpecifyShellfish
DetailsShellfish	DetailsShellfish
VenueShellfish	VenueShellfish
IfEatenFish	IfEatenFish
DetailsFish	DetailsFish
VenueFish	VenueFish
IfEatenRawFish	IfEatenRawFish
DetailsRawFish	DetailsRawFish
VenueRawFish	VenueRawFish
IfEatenSeafood	IfEatenSeafood
DetailsSeafood	DetailsSeafood
VenueSeafood	VenueSeafood
IfEatenHummus	IfEatenHummus
DetailsHummus	DetailsHummus
VenueHummus	VenueHummus
IfEatenSalsa	IfEatenSalsa
DetailsSalsa	DetailsSalsa
VenueSalsa	VenueSalsa
IfEatenGuacamole	IfEatenGuacamole
DetailsGuacamole	DetailsGuacamole
VenueGuacamole	VenueGuacamole
IfEatenDip	IfEatenDip
DetailsDip	DetailsDip
VenueDip	VenueDip
SpecifyDip	SpecifyDip
HummusOften	If at hummus, how often?
HummusDeli	Was hummus purchased from a deli/small market?
HummusGrocery	Was hummus purchased from a grocery store?
HummusOther	Was hummus purchased from an other venue?
HummusRestaurant	HummusRestaurant
VenueHummus2	VenueHummus2
VenueHummus3	VenueHummus3
VenueHummus4	VenueHummus4
DetailsHummus2	DetailsHummus2
DetailsHummus3	DetailsHummus3
DetailsHummus4	DetailsHummus4
DeliCounterHummus	DeliCounterHummus
IfEatenCrab	IfEatenCrab
CrabOften	If ate precooked crab, how often?
CrabDeli	Was crab purchased at a deli/small market?
CrabGrocery	Was crab purchased at a grocery store?
CrabOther	Was crab purchased at an other venue?
CrabRestaurant	CrabRestaurant
VenueCrab	VenueCrab
VenueCrab2	VenueCrab2
VenueCrab3	VenueCrab3
VenueCrab4	VenueCrab4
DetailsCrab	DetailsCrab
DetailsCrab2	DetailsCrab2
DetailsCrab3	DetailsCrab3
DetailsCrab4	DetailsCrab4
DeliCounterCrab	DeliCounterCrab
ShrimpOften	If ate precooked shrimp, how often?
ShrimpDeli	Was shrimp purchased at a deli/small market?
ShrimpGrocery	Was shrimp purchased at a grocery store?
ShrimpOther	Was shrimp purchased at an other venue?
ShrimpRestaurant	ShrimpRestaurant
VenueShrimp2	VenueShrimp2
VenueShrimp3	VenueShrimp3
VenueShrimp4	VenueShrimp4
DetailsShrimp2	DetailsShrimp2
DetailsShrimp3	DetailsShrimp3
DetailsShrimp4	DetailsShrimp4
DeliCounterShrimp	DeliCounterShrimp
FishOften	FishOften
FishDeli	FishDeli
FishGrocery	FishGrocery
FishOther	FishOther
FishRestaurant	FishRestaurant
VenueFish2	VenueFish2
VenueFish3	VenueFish3
VenueFish4	VenueFish4
DetailsFish2	DetailsFish2
DetailsFish3	DetailsFish3
DetailsFish4	DetailsFish4
DeliCounterFish	DeliCounterFish
WholeMilkOften	WholeMilkOften
WholeMilkDeli	WholeMilkDeli
WholeMilkGrocery	WholeMilkGrocery
WholeMilkOther	WholeMilkOther
WholeMilkRestaurant	WholeMilkRestaurant
VenueWholeMilk2	VenueWholeMilk2
VenueWholeMilk3	VenueWholeMilk3
VenueWholeMilk4	VenueWholeMilk4
DetailsWholeMilk2	DetailsWholeMilk2
DetailsWholeMilk3	DetailsWholeMilk3
DetailsWholeMilk4	DetailsWholeMilk4
RawUnpasteurizedWholeMilk	RawUnpasteurizedWholeMilk
_2MilkOften	_2MilkOften
_2MilkDeli	_2MilkDeli
_2MilkGrocery	_2MilkGrocery
_2MilkOther	_2MilkOther
_2MilkRestaurant	_2MilkRestaurant
Venue2Milk2	Venue2Milk2
Venue2Milk3	Venue2Milk3
Venue2Milk4	Venue2Milk4
Details2Milk2	Details2Milk2
Details2Milk3	Details2Milk3
Details2Milk4	Details2Milk4
RawUnpasteurized2Milk	RawUnpasteurized2Milk
_1MilkOften	_1MilkOften
_1MilkDeli	_1MilkDeli
_1MilkGrocery	_1MilkGrocery
_1MilkOther	_1MilkOther
_1MilkRestaurant	_1MilkRestaurant
Venue1Milk2	Venue1Milk2
Venue1Milk3	Venue1Milk3
Venue1Milk4	Venue1Milk4
Details1Milk2	Details1Milk2
Details1Milk3	Details1Milk3
Details1Milk4	Details1Milk4
RawUnpasteurized1Milk	RawUnpasteurized1Milk
SkimMilkOften	If ate skim milk, how often?
SkimMilkDeli	Was skim milk purchased at a deli/small market?
SkimMilkGrocery	Was skim milk purchased at a grocery store?
SkimMilkOther	Was skim milk purchased at an other venue?
SkimMilkRestaurant	SkimMilkRestaurant
VenueSkimMilk2	VenueSkimMilk2
VenueSkimMilk3	VenueSkimMilk3
VenueSkimMilk4	VenueSkimMilk4
DetailsSkimMilk2	DetailsSkimMilk2
DetailsSkimMilk3	DetailsSkimMilk3
DetailsSkimMilk4	DetailsSkimMilk4
RawUnpasteurizedSkimMilk	RawUnpasteurizedSkimMilk
OtherMilkOften	If ate other milk, how often?
OtherMilkDeli	Was other milk purchased at a deli/small market?
OtherMilkGrocery	Was other milk purchased at a grocery store?
OtherMilkOther	Was other milk purchased at an other venue?
OtherMilkRestaurant	OtherMilkRestaurant
VenueOtherMilk2	VenueOtherMilk2
VenueOtherMilk3	VenueOtherMilk3
VenueOtherMilk4	VenueOtherMilk4
DetailsOtherMilk2	DetailsOtherMilk2
DetailsOtherMilk3	DetailsOtherMilk3
DetailsOtherMilk4	DetailsOtherMilk4
RawUnpasteurizedOtherMilk	RawUnpasteurizedOtherMilk
ButterOften	If ate butter, how often?
ButterDeli	Was butter purchased at a deli/small market?
ButterGrocery	Was butter purchased at a grocery store?
ButterOther	Was butter purchased at an other venue?
ButterRestaurant	ButterRestaurant
VenueButter2	VenueButter2
VenueButter3	VenueButter3
VenueButter4	VenueButter4
DetailsButter2	DetailsButter2
DetailsButter3	DetailsButter3
DetailsButter4	DetailsButter4
CreamOften	If ate cream, how often?
CreamDeli	Was cream purchased at a deli/small market?
CreamGrocery	Was cream purchased at a grocery store?
CreamOther	Was cream purchased at an other venue?
CreamRestaurant	CreamRestaurant
VenueCream2	VenueCream2
VenueCream3	VenueCream3
VenueCream4	VenueCream4
DetailsCream2	DetailsCream2
DetailsCream3	DetailsCream3
DetailsCream4	DetailsCream4
IceCreamOften	If ate ice cream, how often?
IceCreamDeli	IceCreamDeli
IceCreamGrocery	Was ice cream purchased at a grocery store?
IceCreamOther	Was ice cream purchased at an other venue?
IceCreamRestaurant	IceCreamRestaurant
VenueIceCream2	VenueIceCream2
VenueIceCream3	VenueIceCream3
VenueIceCream4	VenueIceCream4
DetailsIceCream2	DetailsIceCream2
DetailsIceCream3	DetailsIceCream3
DetailsIceCream4	DetailsIceCream4
SourCreamOften	If ate sour cream, how often?
SourCreamDeli	Was sour cream purchased at a deli/small market?
SourCreamGrocery	Was sour cream purchased at a grocery store?
SourCreamOther	Was sour cream purchased at an other venue?
SourCreamRestaurant	SourCreamRestaurant
VenueSourCream2	VenueSourCream2
VenueSourCream3	VenueSourCream3
VenueSourCream4	VenueSourCream4
DetailsSourCream2	DetailsSourCream2
DetailsSourCream3	DetailsSourCream3
DetailsSourCream4	DetailsSourCream4
YogurtOften	If ate yogurt, how often?
YogurtDeli	Was yogurt purchased at a deli/small market?
YogurtGrocery	Was yogurt purchased at a grocery store?
YogurtOther	Was yogurt purchased at an other venue?
YogurtRestaurant	YogurtRestaurant
VenueYogurt2	VenueYogurt2
VenueYogurt3	VenueYogurt3
VenueYogurt4	VenueYogurt4
DetailsYogurt2	DetailsYogurt2
DetailsYogurt3	DetailsYogurt3
DetailsYogurt4	DetailsYogurt4
IfEatenPotato	IfEatenPotato
DeliCounterPotato	DeliCounterPotato
DetailsPotato	DetailsPotato
VenuePotato	VenuePotato
IfEatenPasta	IfEatenPasta
DeliCounterPasta	DeliCounterPasta
DetailsPasta	DetailsPasta
VenuePasta	VenuePasta
IfEatenEgg	IfEatenEgg
DeliCounterEgg	DeliCounterEgg
DetailsEgg	DetailsEgg
VenueEgg	VenueEgg
IfEatenTuna	IfEatenTuna
DeliCounterTuna	DeliCounterTuna
DetailsTuna	DetailsTuna
VenueTuna	VenueTuna
IfEatenChickenSalad	IfEatenChickenSalad
DeliCounterChickenSalad	DeliCounterChickenSalad
DetailsChickenSalad	DetailsChickenSalad
VenueChickenSalad	VenueChickenSalad
IfEatenBeanSalad	IfEatenBeanSalad
DeliCounterBeanSalad	DeliCounterBeanSalad
DetailsBeanSalad	DetailsBeanSalad
VenueBeanSalad	VenueBeanSalad
IfEatenSeafoodSalad	IfEatenSeafoodSalad
DeliCounterSeafoodSalad	DeliCounterSeafoodSalad
DetailsSeafoodSalad	DetailsSeafoodSalad
VenueSeafoodSalad	VenueSeafoodSalad
IfEatenColeSlaw	IfEatenColeSlaw
DeliCounterColeSlaw	DeliCounterColeSlaw
DetailsColeSlaw	DetailsColeSlaw
VenueColeSlaw	VenueColeSlaw
IfEatenOtherRTESalad	Other ready to eat meat or vegetable salad
DeliCounterOtherRTESalad	Other ready to eat meat or vegetable salad: Other
DetailsOtherRTESalad	Other ready to eat meat or vegetable salad: Details
VenueOtherRTESalad	Other ready to eat meat or vegetable salad: Venue
IfEatenSaladBar	IfEatenSaladBar
DetailsSaladBar	DetailsSaladBar
VenueSaladBar	VenueSaladBar
IfEatenSmoothie	IfEatenSmoothie
DetailsSmoothie	DetailsSmoothie
VenueSmoothie	VenueSmoothie
IfEatenTahini	IfEatenTahini
DetailsTahini	DetailsTahini
VenueTahini	VenueTahini
IfEatenTofu	IfEatenTofu
DetailsTofu	DetailsTofu
VenueTofu	VenueTofu
IfEatenRiceNoodle	IfEatenRiceNoodle
DetailsRiceNoodle	DetailsRiceNoodle
VenueRiceNoodle	VenueRiceNoodle
IfEatenSandwich	IfEatenSandwich
DetailsSandwich	DetailsSandwich
VenueSandwich	VenueSandwich
IfEatenNutButter	IfEatenNutButter
DetailsNutButter	DetailsNutButter
VenueNutButter	VenueNutButter
IfEatenNuts	IfEatenNuts
DetailsNuts	DetailsNuts
VenueNuts	VenueNuts
IfEatenSeeds	IfEatenSeeds
DetailsSeeds	DetailsSeeds
VenueSeeds	VenueSeeds
IfEatenOtherCountry	IfEatenOtherCountry
DetailsOtherCountry	DetailsOtherCountry
VenueOtherCountry	VenueOtherCountry
BeanSaladOften	BeanSaladOften
BeanSaladDeli	BeanSaladDeli
BeanSaladGrocery	BeanSaladGrocery
BeanSaladOther	BeanSaladOther
BeanSaladRestaurant	BeanSaladRestaurant
VenueBeanSalad2	VenueBeanSalad2
VenueBeanSalad3	VenueBeanSalad3
VenueBeanSalad4	VenueBeanSalad4
DetailsBeanSalad2	DetailsBeanSalad2
DetailsBeanSalad3	DetailsBeanSalad3
DetailsBeanSalad4	DetailsBeanSalad4
ColeSlawOften	ColeSlawOften
ColeSlawDeli	ColeSlawDeli
ColeSlawGrocery	ColeSlawGrocery
ColeSlawOther	ColeSlawOther
ColeSlawRestaurant	ColeSlawRestaurant
VenueColeSlaw2	VenueColeSlaw2
VenueColeSlaw3	VenueColeSlaw3
VenueColeSlaw4	VenueColeSlaw4
DetailsColeSlaw2	DetailsColeSlaw2
DetailsColeSlaw3	DetailsColeSlaw3
DetailsColeSlaw4	DetailsColeSlaw4
OtherRTESaladSpecify	OtherRTESaladSpecify
OtherRTESaladOften	OtherRTESaladOften
OtherRTESaladDeli	OtherRTESaladDeli
OtherRTESaladGrocery	OtherRTESaladGrocery
OtherRTESaladOther	OtherRTESaladOther
OtherRTESaladRestaurant	OtherRTESaladRestaurant
VenueOtherRTESalad2	VenueOtherRTESalad2
VenueOtherRTESalad3	VenueOtherRTESalad3
VenueOtherRTESalad4	VenueOtherRTESalad4
DetailsOtherRTESalad2	DetailsOtherRTESalad2
DetailsOtherRTESalad3	DetailsOtherRTESalad3
DetailsOtherRTESalad4	DetailsOtherRTESalad4
PastaOften	If at pasta salad, how often?
PastaDeli	Was pasta salad purchased from a deli/small market?
PastaGrocery	Was pasta salad purchased from a grocery store?
PastaOther	Was pasta salad purchased from an other venue?
PastaRestaurant	PastaRestaurant
VenuePasta2	VenuePasta2
VenuePasta3	VenuePasta3
VenuePasta4	VenuePasta4
DetailsPasta2	DetailsPasta2
DetailsPasta3	DetailsPasta3
DetailsPasta4	DetailsPasta4
PotatoOften	If ate potato salad, how often?
PotatoDeli	Was potato salad purchased from a deli/small market?
PotatoGrocery	Was potato salad purchased from a grocery store?
PotatoOther	Was potato salad purchased at an other venue?
PotatoRestaurant	PotatoRestaurant
VenuePotato2	VenuePotato2
VenuePotato3	VenuePotato3
VenuePotato4	VenuePotato4
DetailsPotato2	DetailsPotato2
DetailsPotato3	DetailsPotato3
DetailsPotato4	DetailsPotato4
SeafoodSaladOften	SeafoodSaladOften
SeafoodSaladDeli	SeafoodSaladDeli
SeafoodSaladGrocery	SeafoodSaladGrocery
SeafoodSaladOther	SeafoodSaladOther
SeafoodSaladRestaurant	SeafoodSaladRestaurant
VenueSeafoodSalad2	VenueSeafoodSalad2
VenueSeafoodSalad3	VenueSeafoodSalad3
VenueSeafoodSalad4	VenueSeafoodSalad4
DetailsSeafoodSalad2	DetailsSeafoodSalad2
DetailsSeafoodSalad3	DetailsSeafoodSalad3
DetailsSeafoodSalad4	DetailsSeafoodSalad4
TunaOften	If ate tuna salad, how often?
TunaDeli	Was tuna salad purchase from a deli/small market?
TunaGrocery	Was tuna salad purchase from a grocery store?
TunaOther	Was tuna salad purchase from an other venue?
TunaRestaurant	TunaRestaurant
VenueTuna2	VenueTuna2
VenueTuna3	VenueTuna3
VenueTuna4	VenueTuna4
DetailsTuna2	DetailsTuna2
DetailsTuna3	DetailsTuna3
DetailsTuna4	DetailsTuna4
IfEatenApples	IfEatenApples
FruitStateApple	FruitStateApple
PreSlicedApple	PreSlicedApple
VenueApple	VenueApple
DetailsApple	DetailsApple
IfEatenCarApple	IfEatenCarApple
DetailsCarApple	DetailsCarApple
VenueCarApple	VenueCarApple
IfEatenGrape	IfEatenGrape
DetailsGrape	DetailsGrape
VenueGrape	VenueGrape
IfEatenRaisin	IfEatenRaisin
DetailsRaisin	DetailsRaisin
VenueRaisin	VenueRaisin
IfEatenPear	IfEatenPear
FruitStatePear	FruitStatePear
DetailsPear	DetailsPear
VenuePear	VenuePear
IfEatenPeach	IfEatenPeach
DetailsPeach	DetailsPeach
FruitStatePeach	FruitStatePeach
VenuePeach	VenuePeach
IfEatenNectarine	IfEatenNectarine
FruitStateNectarine	FruitStateNectarine
DetailsNectarine	DetailsNectarine
VenueNectarine	VenueNectarine
IfEatenApricot	IfEatenApricot
FruitStateApricot	FruitStateApricot
DetailsApricot	DetailsApricot
VenueApricot	VenueApricot
IfEatenPlum	IfEatenPlum
DetailsPlum	DetailsPlum
FruitStatePlum	FruitStatePlum
VenuePlum	VenuePlum
IfEatenStrawberry	IfEatenStrawberry
DetailsStrawberry	DetailsStrawberry
FruitStateStrawberry	FruitStateStrawberry
VenueStrawberry	VenueStrawberry
IfEatenRaspberry	IfEatenRaspberry
DetailsRaspberry	DetailsRaspberry
FruitStateRaspberry	FruitStateRaspberry
VenueRaspberry	VenueRaspberry
IfEatenBlueberry	IfEatenBlueberry
FruitStateBlueberry	FruitStateBlueberry
DetailsBlueberry	DetailsBlueberry
VenueBlueberry	VenueBlueberry
IfEatenBlackberry	IfEatenBlackberry
FruitStateBlackberry	FruitStateBlackberry
DetailsBlackberry	DetailsBlackberry
VenueBlackberry	VenueBlackberry
IfEatenCherry	IfEatenCherry
FruitStateCherry	FruitStateCherry
DetailsCherry	DetailsCherry
VenueCherry	VenueCherry
IfEatenHoneydew	IfEatenHoneydew
DetailsHondeydew	DetailsHondeydew
PreSlicedHoneydew	PreSlicedHoneydew
VenueHoneydew	VenueHoneydew
IfEatenCantaloupe	IfEatenCantaloupe
PreSlicedCantaloupe	PreSlicedCantaloupe
DetailsCantaloupe	DetailsCantaloupe
VenueCantaloupe	VenueCantaloupe
IfEatenWatermelon	IfEatenWatermelon
PreSlicedWatermelon	PreSlicedWatermelon
DetailsWatermelon	DetailsWatermelon
VenueWatermelon	VenueWatermelon
IfEatenPineapple	IfEatenPineapple
PreSlicedPineapple	PreSlicedPineapple
DetailsPineapple	DetailsPineapple
VenuePineapple	VenuePineapple
IfEatenMango	IfEatenMango
PreSlicedMango	PreSlicedMango
FruitStateMango	FruitStateMango
DetailsMango	DetailsMango
VenueMango	VenueMango
IfEatenPapaya	IfEatenPapaya
FruitStatePapaya	FruitStatePapaya
DetailsPapaya	DetailsPapaya
VenuePapaya	VenuePapaya
IfEatenAvocado	IfEatenAvocado
DetailsAvocado	DetailsAvocado
VenueAvocado	VenueAvocado
FruitStateAvocado	FruitStateAvocado
IfEatenFruitSalad	IfEatenFruitSalad
DetailsFruitSalad	DetailsFruitSalad
VenueFruitSalad	VenueFruitSalad
IfEatenOtherFruit	IfEatenOtherFruit
SpecifyOtherFruit	SpecifyOtherFruit
FruitStateOtherFruit	FruitStateOtherFruit
DetailsOtherFruit	DetailsOtherFruit
VenueOtherFruit	VenueOtherFruit
IfEatenSorbet	IfEatenSorbet
DetailsSorbet	DetailsSorbet
VenueSorbet	VenueSorbet
IfEatenZoo	Spent time at a petting zoo
DetailsZoo	Spent time at a petting zoo: Details
VenueZoo	Spent time at a petting zoo: Venue
IfEatenPetFood	Fed cat or dog raw pet food
DetailsPetFood	Fed cat or dog raw pet food: Details
VenuePetFood	Fed cat or dog raw pet food: Venue
IfEatenPetTreats	Fed cat or dog refrigerated, frozen, or freeze-dried treats
DetailsPetTreats	Fed cat or dog refrigerated, frozen, or freeze-dried treats: Venue
VenuePetTreats	Fed cat or dog refrigerated, frozen, or freeze-dried treats: Details
FruitSaladOften	FruitSaladOften
FruitSaladDeli	FruitSaladDeli
FruitSaladGrocery	FruitSaladGrocery
FruitSaladOther	FruitSaladOther
FruitSaladRestaurant	FruitSaladRestaurant
VenueFruitSalad2	VenueFruitSalad2
VenueFruitSalad3	VenueFruitSalad3
VenueFruitSalad4	VenueFruitSalad4
DetailsFruitSalad2	DetailsFruitSalad2
DetailsFruitSalad3	DetailsFruitSalad3
DetailsFruitSalad4	DetailsFruitSalad4
DeliCounterFruitSalad	DeliCounterFruitSalad
CantaloupeOften	CantaloupeOften
CantaloupeDeli	CantaloupeDeli
CantaloupeGrocery	CantaloupeGrocery
CantaloupeOther	CantaloupeOther
CantaloupeRestaurant	CantaloupeRestaurant
VenueCantaloupe2	VenueCantaloupe2
VenueCantaloupe3	VenueCantaloupe3
VenueCantaloupe4	VenueCantaloupe4
DetailsCantaloupe2	DetailsCantaloupe2
DetailsCantaloupe3	DetailsCantaloupe3
DetailsCantaloupe4	DetailsCantaloupe4
HoneydewOften	If ate honeydew, how often?
HoneydewDeli	Was honeydew purchased at a deli/small market?
HoneydewGrocery	Was honeydew purchased at a grocery store?
HoneydewOther	Was honeydew purchased at an other venue?
HoneydewRestaurant	HoneydewRestaurant
VenueHoneydew2	VenueHoneydew2
VenueHoneydew3	VenueHoneydew3
VenueHoneydew4	VenueHoneydew4
DetailsHoneydew2	DetailsHoneydew2
DetailsHoneydew3	DetailsHoneydew3
DetailsHoneydew4	DetailsHoneydew4
WatermelonOften	WatermelonOften
WatermelonDeli	WatermelonDeli
WatermelonGrocery	WatermelonGrocery
WatermelonOther	WatermelonOther
WatermelonRestaurant	WatermelonRestaurant
VenueWatermelon2	VenueWatermelon2
VenueWatermelon3	VenueWatermelon3
VenueWatermelon4	VenueWatermelon4
DetailsWatermelon2	DetailsWatermelon2
DetailsWatermelon3	DetailsWatermelon3
DetailsWatermelon4	DetailsWatermelon4

---

Sheet 29: Latent TB Infection

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
TB State Case Number	State case number for the case specific to TB investigations (4 digit report year + 2 letter state + 9 digit alphanumeric number)	N/A	P
City or County Case Number	City or county case number assigned to this case	N/A	P
Birth Sex	What was the patient's sex at birth?	PHVS_Sex_MFU	P
Previously Counted Case	Has this case already been counted by another reporting area?	PHVS_CaseCountStatus_TB	P
Previously Reported State Case Number	If case previously counted, provide the state case number from the other reporting area.	N/A	P
Country of Verified Case	If the case was previously reported by another country, specify the country.	PHVS_BirthCountry_CDC	P
Patient Address City	Patient address city	N/A	P
Inside City Limits	Is the patient's residence within city limits?	PHVS_YesNoUnknown_CDC	P
Census Tract of Case-Patient Residence	Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area.	N/A	P
Detailed Race	Provide the detailed race information for the patient.	PHVS_Race_CDC	P
Date Arrived in US	If country of birth is NOT United States, regardless of citizenship, indicate the date when the patient first arrived in the US.	N/A	P
US Born	Was the patient eligible for US citizenship at birth?	PHVS_YesNoUnknown_CDC	P
Primary Guardian(s) Country of Birth	Indicates the birth country of the primary guardian(s) of patient (pediatric [<15 years old] cases only)	PHVS_BirthCountry_CDC	P
Remain in US After Report	If not US reporting area, did patient remain in the United States for >= 90 days after report date?	PHVS_YesNoUnknown_CDC	P
Initial Reason for Evaluation	What was the initial reason the patient was evaluated for TB?	PHVS_PrimaryReasonForEvaluation_TB	P
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case. Please provide a response for each of the main test types (culture, smear, pathology/cytology, NAA, TST, IGRA, HIV, diabetes) If test was not done please indicate so.	PHVS_LabTestType_TB	P
Test Result	Epidemiologic interpretation of the results of the test(s) performed for this case - This is a qualitative test result. (e.g., positive, detected, negative)	PHVS_LabTestInterpretation_TB	P
Date/Time of Lab Result	Date result sent from reporting laboratory. Time of result is an optional addition to date.	N/A	P
Specimen Source Site	This indicates the anatomical source of the specimen tested.	PHVS_MicroscopicExamCultureSite_TB	P
Specimen Collection Date/Time	Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection is an optional addition to date.	N/A	P
Test Result Quantitative	Quantitative test result value	N/A	P
Result Units	Units of measure for the Quantitative Test Result Value	PHVS_UnitofMeasure_TB	P
Type of Chest Study	Indicate the type of chest study performed. Please provide a response for each of the main test types (plain chest radiograph, chest CT Scan) and if test was not done please indicate so.	PHVS_TypeofRadiologyStudy_CDC	P
Result of Chest Study	Result of chest diagnostic testing	PHVS_ResultofRadiologyStudy_TB	P
Evidence of Cavity	Did test show evidence of cavity?	PHVS_YesNoUnknown_CDC	P
Evidence of Miliary TB	Did test show evidence of miliary TB?	PHVS_YesNoUnknown_CDC	P
Date of Chest Study	Date of the chest diagnostic study	N/A	P
Current Occupation	This data element is used to capture the narrative text of a subject's current occupation.	N/A	P
Current Occupation Standardized	This data element is used to capture the CDC NIOSH standard occupation code based upon the narrative text of a subject's current occupation. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes. The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here: http://www.cdc.gov/niosh/topics/coding/overview.html	PHVS_Occupation_CDC_Census2010	P
Current Industry	This data element is used to capture the narrative text of subject's current industry.	N/A	P
Current Industry Standardized	This data element is used to capture the CDC NIOSH standard industry code based upon the narrative text of a subject's current industry. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes. The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here: http://www.cdc.gov/niosh/topics/coding/overview.html	PHVS_Industry_CDC_Census2010	P
Patient Epidemiological Risk Factors	Exposed risk factors for the patient - Please provide a response for all risk factors in the value set with an associated indicator	PHVS_EpidemiologicalRiskFactors_TB	P
Patient Epidemiological Risk Factors Indicator	Provide a response for each value in the patient epidemiological risk factors value set	PHVS_YesNoUnknown_CDC	P
Type of Correctional Facility	If patient was a Resident of Correctional Facility at Diagnostic Evaluation, indicate the type of correctional facility.	PHVS_CorrectionalFacilityType_NND	P
Type of Long-Term Care Facility	If patient was a Resident of Long Term Care Facility at Diagnostic Evaluation, indicate the type of long term care facility.	PHVS_LongTermCareFacilityType_NND	P
Smoking Status	What is the patient's current tobacco smoking status?	PHVS_SmokingStatus_CDC	P
Patient lived outside of US for more than 2 months	Residence or Travel in countries other than the United States, Canada, Australia, New Zealand, or countries in northern or western Europe for >60 consecutive days at any point in the patient's lifetime.	PHVS_YesNoUnknown_CDC	P
Identified During Contact Investigation	Was the patient identified during the contact investigation around the likely source case?	PHVS_YesNoUnknown_CDC	P
Evaluation During Contact Investigation	If patient was identified during contact investigation, was the patient evaluated for TB during the contact investigation?	PHVS_YesNoUnknown_CDC	P
Linked Case Number	State case numbers for epidemiologically linked cases	N/A	P
Date Treatment or Therapy Started	Date the initial treatment regimen was started	N/A	P
Treatment Administration Type	Choose all treatment administration types that apply to the case, such as DOT, eDOT, or SAT.	PHVS_TreatmentAdministrationType_TB	P
Date Treatment or Therapy Stopped	Date treatment stopped	N/A	P
Treatment Started	Was treatment started for LTBI?	PHVS_YesNoUnknown_CDC	P
Initial LTBI Drug Regimen	If treatment was started indicate the initial LTBI drug regimen.	PHVS_LTBIDrugRegimen_TB	P
Primary Reason LTBI Treatment Not Started	If treatment was not started, what was the primary reason LTBI treatment was not started?	PHVS_ReasonLTBINotStarted_TB	P
Reason LTBI Treatment Stopped	Reason LTBI treatment stopped	PHVS_ReasonLTBITreatmentStopped_TB	P
NTSS State Case Number	If patient developed TB from LTBI, list the NTSS state case number	N/A	P
Adverse Event Severity	If treatment was stopped due to adverse event from LTBI treatment indicate the severity.	PHVS_AdverseEventSeverity_TB	P
Usual Occupation and Industry	Usual occupation and industry	TBD	P
Meets Binational Reporting Criteria	Does case meet binational reporting criteria?	PHVS_YesNoUnknown_CDC	P

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Sheet 30: Lyme

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Erythema Migrans	Indicates whether the patient had erythema migrans (physician diagnosed EM at least 5 cm in diameter).	PHVS_YesNoUnknown_CDC
Swelling	Indicates whether the patient had arthritis characterized by brief attacks of joint swelling.	PHVS_YesNoUnknown_CDC
Bell’s Palsy or other cranial neuritis	Indicates whether the patient had Bell's palsy or other cranial neuritis.	PHVS_YesNoUnknown_CDC
Radiculoneuropathy	Indicates whether the patient had radiculoneuropathy.	PHVS_YesNoUnknown_CDC
Lymphocytic meningitis	Indicates whether the patient had lymphocytic meningitis.	PHVS_YesNoUnknown_CDC
Encephalitis/Encephalomyelitis	Indicates whether the patient had encephalitis/encephalomyelitis.	PHVS_YesNoUnknown_CDC
2nd or 3rd degree atrioventricular block	Indicates whether the patient had 2nd or 3rd degree atrioventricular block.	PHVS_YesNoUnknown_CDC
OtherSpeci	Name of another laboratory test performed	TEXT
Results	Result of other specific laboratory tests performed	P/N/E/ND/U
EIA_IFA test type	Type of EIA performed	Whole cell antigen EIA/ELISA/ELFA; Defined antigen EIA/ELISA/ELFA;Antigen capture EIA/ELISA/ELFA; IFA; Unknown; Other; not done
EIA_IFA test result	Result of EIA	IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done
Immunoblot result	Result of immunblot	IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done
IgM_21kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgM_39kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgM_41kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_18kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_21kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_28kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_30kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_39kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_41kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_45kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_58kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_66kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
IgG_93kDa	Immunoblot specific test result; linked to laboratory criteria	positive; negative; unknown; not done
Exposure in high incidence state	Did patient live in or visit a state defined as high incidence within 30 days prior to onset of symptoms?	PHVS_YesNoUnknown_CDC	P
Symptom onset greater than 30 days	Did onset of symptoms occur more than 30 days prior to diagnosis?	PHVS_YesNoUnknown_CDC	P
Clinical Manifestation	Clinical manifestation of Lyme disease	PHVS_ClinicalManifestations_Lyme	P
Clinical Manifestation Indicator	For each clinical manifestation reported, indicate whether the subject developed the specified manifestation as a result of the illness.	PHVS_YesNoUnknown_CDC	P
Medication Administered	What antibiotic did the patient receive for this episode?	PHVS_MedicationReceived_Lyme	P
Date Treatment or Therapy Started	Date the treatment or therapy was initiated	N/A	P
Treatment Duration	Number of days the patient actually took the antibiotic referenced	N/A	P

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Sheet 31: Malaria

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Height	Subject's height
Height Units	Subject's height units	PHVS_HeightUnit_UCUM
Weight	Subject's weight
Weight Units	Subject's weight units	PHVS_WeightUnit_UCUM
Hospital Name	Name of hospital where case was admitted	free text
Hospital Record Number	Hospital Record Number, if subject was hospitalized
Patient last name	Patient's last name	free text
Patient first name	Patient's first name	free text
Physician last name	Last name of physician seen for this case	free text
Physician first name	First name of physician seen for this case	free text
Physician phone number	Phone number of the physician seen for this case
Laboratory Name	Reporting Laboratory Name
Laboratory Phone Number	Reporting Laboratory Phone Number
Specimen(s) sent to CDC?	Was specimen sent to CDC for Malaria confirmation?	PHVS_YesNoUnknown_CDC
Specimen Type(s) sent to CDC	Type(s) of specimen sent to CDC.	PHVS_SpecimenType_Malaria
Description of other specimen type	Description of the other type of specimen sent to CDC	free text
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case.	PHVS_LabTestProcedure_Malaria
Organism Name	Species identified through testing.	PHVS_Species_Malaria
Description of other organism	Description of the other organism tested positive for	free text
Parasitemia Level Percentage	The estimated number of infected erythrocytes expressed as a percentage of the total erythrocytes.
Subject Traveled or Lived Outside U.S.	Has the subject traveled or lived outside the U.S. during the past two years?	PHVS_YesNoUnknown_CDC
Subject Reside in U.S. prior to most recent travel	Did the subject reside in the U.S. prior to most recent travel?	PHVS_YesNoUnknown_CDC
Subject's Country of Residence prior to most recent travel	If the subject did not reside in the U.S. prior to most recent travel, what was the country of residence?	PHVS_Country_ISO_3166-1
Principal reason for Travel	If the subject did not reside in the U.S. prior to most recent travel, what was the country of residence?	PHVS_TravelReason_Malaria
Description of other reason for travel	Description of the other reason for travel from/to the US	free text
International Destination(s) or residence(s) #1	Destination(s) or residence(s) outside the U.S. during the past 2 years	PHVS_Country_ISO_3166-1
Date of return from travel #1	Date the subject returned/arrived to the U.S. from an international destination or residence.
Duration of Stay #1	Duration of stay in country outside the U.S.
Duration of Stay Units #1	Duration of stay units in country outside the U.S.	PHVS_AgeUnit_UCUM
International Destination(s) or residence(s) #2	Destination(s) or residence(s) outside the U.S. during the past 2 years	PHVS_Country_ISO_3166-1
Date of return from travel #2	Date the subject returned/arrived to the U.S. from an international destination or residence.
Duration of Stay #2	Duration of stay in country outside the U.S.
Duration of Stay Units #2	Duration of stay units in country outside the U.S.	PHVS_AgeUnit_UCUM
International Destination(s) or residence(s) #3	Destination(s) or residence(s) outside the U.S. during the past 2 years	PHVS_Country_ISO_3166-1
Date of return from travel #3	Date the subject returned/arrived to the U.S. from an international destination or residence.
Duration of Stay #3	Duration of stay in country outside the U.S.
Duration of Stay Units #3	Duration of stay units in country outside the U.S.	PHVS_AgeUnit_UCUM
Was malaria chemoprophylaxis taken?	Was malaria chemoprophylaxis taken for prevention of malaria?	PHVS_YesNoUnknown_CDC
Preventative Medication(s)	Listing of preventative medication(s) taken by the subject	PHVS_MedicationProphylaxis_Malaria
Description of other malaria chemophophylaxis taken	Description of the other type of malaria chemoprophylaxis taken	free text
Preventative Medication taken as prescribed?	Was all preventative medication taken as prescribed?	PHVS_YesNoUnknown_CDC
If doses were missed, what was the reason?	If doses of preventative medicine were missed, what was the primary reason?	PHVS_MedicationMissedReason_Malaria
Specific side effect that caused missed doses	Desciption of the side effect that was the reason for missing doses of malaria chemoprophylaxis	free text
Description of the Other reason for missing chemophophylaxis doses	Description of the other reason that resulted in missing doses of malaria chemoprophylaxis	free text
History of malaria past 12 months	Does the subject have a previous history of malaria in the last 12 months (prior to this report)?	PHVS_YesNoUnknown_CDC
Date of previous malaria attack	Date of previous malaria attack
Malaria species associated with previous attack	Malaria species associated with previous attack	PHVS_Species_Malaria
Description of other malaria species associated with previous attack	Description of the other malaria species associated with the malaria attack in the past 12 months	free text
Received blood transfusion/organ transplant	Has the subject received a blood transfusion or organ transplant within the last 12 months?	PHVS_YesNoUnknown_CDC
Blood transfusion/organ transplant date	If subject has received a blood transfusion/organ transplant within the last 12 months, what was the date?
Complication(s)	Listing of complications as related to this attack.	PHVS_Complications_Malaria
Other complication(s)	Description of the other clinical complications experienced during this episode/attack of malaria	free text
Treatment Medication(s)	Listing of treatment medication the subject received for this attack.	PHVS_MedicationTreatment_Malaria
Other treatment medication(s)	Description of the other treatment medications received for this attack	free text
Medications pre-treatment	List of all medications taken during the 2 weeks before starting treatment for malaria	free text
Medications post-treatment	List of all medications taken during the 4 weeks after starting treatment for malaria	free text
Malaria treatment taken as prescribed	Was the medicine for malaria treatment taken as prescribed?	PHVS_YesNoUnknown_CDC
Symptoms resolved within 7 days after treatment	Did all signs or symptoms of malaria resolve without any additional malaria treatment within 7 days after starting treatment?	PHVS_YesNoUnknown_CDC
Recurrence of symptoms during 4 weeks after treatment	If signs and symptoms resolved within 7 days after starting treatment, did the patient experience a recurrence of signs or symptoms of malaria during 4 weeks after starting treatment?	PHVS_YesNoUnknown_CDC
Adverse events within 4 weeks after starting treatment	Did the patient experience any adverse events within 4 weeks after receiving the malaria treatment	PHVS_YesNoUnknown_CDC
Adverse Event #1 description	Adverse Event description	free text
Adverse Event #1 relationship to treatment	Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility?	checkbox
Adverse Event #1 time to onset	Time to onset since starting treatment	free text
Adverse Event #1 fatal	Was the adverse event fatal?	checkbox
Adverse Event #1 life-threatening	Was the adverse event life-threatening?	checkbox
Adverse Event #1 other seriousness	Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)?	checkbox
Adverse Event #2 description	Adverse Event description	free text
Adverse Event #2 relationship to treatment	Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility?	checkbox
Adverse Event #2 time to onset	Time to onset since starting treatment	free text
Adverse Event #2 fatal	Was the adverse event fatal?	checkbox
Adverse Event #2 life-threatening	Was the adverse event life-threatening?	checkbox
Adverse Event #2 other seriousness	Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)?	checkbox
Adverse Event #3 description	Adverse Event description	free text
Adverse Event #3 relationship to treatment	Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility?	checkbox
Adverse Event #3 time to onset	Time to onset since starting treatment	free text
Adverse Event #3 fatal	Was the adverse event fatal?	checkbox
Adverse Event #3 life-threatening	Was the adverse event life-threatening?	checkbox
Adverse Event #3 other seriousness	Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)?	checkbox
Adverse Event #4 description	Adverse Event description	free text
Adverse Event #4 relationship to treatment	Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility?	checkbox
Adverse Event #4 time to onset	Time to onset since starting treatment	free text
Adverse Event #4 fatal	Was the adverse event fatal?	checkbox
Adverse Event #4 life-threatening	Was the adverse event life-threatening?	checkbox
Adverse Event #4 other seriousness	Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)?	checkbox
Adverse Event #5 description	Adverse Event description	free text
Adverse Event #5 relationship to treatment	Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility?	checkbox
Adverse Event #5 time to onset	Time to onset since starting treatment	free text
Adverse Event #5 fatal	Was the adverse event fatal?	checkbox
Adverse Event #5 life-threatening	Was the adverse event life-threatening?	checkbox
Adverse Event #5 other seriousness	Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)?	checkbox
CSID	10-digit, de-identified specimen number generated after submission of the 50.34 form for CDC diagnostic assistance (Example data: 3000123456)
Admitted as Inpatient	Was subject admitted to the hospital for greater than 24 hours as an inpatient?	PHVS_YesNoUnknown_CDC	P
Date Treatment or Therapy Started	Date the treatment was initiated	N/A	P
Date Treatment or Therapy Stopped	Date treatment stopped	N/A	P
Treatment Duration	Number of days the patient was prescribed antimalarial treatment	N/A	P
Medication Administered Relative to Treatment	Indicate if the patient took the medication 2 weeks before treatment or within the 4 weeks after starting treatment.	PHVS_MedicationAdministeredRelativeTreatment_Malaria	P
Medication Administered	Please list all prescription and over the counter medicines the patient had taken during the 2 weeks before and during the 4 weeks after starting treatment for malaria. If information for both pre- and post-treatment are available, please complete below questions for each time frame.	N/A	P
Medication Start Date	Medication Start Date	N/A	P
Medication Stop Date	Medication Stop Date	N/A	P
Medication Duration	Number of days that patient took the medication referenced	N/A	P

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Sheet 32: Measles

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the subject have a rash?	Did the subject being reported in this investigation have a rash?	PHVS_YesNoUnknown_CDC
Rash onset date	What was the onset date of the subject's rash?
Rash Duration	How many days did the rash reported in this investigation last?
Was the rash generalized?	Was the rash generalized? (Occurring on more than one or two parts of the body?)	PHVS_YesNoUnknown_CDC
Rash onset occur within 21 days of entering USA	Did rash onset occur within 21 days of entering the USA, following any travel or living outside the USA?	PHVS_YesNoUnknown_CDC
Did the subject have a fever?	Did the subject have a fever? I.E., a measured temperature >2 degrees above normal	PHVS_YesNoUnknown_CDC
Highest Measured Temperature	What was the subject's highest measured temperature during this illness?
Temperature units	The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius.	PHVS_TemperatureUnit_UCUM
Date of fever onset	Date of fever onset
Cough	Did the subject develop a cough during this illness?	PHVS_YesNoUnknown_CDC
Coryza (runny nose)	Did the subject develop coryza (runny nose) during this illness?	PHVS_YesNoUnknown_CDC
Conjunctivitis	Did the subject develop conjunctivitis during this illness?	PHVS_YesNoUnknown_CDC
Otitis Media (Complication)	Did the subject develop otitis media as a complication of this illness?	PHVS_YesNoUnknown_CDC
Diarrhea (Complication)	Did the subject develop diarrhea as a complication of this illness?	PHVS_YesNoUnknown_CDC
Pneumonia (Complication)	Did the subject develop pneumonia as a complication of this illness?	PHVS_YesNoUnknown_CDC
Encephalitis (Complication)	Did the subject develop encephalitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Thrombocytopenia (Complication)	Did the subject develop thrombocytopenia as a complication of this illness?	PHVS_YesNoUnknown_CDC
Croup (Complication)	Did the subject develop croup as a complication of this illness?	PHVS_YesNoUnknown_CDC
Hepatitis (Complication)	Did the subject develop hepatitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Other Complication	Did the subject develop other conditions as a complication of this illness?	PHVS_YesNoUnknown_CDC
Specify Other Complication	Please specify the other complication the subject developed, during or as a result of this illness.
Was laboratory testing done for measles?	Was laboratory testing done to confirm a diagnosis of measles?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case	PHVS_LabTestProcedure_Measles
Test Result	Epidemiologic interpretation of the results of the tests performed for this case.	PHVS_LabTestInterpretation_VPD
Sample Analyzed Date	The date the specimen/isolate was tested.
Test Method	The technique or method used to perform the test and obtain the test results.	PHVS_LabTestMethod_CDC
Date Collected	Date of specimen collection
Specimen Source	The medium from which the specimen originated.	PHVS_SpecimenSource_Measles
Were the specimens sent to CDC for genotyping (molecular typing)?	Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Specimen type sent to CDC for genotyping	Specimen type sent to CDC for genotyping	PHVS_SpecimenSource_Measles
Date sent for genotyping	The date the specimens were sent to the CDC laboratories for genotyping.
Was Measles virus genotype sequenced?	Identifies whether the Measles virus was genotype sequenced.	PHVS_YesNoUnknown_CDC
Type of Genotype Sequence	Identifies the genotype sequence of the Measles virus	PHVS_Genotype_Measles
Transmission Setting	What was the transmission setting where the measles was acquired?	PHVS_TransmissionSetting_NND
Source of Infection	What was the source of the measles infection?
Were age and setting verified?	Does the age of the case match or make sense for the transmission setting listed (i.e. A subject aged 80 probably would not have a transmission setting of child day care center.)?	PHVS_YesNoUnknown_CDC
Is this case Epi-linked to another confirmed or probable case?	Specify if this case is Epidemiologically-linked to another confirmed or probable case of measles?	PHVS_YesNoUnknown_CDC
Is this case linked to an international imported case either directly or within same chain of transmission?	A "Yes" answer to this question denotes this case was infected by another subject who acquired infection while outside of the U.S.	PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel	List any international destinations of recent travel	PHVS_Country_ISO_3166-1
Date of return from travel.	Date the subject returned from all travel
Did the subject ever receive a disease-containing vaccine?	Did the subject ever receive a measles-containing vaccine?	PHVS_YesNoUnknown_CDC
If no, reason subject did not receive a disease-containing vaccine	If the subject did not receive a measles-containing vaccine, what was the reason?	PHVS_VaccineNotGivenReasons_CDC
Number of doses received BEFORE first birthday	The number of doses of measles-containing vaccine the subject received before their first birthday.
Number of doses received ON or AFTER first birthday	The number of measles-containing vaccine doses the subject received on or after their first birthday.
Reason for vaccinating before first (1st) birthday but not after	If the subject was vaccinated with measles-containing vaccine BEFORE the first birthday, but did not receive a vaccine dose after their first birthday, state the reason.	PHVS_VaccineNotGivenReasons_CDC
Reason subject received one dose ON or AFTER first birthday, but never received a second dose after the first (1st) birthday	If the subject 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?	PHVS_VaccineNotGivenReasons_CDC
Total doses disease-containing vaccine	Total doses measles-containing vaccine
Vaccine Administered	The type of vaccine administered	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered
Vaccine Administered Date	The date that the vaccine was administered
US Acquired	Sub-classification of disease or condition acquired in the US	PHVS_CaseClassificationExposureSource_NND
Age at Rash Onset	Age of patient at rash onset
Age Type at rash Onset	Age units of patient at rash onset
Chest x-ray for pneumonia	Was a chest x-ray for pneumonia done?
Case Patient a Healthcare Worker	Was the case patient a healthcare provider (HCP) at illness onset?
Import Status	Was this case imported?
Vaccination Doses Prior to Illness Onset	Number of vaccine doses against this disease prior to illness onset
Date of Last Dose Prior to Illness Onset	Date of last vaccine dose against this disease prior to illness onset
Vaccine History Comments	Comments about the subject's vaccination history

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Sheet 33: Melioidosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
State Case ID	States use this field to link NEDSS investigations back to their own state investigations.
Date of First Report to CDC	Date the case was first reported to the CDC
Notification Result Status	Status of the notification.	PHVS_ResultStatus_NETSS
Condition Code	Condition or event that constitutes the reason the notification is being sent	PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
MMWR Week	MMWR Week for which case information is to be counted for MMWR publication.
MMWR Year	MMWR Year (YYYY) for which case information is to be counted for MMWR publication.
Reporting State	State reporting the notification.	PHVS_State_FIPS_5-2
Reporting County	County reporting the notification.	PHVS_County_FIPS_6-4
National Reporting Jurisdiction	National jurisdiction reporting the notification to CDC.	PHVS_NationalReportingJurisdiction_NND
Reporting Source Type Code	Type of facility or provider associated with the source of information sent to Public Health.	PHVS_ReportingSourceType_NND
Reporting Source ZIP Code	ZIP Code of the reporting source for this case.
Date First Reported PHD	Earliest date the case was reported to the public health department whether at the local, county, or state public health level.
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Title	Job title / description of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Affiliation	Affiliated Facility of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Subject Address State	State of residence of the subject	PHVS_State_FIPS_5-2
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Country of Birth	Country of Birth	PHVS_CountryofBirth_CDC
Time in U.S.	Length of time this subject has been living in the U.S. (if born out of the U.S.
Date entered U.S.	Date entered U.S. in YYYYMM format (if born out of the U.S.)
Travel or Live Outside U.S.	Did the subject travel or live outside the U.S.A.?	PHVS_YesNoUnknown_CDC
Country of Exposure or Country Where Disease was Acquired Note: use exposure or acquired consistently across variables	Indicates the country in which the disease was potentially acquired.	PHVS_Country_ISO_3166-1
Subject’s Sex	Subject’s current sex	PHVS_Sex_MFU
Race Category	Field containing one or more codes that broadly refer to the subject’s race(s).	PHVS_RaceCategory_CDC
Ethnic Group Code	Based on the self-identity of the subject as Hispanic or Latino	PHVS_EthnicityGroup_CDC_Unk
Country of Usual Residence	Where does the person usually* live (defined as their residence) *For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf .	PHVS_CountryofBirth_CDC
Earliest Date Reported to County	Earliest date reported to county public health system
Earliest Date Reported to State	Earliest date reported to state public health system
Diagnosis Date	Earliest date of diagnosis (clinical or laboratory) of condition being reported to public health system
Date of Onset of symptoms	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 sample collected	Provide date test was performed in YYYYMM format
Date test performed	Provide date test was performed in YYYYMM format
Type of test utilized to identify case	Indicate the type of test performed to confirm case
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_melioidosis
Hospitalized	Indicate whether subject was or is currently hospitalized due to this illness	PHVS_YesNoUnknown_CDC
Did patient expire?	Indicate whether subject died of this illness	PHVS_YesNoUnknown_CDC
Current antimicrobial Treatment	Indicate all antimicrobial drugs used to treat subject	PHVS_MedicationTreatment_Melioidosis
Date current antimicrobial Treatment	Indicate the date antimicrobial treatment started	PHVS_MedicationTreatment_Date_Melioidosis
Diabetes	Does subject have diabetes?	PHVS_YesNoUnknown_CDC
Chronic renal disease	Does subject have chronic renal disease?	PHVS_YesNoUnknown_CDC
Chronic lung disease	Does subject have chronic lung disease?	PHVS_YesNoUnknown_CDC
Liver disease or chronic alcohol abuse	Does subject have liver disease or chronic alcohol abuse?	PHVS_YesNoUnknown_CDC
Thalassemia	Does subject have thalassemia?	PHVS_YesNoUnknown_CDC
Non HIV-related immune suppression	Does subject have non HIV-related immune suppression?	PHVS_YesNoUnknown_CDC
Military service	Has subject ever served overseas in in the military?	PHVS_YesNoUnknown_CDC
Military service Date	If yes, date of service in YYYYMM format.
Laboratory exposure	Was subject ever exposed to burkolderia through lab work?	PHVS_YesNoUnknown_CDC
Laboratory exposure Date	If yes, date of exposure in YYYYMM format.
Contact with soil or water in melioidosis-endemic areas	Has subject ever been in contact with soil or water in melioidosis-endemic areas?	PHVS_YesNoUnknown_CDC
Contact with soil or water in melioidosis-endemic areas service Date	If yes, date of contact in YYYYMM format.
Contact with someone with the same disease	Did subject have contact with someone diagnosed with melioidosis?	PHVS_YesNoUnknown_CDC
Were you at any recent mass gathering?	Was subject present at any recent mass gathering?	PHVS_YesNoUnknown_CDC

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Sheet 34: Mumps

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the subject have a fever?	Did the subject have a measured temperature greater than two degrees above normal?	PHVS_YesNoUnknown_CDC
Date of Fever Onset	Date of fever onset
Highest Measured Temperature	What was the subject's highest measured temperature during this illness?
Temperature Units	The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius.	PHVS_TemperatureUnit_UCUM
Parotitis (opposite second (2nd) molars)? (Symptom)	Did the subject have parotitis as a symptom of this illness?	PHVS_YesNoUnknown_CDC
Unilateral or Bilateral Parotitis (Symptom)	Indicates if the parotitis is unilateral or bilateral	PHVS_ParotitisLaterality_Mumps
Jaw Pain (Symptom)	Did the subject have jaw pain as a symptom of this illness?	PHVS_YesNoUnknown_CDC
Salivary Gland Swelling Onset Date	Date of subject's salivary gland swelling (including parotitis) onset.
Salivary Gland Swelling Duration	The length of time that the subject exhibited swelling of the salivary gland.
Salivary Gland Swelling Duration Units	The length of time units that the subject exhibited swelling of the salivary gland	PHVS_AgeUnit_UCUM
Submandibular Swelling (Symptom)	Did the subject have submandibular swelling as a symptom of this illness?	PHVS_YesNoUnknown_CDC
Sublingual Swelling (Symptom)	Did the subject have sublingual swelling as a symptom of this illness?	PHVS_YesNoUnknown_CDC
Import Status	Did symptom onset occur within 12-25 days of entering the U.S., following any travel or living outside the U.S.?	PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel	List any international destinations of recent travel	PHVS_Country_ISO_3166-1
Date of return from travel	Date the subject returned from all travel
Encephalitis (Complication)	Did the subject develop encephalitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Meningitis (Complication)	Did the subject develop meningitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Deafness (Complication)	Did the subject become deaf as a complication of this illness?	PHVS_YesNoUnknown_CDC
Type of Deafness	Was the type of deafness permanent or temporary?	PHVS_DeafnessType_Mumps
Orchitis (Complication)	Did the subject develop orchitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Other Complication	Did the subject develop an other condition as a complication of this illness?	PHVS_YesNoUnknown_CDC
Specify Other Complication	Please specify the other complication the subject developed, during or as a result of this illness.
Was laboratory testing done for mumps?	Was laboratory testing done to confirm a diagnosis of mumps?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case.	PHVS_LabTestProcedure_Mumps
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_VPD
Numeric Test Result	Numeric quantitative result of the test(s) performed for this case
Numeric Test Result Units	Numeric quantitative result unit of the test(s) performed for this case	PHVS_UnitsOfMeasure_CDC
Sample Analyzed Date	The date the specimen/isolate was tested.
Test Method	The technique or method used to perform the test and obtain the test results.	PHVS_LabTestMethods_CDC
Date Collected	Date of specimen collection
Specimen Source	The medium from which the specimen originated	PHVS_SpecimenSource_Mumps
Were the specimens sent to CDC for genotyping (molecular typing)?	Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Date sent for genotyping	The date the specimens were sent to the CDC laboratories for genotyping
Transmission Setting	What was the transmission setting where the mumps was acquired?	PHVS_TransmissionSetting_NND
Were Age and Setting Verified?	Does the age of the case match or make sense for the transmission setting listed (e.g., a subject aged 80 probably would not have a transmission setting of child day care center)?	PHVS_YesNoUnknown_CDC
Source of Infection	What was the source of the mumps infection?
Case Class by Source	If this is a case aquired in the U.S., how should the case be classified by source?	PHVS_CaseClassificationExposureSource_NND
Is this Case Epi-Linked to Another Confirmed or Probable Case?	Specify if this case is Epidemiologically-linked to another confirmed or probable case of mumps?	PHVS_YesNoUnknown_CDC
Did the subject ever receive a disease-containing vaccine?	Did the subject ever receive a mumps-containing vaccine?	PHVS_YesNoUnknown_CDC
If no, reason subject did not receive a disease-containing vaccine	Specifies reason the subject did not receive a mumps-containing vaccine	PHVS_VaccineNotGivenReasons_CDC
Number of doses received ON or AFTER first birthday	The number of measles-containing vaccine doses the subject received on or after their first birthday
Vaccine History Comments	Comments about the subject's vaccination history.
Vaccine Administered	The type of vaccine administered.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered.
Vaccine Administered Date	The date that the vaccine was administered.
US Acquired	Sub-classification of disease or condition acquired in the US	PHVS_CaseClassificationExposureSource_NND
Length of time in the US	Length of time in the US, from NBS MM
Length of Time in the U.S. units	Length of time in the US Units
Patient Address City	Patient address city, from NBS MM
Case Investigation Status Code	Case Investigation Status Code, from NBS MM
Detection Method	Detection Method, from NBS MM
Transmission Setting, Other	If Other, Specify Transmission Setting
Laboratory Confirmed	Was the case laboratory confirmed?
Specimen sent to CDC	Was a specimen sent to CDC for testing?
Type of testing at CDC	What type of testing was done at CDC for this subject?
Type of testing at CDC, other	If other, specify testing done at CDC
Date specimen sent to CDC	Date specimen sent to CDC
VPD Lab Message Patient Identifier	VPD Lab Message Patient Identifier
VPD Lab Message Observation Identifier	VPD Lab Message Observation Identifier
VPD Lab Message Observation Value	VPD Lab Message Observation Value
Other Lab Test	If other, specify lab test
Performing Laboratory Type	Performing laboratory type
Other (Performing Laboratory Type)	If other, specify performing laboratory type
Date of last dose prior to illness onset	Date of last disease-containing vaccination dose prior to illness onset
Vaccination doses prior to onset	Number of disease-containing vaccination doses prior to illness onset
Vaccinated per ACIP recommendations	Was subject vaccinated as recommended by ACIP?
Reason not vaccinated per ACIP recommendations	Reason subject not vaccinated as recommended by ACIP
Reason not vaccinated per ACIP, Other	If other, specify reason not vaccinated per ACIP
Vaccine Administered Product Type, Other	If other, specify type of vaccine administered
Vaccine Product Manufacturer, Other	If other, specify vaccine manufacturer
NDC Brand Name/Bar Code information	NDC from the vaccine's bar code. With the NDC code, vaccine brand name and manufacturer can be obtained.
Vaccination Record ID	Vaccination Record ID, from NBS MM
Reason immunizaton not given, regardless of the schedule used	Reason subject was not vaccinated, regardless of the immunization schedule used

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Sheet 35: Neisseria meningitidis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
DAYCARE	If <6 years of age, is the patient in daycare?	PHVS_YesNoUnknown_CDC
FACNAME	Name of the daycare facility.	PHVS_YesNoUnknown_CDC
NURSHOME	Does the patient reside in a nursing home or other chronic care facility?	PHVS_YesNoUnknown_CDC
NHNAME	Name of the nursing home or chronic care facility.
SYNDRM	Types of infection that are caused by the organism. This is a multi-select field.	TBD
SPECSYN	Other infection that is caused by the organism.
SPECIES	Bacterial species that was isolated from any normally sterile site.	TBD
OTHBUG1	Other bacterial species that was isolated from any normally sterile site.	TBD
STERSITE	Sterile sites from which the organism was isolated. This is a multi-select field.	TBD
OTHSTER	Other sterile site from which the organism was isolated.
DATE	Date the first positive culture was obtained. (This is considered diagnosis date.)
NONSTER	Nonsterile sites from which the organism was isolated. This is a multi-select field.	TBD
UNDERCOND	Did the patient have any underlying conditions?	PHVS_YesNoUnknown_CDC
COND	Underlying conditions that the subject has. This is a multi-select field.	TBD
OTHMALIG	Other malignancy that the subject had as an underlying condition.
OTHORGAN	Detail of the organ transplant that the subject had as an underlying condition.
OTHILL	Other prior illness that the subject had as an underlying condition.
OTHOTHSPC	Another Bacterial Species not listed in the Other Bacterial Species drop-down list.
Specify Internal Body Site	Internal Body Site where the organism was located.	TBD
Other Prior Illness 2	Other prior illness that the subject had as an underlying condition.
Other Prior Illness 3	Other prior illness that the subject had as an underlying condition.
Other Nonsterile Site	Other nonsterile site from which the organism was isolated.
INSURANCE	Patient's type of insurance (multi-selection).	TBD
INSURANCEOTH	Patient's other type of insurance.
WEIGHTLB	Weight of the patient in pounds.
WEIGHTOZ	Weight of the patient in ounces.
WEIGHTKG	Weight of the patient in kilograms.
HEIGHTFT	Height of the patient in feet.
HEIGHTIN	Height of the patient in inches.
HEIGHTCM	Height of the patient in centimeters.
WEIGHTUNK	Indicator that the weight of the patient is unknown.	PHVS_TrueFalse_CDC
HEIGHTUNK	Indicator that the height of the patient is unknown.	PHVS_TrueFalse_CDC
SEROGROUP	Serogroup of the culture.	TBD
OTHSERO	Other serogroup of the culture.
COLLEGE	Is patient currently attending college? This question is only applicable if the patient is 15-24 years of age.	PHVS_YesNoUnknown_CDC
CASEID	How was the case identified?	TBD
OTHSTRST	Other sterile site from which species was isolated.
OTHID	Other case identification method.
SCHOOLYR	Patient's year in college. (freshman, sophomore, etc.)	TBD
STUDTYPE	Patient's status in college as defined by the university.	TBD
HOUSE	Patient's current living situation.	TBD
OTHHOUSE	Other housing option.
SCHOOLNM	Full name of the college or university the patient is currently attending.
POLYVAC	Has patient received the polysaccharide meningococcal vaccine?	PHVS_YesNoUnknown_CDC
SECCASE	Is this case of Neiserria meningitidis a secondary case?	PHVS_YesNoUnknown_CDC
SECCASETY	Type of secondary contact for a case of Neisseria meningitidis.	TBD
OTHSECCASE	Other field available if the secondary case type selected is other.
NMSULFRES	Neisseria meningitidis resistance to Sulfa.	PHVS_YesNoUnknown_CDC
NMRIFARES	Neisseria meningitidis resistance to Rifampin.	PHVS_YesNoUnknown_CDC
DIAGDATE	Date the sample was collected for diagnostic testing if a culture was not done.
PCRSOURCE	Specifies the PCR source for how the case was identified.	TBD
IHCSPEC1	Specifies the first IHC specimen.
IHCSPEC2	Specifies the second IHC specimen.
IHCSPEC3	Specifies the third IHC specimen.
MENGVAC	Specifies whether the patient has received a meningococcal vaccine.
Bacterial Infection Syndrome	Types of infection caused by organism	PHVS_InfectionType_RIBD	P
Gestational Age	If patient <1 month of age, indicate gestational age (in weeks)	N/A	P
Birth Weight	If patient <1 month of age, indicate birth weight (grams)	N/A	P
Birth Weight Units	Birth Weight Units	PHVS_WeightUnit_UCUM	P
Secondary Case	Is this a secondary case?	PHVS_YesNoUnknown_CDC	P
Recurrent Disease with Same Pathogen	Does this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.)	PHVS_YesNoUnknown_CDC	P
Previous State ID (Recurrent Case)	StateID of 1st occurrence for this pathogen and person.	N/A	P
Case Report Form Status	Case Report Form Status	PHVS_FormStatus_RIBD	P
Had Sex with a Male within the Past 12 Months	Had sex with a male within the past 12 months?	PHVS_YNRD_CDC	P
Had Sex with a Female within the Past 12 Months	Had sex with a female within the past 12 months?	PHVS_YNRD_CDC	P
Number of Male Sexual Partners	In the 3 months prior to the onset of symptoms, number of male sex partners the person had?	N/A	P
HIV Status	Documented or self-reported HIV status at the time of event	PHVS_HIVStatus_STD	P
Homeless	Was the patient homeless at time of symptom onset?	PHVS_YesNoUnknown_CDC	P
Signs and Symptoms	Indicate what symptoms of interest the patient had during the course of the illness	PHVS_SignsSymptoms_RIBD	P
Signs and Symptoms Indicator	Indicator for associated sign and symptom	PHVS_YesNoUnknown_CDC	P
Eculizumab	Was the patient taking eculizumab/Soliris at the time of disease onset?	PHVS_YesNoUnknown_CDC	P
Illness Onset Age	Illness onset age	N/A	P
Illness Onset Age Units	Illness onset age units	PHVS_AgeUnit_UCUM	P
Residence	Where was the patient a resident at time of initial culture?	PHVS_ResidenceLocation_RIBD	P
Epi-Linked to a Laboratory-Confirmed Case	Is this case epi-linked to a laboratory-confirmed case?	PHVS_YesNoUnknown_CDC	P
ABCS Case	ABCs Case?	PHVS_YesNoUnknown_CDC	P
ABCS State ID	ABCS State ID	N/A	P
Laboratory Testing Performed	Was laboratory testing done to confirm the diagnosis?	PHVS_YesNoUnknown_CDC	P
Laboratory Confirmed	Was the case laboratory confirmed?	PHVS_YesNoUnknown_CDC	P
Serogroup Method	Serogroup method	PHVS_SerogroupMethod_RIBD	P
Test Manufacturer	Test Manufacturer	N/A	P
Lab Accession Number	Lab Accession Number (including CDC Lab ID)	N/A	P
Susceptibility Test	Was any susceptibility data available?	PHVS_YesNoUnknown_CDC	P
Did the Subject Ever Receive a Vaccine Against This Disease	Did the subject ever receive a vaccine against this disease?	PHVS_YesNoUnknown_CDC	P
Date of Last Dose Prior to Illness Onset	Date of last vaccine dose against this disease prior to illness onset	N/A	P
Vaccination Doses Prior to Onset	Number of vaccine doses against this disease prior to illness onset	N/A	P
Vaccine History Comments	Vaccine History Comments	N/A	P
Vaccine Name	Vaccine Name	N/A	P
Age at Vaccination	The persons age at the time the vaccine was given	N/A	P
Age at Vaccination Units	The age units of the person at the time the vaccine was given	PHVS_AgeUnit_UCUM	P
Vaccine History Information Source	What sources were used for vaccination history?	PHVS_InformationSource_RIBD	P
Vaccine Information Source Indicator	Vaccination History Information Source Indicator	PHVS_YesNoUnknown_CDC	P

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Sheet 36: Novel Influenza A

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Fever >38°C (100.4°F)	Did/does the patient have a fever (specify max temp)?
Feverish but temp not taken	Did/does the patient have a fever but temperature not taken?
Cough	Was cough a symptom?
Headache	Did/does the patient have a headache?
Seizures	Did/does the patient have seizures?
Sore throat	Did/does the patient have a sore throat?
Conjunctivitis	Did/does the patient have conjunctivitis?
Shortness of breath	Did/does the patient have shortness of breath?
Diarrhea	Did/does the patient have shortness of breath?
Other	Did/does the patient have any other symptoms (specify)?
Vaccinated	Was the patient vaccinated against human influenza in the past year?
Vaccination date	If yes, date of vaccination
Vaccine type	If yes, type of vaccine received?
Antiviral medications	Did the patient receive antiviral medications?
Date initiated oseltamivir	What was the date that oseltamivir was intiated?
Date discontinued oseltamivir	What was the date that oseltamivir was discontinued?
Oseltamivir dosage	What was the dosage of oseltamivir?
Zanamivir	What was the date that zanamivir was intiated?
Date initiated zanamivir	What was the date that zanamivir was discontinued?
Date discontinued zanamivir	What was the dosage of zanamivir?
Rimantidine	What was the date that rimantidine was intiated?
Date initiated rimantidine	What was the date that rimantidine was discontinued?
Date discontinued rimantidine	What was the dosage of rimantidine?
Amantidine	What was the date that amantidine was intiated?
Date initiated amantidine	What was the date that amantidine was discontinued?
Date discontinued amantidine	What was the dosage of amantidine?
Other antivial (specify)	What was the date that an other antiviral was intiated?
Dateintiated other	What was the date that an other antiviral was discontinued?
Date discontinued other	What was the dosage of an other antiviral?
Leukopenia	Was leukopenia a lab finding?
Lymphopenia	Was lymphopenia a lab finding?
Thrombocytopenia	Was thrombocytopenia a lab finding?
Underlying medical conditions	Does the patient have any underlying medical conditions?
Compromised immune function	Does the patient have compromised immune function such as HIV infection, cancer, chronic corticosteroid therapy, diabetes, or organ transplant recipient?
Compromised immune function specified	If yes, specify function.
Mechanical ventilation	Did the patient require mechanical ventilation?
Chest x-ray/CAT	Did the patient have a chest x-ray or CAT scan performed?
Pneumonia	If abnormal, was there evidence of pneumonia?
ARDS	If abnormal, did the patient have acute respiratory distress syndrome??
Death	Did the patient die a s a result of this illness?
Test 1 Specimen Type	What was the specimen type for diagnostic test 1?
Test 1 Date collected	Date of collection of specimen for test 1?
Test 1 type	What is the test type for diagnostic test 1?
Test 2 Specimen Type	What was the specimen type for diagnostic test 2?
Test 2 Date collected	Date of collection of specimen for test 2?
Test 2 type	What is the test type for diagnostic test 2?
Specimens to CDC	Indicate when and what type of specimens (including sera) were sent to CDC
Epi Risk - Travel	In the 10 days prior to illness onset, did the patient travel?
Country/Arrival/Departure	If yes, fill in the arrival and departure dates for all countries visited.
Case close contact	Did the patient have close contact with a person who is a suspected, probable,, or confirmed novel human influenza A case?
Animal touch	Did the patient touch animals or their remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Animal exposure	Was the patient exposed to animal remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Environmental exposure	Was the patient exposed to environments contaminated by animal feces in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Raw/Undercooked animals	Did the patient consume raw or undercooked animals in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Animal contact	Did the patient have any animal contact (specify)?
Laboratory sample handling	Did the patient handle samples suspected of containing influenza virus in a laboratory or other setting?
HC setting	Does the patient work in a healthcare facility or setting?
Household illness contact	Did the patient visit or stay in the same household with anyone with pneumonia or severe influenza-like illness?
Household death contact	Did the patient visit or stay in the same household with anyone who died following thevisit?
Porcine exposure	Did the patient visit an agricultural event, farm, petting zoo, or place where pigs live or were exhibited in the last month?
Porcine contact	Did the patient have direct contact with pigs at an agricultural event, farm, petting zoo, or place where pigs were exhibited in the last month?
Epidemiological link with lab-confirmed or probable case	If this patient has a diagnosis of novel influenza A virus infection that has not been serologically confirmed, is there an epidemiologic link between this patient and a lab-confirmed or probable novel influenza A case?

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Sheet 37: Ped Flu Deaths

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Autopsy	Was an autopsy performed on the patient?
Cardiac/respiratory arrest	Did the patient experience cardiac/respiratory arrest outside the hospital?
Location of death	What was the location of the patient's death?
Hospital Admission Date	If patient's death occurrred in a hospital, what was the date of admission?
Pathology specimens to CDC	Were pathology specimens sent to CDC's Infectious Diseases Pathology Branch?
Lab ID for pathology specimen	Provide the lab ID number(if known) for pathology specimen(s) sent to CDC.
Isolates/original clinical material	Were influenza isolates or original clinical material sent to CDC Influenza Division?
Lab ID for isolates/clinical specimen	Provide the lab ID number(if known) for isolates/clinical specimen(s) sent to CDC.
Staph aureus isolates	Were staph aureus isolates sent to CDC's Healthcare Quality Promotion?
Lab ID for isolates	Provide the lab ID number(if known) for isolate(s) sent to CDC.
Commercial Rapid Diagnostic Test	Indicate if commercial rapid test used.
Rapid test result	What is the result of the rapid test?
Rapid test specimen collection date	What is the specimen collection date for the rapid test?
Viral Culture	Indicate if viral culture used.
Viral culture result	What is the result of the viral culture?
Viral culture specimen collection date	What is the specimen collection date for the viral culture?
Fluorescent Antibody (IFA or DFA)	Indicate if fluorescent antibody test used.
IFA/DFA result	What is the result of the IFA/DFA?
IFA/DFA specimen collection date	What is the specimen collection date for the IFA/DFA?
Enzyme Immunoassay	Indicate if enzyme immunoassay used.
EIA result	What is the result of the EIA?
EIA collection date	What is the specimen collection date for the EIA?
RT-PCR test	Indicate if an RT-PCR test was used.
RT-PCR result	What is the result of the RT-PCR?
RT-PCR specimen collection date	What is the specimen collection date for the RT-PCR?
IHC test	Indicate if an immunohistochemistry test was used.
IHC result	What is the result of the IHC?
IHC specimen collection date	What is the specimen collection date for the IHC?
Bacterial Culture	Was a specimen collected for bacterial culture from a normally sterile site?
Specimen Type	What was the specimen type obtained for the bacterial culture? This is a multi-select field.
Collection Date	What was the collection date for the bacterial culture?
Bacterial Culture Results	What was the result of the bacterial culture?
Bacterial culture species isolated	If bacterial culture positive, check the organism cultured. This is a multi-select field.
Other Respiratory Specimen/ Non-sterile site	Were other respiratory specimens from non-sterile site(s) collected for bacterial culture (e.g., sputum, ET tube aspirate)?
Other respiratory specimen site	If yes, indicate the site from which the specimen was obtained. This is a multi-select field.
Other respiratory specimen site	If yes, indicate the date collected of the specimen.
Other respiratory specimen collection date	If yes, indicate the date collected of the specimen.
Other respiratory specimen result	If yes, indicate the result for the specimen culture.
Bacterial species cultured	If positve, what was the organism cultured?
Autopsy Specimen	Was a specimen (e.g., fixed lung tissue) collected from an autopsy for bacterial pathogen testing?
Autopsy Specimen Results	If autopsy specimen was taken, what were the results (indicate in the comments section)?
Mechanical Ventilation	Was the patient placed on mechanical ventilation?
Complications	Did complications occur during the acute illness?
Type complications	If yes, check all complications that occurred during the acute illness. This is a multi-select field.
Existing Medical Conditions	Did the child have any medical conditions that existed before the start of the acute illness?
Medical conditions before acute illness	If yes,check all medical conditions that exised before the start of the acute illness. This is a multi-select field
Medications and/or Therapies	Was the patient receiving any of the listed therapies prior to illness onset?
Medications received before illness	Check all medications/therapies patient was receiving before the acute illness. This is a multi-select field.
Medications received after illness	Did the patient receive any of the following after illness onset? This is a multi-select field.
Influenza Vaccine	Did the patient receive any seasonal influenza vaccine during the current season (before illness)?
Vaccine before illness	If yes, specify the seasonal vaccine received before illness onset.
1 Dose <14 days	If yes, did patient receive 1 dose of vaccine <14 days prior to illness onset (date given)?
1 Dose >14 days	If yes, did patient receive1 dose of vaccine ≥14 days prior to illness onset (date given)?
2 Dose <14 days	If yes, did patient receive vaccines <14 days prior to illness onset (dates given)?
2 Dose >14 days	If yes, did patient receive 2 doses of vaccines ≥14 days prior to illness onset (dates given)?
Previous Seasonal Vaccine	Did the patient receive any seasonal influenza vaccine in previous seasons?
1 Dose Seasonal	If yes, and patient was between 6 months and ≤8 years of age at the time of death, was the 2009-2010 influenza season the first time the patient received seasonal influenza vaccine?
2 Dose Seasonal	If yes, did patient receive 2 doses of seasonal influenza vaccine during the 2009-2010 influenza season?
1 Dose AT Least	If the patient was between 6 months and ≤8 years of age at the time of death, did they receive at least 1 dose of 2009 influenza A (H1N1) vaccine during the previous season?

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Sheet 38: Pertussis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the patient have a cough?	Did the patient's illness include the symptom of cough?	PHVS_YesNoUnknown_CDC
Cough Onset Date	Cough onset date
Paroxysmal Cough	Did the patient's illness include the symptom of paroxysmal cough?	PHVS_YesNoUnknown_CDC
Whoop	Did the patient's illness include the symptom of whoop?	PHVS_YesNoUnknown_CDC
Post-tussive Vomiting	Did the patient's illness include the symptom of post-tussive vomiting?	PHVS_YesNoUnknown_CDC
Apnea	Did the patient's illness include the symptom of apnea?	PHVS_YesNoUnknown_CDC
Date of Final Interview	Date of the patient's final interview
Did the patient have a cough at final interview?	Was there a cough at the patient's final interview?	PHVS_YesNoUnknown_CDC
Total Cough Duration	What was the duration (in days) of the patient's cough?
Result of chest X-ray for pneumonia	Result of chest x-ray for pneumonia	PHVS_ChestXrayResult_CDC
Did the patient have generalized or focal seizures due to pertussis?	Did the patient have generalized or focal seizures due to pertussis?	PHVS_YesNoUnknown_CDC
Did the patient have acute encephalopathy due to pertussis?	Did the patient have acute encephalopathy due to pertussis?	PHVS_YesNoUnknown_CDC
Were antibiotics given?	Were antibiotics given to the patient?	PHVS_YesNoUnknown_CDC
Antibiotic Name	What antibiotic did the patient receive?	PHVS_AntibioticReceived_Pertussis
Antibiotic Start Date	Date the patient first started taking the antibiotic
Number of days antibiotic actually taken.	Number of days the patient actually took the antibiotic referenced
Second antibiotic patient received?	If Other, please specify antibiotic	PHVS_AntibioticReceived_Pertussis
Date second antibiotic started	Date second antibiotic started
Number of days second antibiotic actually taken	Number of days second antibiotic actually taken
Was laboratory testing done for pertussis?	Was laboratory testing done for pertussis?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case	PHVS_LabTestProcedure_Pertussis
Test Result	Epidemiologic interpretation of the results of the tests performed for this case.	PHVS_LabTestInterpretation_Pertussis
Date Collected	Date of specimen collection
Did the subject ever receive a disease-containing vaccine?	Did the patient ever receive a pertussis-containing vaccine?	PHVS_YesNoUnknown_CDC
Vaccine Administered	The type of vaccine administered.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered.
Vaccine Administered Date	The date that the vaccine was administered.
Is this case epi-linked to a laboratory-confirmed case?	Is this case epi-linked to a laboratory-confirmed case?	PHVS_YesNoUnknown_CDC
Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)?	Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)?	PHVS_YesNoUnknown_CDC
Transmission Setting	Transmission setting (Where did this case acquire pertussis?)	PHVS_TransmissionSetting_NND
Was there documented transmission from this case of pertussis to a new setting? (not in household)	Was there documented transmission (outside of the household) for transmission from this case?	PHVS_YesNoUnknown_CDC
Number of contacts of this case recommended to receive antibiotic prophylaxis	Number of contacts of this case recommended to receive antibiotic prophylaxis
Age of person contracted patient contracted pertussis from	Age of the person from whom this patient contracted pertussis
Age Type	Age Type	Age_Type
Setting where patient contracted pertussis	Transmission setting (Where did this patient acquire pertussis?)	PHVS_TransmissionSetting_NND
Specify In which setting was pertussis acquired.	setting in which pertussis was acquired
Specify In which setting was there secondary spread	In which setting was there secondary spread
Name Of Contacts	Name Of Contacts
Birth Date of contacts	Birth Date of contacts
Contact Relationship to Subject	Relationship of contact	PHVS_Relationship_Flu
Case?	Case
Contact Case ID	Unique case identifier of the contact. This would be the same as INV168 (Case Local ID)
Cough Onset Date(If Present	Cough Onset Date(If Present
Number of PCVs*	Number of PCVs*
Date of Last PCV	Date of Last PCV
Parent’s Name (If Applicable)	Parent’s Name (If Applicable)
Parent’s Phone # (If Applicable)	Parent’s Phone # (If Applicable)
Cyanosis	Did patient have cyanosis during his/her illness?
Treatment Drug, Other	If other, specify antibiotic used
Case patient a healthcare worker	Was case patient healthcare personnel (HCP) (at illness onset)?
Mother’s age at infant’s birth	Mother’s age at infant’s birth (used only if patient under 12 months old)
Gestational age in weeks	Gestational age (if case-patient < 1 year of age at illness onset)
Birth Weight	Infant’s birth weight (used only if patient under 12 months old)
Birth Weight Units	Infant’s birth weight units
Did mother receive Tdap?	Did mother receive Tdap (if case-patient < 1 year of age at illness onset)?
Timing of mother's Tdap administration	If mother received Tdap, when was it administered?
Date of mother's Tdap administration	If mother received Tdap, what date was it administered? *(if available)
One or more suspected sources?	Was there one or more suspected sources of infection? (from NBS MM)
Number of suspected sources?	Number of suspected sources? (from NBS MM)
Suspected source sex	Suspected source sex (from NBS MM)
Suspected source relationship to case (other)	Suspected source relationship to case (other)
Patient Address City	Patient Address City, from NBS MM
Case Investigation Status Code	Case Investigation Status Code, from NBS MM
Detection Method	Detection Method, from NBS MM
Age at cough onset	Age of patient at cough onset
Age type at cough onset	Age units at cough onset
Laboratory Confirmed	Was the case laboratory confirmed?
Specimen sent to CDC	Was a specimen sent to CDC for testing?
Type of testing at CDC	What type of testing was done at CDC for this subject?
Type of testing at CDC, Other	If other, specify testing done at CDC
Date specimen sent to CDC	Date specimen sent to CDC
VPD Lab Message Patient Identifier	VPD Lab Message Patient Identifier
VPD Lab Message Observation Identifier	VPD Lab Message Observation Identifier
VPD Lab Message Observation Value	VPD Lab Message Observation Value
Test Type, Other	If other, specify lab test
Specimen ID Placer Assigned Identifier	Specimen ID Placer Assigned Identifier
Specimen ID Filler Assigned Identifier	Specimen ID Filler Assigned Identifier
Performing Laboratory Type	Performing Laboratory Type
Performing Laboratory Type, Other	If other, specify performing laboratory type
Numeric Test Result	Numeric Result Value
Numeric Test Result Units	The unit of measure for numeric result value.
Vaccinated per ACIP recommendations	Was subject vaccinated as recommended by ACIP?
Reason not vaccinated per ACIP recommendations	Reason subject not vaccinated as recommended by ACIP
Reason not vaccinated per ACIP, Other	If other, specify reason not vaccinated per ACIP
Vaccine Administered Product Type, Other	If other, specify type of vaccine administered
NDC Brand Name/Bar Code information	NDC from the vaccine’s bar code. With the NDC code, vaccine brand name and manufacturer can be obtained.
Vaccine Product Manufacturer, Other	If other, specify vaccine manufacturer
Vaccine Lot Expiration Date	Vaccine expiration date
Vaccination Record ID	Vaccination Record ID, from NBS MM
Reason immunizaton not given, regardless of the schedule used	Reason subject was not vaccinated, regardless of the immunization schedule used
Other transmission setting	If other, specify the other transmission setting
Setting of further spread	If other, specify transmission setting of further spread
Suspected source relation to case	Suspexcted source of infection relationship to case
Estimated cough onset date of suspected source	Estimated cough onset date of suspected source of infection

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Sheet 39: Plague

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Primary plague type	Classification of primary clinical manifestation of infection	TBD	P
Animal Contact	Contact with sick or dead animals	TBD	P
Flea bite	Flea bite	TBD	P
Immuncompromised	If patient has any immunocompromising conditions, specify	N/A	P
Date first medical	Date that the patient was first seen by medical person.	N/A	P
Fever/sweats/chills	Did the patient's illness include the symptom of fever/sweats/chills?	PHVS_YesNoUnknown_CDC	P
Confusion/delirium	Did the patient's illness include the symptom of confusion/delirium?	PHVS_YesNoUnknown_CDC	P
Vomiting/diarrhea/abdominal pain	Did the patient's illness include the symptom of vomiting/diarrhea/abdominal pain?	PHVS_YesNoUnknown_CDC	P
Sore throat	Did the patient's illness include the symptom of sore throat?	PHVS_YesNoUnknown_CDC	P
Cough	Did the patient's illness include the symptom of cough?	PHVS_YesNoUnknown_CDC	P
Chest Pain	Did the patient's illness include the symptom of chest pain?	PHVS_YesNoUnknown_CDC	P
Shortness of breath	Did the patient's illness include the symptom of shortness of breath?	PHVS_YesNoUnknown_CDC	P
Other_symptoms	Did the patient's illness include other symptoms of not listed?	PHVS_YesNoUnknown_CDC	P
Other_symptoms_specify	Which other symptoms did the patient's illness include?	N/A	P
Bubo	Did patient have bubo?	PHVS_YesNoUnknown_CDC	P
Type of Bubo	Specify type of bubo	TBD	P
Location/description Bubo	Describe location and appearance of bubo	N/A	P
Insect bites/skin ulcer	Did patient have any insect bites/skin ulcer	PHVS_YesNoUnknown_CDC	P
Location/description insect bites/skin ulcer	Describe location and appearance of insect bites/skin ulcer	N/A	P
Chest X-ray	Results of chest x-ray	TBD	P
Antibiotic	Did patient receive an effective antibiotic for illness?	TBD	P
Antibiotic start date	Date each antibiotic started	N/A	P
Illness outcome	Outcome of illness	TBD	P
Primary plague type	Classification of primary clinical manifestation of infection	TBD	P
Secondary pneumonic plague	Did patient have secondary pneumonic plague?	PHVS_YesNoUnknown_CDC	P
Y. pestis cultured	Was Y. pestis cultured?	PHVS_YesNoUnknown_CDC	P
Specimen source	Source of culture	N/A	P
Date specimen collected	Date specimen was collected	N/A	P
Y. pestis detected	Was Y. pestis detected by other tests?	PHVS_YesNoUnknown_CDC	P
Test performed	Test used to detect Y. pestis	N/A	P
Specimen source	Specimen source in which Y. pestis was detected	N/A	P
Date specimen collected	Date of specimen collection	N/A	P
Serology	Serology results	TBD	P
First Serum titer	Titer of first serum specimen	N/A	P
Second Serum titer	Titer of second serum specimen	N/A	P
Date first serum drawn	Date first serum drawn	N/A	P
Date second serum drawn	Date second serum drawn	N/A	P
Epi-linked to any other plague cases	Was this illness epi-linked to any other plague cases?	PHVS_YesNoUnknown_CDC	P
Likely location of exposure	Most likely location of exposure	TBD	P
Animal contact	Did patient have any animal contact in the 2 weeks preceding illness?	PHVS_YesNoUnknown_CDC	P
Nature of contact	Nature of animal contact in the 2 weeks preceding illness	TBD	P
Type of animal contact	Was animal domestic or wild	TBD	P
Flea bite or insect bites	Did patient have flea or insect bites in the 2 weeks preceding illness?	PHVS_YesNoUnknown_CDC	P
Wild animal	Specify wild animal that patient had contact with in the 2 weeks preceding illness	N/A	P
Domestic animal	Specify domestic animal that patient had contact with in the 2 weeks preceding illness	N/A	P
Evidence of infected animals or fleas	Evidence of infected animals or fleas in the likely exposure location	PHVS_YesNoUnknown_CDC	P
Specify infected animals or fleas	Describe evidnece of Y. pestis infected animals or fleas in likely exposure location	N/A	P
Other exposure	Specify any other exposures in the two weeks preceding illness	N/A	P
Comments	Additional comments	N/A	P
Person to person transmission	Evidence of person to person transmission from a known plague patient	PHVS_YesNoUnknown_CDC	P

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Sheet 40: Polio

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Paralysis onset date	Date of onset of paralysis
Clinical course	Clinical course
CSF date	Date of CSF results
WBCs	White blood cell test results for cerebral spinal fluid
RBCs	Red blood cell test results for cerebral spinal fluid
%Lymph	%lymphs test results for CSF
%polys	%polys test results for CSF
Protein	Protein test results for CSF
Glucose	Glucose test results for CSF
60-day follow up date	Date of 60-day follow up
Paralysis site	Sites of paralysis
Specific sites	Specific sites of paralysis
60-day residual	60-day paralysis residual
TOPV immunization history	TOPV within 30 days prior to onset of symptoms?
Date of TOPV	TOPV immunization date
Lot number	TOPV vaccine lot number
IPV-containing vaccine	Total doses ever received of IPV-containing vaccine
Date 1 IPV	First IPV vaccine date
Date 2 IPV	Second IPV vaccine date
Date 3 IPV	Third IPV vaccine date
TOPV vaccine	Total doses ever received of TOPV vaccine
Date 1 TOPV	First TOPV vaccine date
Date 2 TOPV	Second TOPV vaccine date
Date 3 TOPV	Third TOPV vaccine date
BOPV vaccine	Total doses ever received of BOPV vaccine
Date 1 BOPV	First BOPV vaccine date
Date 2 BOPV	Second BOPV vaccine date
Date 3 BOPV	Third BOPV vaccine date
MOPV vaccine	Total doses ever received of MOPV vaccine
Date 1 MOPV	First MOPV vaccine date
Date 2 MOPV	Second MOPV vaccine date
Date 3 MOPV	Third MOPV vaccine date
First injection date	Date of first injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of first injection
Describe	Description of first injection substance
First injection site	Site of first injection
Second injection date	Date of second injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of second injection
Describe	Description of second injection substance
Second injection site	Site of second injection
Third injection date	Date of third injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of third injection
Describe	Description of third injection substance
Third injection site	Site of third injection
Fourth injection date	Date of fourth injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of fourth injection
Describe	Description of fourth injection substance
Fourth injection site	Site of fourth injection
Travel to endemic/epidemic area(s)	Did case/household member travel to endemic/epidemic area(s)?
Exposure location(s) 1	Locations of exposure of case/household member
Departure date 1	Date of travel departure
Return date 1	Date of travel return
Exposure to person(s) from or returning to endemic areas	Was case/household members exposed to persons from or returning to endemic areas?
Exposure location(s) 2	Locations of exposure to case/household member who traveled/is from endemic area
Departure date 2	Date of travel departure of person to whom exposed
Return date 2	Date of travel return of person to whom exposed
Contact with known case	Did case/household member have contact with known case?
Contact name	Name of case contact (last, first)
Exposure to case location	Location of exposure to case?
Contact date	Date of contact with known case
OVP recipient contact	Did case have contact with OPV vaccine recipient
OVP recipient contact	If yes, date of contact with household OVP vaccine
OVP recipient relation	Relationship of household OVP vaccine recipient to case
OVP recipient age	Age of the OVP vaccine recipient
OPV recipient agetype	Agetype of the OVP vaccine recipient
Date received OVP	Date contact received OVP vaccine
OVP dose number	Number of doses of OVP vaccine received by contact
OVP lot number	Lot number of OVP vaccine received by contact
State or local laboratory name	Name of state or local laboratory which received serum specimens
Serum 1	Indicate whether P1, P2, or P3
Serum 1 test type	Test type (neut/CSF)
Serum 1 result	Test result for serum 1
Serum 1 date	Date drawn/obtained for serum1
Serum 2	Indicate whether P1, P2, or P3
Serum 2 test type	Test type (neut/CSF)
Serum 2 result	Test result for serum 2
Serum 2 date	Date drawn/obtained for serum 2
Specimen 1 results	Results of specimen 1 sent for viral isolation
Specimen 1 laboratory	Name of laboratory which received specimens for viral isolation
Specimen 1 type	Type specimen 1 submitted for viral isolation
Specimen 1 date	Date drawn/obtained for specimen 1
Specimen 2 results	Results of specimen 2 sent for viral isolation
Specimen 2 laboratory	Name of laboratory which received specimens for viral isolation
Specimen 2 type	Type specimen 2 submitted for viral isolation
Specimen 2 date	Date drawn/obtained for specimen 2
CDC serum 1	Indicate whether P1, P2, or P3 (serum sent to CDC lab)
CDC serum 1 test type	Test type (neut/CSF for serum sent to CDC lab)
CDC serum 1 result	Test result for serum 1 (sent to CDC lab)
CDC serum 1 date	Date drawn/obtained for serum 1 (sent to CDC)
CDC serum 2	Indicate whether P1, P2, or P3
CDC serum 2 test type	Test type (neut/CSF for serum sent to CDC lab))
CDC serum 2 result	Test result for serum 2 (sent to CDC lab)
CDC serum 2 date	Date drawn/obtained for serum 2 (sent to CDC lab)
CDC specimen 1 type	Type specimen 1 submitted for viral isolation (to CDC lab)
CDC specimen 1 results	Results of specimen 1 sent for viral isolation (to CDC lab)
CDC specimen 1 strain results	Strain characterization results for specimen 1
CDC specimen 1 date received	Date specimen 1 received by CDC lab
CDC specimen 1 obtained	Date specimen 1 obtained for CDC testing
CDC specimen 2 type	Type specimen 2 submitted for viral isolation (to CDC lab)
CDC specimen 2 results	Results of specimen 2 sent for viral isolation (to CDC lab)
CDC specimen 2 strain results	Strain characterization results for specimen 2
CDC specimen 2 date received	Date specimen 2 received by CDC lab
CDC specimen 2 obtained	Date specimen 2 obtained for CDC testing
EMG	Was an EMG performed?
EMG results	What were the results of the EMG?
EMG date	Indicate date of EMG.
Nerve conduction	Was a nerve conduction performed?
Nerve results	What were the results of the nerve conduction?
Nerve conduction date	Indicate date of the nerve conduction.
Immune deficiency	Was an immune deficiency diagnosed prior to OPV exposure?
Immune deficiency diagnosis	What was thespecific diagnosi?s
Immune studies	Indicate any immune studies performed
HIV status	Wehat is the HIV status of the patient?

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Sheet 41: Polio Nonparalytic

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Clinical course	Clinical course
CSF date	Date of CSF results
WBCs	White blood cell test results for cerebral spinal fluid
RBCs	Red blood cell test results for cerebral spinal fluid
%Lymph	%lymphs test results for CSF
%polys	%polys test results for CSF
Protein	Protein test results for CSF
Glucose	Glucose test results for CSF
60-day follow up date	Date of 60-day follow up
TOPV immunization history	TOPV within 30 days prior to onset of symptoms?
Date of TOPV	TOPV immunization date
Lot number	TOPV vaccine lot number
IPV-containing vaccine	Total doses ever received of IPV-containing vaccine
Date 1 IPV	First IPV vaccine date
Date 2 IPV	Second IPV vaccine date
Date 3 IPV	Third IPV vaccine date
TOPV vaccine	Total doses ever received of TOPV vaccine
Date 1 TOPV	First TOPV vaccine date
Date 2 TOPV	Second TOPV vaccine date
Date 3 TOPV	Third TOPV vaccine date
BOPV vaccine	Total doses ever received of BOPV vaccine
Date 1 BOPV	First BOPV vaccine date
Date 2 BOPV	Second BOPV vaccine date
Date 3 BOPV	Third BOPV vaccine date
MOPV vaccine	Total doses ever received of MOPV vaccine
Date 1 MOPV	First MOPV vaccine date
Date 2 MOPV	Second MOPV vaccine date
Date 3 MOPV	Third MOPV vaccine date
First injection date	Date of first injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of first injection
Describe	Description of first injection substance
First injection site	Site of first injection
Second injection date	Date of second injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of second injection
Describe	Description of second injection substance
Second injection site	Site of second injection
Third injection date	Date of third injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of third injection
Describe	Description of third injection substance
Third injection site	Site of third injection
Fourth injection date	Date of fourth injection received within 30 days prior to onset of illness
Substance	Substance (vaccine, antibiotic, other) of fourth injection
Describe	Description of fourth injection substance
Fourth injection site	Site of fourth injection
Travel to endemic/epidemic area(s)	Did case/household member travel to endemic/epidemic area(s)?
Exposure location(s) 1	Locations of exposure of case/household member
Departure date 1	Date of travel departure
Return date 1	Date of travel return
Exposure to person(s) from or returning to endemic areas	Was case/household members exposed to persons from or returning to endemic areas?
Exposure location(s) 2	Locations of exposure to case/household member who traveled/is from endemic area
Departure date 2	Date of travel departure of person to whom exposed
Return date 2	Date of travel return of person to whom exposed
Contact with known case	Did case/household member have contact with known case?
Contact name	Name of case contact (last, first)
Exposure to case location	Location of exposure to case?
Contact date	Date of contact with known case
OVP recipient contact	Did case have contact with OPV vaccine recipient
OVP recipient contact	If yes, date of contact with household OVP vaccine
OVP recipient relation	Relationship of household OVP vaccine recipient to case
OVP recipient age	Age of the OVP vaccine recipient
OPV recipient agetype	Agetype of the OVP vaccine recipient
Date received OVP	Date contact received OVP vaccine
OVP dose number	Number of doses of OVP vaccine received by contact
OVP lot number	Lot number of OVP vaccine received by contact
State or local laboratory name	Name of state or local laboratory which received serum specimens
Serum 1	Indicate whether P1, P2, or P3
Serum 1 test type	Test type (neut/CSF)
Serum 1 result	Test result for serum 1
Serum 1 date	Date drawn/obtained for serum1
Serum 2	Indicate whether P1, P2, or P3
Serum 2 test type	Test type (neut/CSF)
Serum 2 result	Test result for serum 2
Serum 2 date	Date drawn/obtained for serum 2
Viral Isolation Specimen 1 results	Results of specimen 1 sent for viral isolation
Specimen 1 laboratory	Name of laboratory which received specimens for viral isolation
Specimen 1 type	Type specimen 1 submitted for viral isolation
Specimen 1 date	Date drawn/obtained for specimen 1
Specimen 2 results	Results of specimen 2 sent for viral isolation
Specimen 2 laboratory	Name of laboratory which received specimens for viral isolation
Specimen 2 type	Type specimen 2 submitted for viral isolation
Specimen 2 date	Date drawn/obtained for specimen 2
CDC serum 1	Indicate whether P1, P2, or P3 (serum sent to CDC lab)
CDC serum 1 test type	Test type (neut/CSF for serum sent to CDC lab)
CDC serum 1 result	Test result for serum 1 (sent to CDC lab)
CDC serum 1 date	Date drawn/obtained for serum 1 (sent to CDC)
CDC serum 2	Indicate whether P1, P2, or P3
CDC serum 2 test type	Test type (neut/CSF for serum sent to CDC lab))
CDC serum 2 result	Test result for serum 2 (sent to CDC lab)
CDC serum 2 date	Date drawn/obtained for serum 2 (sent to CDC lab)
CDC specimen 1 type	Type specimen 1 submitted for viral isolation (to CDC lab)
CDC specimen 1 results	Results of specimen 1 sent for viral isolation (to CDC lab)
CDC specimen 1 strain results	Strain characterization results for specimen 1
CDC specimen 1 date received	Date specimen 1 received by CDC lab
CDC specimen 1 obtained	Date specimen 1 obtained for CDC testing
CDC specimen 2 type	Type specimen 2 submitted for viral isolation (to CDC lab)
CDC specimen 2 results	Results of specimen 2 sent for viral isolation (to CDC lab)
CDC specimen 2 strain results	Strain characterization results for specimen 2
CDC specimen 2 date received	Date specimen 2 received by CDC lab
CDC specimen 2 obtained	Date specimen 2 obtained for CDC testing
EMG	Was an EMG performed?
EMG results	What were the results of the EMG?
EMG date	Indicate date of EMG.
Nerve conduction	Was a nerve conduction performed?
Nerve results	What were the results of the nerve conduction?
Nerve conduction date	Indicate date of the nerve conduction.
Immune deficiency	Was an immune deficiency diagnosed prior to OPV exposure?
Immune deficiency diagnosis	What was thespecific diagnosi?s
Immune studies	Indicate any immune studies performed
HIV status	Wehat is the HIV status of the patient?

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Sheet 42: Psittacosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Clinical description	Check all signs and symptoms listed below (note maximum temperature). Thi is a multi-select field.
Specific therapy	Specify products, dosage, and duration.
Outcome	What was the outcome of this illness?
Death date	If patient died, date of death.
Acute-phase serum	What was the acute-phase serum test method?
Acute-phase serum collected	What was the acute-phase serum collection date?
Acute-phase serum IgM test result	What was the acute-phase serum IgM result?
Acute-phase serum IgG test result	What was the acute-phase serum IgG result?
Acute-phase serum lab	What was the laboratory name?
Convalescent-phase serum	What was the convalescent-phase serum test method?
Convalescent-phase serum collected	What was the convalescent-phase serum collection date?
Convalescent-phase serum IgM test result	What was the convalescent-phase serum IgM result?
Convalescent-phase serum IgG test result	What was the convalescent-phase serum IgG result?
Convalescent-phase serum lab	What was the laboratory name?
PCR	What was the PCR test specimen type?
PCR collected	What was the PCR specimen collection date?
PCR test result	What was the PCR test result?
PCR specimen lab	What was the laboratory name?
Sputum culture collected	What was the sputum specimen collection date?
Sputum culture test result	What was the sputum specimen test result?
Sputum culture lab	What was the laboratory name?
Chest x-ray	Was a chest x-ray done?
Chest x-ray date	When was the chest x-ray done?
Chest x-ray results	What was the chest x-ray result?
Onset Date Occupation	What was the patient's occupation at date of onset?
Specific duties	What are/were the patient's specific duties?
Contact types prior to onset	Indicate which of the following contacts the patient had during the 5 weeks prior to onset.
Psittacine contact	If exposure to birds, did the patient have contact with psittacines (species, approx number and were birds healthy)?
Pigeons	If exposure to birds, did the patient have contact with pigeons (species, approx number and were birds healthy)?
Domestic fowl	If exposure to birds, did the patient have contact with domestic fowl (species, approx number and were birds healthy)?
Other birds	If exposure to birds, did the patient have contact with any other birds (species, approx number and were birds healthy)?
Healthy birds	If birds were not healthy, please elaborate.
Private home - owner	Indicate the owner of the private home
Private home - adress	Indicate the address of the private home
Private home - species	Indicate the species to which exposed
Private home - setting	Indicate the exposure setting (indoor, outdoor)
Private home - date	Indicate the date of exposure
Private aviary - owner	Indicate the owner of the aviary
Private aviary - adress	Indicate the address of the aviary
Private aviary - species	Indicate the species to which exposed
Private aviary -setting	Indicate the exposure setting (indoor, outdoor)
Private aviary - date	Indicate the date of exposure
Coomercial aviary - owner	Indicate the owner of the aviary
Coomercial aviary - address	Indicate the address of the aviary
Coomercial aviary - species	Indicate the species to which exposed
Coomercial aviary - setting	Indicate the exposure setting (indoor, outdoor)
Coomercial aviary - date	Indicate the date of exposure
Pet shop - owner	Indicate the owner of the pet shop
Pet shop - address	Indicate the address of the pet shop
Pet shop - species	Indicate the species to which exposed
Pet shop - setting	Indicate the exposure setting (indoor, outdoor)
Pet shop - date	Indicate the date of exposure
Bird loft - owner	Indicate the owner of the bird loft
Bird loft - address	Indicate the address of the bird loft
Bird loft - species	Indicate the species to which exposed
Bird loft - setting	Indicate the exposure setting (indoor, outdoor)
Bird loft - date	Indicate the date of exposure
Poultry establishment - owner	Indicate the owner of the establishment
Poultry establishment - address	Indicate the address of the establishment
Poultry establishment - species	Indicate the species to which exposed
Poultry establishment - setting	Indicate the exposure setting (indoor, outdoor)
Poultry establishment - date	Indicate the date of exposure
Other - owner	Indicate the owner of the 'other'
Other - address	Indicate the address of the 'other'
Other - species	Indicate the species to which exposed
Other - setting	Indicate the exposure setting (indoor, outdoor)
Other - date	Indicate the date of exposure
Unknown - owner	Indicate the owner unknown
Unknown - address	Indicate the address unknown
Unknown - species	Indicate if species to which exposed unknown
Unknown - setting	Indicate if exposure setting (indoor, outdoor) is unknown
Unknown - date	Indicate if the date of exposure is unknown
Other epi link	Indicate if any other epi linkage (specify)
Implicated birds	If pet birds, domestic pigeons, or fowl are implicated as the source of the human psittacosis, list address of every known place where the birds were harbored and approx dates.
Additional revelant information	Indicate any additional revelant information
Signs and Symptoms	Indicate what symptoms of interest the patient had during the course of the illness	PHVS_SignsSymptoms_RIBD	P
Signs and Symptoms Indicator	Indicator for associated sign and symptom	PHVS_YesNoUnknown_CDC	P
Highest Measured Temperature	What was the subject's highest measured temperature during this illness?	N/A	P
Temperature Units	Units for highest measured temperature	PHVS_TemperatureUnit_UCUM	P
Antibiotics given	Did the subject take antibiotics as treatment for this illness?	PHVS_YesNoUnknown_CDC	P
Treatment Start Date	Start date of antibiotic	N/A	P
Treatment End Date	Stop date of antibiotic	N/A	P
Treatment Duration	Number of days the patient actually took the antibiotic	N/A	P
Hospital ICU	During any part of the hospitalization, did the subject stay in an Intensive Care Unit (ICU) or a Critical Care Unit (CCU)?	PHVS_YesNoUnknown_CDC	P
Laboratory Testing Performed	Was laboratory testing done to confirm the diagnosis?	PHVS_YesNoUnknown_CDC	P
Laboratory Confirmed	Was the case laboratory confirmed?	PHVS_YesNoUnknown_CDC	P
Test Manufacturer	Test Manufacturer	N/A	P
Autopsy Specimen Type	Type of autopsy specimen	PHVS_SpecimenSite_RIBD	P
Autopsy Result	Autopsy result	N/A	P
Date of Autopsy	Date of autopsy (date autopsy specimen collected)	N/A	P
Autopsy Laboratory Name	Autopsy Laboratory Name	N/A	P
Industry at Date of Onset	Industry at date of onset	PHVS_Industry_CDC_Census2010	P
Personal Protective Equipment	At the time of exposure, which of the following personal protective equipment was used by the patient?	PHVS_PersonalProtectiveEquipment_RIBD	P
Respiratory Protective Equipment	If respiratory protective equipment was used at the time of exposure, specify what kind	PHVS_RespiratoryProtectiveEquipment_RIBD	P
Annual Respirator Fit Testing and Training	Does the patient get annual respirator fit testing and training?	PHVS_YesNoUnknown_CDC	P
Glove Material	If gloves were used, specify glove material	PHVS_GloveMaterial_RIBD	P
Contact Type	Indicate which of the following contacts patient had during 5 weeks prior to onset	PHVS_ContactType_RIBD	P
Bird Type	What type of bird did the patient have contact with during the 5 weeks prior to onset?	PHVS_BirdType_RIBD	P
Bird Species	Bird species	N/A	P
Number of Birds	Approximate number of birds	N/A	P
Illness Onset Age	Illness onset age	N/A	P
Illness Onset Age Units	Illness onset age units	PHVS_AgeUnit_UCUM	P

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Sheet 43: QFever

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Wool or Felt Plant	Did the case work in a wool or felt plant	PHVS_YesNoUnknown_CDC
Tannery or Rendering	Did the case work in a tannery or rendering plant	PHVS_YesNoUnknown_CDC
Dairy	Did the case work in a dairy	PHVS_YesNoUnknown_CDC
Veterinarian	Did the case work as a veterinarian	PHVS_YesNoUnknown_CDC
Medical Researcher	Did the case work as a medical researcher	PHVS_YesNoUnknown_CDC
Animal Researcher	Did the case work as an animal researcher	PHVS_YesNoUnknown_CDC
Slaughterhouse	Did the case work in a slaughterhouse	PHVS_YesNoUnknown_CDC
Laboratory	Did the case work in a laboratory	PHVS_YesNoUnknown_CDC
Rancher	Did the case work as a rancher	PHVS_YesNoUnknown_CDC
Lives in Household	Did the case live in a household with someone who may have one of the above occupational exposures	PHVS_YesNoUnknown_CDC
Military	Did the case work in the military	PHVS_YesNoUnknown_CDC
Other Occupation	Indicate the case's occupation if none of the above
Cattle Contact	Did the case have contact with cattle within two months of illness onset	PHVS_YesNoUnknown_CDC
Sheep Contact	Did the case have contact with sheep within two months of illness onset	PHVS_YesNoUnknown_CDC
Goat Contact	Did the case have contact with goats within two months of illness onset	PHVS_YesNoUnknown_CDC
Pigeon Contact	Did the case have contact with pigeons within two months of illness onset	PHVS_YesNoUnknown_CDC
Cat Contact	Did the case have contact with cats within two months of illness onset	PHVS_YesNoUnknown_CDC
Rabbit Contact	Did the case have contact with rabbits within two months of illness onset	PHVS_YesNoUnknown_CDC
Other Animal Contact	Indicate any other animals the case had contact within within two months of illness onset
Exposure to Birthing Animals	Was the case exposed to birthing animals within two months of illness onset	PHVS_YesNoUnknown_CDC
Exposure to Unpasteurized Milk	Was the case exposed to unpasteurized milk within two months of illness onset	PHVS_YesNoUnknown_CDC
Milk Animal	If the case was exposed to unpasteurized milk, what animal was the milk from	PHVS_YesNoUnknown_CDC
Other Family Ill	Was another family member ill with a similar illness within the last year	PHVS_YesNoUnknown_CDC
Fever	Did the case report a fever of at least 100.5 during this illness	PHVS_YesNoUnknown_CDC
Myalgia	Did the case report myalgia during this illness	PHVS_YesNoUnknown_CDC
Retro Orbital Pain	Did the case report retro orbital pain during this illness	PHVS_YesNoUnknown_CDC
Malaise	Did the case report malaise during this illness	PHVS_YesNoUnknown_CDC
Rash	Did the case report a rash during this illness	PHVS_YesNoUnknown_CDC
Cough	Did the case report a coughduring this illness	PHVS_YesNoUnknown_CDC
Headache	Did the case report a headache during this illness	PHVS_YesNoUnknown_CDC
Splenomegaly	Did the case report splenomegaly during this illness	PHVS_YesNoUnknown_CDC
Hepatomegaly	Did the case report hepatomegaly during this illness	PHVS_YesNoUnknown_CDC
Pneumonia	Did the case report pneumonia during this illness	PHVS_YesNoUnknown_CDC
Hepatitis	Did the case report hepatitis during this illness	PHVS_YesNoUnknown_CDC
Endocarditis	Did the case report endocarditis during this illness	PHVS_YesNoUnknown_CDC
Other Signs or Symptoms	If there were other signs or symptoms reported, the indicate them here
Immunocompromised	Did the case report a pre-existing immunocompromised system	PHVS_YesNoUnknown_CDC
Pregnant	Was the case pregnant during this illness	PHVS_YesNoUnknown_CDC
Valvular Disease	Did the case have a pre-existing valvular heart disease or graft	PHVS_YesNoUnknown_CDC
Other Pre-existing Medical Condition	If the case had nother pre-existing medical conditions, then list them here
Laboratory Name	Indicate the name of the laboratory which supplied results supporting the current CSTE case definitions.
Laboratory State	Indicate the state where the laboratory is located	PHVS_State_FIPS_5-2
Acute Phase I Serology Collection Date	If acute phase I serology was performed, then list the date of collection
Acute Phase I IFA IgG Result	If performed, was the acute phase I IFA IgG positive	PHVS_YesNoUnknown_CDC
Acute Phase I IFA IgG Titer	If performed, what was the reciprocal titer of the acute phase I IFA IgG
Acute Phase I IFA IgM Result	If performed, was the acute phase I IFA IgM positive	PHVS_YesNoUnknown_CDC
Acute Phase I IFA IgM Titer	If performed, what was the reciprocal titer of the acute phase I IFA IgM
Acute Phase I Compliment Fixation Result	If performed, was the acute phase I compliment fixation positive	PHVS_YesNoUnknown_CDC
Acute Phase I Compliment Fixation Titer	If performed, what was the reciprocal titer of the acute phase I compliment fixation
Acute Phase I, Other Test Name	If performed, what was the name of another phase I acute serologic test
Acute Phase I, Other Test Result	If performed, was the other phase I acute serologic test positive	PHVS_YesNoUnknown_CDC
Acute Phase I, Other Test Numeric Result	If performed, what was the numeric result of the other phase I acute serologic test
Acute Phase II Serology Collection Date	If acute phase II serology was performed, then list the date of collection
Acute Phase II IFA IgG Result	If performed, was the acute phase II IFA IgG positive	PHVS_YesNoUnknown_CDC
Acute Phase II IFA IgG Titer	If performed, what was the reciprocal titer of the acute phase II IFA IgG
Acute Phase II IFA IgM Result	If performed, was the acute phase II IFA IgM positive	PHVS_YesNoUnknown_CDC
Acute Phase II IFA IgM Titer	If performed, what was the reciprocal titer of the acute phase II IFA IgM
Acute Phase II Compliment Fixation Result	If performed, was the acute phase II compliment fixation positive	PHVS_YesNoUnknown_CDC
Acute Phase II Compliment Fixation Titer	If performed, what was the reciprocal titer of the acute phase II compliment fixation
Acute Phase II, Other Test Name	If performed, what was the name of another phase II acute serologic test
Acute Phase II, Other Test Result	If performed, was the other phase II acute serologic test positive	PHVS_YesNoUnknown_CDC
Acute Phase II, Other Test Numeric Result	If performed, what was the numeric result of the other phase II acute serologic test
Convalescent Phase I Serology Collection Date	If convalescent phase I serology was performed, then list the date of collection
Convalescent Phase I IFA IgG Result	If performed, was the convalescent phase I IFA IgG positive	PHVS_YesNoUnknown_CDC
Convalescent Phase I IFA IgG Titer	If performed, what was the reciprocal titer of the convalescent phase I IFA IgG
Convalescent Phase I IFA IgM Result	If performed, was the convalescent phase I IFA IgM positive	PHVS_YesNoUnknown_CDC
Convalescent Phase I IFA IgM Titer	If performed, what was the reciprocal titer of the convalescent phase I IFA IgM
Convalescent Phase I Compliment Fixation Result	If performed, was the convalescent phase I compliment fixation positive	PHVS_YesNoUnknown_CDC
Convalescent Phase I Compliment Fixation Titer	If performed, what was the reciprocal titer of the convalescent phase I compliment fixation
Convalescent Phase I, Other Test Name	If performed, what was the name of another phase I convalescent serologic test
Convalescent Phase I, Other Test Result	If performed, was the other phase I convalescent serologic test positive	PHVS_YesNoUnknown_CDC
Convalescent Phase I, Other Test Numeric Result	If performed, what was the numeric result of the other phase I convalescent serologic test
Convalescent Phase II Serology Collection Date	If convalescent phase II serology was performed, then list the date of collection
Convalescent Phase II IFA IgG Result	If performed, was the convalescent phase II IFA IgG positive	PHVS_YesNoUnknown_CDC
Convalescent Phase II IFA IgG Titer	If performed, what was the reciprocal titer of the convalescent phase II IFA IgG
Convalescent Phase II IFA IgM Result	If performed, was the convalescent phase II IFA IgM positive	PHVS_YesNoUnknown_CDC
Convalescent Phase II IFA IgM Titer	If performed, what was the reciprocal titer of the convalescent phase II IFA IgM
Convalescent Phase II Compliment Fixation Result	If performed, was the convalescent phase II compliment fixation positive	PHVS_YesNoUnknown_CDC
Convalescent Phase II Compliment Fixation Titer	If performed, what was the reciprocal titer of the convalescent phase II compliment fixation
Convalescent Phase II, Other Test Name	If performed, what was the name of another phase II convalescent serologic test
Convalescent Phase II, Other Test Result	If performed, was the other phase II convalescent serologic test positive	PHVS_YesNoUnknown_CDC
Convalescent Phase II, Other Test Numeric Result	If performed, what was the numeric result of the other phase II convalescent serologic test
Fourfold	If paired sera were collected, was there a fourfold change in titer between acute and convalescent of the same phase	PHVS_YesNoUnknown_CDC
PCR	If performed, was the polymerase chain reaction assay positive	PHVS_YesNoUnknown_CDC
Immunostain	If performed, were antibodies detected using immunohistochemistry during microscopy	PHVS_YesNoUnknown_CDC
Culture	If performed, was the etiologic agent isolated from culture	PHVS_YesNoUnknown_CDC

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Sheet 44: STSS

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
DAYCARE	If <6 years of age, is the patient in daycare?	PHVS_YesNoUnknown_CDC
FACNAME	Name of the daycare facility.	PHVS_YesNoUnknown_CDC
NURSHOME	Does the patient reside in a nursing home or other chronic care facility?	PHVS_YesNoUnknown_CDC
NHNAME	Name of the nursing home or chronic care facility.
SYNDRM	Types of infection that are caused by the organism. This is a multi-select field.	TBD
SPECSYN	Other infection that is caused by the organism.
SPECIES	Bacterial species that was isolated from any normally sterile site.	TBD
OTHBUG1	Other bacterial species that was isolated from any normally sterile site.	TBD
STERSITE	Sterile sites from which the organism was isolated. This is a multi-select field.	TBD
OTHSTER	Other sterile site from which the organism was isolated.
DATE	Date the first positive culture was obtained. (This is considered diagnosis date.)
NONSTER	Nonsterile sites from which the organism was isolated. This is a multi-select field.	TBD
UNDERCOND	Did the patient have any underlying conditions?	PHVS_YesNoUnknown_CDC
COND	Underlying conditions that the subject has. This is a multi-select field.	TBD
OTHMALIG	Other malignancy that the subject had as an underlying condition.
OTHORGAN	Detail of the organ transplant that the subject had as an underlying condition.
OTHILL	Other prior illness that the subject had as an underlying condition.
OTHOTHSPC	Another Bacterial Species not listed in the Other Bacterial Species drop-down list.
Specify Internal Body Site	Internal Body Site where the organism was located.	TBD
Other Prior Illness 2	Other prior illness that the subject had as an underlying condition.
Other Prior Illness 3	Other prior illness that the subject had as an underlying condition.
Other Nonsterile Site	Other nonsterile site from which the organism was isolated.
INSURANCE	Patient's type of insurance (multi-selection).	TBD
INSURANCEOTH	Patient's other type of insurance.
WEIGHTLB	Weight of the patient in pounds.
WEIGHTOZ	Weight of the patient in ounces.
WEIGHTKG	Weight of the patient in kilograms.
HEIGHTFT	Height of the patient in feet.
HEIGHTIN	Height of the patient in inches.
HEIGHTCM	Height of the patient in centimeters.
WEIGHTUNK	Indicator that the weight of the patient is unknown.	PHVS_TrueFalse_CDC
HEIGHTUNK	Indicator that the height of the patient is unknown.	PHVS_TrueFalse_CDC
SURGERY	Did the patient have surgery?	PHVS_YesNoUnknown_CDC
SURGDATE	Date of the surgery
DELIVERY	Did the patient have a baby (vaginal or C-section)?	PHVS_YesNoUnknown_CDC
BABYDATE	Date of the baby's delivery
GASCOND	Did the patient have other prior conditions? This is a multi-select field.	TBD

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Sheet 45: Rubella

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the subject have a rash?	Did the subject being reported in this investigation have a rash?	PHVS_YesNoUnknown_CDC
Rash onset date	What was the rash onset date?
Duration of rash	How many days did the rash last?
Rash Onset occur within 14-23 days of entering USA	Did rash onset occur 14-23 days after entering USA, following any travel or living outside the USA?	PHVS_YesNoUnknown_CDC
Did the Subject have a fever?	Did the subject have a fever? i.e., a measured temperature >2 degrees above normal	PHVS_YesNoUnknown_CDC
Highest Measured Temperature	What was the person's highest measured temperature during this illness?
Temperature Units	The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius.	PHVS_TemperatureUnit_UCUM
Date of Fever Onset	Date of fever onset
Arthralgia/arthritis (symptom)	Did the Subject have arthralgia/arthritis (symptom)?	PHVS_YesNoUnknown_CDC
Lymphadenopathy (symptom)	Did the Subject have lymphadenopathy (symptom)?	PHVS_YesNoUnknown_CDC
Conjunctivitis (symptom)	Did the Subject have conjunctivitis (symptom)?	PHVS_YesNoUnknown_CDC
Encephalitis (complication)	Did the person develop encephalitis as a complication of this illness?	PHVS_YesNoUnknown_CDC
Thrombocytopenia (complication)	Did the person develop thrombocytopenia as a complication of this illness?	PHVS_YesNoUnknown_CDC
Arthralgia/arthritis (complication)	Did Subject have arthralgia/arthritis (complication)?	PHVS_YesNoUnknown_CDC
Other Complication	Did the person develop an other condition(s) as a complication of this illness?	PHVS_YesNoUnknown_CDC
Specify Other Complication	Please specify the other complication(s) the person developed, during or as a result of this illness.
Cause of Death	Cause of subject's death
Was laboratory testing done for rubella?	Was laboratory testing done for rubella?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case	PHVS_LabTestProcedure_Rubella
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_VPD
Sample Analyzed Date	The date the specimen/isolate was tested
Test Method	The technique or method used to perform the test and obtain the test results	PHVS_LabTestMethod_CDC
Date Collected	Date of specimen collection
Specimen Source	The medium from which the specimen originated	PHVS_SpecimenSource_VPD
Were the specimens sent to CDC for genotyping (molecular typing)?	Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Specimen type sent to CDC for genotyping	Specimen type sent to CDC for genotyping	PHVS_SpecimenSource_VPD
Date sent for genotyping	The date the specimens were sent to the CDC laboratories for genotyping
Was Rubella genotype sequenced?	Identifies whether the Rubella virus was genotype sequenced.	PHVS_YesNoUnknown_CDC
Type of Genotype Sequence	Identifies the genotype sequence of the Rubella virus	PHVS_Genotype_Rubella
Transmission Setting	What was the transmission setting where the Rubella was acquired?	PHVS_TransmissionSetting_NND
Were age and 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?	PHVS_YesNoUnknown_CDC
Source of Infection	What was the source of the Rubella infection?
Is this case Epi-linked to another confirmed or probable case?	Specify if this case is Epidemiologically-linked to another confirmed or probable case of Rubella?	PHVS_YesNoUnknown_CDC
Traceable to international import?	Identifies whether the Rubella case was traceable (linked) to an international import.	PHVS_YesNoUnknown_CDC
Expected Delivery Date	What is the expected delivery date of this pregnancy?
Expected Place of Delivery	Expected place of delivery
Number of weeks gestation at time of disease	Number of weeks gestation at time of rubella disease
Trimester of gestation at time of disease	Trimester of gestation at time of rubella disease	PHVS_PregnancyTrimester_CDC
Documentation of previous disease immunity testing	Is there documentation of previous rubella immunity testing?	PHVS_YesNoUnknown_CDC
Result of previous immunity testing	Result of previous immunity testing	PHVS_LabTestInterpretation_VPD
Year of previous immunity testing	Year of previous immunity testing
Age of Subject at time of immunity testing (in years)	Age of Subject at time of immunity testing
Did the Subject ever have this disease prior to this pregnancy?	Did the Subject ever have rubella disease prior to this pregnancy?	PHVS_YesNoUnknown_CDC
Was previous disease serologically confirmed?	Was previous rubella disease serologically confirmed?	PHVS_YesNoUnknown_CDC
Year of previous disease	If previous rubella was serologically confirmed, what was the year of previous disease?
Age of the Subject at time of previous disease (in years)	If previous rubella was serologically confirmed, what was the age of the Subject at time of previous disease?
Current Pregnancy Outcome	What was the outcome of the current pregnancy?	PHVS_BirthOutcome_Rubella
At the time of cessation of pregnancy, what was the age of the fetus (in weeks)?	If applicable, at the time of cessation of pregnancy, what was the age of the fetus (in weeks)?
Was an autopsy performed?	Was an autopsy performed on the subject's body?	PHVS_YesNoUnknown_CDC
Final Anatomical Diagnosis of Death from Autopsy Report	The final anatomical cause of subject's death
Did the Subject ever receive disease-containing vaccine?	Did the Subject ever receive rubella-containing vaccine?	PHVS_YesNoUnknown_CDC
If no, reason subject did not receive a disease-containing vaccine	If the subject did not receive a rubella-containing vaccine, what was the reason?	PHVS_VaccineNotGivenReasons_CDC
Number of doses received ON or AFTER first birthday	Number of rubella-containing vaccine doses Subject received ON or AFTER first birthday
Vaccine Administered	The type of vaccine administered, (e.g., Varivax, MMRV). First question of a repeating group of vaccine questions.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine. Second question of a repeating group of vaccine questions.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered. Third question of a repeating group of vaccine questions.
Vaccine Administered Date	The date that the vaccine was administered. Fourth question of a repeating group of vaccine questions.
US Acquired	Sub-classification of disease or condition acquired in the US	PHVS_CaseClassificationExposureSource_NND
Part of Outbreak	Is this case part of an outbreak of 3 or more
Date of Return from Travel	Date of return from most recent travel
Case Patient a Healthcare Worker	Was the case patient a healthcare provider (HCP) at illness onset?
Previous case diagnosed by	Who diagnosed previous case?
Vaccination Doses Prior to Onset	Number of vaccine doses against this disease prior to illness onset
Date of Last Dose Prior to Illness Onset	Date of last vaccine dose against this disease prior to illness onset
Vaccine History Comments	Comments about the subject's vaccination history
Age at rash onset	Age at rash onset
Age units at rash onset	Age units at rash onset
Age units at previous diagnosis	Age units at previous diagnosis
Length of time in U.S.	Length of time in U.S.
Length of time in U.S. Units	Length of time in U.S. Units
International Destination(s) of Recent Travel	List any international destinations of recent travel.

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Sheet 46: Salmonellosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
AgClinic	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory?
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BioId	Was the pathogen identified by culture?
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
Immigrate	Did case-patient immigrate to the U.S.? (within 7 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Ccase-patient's medical record number
OtherCdcTest	What was the result of specimen testing using another test at CDC?
OtherClinicTest	What was the result of specimen testing using another test at a clinical laboratory?
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing using another test at a state public health laboratory?
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PcrClinic	What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SalGroup	Salmonella serogroup
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SeroSite	Serotype/species of pathogen
SLabsID	State lab identification number
SpecSite	Case patient's specimen collection source
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 7 days of onset)
Dom_travel	In the 7 days before illness, would you/your child have traveled within the US but outside of the area where you live or work?
Out_freq	How many times would you/your child have eaten out (deli, fast food, or other restaurant)?
Chx_handle	Would you/your child, or anyone in your household, have handled raw chicken in the home?
Chicken	How many times would you/your child have eaten chicken or any foods containing chicken?
Chx_uncook	In the 7 days before illness, would you/your child have eaten any chicken that was raw or undercooked?
chx_ground	In the 7 days before illness, would you/your child have eaten any ground chicken?
Chx_whole	In the 7 days before illness, would you/your child have eaten any whole or cut chicken parts (e.g., rotisserie, chicken breasts, wings, etc.)?
chx_processed	In the 7 days before illness, would you/your child have eaten any processed chicken (e.g., deli meat, chicken nuggets, pre-made dinners, etc.)?
Chx_outside	In the 7 days before illness, would you/your child have eaten any chicken made outside of home (deli, fast food, take-out, or restaurant)?**
Chx_home	In the 7 days before illness, would you/your child have eaten any chicken made at home?
Chx_fresh	Was the chicken bought fresh (refrigerated)? (Answer if Yes to Q56)
Chx_frozen	Was the chicken bought frozen? (Answer if Yes to Q56)
Turkey_handle	Would you/your child, or anyone in your household, have handled raw turkey in the home?
Turkey	In the 7 days before illness, would you/your child have eaten any turkey or any foods containing turkey?
Turkey_uncook	In the 7 days before illness, would you/your child have eaten any turkey that was undercooked or raw?
Turkey_ground	In the 7 days before illness, would you/your child have eaten any ground turkey?
Turkey_whole	In the 7 days before illness, would you/your child have eaten any whole or cut turkey parts?
Turkey_processed	In the 7 days before illness, would you/your child have eaten any processed turkey (e.g., deli meat, bacon, sausage, pre-made dinners, etc.)?**
Turkey_outside	In the 7 days before illness, would you/your child have eaten any turkey made outside of home (deli, fast food, take-out, or restaurant)?
Turkey_home	In the 7 days before illness, would you/your child have eaten any turkey made at home?
Other_poultry	In the 7 days before illness, would you/your child have eaten any poultry other than chicken or turkey (e.g., duck, cornish hens, quail, etc.)?
Beef_handle	Would you/your child, or anyone in household, have handled raw beef in the home?
Beef	In the 7 days before illness, would you/your child have eaten beef or any foods containing beef?
Beef_uncook	In the 7 days before illness, would you/your child have eaten any beef that was undercooked or raw?
Beef_ground	In the 7 days before illness, would you/your child have eaten any ground beef?
Beef_whole	In the 7 days before illness, would you/your child have eaten any whole or cut beef parts (e.g., steaks, roasts, etc.)?
Beef_processed	In the 7 days before illness, would you/your child have eaten any processed beef (e.g., deli meat, sausage, jerky, pre-made dinners, etc.)?
Beef_outside	In the 7 days before illness, would you/your child have eaten any beef made outside of home (deli, fast food, take-out, or restaurant)?
Beef_home	In the 7 days before illness, would you/your child have eaten any beef made at home?
Beef_fresh	Was the beef bought fresh (refrigerated)? (Answer if Yes to Q75)
Beef_frozen	Was the beef bought frozen? (Answer if Yes to Q75)
Pork_handle	Would you/your child, or anyone in your household, have handled raw pork in the home?
Pork	In the 7 days before illness, would you/your child have eaten pork or any foods containing pork?
Pork_uncook	In the 7 days before illness, would you/your child have eaten any undercooked or raw pork?
Pork_whole	In the 7 days before illness, would you/your child have eaten any whole or cut pork parts (e.g., ham shank, pork chops, chitlins, etc.)?
Pork_processed	In the 7 days before illness, would you/your child have eaten any processed pork (e.g., deli meat [like ham slices], bacon, sausage, etc.)?**
Lamb	In the 7 days before illness, would you/your child have eaten any lamb?
Seafood	In the 7 days before illness, would you/your child have eaten any non-fish seafood (e.g., crab, shrimp, oysters, clams, etc.) that was not from a can?
seafood_uncook	In the 7 days before illness, would you/your child have eaten any non-fish seafood that was undercooked or raw (e.g., raw oysters, clams, etc.)?
Fish	In the 7 days before illness, would you/your child have eaten any fish or fish products (processed or unprocessed) that was not from a can?
Fish_uncook	In the 7 days before illness, would you/your child have eaten any fish that was undercooked or raw (e.g., sushi, etc.)?
Fish_whole	In the 7 days before illness, would you/your child have eaten any whole fish or fish filets (unprocessed fish)?
Eggs	In the 7 days before illness, would you/your child have eaten eggs or any foods containing eggs?
Eggs_outside	In the 7 days before illness, would you/your child have eaten any eggs made away outside of home (deli, fast food, take-out, or restaurant)?**
Eggs_home	In the 7 days before illness, would you/your child have eaten any eggs made at home?
Eggs_uncook	In the 7 days before illness, would you/your child have eaten any eggs that were runny or raw, or uncooked foods made with raw eggs?
Dairy	In the 7 days before illness, would you/your child have eaten or drank any dairy products (e.g., milk, yogurt, cheese, ice cream, etc.)?
Queso_fresco	In the 7 days before illness, would you/your child have eaten any queso fresco, queso blanco, or other type of Mexican-style soft cheese?
Dairy_uncook	…eaten or drank any dairy products that were raw or unpasteurized (e.g., raw milk, or cheeses, yogurts, and ice cream made from raw milk)?
Cantaloupe	In the 7 days before illness, would you/your child have eaten any fresh cantaloupe?
Strawberries	In the 7 days before illness, would you/your child have eaten any fresh (unfrozen) strawberries?
Other_berries	In the 7 days before illness, would you/your child have eaten any other fresh (unfrozen) berries?
Watermelon	In the 7 days before illness, would you/your child have eaten any fresh watermelon?
Apples	In the 7 days before illness, would you/your child have eaten any fresh apples?
Honeydew	In the 7 days before illness, would you/your child have eaten any fresh honeydew melon?
Pineapple	In the 7 days before illness, would you/your child have eaten any fresh pineapple?
Raw_cider	In the 7 days before illness, would you/your child have drank any unpasteurized juice or cider?
Other_fruit	In the 7 days before illness, would you/your child have eaten any other fruit (fresh or frozen) or drank other fruit juices?
Nuts_uncook	In the 7 days before illness, would you/your child have eaten any raw or uncooked nuts?
Lettuce	In the 7 days before illness, would you/your child have eaten any fresh, raw lettuce?
Cabbage	In the 7 days before illness, would you/your child have eaten any fresh, raw cabbage?
Spinach	In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw spinach?
Broccoli	In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw broccoli?
Tomatoes	In the 7 days before illness, would you/your child have eaten any fresh, raw tomatoes?
Onions	In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw onions?
Carrots	In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw carrots?
Sprouts	In the 7 days before illness, would you/your child have eaten any fresh, raw sprouts?
Herbs	In the 7 days before illness, would you/your child have eaten any fresh (not dried) herbs?
Other_veggies	In the 7 days before illness, would you/your child have eaten any other vegetables (fresh or frozen) or drank any vegetable juices?
Infant_formula	If you are answering for an ill infant aged 1 year or younger, are they drinking infant formula?
Infant_bmilk	If you are answering for an ill infant aged 1 year or younger, are they drinking breast milk?
Infant_omilk	If you are answering for an ill infant aged 1 year or younger, are they drinking any other milk?
Well_water	In the 7 days before illness, would you/your child have drank any water from a well?
Other_untreated	In the 7 days before illness, would you/your child have swallowed or drank any water directly from a natural spring, lake, pond, stream, or river?
Swim_unchlor	In the 7 days before illness, would you/your child have swam in, waded in, or entered an ocean, lake, pond, river, stream, or natural spring?
Sick_contacts	Was there a household member or a close contact with diarrhea?
Diaper_contact	In the 7 days before illness, would you/your child have had contact with dirty diapers?
Shared_facility	In the 7 days before illness, would you/your child have lived, worked, or volunteered in a shared living facility (e.g., dorm, nursing home, etc.)?
Daycare	Would you/your child, or anyone in your house, have attended, worked, or volunteered at a day care?
Sick_pet	In the 7 days before illness, would you/your child have had any contact with a pet that had diarrhea?
Reptile_amphib	In the 7 days before illness, would you/your child have had any contact with a reptile or amphibian (e.g., frog, snake, turtle, etc.)?
Outdoors	In the 7 days before illness, would you/your child have done any hiking, camping, gardening, or yard work?
Manure_compost	In the 7 days before illness, would you/your child have had any contact with animal manure, pet feces, or compost?
Farm_ranch	In the 7 days before illness, would you/your child have visited, worked, or lived on farm, ranch, petting zoo, or other setting that has farm animals?
Live_poultry	Were there any live poultry (e.g., chickens, turkeys, hens, etc.)? (Answer if Yes to Q130)
Cattle_others	Were there any cattle, goats, or sheep? (Answer if Yes to Q130)
Other_animals	Were there any other farm animals (e.g., pigs, horses, etc.)? (Answer if Yes to Q130)
Site ID	Site ID assigned by CDC.
Disease	Foodborne Disease.
State Lab ID	Identification of Isolate
Collection Date	Date isolate taken from patient
Last Updated	Date of Last Modification
Confirmed	Is isolate confirmed
Specimen Source	Source of isolate
Test Result	Serotype/Species/Test Result
Occupation/Industry/Place of Business	Is patient employed in a high risk occupation (e.g., food handler, healthcare worker, daycare worker)?
Child care attendee	Did patient have a high risk exposure related to child care facility?
Long term care facility resident	Did patient have a high risk exposure related to residence in a long term care facility?
Contact of a Salmonellosis case	Did patient have a high risk exposure related to contact with a Salmonellosis case?
Method(s) of laboratory testing	Type of laboratory testing performed
Name of test	Name of laboratory test performed
Name of test manufacturer	Name of test manufacturer
Probable case from CIDT testing	Probable case status confirmed by CIDT testing
Probable case from Epi-linkage	Probable case confirmed by Epi-linkage
Reported  symptoms and signs of illness	Symptoms and signs associated with illness
WGS (Whole-Genome Sequencing) ID	The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P

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Sheet 47: S.Paratyphi Infection

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Formtype	Type of form reported on (9=carrier form or known carrier)	N/A	P
CDCNUM	CDC Number	N/A	P
StateEpiNumber	State Epi Number	N/A	P
SLABSID	State Lab Isolate ID Number	N/A	P
SLABSID2	State Lab Isolate ID Number 2, maybe if another entry is associated in NARMS data	N/A	P
SpecNumber	NARMS Isolate Identification Number	N/A	P
SpecNumber2	NARMS Isolate Identification Number- for dulplicate sample from a single patient	N/A	P
SpecNumber3	NARMS Isolate Identification Number- for dulplicate sample from a single patient	N/A	P
Year	Year of report (based on date onset)	N/A	P
Date Entered	Date Form was entered into database	N/A	P
Date Rec CDC	Date Form was received to CDC	N/A	P
Name	First three letters of patient's last name	N/A	P
Foodhand	Work as foodhandler? (1=Yes, 2=No, 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
Citizen	Citizen (1=US 2=other 9=unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9=didn't answer) WAIT to change in SAS		P
Othcitzn	Other citizenship	N/A	P
Ill	Ill with typhoid fever (1=Yes 2=No 9=Unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9 didn't answer) Changed in SAS!	PHVS_YesNoUnknown_CDC	P
Dtonset	Date of onset of Symptoms	N/A	P
Outcome	Outcome of case (1=Recovered 2=Died 3=didn't answer 9=unknown)	PHVS_ConditionStatus_FDD	P
Dtisol	Date Salmonella first isolated	N/A	P
Site	Sites of isolation (1=Blood 2=Stool 3=didn't answer 9=unknown 4=gallbalder 5=other) CAREFUL with this variable - LOTS of dif. codes!	PHVS_SpecimenCollectionSource_FDD	P
Othsite	Other site of isolation	N/A	P
Serotype		N/A	P
Sensi	Was sensitivity testing done? (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
Ampr	Resistant to ampicillin on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)	PHVS_YesNoUnknown_CDC	P
Chlorr	Resistant to chloramphenicol on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)	PHVS_YesNoUnknown_CDC	P
Tmpsmxr	Resistant to trimethoprim-sulfamethoxazole on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)	PHVS_YesNoUnknown_CDC	P
quinol	Resistant to fluoroquinolone on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)	PHVS_YesNoUnknown_CDC	P
Ceft	Resistant to ceftriaxone (1=Yes 2=No 9=unknown)	PHVS_YesNoUnknown_CDC	P
outbreak	Case occur as part of outbreak? (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
vac5yr	Vaccinated within 5 yrs? (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
stanvax	Standard Killed typhoid shot (1=Yes 2=No, 9=unknown, 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
yrstanvx	Year standard vaccine received	N/A	P
ty21vax	Oral Ty 21a or Vivotof four pill series (1=Yes 2=No, 9=unknown, 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
yrty21	Year of Oral Ty 21a or Vivotof four pill series received	N/A	P
vicps	VICPS or Typhium VI shot (1=Yes 2=No, 9=unknown, 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
yrvicps	Year VICPS or Typhium VI shot received	N/A	P
outus	Travel outside of US? (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
country1	Country 1 visited	PHVS_Country_ISO_3166-1	P
country2	Country 2 visited	PHVS_Country_ISO_3166-1	P
country3	Country 3 visited	PHVS_Country_ISO_3166-1	P
country4	Country 4 visited	PHVS_Country_ISO_3166-1	P
country1oth	country 1 other	PHVS_Country_ISO_3166-1	P
country2oth	country 2 other	PHVS_Country_ISO_3166-1	P
country3oth	country 3 other	PHVS_Country_ISO_3166-1	P
country4oth	country 4 other	PHVS_Country_ISO_3166-1	P
dtentus	Date of most return or entry in the US	N/A	P
business	Business is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_TravelPurpose_FDD	P
tourism	Tourism is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_TravelPurpose_FDD	P
visitfam	Visiting relatives or friends is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_TravelPurpose_FDD	P
immigrat	Immigration to the US is purpose of international travel (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_TravelPurpose_FDD	P
othtrav	Other travel is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)Reason for other travel	PHVS_TravelPurpose_FDD	P
travreas	Reason for other travel	N/A	P
anycarr	Case traced to typhoid carrier? (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
prevcarr	Carrier previously known to health dept (1=Yes 2=No 9=unknown 3=didn't answer)	PHVS_YesNoUnknown_CDC	P
comment	Comments	N/A	P
dtform	Date PH Dept completed form	N/A	P
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is not 30 days. Specify the time interval in days here. Otherwise, leave blank.	N/A	P
health care worker	Was the patient a health care provider?	PHVS_YesNoUnknown_CDC	P
day care attendee	Was the patient a health care attendee?	PHVS_YesNoUnknown_CDC	P
day care worker	Was the patient a day care provider?	PHVS_YesNoUnknown_CDC	P

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Sheet 48: S. Typhi Infection

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Formtype	Type of form reported on (9=carrier form or known carrier)
CDCNUM	CDC Number
StateEpiNumber	State Epi Number
SLABSID	State Lab Isolate ID Number
SLABSID2	State Lab Isolate ID Number 2, maybe if another entry is associated in NARMS data
SpecNumber	NARMS Isolate Identification Number
SpecNumber2	NARMS Isolate Identification Number- for dulplicate sample from a single patient
SpecNumber3	NARMS Isolate Identification Number- for dulplicate sample from a single patient
Year	Year of report (based on date onset)
Date Entered	Date Form was entered into database
Date Rec CDC	Date Form was received to CDC
State	Reporting State
Name	First three letters of patient's last name
DOB	Date of Birth
Age	Age
Sex	Sex (1=Male 2=Female)
Foodhand	Work as foodhandler? (1=Yes, 2=No, 9=unknown 3=didn't answer)
Citizen	Citizen (1=US 2=other 9=unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9=didn't answer) WAIT to change in SAS
Othcitzn	Other citizenship
Ill	Ill with typhoid fever (1=Yes 2=No 9=Unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9 didn't answer) Changed in SAS!
Dtonset	Date of onset of Symptoms
Hosp	Hospitalized? (1=Yes 2=No, 9=unknown, 3=didn't answer)
Hospdays	Days hospitalized NOTE -- 999= didn't answer in a field like this!
Outcome	Outcome of case (1=Recovered 2=Died 3=didn't answer 9=unknown)
Dtisol	Date Salmonella first isolated
Site	Sites of isolation (1=Blood 2=Stool 3=didn't answer 9=unknown 4=gallbalder 5=other) CAREFUL with this variable - LOTS of dif. codes!
Othsite	Other site of isolation
Serotype
Sensi	Was sensitivity testing done? (1=Yes 2=No 9=unknown 3=didn't answer)
Ampr	Resistant to ampicillin on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)
Chlorr	Resistant to chloramphenicol on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)
Tmpsmxr	Resistant to trimethoprim-sulfamethoxazole on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)
quinol	Resistant to fluoroquinolone on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown)
Ceft	Resistant to ceftriaxone (1=Yes 2=No 9=unknown)
outbreak	Case occur as part of outbreak? (1=Yes 2=No 9=unknown 3=didn't answer)
vac5yr	Vaccinated within 5 yrs? (1=Yes 2=No 9=unknown 3=didn't answer)
stanvax	Standard Killed typhoid shot (1=Yes 2=No, 9=unknown, 3=didn't answer)
yrstanvx	Year standard vaccine received
ty21vax	Oral Ty 21a or Vivotof four pill series (1=Yes 2=No, 9=unknown, 3=didn't answer)
yrty21	Year of Oral Ty 21a or Vivotof four pill series received
vicps	VICPS or Typhium VI shot (1=Yes 2=No, 9=unknown, 3=didn't answer)
yrvicps	Year VICPS or Typhium VI shot received
outus	Travel outside of US? (1=Yes 2=No 9=unknown 3=didn't answer)
country1	Country 1 visited
country2	Country 2 visited
country3	Country 3 visited
country4	Country 4 visited
country1oth	country 1 other
country2oth	country 2 other
country3oth	country 3 other
country4oth	country 4 other
dtentus	Date of most return or entry in the US
business	Business is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)
tourism	Tourism is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)
visitfam	Visiting relatives or friends is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)
immigrat	Immigration to the US is purpose of international travel (1=Yes 2=No 9=unknown 3=didn't answer)
othtrav	Other travel is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)Reason for other travel
travreas	Reason for other travel
anycarr	Case traced to typhoid carrier? (1=Yes 2=No 9=unknown 3=didn't answer)
prevcarr	Carrier previously known to health dept (1=Yes 2=No 9=unknown 3=didn't answer)
comment	Comments
dtform	Date PH Dept completed form
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is not 30 days. Specify the time interval in days here. Otherwise, leave blank.	N/A	P
health care worker	Was the patient a health care provider?	PHVS_YesNoUnknown_CDC	P
day care attendee	Was the patient a health care attendee?	PHVS_YesNoUnknown_CDC	P
day care worker	Was the patient a day care provider?	PHVS_YesNoUnknown_CDC	P

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Sheet 49: SARS

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Fever	Did the patient have a fever (subjective or objective)?
Fever date	If yas, date of fever onest
Temperature >38°C(100.4°F)	Was the measured temperature >38°C?
Lower respiratory symptoms	Did the patient have any lower respiratory symptoms (e.g., a cough, shortness of breath, difficulty breathing?)?
Chest x-ray/CAT scan	Was a chest x-ray or CAT scan performed?
Pneumonia/RDS evidence	If yes, did the patient have radiographic evidence of pneumonia or respiratory distress syndrome?
Evaluation first date	Indicate date of the first evaluation for this illness.
Hospitalization	Was patient hospitalized for >24 hours during the course?
Hospital name	If yes, indicate the name of the hospital
Hospital city	If yes, indicate the city of the hospital
Hospital state	If yes, indicate the state of the hospital
Hospitalization date	Indicate date of hospitalization
Discharge date	Indicate date of hospital discharge
ICU admission	Was trhe patient ever admitted to the intensive care unit (ICU)?
Mechanical ventilation	Was the patient ever placed on mechanical ventilation?
Death	Did the patient die as a result of his /her illness?
Death date	Indicate date of death
Autopsy	Was an autopsy performed?
Pathology results	Was pathology consistent with pneumonia or RDS?
HCW	Is the patient a healthcare worker?
HCW type	If so, indicate type of HCW (physician, nurse/PA, lab, other [specify])
Direct patient care	Does patient have DIRECT patient care responsibilities?
Occupation	If not a HCW, list occupation.
Case contact	In the 10 days prior to symptom onset did the patient have close contact with a confirmed or probable SARS-CoV case?
RUI-2 or RUI-3 contact	In the 10 days prior to symptom onset did the patient have close contact with a person considered an RUI-2 or RUI-3?
Travel to SARS area	In the 10 days prior to symptom onset did the patient have travel to foreign or domestic area with documented or suspected recent local transmissionof SARS cases?
Travel destination	If yes, list travel destinations (departure and arrival dates).
Contact classification	Classification of contact (RUI-2w, RUI-3, probable SARS-CoV, confirmed SARS-CoV).
Nature of contact	Nature of contact (same household, coworker, HC environment, other).
Contact start	Date contact started
Contact end	Date contact ended
Contact travel to SARS area	Did the ill contact recently travel to an area with SARS transmission (specify where)?
Contact CDC ID	Contact CDC ID
Contact State ID	Contact State ID
Contact name	If CDC ID or State ID unavailable ((first, middle initial, last)
Foreign travel Health Alert	If recent foreign travel, did the patient recive a health Alert or other SARS educational information on arrival in the U.S?
Symptomatic during travel for a SARS area	Was the patient symptomatic during the travel from a SARS affected area within 24 hours of return to the U.S or local area?
SARS suspect name	If yes, provide to the CDC the name of the SARS suspect who has traveled (enter name)
Public conveyance travel departure	If yes, indicate public conveyance departure date
Public conveyance travel departure city	If yes, indicate public conveyance departure city
Public conveyance travel arrival city	If yes, indicate public conveyance arrival city
Public conveyance transport type	Public conveyance transport type (airline, train, cruise, bus, auto, tour grp, other)
Transport company	Name of transport company
Transport number	Indicate transport number
Comment
Initial patient classification	Patient's intial classification by state of municipality (RUI-1, RUI-2, RUI-3, RUI-4, or probable SARS-CoV, confirmed SARS-CoV)
Updated patient classification	Patient's updated classification( RUI-1, RUI-2, RUI-3, RUI-4, probable SARS-CoV, confirmed SARS-CoV, not a case: negative serology, not a case: alternative diagnosis accounts for illness)
Date updated	Most recent updated classification
Laboratory Specimen 1	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 1 collection date	Collection date for specimen 1
Lab specimen 1 test	Test requested for specimen 1
Lab specimen 1 source of local testing	Source of local testing for specimen 1
Lab specimen 1 result	Result of lab testing for specimen 2
Laboratory Specimen 2	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 2 collection date	Collection date for specimen 2
Lab specimen 2 test	Test requested for specimen 2
Lab specimen 2 source of local testing	Source of local testing for specimen 2
Lab specimen 2 result	Result of lab testing for specimen 2
Laboratory Specimen 3	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 3 collection date	Collection date for specimen 3
Lab specimen 3 test	Test requested for specimen 3
Lab specimen 3 source of local testing	Source of local testing for specimen 3
Lab specimen 3 result	Result of lab testing for specimen 3
Laboratory Specimen 4	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 4 collection date	Collection date for specimen 4
Lab specimen 4 test	Test requested for specimen 4
Lab specimen 4 source of local testing	Source of local testing for specimen 4
Lab specimen 4 result	Result of lab testing for specimen 4
Laboratory Specimen 5	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 5 collection date	Collection date for specimen 5
Lab specimen 5 test	Test requested for specimen 5
Lab specimen 5 source of local testing	Source of local testing for specimen 5
Lab specimen 5 result	Result of lab testing for specimen 5
Laboratory Specimen 6	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 6 collection date	Collection date for specimen 6
Lab 6 test	Test requested for specimen 6
Lab specimen 6 source of local testing	Source of local testing for specimen 6
Lab specimen 6 result	Result of lab testing for specimen 6
Laboratory Specimen 7	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 7 collection date	Collection date for specimen 7
Lab 7 test	Test requested for specimen 7
Lab specimen 7 source of local testing	Source of local testing for specimen 7
Lab specimen 7 result	Result of lab testing for specimen 7
Laboratory Specimen 8	Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type])
Lab specimen 8 collection date	Collection date for specimen 8
Lab 8 test	Test requested for specimen 8
Lab specimen 8 source of local testing	Source of local testing for specimen 8
Lab specimen 8 result	Result of lab testing for specimen 8
Alternative Diagnosis	Was an alternative respiratory pathogen detected?
Alternative pathogen	If yes, indicate the pathogen isolated.
CDC Specimen 1	List specimen(s) sent to CDC
Tissue specimen 1	If 'tissue', specify.
CDC specimen 1 date	Date specimen 1 sent to CDC
CDC Specimen 2	List specimen(s) sent to CDC
Tissue specimen 2	If 'tissue', specify.
CDC specimen 2 date	Date specimen 2 sent to CDC
CDC Specimen 3	List specimen(s) sent to CDC
Tissue specimen 3	If 'tissue', specify.
CDC specimen 3 date	Date specimen 3 sent to CDC
CDC Specimen 4	List specimen(s) sent to CDC
Tissue specimen 4	If 'tissue', specify.
CDC specimen 4 date	Date specimen 4 sent to CDC
CDC Specimen 5	List specimen(s) sent to CDC
Tissue specimen 5	If 'tissue', specify.
CDC specimen 5 date	Date specimen 5 sent to CDC
CDC Specimen 6	List specimen(s) sent to CDC
Tissue specimen 6	If 'tissue', specify.
CDC specimen 6 date	Date specimen 6 sent to CDC
CDC Specimen 7	List specimen(s) sent to CDC
Tissue specimen 7	If 'tissue', specify.
CDC specimen 7 date	Date specimen 7 sent to CDC
CDC Specimen 8	List specimen(s) sent to CDC
Tissue specimen 8	If 'tissue', specify.
CDC specimen 8 date	Date specimen 8 sent to CDC
Notes	Any notes needed

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Sheet 50: Shigella

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Site ID	Site ID assigned by CDC.
Disease	Foodborne Disease.
State Lab ID	Identification of Isolate
Collection Date	Date isolate taken from patient
Last Updated	Date of Last Modification
Confirmed	Is isolate confirmed
Specimen Source	Source of isolate
Test Result	Serotype/Species/Test Result
International travel in the 7 days prior to onset	Did patient travel internationally within 7 days of illness onset?
Occupation/Industry/Place of Business	Is patient employed in a high risk occupation (e.g., food handler, healthcare worker, daycare worker)?
Child care attendee	Did patient have a high risk exposure related to attendance at a child care facility?
Long term care facility resident	Did patient have a high risk exposure related to residence in a long term care facility?
Contact of a Shigellosis case	Did patient have a high risk exposure related to contact with a Shigellosis case?
Method(s) of laboratory testing	Type of laboratory testing performed
Name of test	Name of laboratory test performed
Name of test manufacturer	Name of test manufacturer
Probable case from CIDT	Probable case status confirmed by CIDT (Culture Independent Diagnostic Testing)
Probable case from Epi-linkage	Probable case confirmed by Epi-linkage
Reported  symptoms and signs of illness	Symptoms and signs associated with illness
WGS (Whole-Genome Sequencing) ID	The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P
Did The Case Travel Domestically Prior To Illness Onset?	Did the case patient travel domestically within program specific timeframe?	PHVS_YesNoUnknown_CDC	P
Travel State	Domestic destination, state(s) traveled to	PHVS_State_FIPS_5-2	P
International Destination(S) Of Recent Travel	International destination or countries the patient traveled to	PHVS_Country_ISO_3166-1	P

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Sheet 51: STD (not congenital)

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Notification ID	The unique identifier for the notification record
Receiving Application	CDC's PHIN Common Data Store (CDS) is the Receiving Application for this message.
Message Profile ID	First instance is the reference to the structural specification used to validate the message. Second instance is the reference to the PHIN Message Mapping Guide from which the content is derived.
Local Subject ID	The local ID of the subject/entity.
Subject Name Type	Name is not requested by the program, but the Patient Name field is required to be populated for the HL7 message to be valid. Have adopted the HL7 convention for processing a field where the name has been removed for de-identification purposes.	PHVS_NameType_HL7_2x
Local Record ID	Sending system-assigned local ID of the case investigation with which the subject is associated. Note: The local record ID should be the unique identifier for the case being reported.
Subject Type	Type of subject for the notification. "Person," "Place/Location," or "Non-Person Living Subject" are the appropriate subject types for Notifications to CDC.	PHVS_NotificationSectionHeader_CDC
Notification Type	Type of notification. Notification types are "Individual Case," "Environmental," "Summary," and "Laboratory Report".	PHVS_NotificationSectionHeader_CDC
Date First Submitted	Date/time the notification was first sent to CDC. This value does not change after the original notification.
Date of Report	Date/time this version of the notification was sent. It will be the same value as NOT103 for the original notification. For updates, this is the update/send date/time.
Notification Result Status	Status of the notification.	PHVS_ResultStatus_NND
Immediate National Notifiable Condition	Does this case meet the criteria for immediate (extremely urgent or urgent) notification to CDC?	PHVS_NationalReportingJurisdiction_NND
Reporting State	State reporting the notification.	PHVS_State_FIPS_5-2
Reporting County	County reporting the notification.	PHVS_County_FIPS_6-4
National Reporting Jurisdiction	National jurisdiction reporting the notification to CDC.	PHVS_NationalReportingJurisdiction_NND
Condition Code	Condition or event that constitutes the reason the notification is being sent	PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS
Birth Date	Date of birth in YYYYMMDD format
Subject’s Sex	Subject’s current sex
Race Category	Field containing one or more codes that broadly refer to the subject’s race(s).	PHVS_RaceCategory_CDC
Subject Address County	County of residence of the subject	PHVS_County_FIPS_6-4
Subject Address State	State of residence of the subject	PHVS_State_FIPS_5-2
Subject Address ZIP Code	ZIP Code of residence of the subject
Ethnic Group Code	Based on the self-identity of the subject as Hispanic or Latino	PHVS_EthnicityGroup_CDC_Unk
Country of Birth	Country of Birth	PHVS_CountryofBirth_CDC
Census tract of case-patient residence	Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area. A single community may be composed of several census tracts.
Country of Usual Residence	Where does the person usually* live (defined as their residence) *For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf .	PHVS_CountryofBirth_CDC
Jurisdiction Code	Identifier for the physical site from which the notification is being submitted.
Case Investigation Status Code	Status of the investigation	PHVS_CaseInvestigationStatus_NND
Investigation Date Assigned	Date the investigator was assigned to this investigation.
Date of Report/Referral	Date the event or illness was first reported by the reporting source (physician or lab reported to the local/county/state health department).
Reporting Source Type Code	Type of facility or provider associated with the source of information sent to Public Health.	PHVS_ReportingSourceType_NND
Reporting Source ZIP Code	ZIP Code of the reporting source for this case.
Earliest Date Reported to County	Earliest date reported to county public health system
Earliest Date Reported to State	Earliest date reported to state public health system
Hospitalized	Was subject hospitalized because of this event?	PHVS_YesNoUnknown_CDC
Admission Date	Subject’s admission date to the hospital for the condition covered by the investigation.
Discharge Date	Subject's discharge date from the hospital for the condition covered by the investigation.
Duration of hospital stay in days	Subject's duration of stay at the hospital for the condition covered by the investigation.
Diagnosis Date	Date of diagnosis of condition being reported to public health system
Date of Illness Onset	Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system
Illness End Date	Time at which the disease or condition ends.
Illness Duration	Length of time this subject had this disease or condition.
Illness Duration Units	Unit of time used to describe the length of the illness or condition.	PHVS_AgeUnit_UCUM
Did the subject die from this condition?	Did the subject die from this illness or complications of this illness?	PHVS_YesNoUnknown_CDC
Deceased Date	If the subject died from this illness or complications associated with this illness, indicate the date of death
Case Investigation Start Date	The date the case investigation was initiated.
Case Outbreak indicator	Denotes whether the reported case was associated with an identified outbreak.	PHVS_YesNoUnknown_CDC
Case Outbreak Name	A state-assigned name for an indentified outbreak.
Case Disease Imported Code	Indication of where the disease/condition was likely acquired.	PHVS_DiseaseAcquiredJurisdiction_NETSS
Imported Country	If the disease or condition was imported, indicates the country in which the disease was likely acquired.	PHVS_Country_ISO_3166-1
Imported State	If the disease or condition was imported, indicates the state in which the disease was likely acquired.	PHVS_State_FIPS_5-2
Imported City	If the disease or condition was imported, indicates the city in which the disease was likely acquired.	PHVS_City_USGS_GNIS
Imported County	If the disease or condition was imported, contains the county of origin of the disease or condition.	PHVS_County_FIPS_6-4
Transmission Mode	Code for the mechanism by which disease or condition was acquired by the subject of the investigation.	PHVS_CaseTransmissionMode_NND
Case Class Status Code	Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions.	PHVS_CaseClassStatus_NND
MMWR Week	MMWR Week for which case information is to be counted for MMWR publication.
MMWR Year	MMWR Year (YYYY) for which case information is to be counted for MMWR publication.
State Case ID	States use this field to link NEDSS investigations back to their own state investigations. Note: This may be any state-assigned ID number for the case; may be different than INV168, which is the system-assigned unique identified for the 'case' of disease being reported.
Date of First Report to CDC	Date the case was first reported to the CDC
Date First Reported PHD	Earliest date the case was reported to the public health department whether at the local, county, or state public health level.
Pregnancy status	Indicates whether the subject was pregnant at the time of the event.	PHVS_YesNoUnknown_CDC
Person Reporting to CDC - Name	Name of the person who is reporting the case to the CDC
Person Reporting to CDC - Phone Number	Phone Number of the person who is reporting the case to the CDC
Person Reporting to CDC - Title	Job title / description of the person reporting the case to the CDC
Person Reporting to CDC - Affiliation	Affiliated Facility of the person reporting the case to the CDC
Legacy Case ID	CDC uses this field to link current case notifications to case notifications submitted by a previous system (NETSS, STD-MIS, etc.)
Age at case investigation	Subject age at time of case investigation
Age units at case investigation	Subject age units at time of case investigation	PHVS_AgeUnit_UCUM_NETSS
Country of Exposure or Country Where Disease was Acquired Note: use exposure or acquired consistently across variables	Indicates the country in which the disease was potentially acquired.	PHVS_CountryofBirth_CDC
State or Province of Exposure	Indicates the state in which the disease was potentially acquired. Business Rule: If Country of exposure was US, populate with US State. If Country of exposure was Mexico, populate with Mexican State. If country of exposure was Canada, populated with Canadian Province. For all other countries, leave null.	PHVS_State_FIPS_5-2
City of Exposure	Indicates the city in which the disease was potentially acquired. Business Rule: If country of exposure is US, populate with US city. For all other cities, can be populated but not required. Note: Since value set only includes US cities, would allow states to populate the CWE 9th component with another city.
County of Exposure	Indicates the county in which the disease was potentially acquired. Business Rule: If country of exposure is US, populate with US county. Otherwise, leave null.
Binational Reporting Criteria	For cases meeting the binational criteria, select all the criteria which are met	PHVS_BinationalReportingCriteria_CDC
Date of initial health exam associated with case report "health event"	Date of earliest healthcare encounter/visit /exam associated with this event/case report. May equate with date of exam or date of diagnosis.
Neurological involvement?	If event = some stage of syphilis, does the patient have neurologic involvement based on current case definition?	New Value Set PHVS_Neurological_involvement_CDC
Treatment Date	Date treatment initiated for the condition that is the subject of this case report.
HIV Status	Documented or self-reported HIV status at the time of event.	New Value Set PHVS_HIVStatus_CDC
Had sex with a male within past 12 months?	Had sex with a male within past 12 months?	New Value Set PHVS_YNRD_CDC
Had sex with a female within past 12 months?	Had sex with a female within past 12 months?	New Value Set PHVS_YNRD_CDC
Had sex with an anonymous partner within past 12 months?	Had sex with an anonymous partner within past 12 months?	New Value Set PHVS_YNRD_CDC
Had sex with a person know to him/her to be an IDU within past 12 months?	Had sex with a person known to him/her to be an IDU within past 12 months?	New Value Set PHVS_YNRD_CDC
Had sex while intoxicated and/or high on drugs within past 12 months?	Had sex while intoxicated and/or high on drugs within past 12 months?	New Value Set PHVS_YNRD_CDC
Exchanged drugs/money for sex within past 12 months?	Exchanged drugs/money for sex within past 12 months?	New Value Set PHVS_YNRD_CDC
Had sex with a person who is know to her to be an MSM within past 12 months?	Had sex with a person who is known to her to be an MSM within past 12 months? NOTE: For women only.	New Value Set PHVS_YNRD_CDC
Engaged in injection drug use within past 12 months?	Engaged in injection drug use within past 12 months?	New Value Set PHVS_YNRD_CDC
During the past 12 months, which of the following injection or non-injection drugs have been used?	During the past 12 months, which of the following injection or non-injection drugs have been used?	New Value Set PHVS_DrugsUsed_CDC
Previous STD history?	Does the patient have a history of ever having had an STD prior to the condition reported in this case report?	New Value Set PHVS_PreviousSTDhistory_CDC
Been incarcerated with past 12 months?	Been incarcerated within past 12 months?	New Value Set PHVS_YNRD_CDC
Have you met sex partners through the Internet in the last 12 months?	Did the patient use an online computer site to exchange messages by typing them onscreen to engage in conversation with other visitors to the site for the purpose of having sex?	New Value Set PHVS_YNRD_CDC
Total number of sex partners last 12 months?	Total number of sex partners that the case patient has had in the last 12 months. Total partners equal the sum of all male, female, and transgender partners during the period.
Clinician-observed lesion(s) indicative of syphilis	If condition = any stage of syphilis, report anatomic site(s) of clinician-observed lesion(s) (e.g., chancre, rash, condyloma lata) at time of initial exam or specimen collection. Mark all that apply.	New Value Set PHVS_Clinician-observed lesions_CDC
Type of nontreponemal serologic test for syphilis	What type of non-treponemal serologic test for syphilis was performed on specimen collected to support case patient's diagnosis of syphilis?	New Value Set PHVS_nontreponemalserologictest_CDC
Quantitative syphilis test result	If the test performed provides a quantifiable result, provide quantitative result (e.g. if RPR is positive, provide titer, e.g. 1:64) Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.
Patient refused to answer questions regarding number of sex partners	Patient refused to answer questions regarding number of sex partners	PHVS_YesNoUnknown_CDC
Unknown number of sex partners in last 12 months	Unknown number of sex partners in last 12 months	PHVS_YesNoUnknown_CDC
Date of laboratory specimen collection	Date of collection of initial laboratory specimen used for diagnosis of health event reported in this case report. PREFERRED date for assignment of MMWR week. First date in hierarchy of date types associated with case report/event.
Specimen source	Anatomic site or specimen type from which positive lab specimen was collected.	New Value Set PHVS_SpecimenSource_CDC
Date of lab result	Date result sent from Reporting Laboratory.
HIV status documented through eHARS Record Search?	Was the HIV status of this case investigated through search of eHARS?	PHVS_YesNoUnknown_CDC
eHARS Stateno	Stateno from eHARS registry for HIV+ cases.
Trans_Categ (eHARS, person dataset)	Mode of exposure from eHARS for HIV+ cases.	New Value Set PHVS_TransCateg_CDC
Case sampled for enhanced investigation?	Was this case selected by reporting jurisdiction for enhanced investigarion?	PHVS_YesNoUnknown_CDC
Method of case detection	How case patient first came to the attention of the health department for this condition	New Value Set PHVS_DetectionMethod_CDC
Type of treponemal serologic test for syphilis	What type of treponemal serologic test for syphilis was performed on specimen collected to support case patient's diagnosis of syphilis?	New Value Set PHVS_treponemalserologic_CDC
Count	represents # of cases reported in this ‘record’; supports aggregate-(when >1) or case-specific (when=1) reporting.	##### Default=00001 for case-specific records where a single case is represented by data record.
Event date	date of disease in YYMMDD format.  This date depends upon how case dates are assigned in the STD program. i.e., date could be the onset of symptoms date, diagnosis date, laboratory result date, date case first recognized and/or reported to STD program, or date case reported to CDC.	YYMMDD Unknown=999999
Datetype	describes the type of date provided in Event date	1=Onset Date 2=Date of diagnosis 3=Date of laboratory result 4=Date of first report to coummunity health system 5=State/MMWR report date 9=Unknown
NETSS version	What version of the NETSS record layout are you providing?	i.e. Version 3 (January 2011) 03=Version 3
STD-Associated Lab Tests	STD-Associated Lab Tests	STD-Associated RCMT Lab Tests (OBX-3)
STD-Associated Lab Results	STD-Associated Lab Results	STD-Associated RCMT Lab Results (OBX-5)
Injection or non-injection drugs use indicator	Injection or non-injection drug use indicator	New Value Set PHVS_YNRD_CDC
Nontreponemal serologic syphilis test (quantitative)	If the test performed provides a quantifiable result, provide quantitative result (e.g. if RPR is positive, provide titer, e.g. 1:64) Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.	New Value Set PHVS_QuantitativeSyphilisTestResult_STD
Nontreponemal serologic syphilis test (qualitative)	Qualitative test result of STD123 Nontreponemal serologic syphilis test result (quantitative)	New Value Set PHVS_LabTestReactivity_NND
Qualitative treponemal serologic syphilis test result	If the test performed provides a qualitative result, provide qualitative result, e.g. weakly reactive.	New Value Set PHVS_LabTestResultQualitative_NND
Neurological manifestations	Neurological manifestations of disease
Ocular Manifestations	Infection of any eye structure with T. pallidum, as evidenced by manifestations including posterior uveitis, panuveitis, anterior uveitis, optic neuropathy, and retinal vasculitis.
Otic Manifestations	Infection of the cochleovestibular system with T. pallidum, as evidenced by manifestations including sensorineural hearing loss, tinnitus, and vertigo.
Late Clinical Manifestations (tertiary syphilis)	Late clinical manifestations of syphilis (tertiary syphilis) may include inflammatory lesions of the cardiovascular system, skin, bone, or other tissue. Certain neurologic manifestations (e.g., general paresis and tabes dorsalis) are late clinical manifestations of syphilis.
Transgender	Patient identified as transgender (i.e., an individual’s personal sense of being male, female, or transgender).
Sexual Orientation	Patient identified sexual orientation (i.e., an individual's physical and/or emotional attraction to another individual of the same gender, opposite gender, or both genders).

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Sheet 52: STEC

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
AgClinic	For possible E. coli cases: What was the result of specimen testing for Shiga toxin using an antigen-based test (e.g.EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	For possible E. coli cases: What was the result of specimen testing for Shiga toxin using an antigen-based test (e.g.EIA or lateral flow) at a state public health laboratory?
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BioId	Was the pathogen identified by culture?
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
HUS	Did case patient have a diagnosis of HUS?
Immigrate	Did case-patient immigrate to the U.S.? (within 7 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Ccase-patient's medical record number
OtherCdcTest	What was the result of specimen testing for Shiga toxin using another test at the CDC?
OtherClinicTest	What was the result of specimen testing for Shiga toxin using another test at a clinical laboratory
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing for Shiga toxin using another test at a state public health laboratory?
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for Shiga toxin using PCR at CDC?
PcrClinic	What was the result of specimen testing for Shiga toxin using PCR at a clincal laboratory?
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for Shiga toxin using PCR at a state public health laboratory?
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SLabsID	State lab identification number
SpecSite	Case patient's specimen collection source
StecH7	Was it H7 antigen positive?
StecHAg	What was the H-antigen number?
StecNM	Was the isolate non-motile?
StecO157	Was it O157 positive?
StecOAg	What was the O-antigen number?
StecStx	Was E. coli Shiga toxin-producing?
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 7 days of onset)
PulseNet Key	Identification tag in PulseNet database
Date of interview	Date questionnaire administered to case
Respondent	Individual who was interviewed	Self; Parent; Spouse; Other
Other Respondent	If case, parent, or spouse not interviewed, then who was?
City of residence	City where patient resides
Month of birth	Month when patient was born	12-Jan
Year of birth	Year when patient was born
Hispanic or Latino	Is the patient of Hispanic or Latino origin	Hispanic; Non-Hispanic; Unknown
Total days ill	Length of patient's illness in days
Still ill	Is the patient still ill	Yes; No
Diarrhea	Patient experienced 3 or more loose stools in 24-hour period	Yes; No; Maybe; Unknown
Diarrhea onset	Date patient first expierenced 3 or more loose stools
Bloody stool	Patient experienced blood in stool	Yes; No; Maybe; Unknown
Still hospitalized	Is the patient still hospitalizaed	Yes; No
HUS	Patient diagnosed by doctor with HUS or kidney failure	Yes; No; Maybe; Unknown
Food handler	Patient works as a food handler at dining establishment	Yes; No; Maybe; Unknown
Daycare worker	Patient works in a daycare facility	Yes; No; Maybe; Unknown
Foods at home	List of locations where foods eaten at home were purchased
Foods away from home	List of locations where foods were eaten outside of the home
Handled raw ground beef	Patient handled raw ground beed (even if not consumed) in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Ground beef	Patient consumed ground beef in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Ground beef at home	Patient consumed ground beef at home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Pink ground beef at home	Patient consumed red or pink ground beef at home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Ground beef at home purchase location	Location(s) where ground beef consumed at home in 7 days prior to illness onset was purchased
Ground beef at home purchase date	Date(s) when ground beef consumed at home in 7 days prior to illness onset was purchased
Ground beef brand	Brand(s) of ground beef eaten at home in 7 days prior to illness onset
Ground beef bulk	Ground beef eaten at home was purchased in bulk	Yes; No
Ground beef patties	Ground beef eaten at home was purchased in pre-formed patties	Yes; No
Ground beef other	Ground beef eaten at home was purchased in other form	Yes; No
Ground beef unknown purchase form	Patient unable to recall form in which ground beef eaten at home was purchased	Yes; No
Home ground beef size	Size in which ground beef consumed at home was purchased	Number of pounds; Unknown
Percent lean	Percentage lean of ground beef eaten at home	Percentage; Unknown
Fresh ground beef	Ground beef eaten at home was purchased fresh	Yes; No
Frozen ground beef	Ground beef eaten at home was purchased frozen	Yes; No
Unknown fresh/frozen ground beef	Patient unable to recall if ground beef consumed at home was purchased fresh or frozen	Yes; No
Ground beef away from home	Patient consumed ground beef away from home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Gound beef away from home location	Location(s) where ground beef consumed away from home
Pink ground beef away	Patient consumed red or pink ground beef away from home	Yes; No; Maybe; Unknown
Hamburger	Ground beef eaten outside the home as hamburger	Yes; No
Meatball	Ground beef eaten outside the home as meatball	Yes; No
Meatloaf	Ground beef eaten outside the home as meatloaf	Yes; No
Taco	Ground beef eaten outside the home in a taco	Yes; No
Ground beef in a dish	Ground beef eaten in a dish (ex. casserole) outside the home	Yes; No
Other form of ground beef outside home	Ground beef eaten outside the home in form other than hamburger, meatball, meatloaf, taco, or in a dish	Yes; No
Specify other form of ground beef	Other type of ground beef eaten outside the home
Steak	Patient consumed steak in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Steak at home	Patient consumed steak at home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Pink steak at home	Steak consumed at home was pink or read	Yes; No; Maybe; Unknown
Steak at home purchase location	Location(s) where steak consumed at home was purchased
Steak at home purchase date	Date(s) when steak consumed at home was purchased
Steak brand	Brand(s) of steak eaten at home
Steak consumed as steak	Steak was consumed as steak	Yes; No
Steak consumed as stew	Steak was consumed in a stew	Yes; No
Steak consumed as roast	Steak was consumed as a roast	Yes; No
Unknown steak type	Patient unable to recall how steak was consumed	Yes; No
Steak consumed as other	Steak was consumed in form other than steak, stew, roast	Yes; No
Specify how steak was consumed	If steak was consumed in other form, then specify
Steak away from home	Patient consumed steak away from home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Steak away from home location	Location(s) where steak was consumed away from home
Steak away from home dates	Date(s) when steak was consumed away from home
Pink steak away	Patient consumed red or pink steak away from home	Yes; No; Maybe; Unknown
Pink steak away as steak	Patient consumed red or pink steak away from home as steak	Yes; No
Pink steak away as stew	Patient consumed red or pink steak away from home as stew	Yes; No
Pink steak away as roast	Patient consumed red or pink steak away from home as a roast	Yes; No
Pink steak away as other product	Patient consumed red or pink steak away from home in form other than steak, stew, or roast	Yes; No
Specify how other pink steak was consumed	Specify if 'Other' red or pink steak was reported
Bison	Patient consumed bison in the 7 days prior to illness onset	Yes; No; Maybe; Unknown
Bison at home	Patient consumed bison at home in the 7 days prior to illness onset	Yes; No; Maybe; Unknown
Pink bison at home	Patient consumed red or pink bison at home	Yes; No; Maybe; Unknown
Bison purchase location	Location(s) where ground beef consumed at home was purchased
Bison purchase date	Date(s) when bison consumed at home was purchased
Bison at home brand	Brand of bison purchased for home consumption
Bison away from home	Patient consumed bison away from home in 7 days prior to illness onset	Yes; No; Maybe; Unknown
Bison away location	Location(s) where bison was consumed outside the home
Bison away date	Date(s) when bison was consumed outside the home
Pink bison away from home	Bison eaten outside the home was red or pink	Yes; No; Maybe; Unknown
Wild game	Patient consumed wild game in the 7 days before illness onset	Yes; No; Maybe; Unknown
Dried meat	Patient consumed dried meat in the 7 days before illness onset	Yes; No; Maybe; Unknown
Pepperoni	Patient consumed dried meat that was pepperoni	Yes; No
Salami	Patient consumed dried meat that was salami	Yes; No
Sausage	Patient consumed dried meat that was sausage	Yes; No
Other dried meat	Patient consumed dried meat that was not pepperoni, salami, or sausage	Yes; No
Typle of other dried meat	Specify other type of dried meat consumed
Jerky	Patient consumed jerkey of any type in the 7 days before illness onset	Yes; No; Maybe; Unknown
Raw milk	Patient consumed raw milk in the 7 days before illness onset	Yes; No; Maybe; Unknown
Raw cheese	Patient consumed cheese made with raw milk in the 7 days before illness onset	Yes; No; Maybe; Unknown
Raw cheese type	Type of raw milk cheese consumed
Raw cheese location	Location(s) where raw milk cheese was purchased
Raw cheese date	Date(s) when raw milk cheese was purchased
Raw ice cream	Patient consumed ice cream made with raw milk in the 7 days before illness onset	Yes; No; Maybe; Unknown
Raw juice	Patient consumed raw or unpasteurized juice or cide in the 7 dayse before illness onset	Yes; No; Maybe; Unknown
Lettuce	Patient consumed lettuce of any kind in the 7 days before illness onset	Yes; No; Maybe; Unknown
Lettuce at home	Patient consumed lettuce of any kind at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Lettuce at home purchase location	Location(s) where lettuce consumed at home was purchased
Lettuce at home purchase date	Date(s) when lettuce consumed at home was purchased
Lettuce at home brand	Brand(s) of lettuce purchased for home consumption
Loose lettuce at home	Patient consumed loose lettuce of any kind in the 7 days before illness onset	Yes; No
Prepackaged lettuce at home	Patient consumed prepackaged lettuce of any kind in the 7 days before illness onset	Yes; No
Unknown packaging of lettuce at home	Patient unable to recall how lettuce consumed at home was packaged	Yes; No
Lettuce away from home	Patient consumed lettuce of any kind away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Lettuce away from home location	Location(s) where the lettuce was consumed away from home
Mesclun lettuce	Patient consumed mesclun lettuce in the 7 days before illness onset	Yes; No; Maybe; Unknown
Mesclun lettuce at home	Patient consumed mesclun lettuce at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Mesclun lettuce at home purchase location	Location(s) where mesclun lettuce consumed at home was purchased
Mesclun lettuce at home purchase date	Date(s) when mesclun lettuce consumed at home was purchased
Mesclun lettuce at home brand	Brand(s) of mesclun lettuce consumed at home
Loose mesclun lettuce at home	Patient consumed loose mesclun lettuce at home	Yes; No
Prepackaged mesclun lettuce at home	Patient consumed prepackaged mesclun lettuce at home	Yes; No
Unknown packaging of mesclun lettuce at home	Patient unable to recall how mesclun lettuce consumed at home was purchased	Yes; No
Mesclun lettuce away from home	Patient consumed mesclun lettuce away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Mesclun lettuce away from home location	Location(s) where the mesclun lettuce was consumed away from home
Iceberg lettuce	Patient consumed iceberg lettuce in the 7 days before illness onset	Yes; No; Maybe; Unknown
Iceberg lettuce at home	Patient consumed iceberg lettuce at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Iceberg lettuce at home purchase location	Location(s) where iceberg lettuce consumed at home was purchased
Iceberg lettuce at home purchase date	Date(s) when iceberg lettuce consumed at home was purchased
Iceberg lettuce at home brand	Brand(s) of iceberg lettuce consumed at home
Loose iceberg lettuce at home	Patient consumed iceberg mesclun lettuce at home	Yes; No
Prepackaged iceberg lettuce at home	Patient consumed prepackaged iceberg lettuce at home	Yes; No
Unknown packaging of iceberg lettuce at home	Patient unable to recall how iceberg lettuce consumed at home was purchased	Yes; No
Iceberg lettuce away from home	Patient consumed iceberg lettuce away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Iceberg lettuce away from home location	Location(s) where the iceberg lettuce was consumed away from home
Romaine lettuce	Patient consumed romaine lettuce in the 7 days before illness onset	Yes; No; Maybe; Unknown
Romaine lettuce at home	Patient consumed romaine lettuce at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Romaine lettuce at home purchase location	Location(s) where romaine lettuce consumed at home was purchased
Romaine lettuce at home purchase date	Date(s) when romaine lettuce consumed at home was purchased
Romaine lettuce at home brand	Brand(s) of romaine lettuce consumed at home
Loose romaine lettuce at home	Patient consumed loose romaine lettuce at home	Yes; No
Prepackaged romaine lettuce at home	Patient consumed prepackaged romaine lettuce at home	Yes; No
Unknown packaging of romaine lettuce at home	Patient unable to recall how romaine lettuce consumed at home was purchased	Yes; No
Romaine lettuce away from home	Patient consumed romaine lettuce away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Romaine lettuce away from home location	Location(s) where the romaine lettuce was consumed away from home
Red leaf lettuce	Patient consumed red leaf lettuce in the 7 days before illness onset	Yes; No; Maybe; Unknown
Red leaf lettuce at home	Patient consumed red leaf lettuce at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Red leaf lettuce at home purchase location	Location(s) where red leaf lettuce consumed at home was purchased
Red leaf lettuce at home purchase date	Date(s) when red leaf lettuce consumed at home was purchased
Red leaf lettuce at home brand	Brand(s) of red leaf lettuce consumed at home
Loose red leaf lettuce at home	Patient consumed loose red leaf lettuce at home	Yes; No
Prepackaged red leaf lettuce at home	Patient consumed prepackaged red leaf lettuce at home	Yes; No
Unknown packaging of red leaf lettuce at home	Patient unable to recall how red leaf lettuce consumed at home was purchased	Yes; No
Red leaf lettuce away from home	Patient consumed red leaf lettuce away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Red leaf lettuce away from home location	Location(s) where the red leaf lettuce was consumed away from home
Spinach	Patient consumed spinach in the 7 days before illness onset	Yes; No; Maybe; Unknown
Spinach at home	Patient consumed spinach at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Spinach at home purchase location	Location(s) where spinach consumed at home was purchased
Spinach at home purchase date	Date(s) when spinach consumed at home was purchased
Spinach at home brand	Brand(s) of spinach consumed at home
Loose spinach at home	Patient consumed spinach at home	Yes; No
Prepackaged spinach at home	Patient consumed prepackaged spinach at home	Yes; No
Unknown packaging of spinach at home	Patient unable to recall how spinach consumed at home was purchased	Yes; No
Spinach away from home	Patient consumed spinach away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Spinach away from home location	Location(s) where the spinach was consumed away from home
Other leafy greens	Patient consumed other leafy greens in the 7 days before illness onset	Yes; No; Maybe; Unknown
Other leafy greens at home	Patient consumed other leafy greens at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Other leafy greens at home purchase location	Location(s) where other leafy greens consumed at home was purchased
Other leafy greens at home purchase date	Date(s) when other leafy greens consumed at home was purchased
Other leafy greens at home brand	Brand(s) of other leafy greens consumed at home
Loose other leafy greens at home	Patient consumed other leafy greens at home	Yes; No
Prepackaged other leafy greens at home	Patient consumed prepackaged other leafy greens at home	Yes; No
Unknown packaging of other leafy greens at home	Patient unable to recall how other leafy greens consumed at home was purchased	Yes; No
Other leafy greens away from home	Patient consumed other leafy greens away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Other leafy greens away from home location	Location(s) where the other leafy greens was consumed away from home
Sprouts	Patient consumed sprouts of any kind in the 7 days before illness onset	Yes; No; Maybe; Unknown
Sprouts at home	Patient consumed sprouts of any kind at home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Sprouts at home purchase locations	Location(s) where sprouts consumed at home were purchased
Sprouts at home purchase date	Date(s) when sprouts consumed at home were purchased
Sprouts at home brand	Brand(s) of sprouts consumed at home
Sprouts away from home	Patient consumed sprouts of any kind away from home in the 7 days before illness onset	Yes; No; Maybe; Unknown
Sprouts away from home location	Location(s) where sprouts were consumed away from home
Sprouts way from home type	Type of sprouts consumed outside the home
Petting zoo	Patient visited a petting zoo in the 7 days before illness onset	Yes; No; Maybe; Unknown
Farm with livestock	Patient visited, worked, or lived on a farm with livestock in the 7 days before illness onset	Yes; No; Maybe; Unknown
Farm and Feed store	Patient visited an agricultural 'Farm and Feed' store in the 7 days before illness onset	Yes; No; Maybe; Unknown
Pet store	Patient visited a pet store, swap meets, or other places where animals/birds are sold or shown in the 7 dayse before illness onset	Yes; No; Maybe; Unknown
Fair	Patient visited a county or state fair, 4-H event, or similar even with animals in the 7 days before illness onset	Yes; No; Maybe; Unknown
Pet treats	Patient had contact with pet treats or chews in the 7 days before illness onset	Yes; No; Maybe; Unknown
Animal droppings	Patient had contact with dried animal droppings or pellets in the 7 days before illness onset	Yes; No; Maybe; Unknown
Daycare	Patient attended or had contact with a daycare facility in the 7 days before illness onset	Yes; No; Maybe; Unknown
Any travel	Patient spent all or some of the 7 days before illness onset outside of their state of residence	Yes; No; Maybe; Unknown
Domestic travel	Postal code abbreviation of state(s) where patient traveled
Domestic travel start date	Domestic travel start date
Domestic travel end date	Domestic travel end date
International travel	Countries visited in the 7 days before illness onset
International travel start date	International travel start date
International travel end date	International travel end date
Group meals	Patient attended a group meal in the 7 days before illness onset	Yes; No; Maybe; Unknown
Institution	Patient visited, lives, or works in an institutional home (jail, nursing home, etc.)	Yes; No; Maybe; Unknown
Institution location	Location of institution where patient visits, lives, or works
Source of drinking water	Main source of drinking water for patient during the 7 days before illness onset	City/municipal; Well; Bottled; Unknown
Site ID	Site ID assigned by CDC.
Disease	Foodborne Disease.
State Lab ID	Identification of Isolate
Collection Date	Date isolate taken from patient
Last Updated	Date of Last Modification
Confirmed	Is isolate confirmed
Specimen Source	Source of isolate
Test Result	Serotype/Species/Test Result
Probable – laboratory-diagnosed	Probable case is laboratory-diagnosed
Probable – epi-linked	Probable case is epidemiologically linked
TTP	Patient had a diagnosis of TTP (Thrombotic thrombocytopenic purpura)
Ill contact	Patient had close contact with anyone with diarrhea or vomiting in the 7 days prior to illness onset
Gourmet cheese	Patient consumed artisanal or gourmet cheese in the 7 days before illness onset
Specify other leafy greens	Specify other leafy greens
Sprouts location	Purchase location of sprouts
Sprouts brand	Brand and variety of sprouts
Treated recreational water	Visit or swim in any treated recreational water facilities in 7 days prior to illness onset
Untreated recreational water	Visit or swim in any untreated recreational water facilities in 7 days prior to illness onset
Treated recreational water location	Location of treated recreational water facilities
Untreated recreational water location	Location of untreated recreational water facilities
Other related diagnosis	Other related diagnosis
Specify other related diagnosis	Specify other related diagnosis
Shopper card consent	Consent to retrieve purchases based on shopper card information
Ground beef at home brand	Brand and variety of ground beef consumed at home
Steak at home brand	Brand and variety of steak consumed at home
Steak at home frozen	Steak consumed at home was purchased frozen
Steak at home fresh	Steak consumed at home was purchased fresh
Bison brand	Brand and variety of bison
Wild game brand	Brand and variety of wild game
Dried meat brand	Brand and variety of dried or fermented meat
Other dried meat brand	Brand and variety of other dried or fermented meat
Pork	Patient consumed pork in 7 days prior to illness onset
Pork at home	Patient consumed pork at home in 7 days prior to illness onset
Pork at home purchase location	Purchase location of pork consumed at home
Pork at home brand	Brand and variety of pork consumed at home
Pork at home ground	Pork consumed at home was ground
Pork at home whole	Pork consumed at home was whole pig
Pork at home other form	Pork consumed at home was other form
Specify other form of pork at home	Specify other type of pork consumed at home
Pork away from home	Patient consumed pork away from home in 7 days prior to illness onset
Pork away from home location	Purchase location of pork consumed away from home
Pork away from home dish	Dish in which pork was consumed away from home
Raw milk location	Purchase location of raw milk
Raw milk brand	Brand and variety of raw milk
Raw cheese	Purchase location of cheese made from raw milk
Raw cheese brand	Brand and variety of cheese made from raw milk
Raw cheese aged	Cheese made from raw milk was aged for 60 days
Gourmet cheese location	Purchase location of artisanal or gourmet cheese
Gourmet cheese brand	Brand and variety of artisanal or gourmet cheese
Raw juice location	Purchase location of unpasteurized juice or cider
Raw juice brand	Brand and variety of unpasteurized juice or cider
Other raw dairy product	Patient consumed any other unpasteurized dairy product in 7 days prior to illness onset
Specify other raw dairy product	Specify other unpasteurized dairy product
Other raw dairy product location	Purchase location of other unpasteurized dairy product
Other raw dairy product brand	Brand and variety of other unpasteurized dairy product
Raw dough	Patient ate, tasted, or licked uncooked or unbaked dough or batter
Leafy greens	Patient consumed fresh, uncooked leafy greens in 7 days prior to illness onset
Leafy greens location	Purchase location of fresh, uncooked leafy greens
Leafy greens brand	Brand and variety of fresh, uncooked leafy greens
Loose leafy greens	Patient consumed loose fresh, uncooked leafy greens
Prepackaged leafy greens	Patient consumed prepackaged fresh, uncooked leafy greens
Cabbage	Patient consumed cabbage in 7 days prior to illness onset
Cabbage location	Purchase location of cabbage
Cabbage brand	Brand and variety of cabbage
Arugula	Patient consumed arugula in 7 days prior to illness onset
Arugula location	Purchase location of arugula
Arugula brand	Brand and variety of arugula
Kale	Patient consumed kale in 7 days prior to illness onset
Kale location	Purchase location of kale
Kale brand	Brand and variety of kale
Premade salad	Patient consumed pre-made, single-serving salads in 7 days prior to illness onset
Premade salad location	Purchase location of pre-made, single-serving salads
Premade salad brand	Brand and variety of pre-made, single-serving salads
Other prepackaged leafy greens	Patient consumed other pre-packaged leafy greens or salad kits
Other prepackaged leafy greens location	Purchase location of other pre-packaged leafy greens or salad kits
Other prepackaged leafy greens brand	Brand and variety of other pre-packaged leafy greens or salad kits
Other leafy greens location	Purchase location of other leafy greens
Other leafy greens brand	Brand and variety of other leafy greens
Herbs	Patient consumed fresh herbs in 7 days prior to illness onset
Specify herbs	Specify fresh herbs
Herbs location	Purchase location of fresh herbs
Herbs brand	Brand and variety of fresh herbs
Specify petting zoo	Specify petting zoo
Specify type of livestock	Specify type of livestock
Specify fair	Specify fair or event with animals
Pet	Patient has a pet of their own
Specify pet	Specify pet
Specify institution	Specify institution
Treated recreational water type	Types of treated recreational water facilities
Untreated recreational water type	Types of untreated recreational water facilities
Occupation	Patient's occupation
Food allergy	Does the patient have a food allergy?
Special diet	Is the patient on a special diet?
Specify Different Exposure Window	If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P
Specify Different Travel Exposure Window	If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P

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Sheet 53: TBRD

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Clinically Compatible Illness	Did this case have a clinically compatible illness as defined by the latest CSTE case definitions?	PHVS_YesNoUnknown_CDC
History of Tick Bite	Was there a history of a tick bite within 14 days of onset?	PHVS_YesNoUnknown_CDC
Eschar	Was there an eschar, or tache noire, present?	PHVS_YesNoUnknown_CDC
Immunosuppressive Condition	If the case reports an immunosuppressive condition, then indicate condition here
Adult respiratory distress syndrome	Did the case report adult respiratory distress syndrome during the course of this illness?	PHVS_YesNoUnknown_CDC
Disseminated Intravascular Coagulation	Did the case report disseminated intravascular coagulation during the course of this illness?	PHVS_YesNoUnknown_CDC
Meningitis	Did the case report meningitis during the course of this illness?	PHVS_YesNoUnknown_CDC
Encephalitis	Did the case report encephalitis during the course of this illness?	PHVS_YesNoUnknown_CDC
Renal Failure	Did the case report renal failure during the course of this illness?	PHVS_YesNoUnknown_CDC
Othere life threatening complication	If the case reported another life threatening complication during the course of this illness, then list it here
Laboratory Name	Indicate the name of the laboratory which supplied results supporting the current CSTE case definitions.
Laboratory State	Indicate the state where the laboratory is located	PHVS_State_FIPS_5-2
Acute Serology Collection Date	If an acute serology was collected, then list the date of collection
Acute IFA IgG Result	If performed, was the acute IFA IgG positive	PHVS_YesNoUnknown_CDC
Acute IFA IgG Titer	If performed, what was the reciprocal titer of the acute IFA IgG
Acute IFA IgM Result	If performed, was the acute IFA IgM positive	PHVS_YesNoUnknown_CDC
Acute IFA IgM Titer	If performed, what was the reciprocal titer of the acute IFA IgM
Acute Serology, Other Test	If performed, what was the name of another acute serology test
Acute Serology Result, Other Test	If performed, was this other acute serology test positive	PHVS_YesNoUnknown_CDC
Acute Serology Numeric Result, Other Test	If performed, what was the numeric result of the other serology test
Convalescent Serology Collection Date	If an convalescent serology was collected, then list the date of collection
Convalescent IFA IgG Result	If performed, was the convalescent IFA IgG positive	PHVS_YesNoUnknown_CDC
Convalescent IFA IgG Titer	If performed, what was the reciprocal titer of the convalescent IFA IgG
Convalescent IFA IgM Result	If performed, was the convalescent IFA IgM positive	PHVS_YesNoUnknown_CDC
Convalescent IFA IgM Titer	If performed, what was the reciprocal titer of the convalescent IFA IgM
Convalescent Serology, Other Test	If performed, what was the name of another convalescent serology test
Convalescent Serology Result, Other Test	If performed, was this other convalescent serology test positive	PHVS_YesNoUnknown_CDC
Convalescent Serology Numeric Result, Other Test	If performed, what was the numeric result of the other serology test
PCR	If performed, was the polymerase chain reaction assay positive	PHVS_YesNoUnknown_CDC
Morulae	If performed, were morulae visualized during microscopy	PHVS_YesNoUnknown_CDC
Immunostain	If performed, were antibodies detected using immunohistochemistry during microscopy	PHVS_YesNoUnknown_CDC
Culture	If performed, was the etiologic agent isolated from culture	PHVS_YesNoUnknown_CDC
Fourfold	If paired sera were collected, was there a fourfold change in titer between acute and convalescent	PHVS_YesNoUnknown_CDC
Other Etiologic Agent	If etiologic agent was unusual, then indicate the species here (for example, R. africae)
Physician Name	Name of subject's clinician/provider of care,Provide the name in the following format:,<last name>, <first name>	N/A	P
Physician Phone	Phone number of subject's clinician/provider of care	N/A	P
Clinical Manifestation	Clinical manifestation of TBRD	PHVS_ClinicalManifestation_TBRD	P
Clinical Manifestation Indicator	For each clinical manifestation reported, indicate (YNU) whether the subject developed the specified manifestation as a result of the illness.	PHVS_YesNoUnknown_CDC	P
Experienced Complication	Did the subject experience any complications due to this episode?	PHVS_YesNoUnknown_CDC	P
Type of Complication	If the subject experienced complications due to this episode, what was the complication?	PHVS_Complication_TBRD	P
Patient Immunocompromised	At the time of diagnosis, was the subject immunocompromised?	PHVS_YesNoUnknown_CDC	P
Treatment Drug Indicator	Did the subject receive antimicrobial treatment for this infection?	PHVS_YesNoUnknown_CDC	P
Medication Administered	What antibiotic did the patient receive for this episode?	PHVS_MedicationReceived_TBRD	P
Date Treatment or Therapy Started	Date the treatment was initiated		P
Treatment Duration	Number of days the patient actually took the antibiotic referenced		P
Occupation related to exposure	Is the subject's current occupation related to the exposure?	PHVS_YesNoUnknown_CDC	P
Travel	In the two weeks before symptom onset or diagnosis (use earlier date), did the subject travel out of their county, state, or country of residence?	PHVS_YesNoUnknown_CDC	P
International Destination(s) of Recent Travel	International destination, countries traveled to	PHVS_YesNoUnknown_CDC	P
Travel State	Domestic destination, state(s) traveled to	PHVS_State_FIPS_5-2	P
Travel County	Intrastate destination, counties traveled to	PHVS_County_FIPS_6-4	P
Date of Arrival to Travel Destination	If the subject traveled, when did they arrive to their travel destination?		P
Date of Departure from Travel Destination	If the subject traveled, when did they depart from their travel destination?		P
Tick Bite Location	If subject noticed tick bite, where did the bite occur (geographic location)?		P
Tick Bite Date	If subject noticed tick bite, when did the bite occur?		P
Blood Transfusion	In the year before symptom onset or diagnosis (use earlier date), did the subject receive a blood transfusion?	PHVS_YesNoUnknown_CDC	P
Blood Transfusion Date	Date(s) of blood transfusion(s)		P
Transfusion Associated	Was the subject’s infection transfusion associated?	PHVS_YesNoUnknown_CDC	P
Transfused Product	If a transfused blood product was implicated in an investigation, specify which type(s) of product.	PHVS_BloodProduct_CDC	P
Organ Transplant	In the year before symptom onset or diagnosis (use earlier date), did the subject receive an organ transplant(s)?	PHVS_YesNoUnknown_CDC	P
Transplant type	If the subject received an organ transplant, what was the organ?		P
Transplant date	Date(s) of organ transplant(s)		P
Transplant associated infection	Was the subject's infection transplant-related?	PHVS_YesNoUnknown_CDC	P
Blood Donor	Did the subject donate blood in the 30 days prior to symptom onset?	PHVS_YesNoUnknown_CDC	P
Blood Donation Date	Date(s) of blood donation(s)		P
Blood Donor Implicated During Investigation	Was the subject a blood donor identified during a transfusion investigation (i.e., had positive test results and was linked to an infected recipient)?	PHVS_YesNoUnknown_CDC	P
Donated Product	If a donated blood product was implicated in an investigation, specify which type(s) of product.	PHVS_BloodProduct_CDC	P
Blood bank notified	Was the blood bank/hospital/transplant service notified?	PHVS_YesNoUnknown_CDC	O
Co-infection	Was the subject diagnosed with a co-infection?	PHVS_YesNoUnknown_CDC	P
Co-infection type	Specify coinfection		P

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Sheet 54: Tetanus

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Date of Illness Onset	Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system
Primary occupation	Specifies patient's primary occupation.
Military Service	History of Military (Active or Reserve)?	PHVS_YesNoUnknown_CDC
Military Service Year	Year of Entry into Militart Service
Tetanus Toxoid Vaccination	Tetanus Toxoid (TT) History Prior to Tetanus Disease (Exclude Doses Received Since Acute Injury)	0 = Never 1 = 1 dose 2 = 2 doses 3 = 3 doses 4 = 4 + doses 9 = Unknown
Year of last tetanus dose	Specifies the year of patients' last tetanus dose.
Acute wound	Did the patient have an acute wound or injury?	PHVS_YesNoUnknown_CDC
Acute wound date	This field indicates the date an acute wound or injury occurred.
Acute wound anatomic site	Specifies the anatomic site of acute wound or injury.	Body Region (Tetanus)
Acute wound work related	If there was an acute wound or injury, was it work related?	PHVS_YesNoUnknown_CDC
Acute wound environment	Specifies the environment where the acute wound or injury was work related.	Injury Occurred Environment (VPD)
Acute wound circumstances	Specifies the circumstances under which the acute wound or injury occurred.
Acute wound type	Specifies the principle acute wound or injury type.	Injury Type (VPD)
Wound Contaminated	Wound Contaminated	PHVS_YesNoUnknown_CDC
Depth of Wound	Depth of Wound	1 = 1 cm or les 2 = more than 1 cm 9 = Unknown
Acute wound signs of infection	Were there signs of infection at the time of care for the acute wound or injury?	PHVS_YesNoUnknown_CDC
Denervated Tissue Present	Devitalized, Ischemic, or Denervated Tissue Present?	PHVS_YesNoUnknown_CDC
Acute wound medical care	Did the patient obtain medical care for the acute wound or injury before tetanus symptom onset?	PHVS_YesNoUnknown_CDC
Acute wound tetanus toxiod administered	Was patient administered tetanus toxiod (Td, TT, DT, DTaP) for the acute wound or injury before tetanus symptom onset?	PHVS_YesNoUnknown_CDC
If Yes, tetanus toxiod administered, How Soon after Injury?	If Yes, How Soon after Injury?	PHVS_AftterInjury_Time
Wound Debrided	Wound Debrided before Tetanus Onset	PHVS_YesNoUnknown_CDC
If Yes, Debrided How Soon after Injury?	If Yes, Debrided How Soon after Injury?	PHVS_AftterInjury_Time
TIG given before symptom onset	Indicates whether tetanus immune globulin (TIG) prophylaxis was given as a part of the wound care before tetanus symptom onset.	PHVS_YesNoUnknown_CDC
If Yes, TIG Given How Soon after Injury?	If Yes, TIG Given How Soon after Injury?	PHVS_AftterInjury_Time
TIG given before symptom onset dosage	Specifies the date the tetanus immune globulin (TIG) prophylaxis units given.
Tetanus Associated Condition	Tetanus Associated Conditions Prior to Onset(If no Acute Injury)	PHVS_TET_Associated_Conditions
Diabetes	Indicates whether patient have diabetes.	PHVS_YesNoUnknown_CDC
Insulin dependents	Indicates whether the patient is insulin dependent.	PHVS_YesNoUnknown_CDC
Parenteral Drug Abuse?	Pranteral Drug Abuse?	PHVS_YesNoUnknown_CDC
Tetanus type	Type of tetanus.	Tetanus Type (VPD)
TIG given after symptom onset	Indicates whether the tetanus immune globulin (TIG) therapy was given after symptom onset.	PHVS_YesNoUnknown_CDC
If Yes, How Soon after Injury?	If Yes, How Soon after Injury?	PHVS_AftterInjury_Time
TIG given after symptom onset dosage	Specifies the total therapeutic TIG dosage.
Intensive Care Unit	Was the patient in the Intensive Care Unit (ICU)?	PHVS_YesNoUnknown_CDC
Mechanical Ventilation Days	Number of days the patient received mechanically ventilation.
Final outcome	Final outcome (e.g. Recovered, Died, Unknown)	Treatment Outcome Tetanus (VPD)
Mother's Age	Specifies mothers age.
Mother's DOB	Specifies mothers DOB.
Date mother first resided in the U.S.	Date mother first resided in the U.S.
Mother tetanus vacc number of known doses	Specifies number of known tetanus vaccination doses mother received prior to the infant's (case's) birth.	PHVS_VaccineDosesReceived_Tetanus
Last time mother received tetanus vacc	Specifies number of years or months since mother received last tetanus vaccination.
Infant's birth place location	Specifies infant's (case) birth place location (e.g. Hospital, Home, Other, Unknown).	PHVS_BirthLocation_VPD
Birth attendees	Specifies birth attendees (e.g. Physician, Nurse, Licensed midwife, Unlicensed midwife, Family, EMS technician(s)).	PHVS_BirthAttendees_VPD

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Sheet 55: Trichinellosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Eosinophilia	Did patient have Eosinophilia?	PHVS_YesNoUnknown_CDC
Eosin Absolute	If "Yes," please specify absolute number or percentage:
Eosin Units	Specify percent or numeric	Eosin Units_FDD
Fever	Did patient have a fever?	PHVS_YesNoUnknown_CDC
Temperature	If "Yes," please specify temperature:
Temperature Units	Specify fahrenheit or celsius	PHVS_TemperatureUnit_UCUM
Trichinellosis Signs and Symptoms Code(s)	Did patient have any of the following signs or symptoms of Trichinellosis?	PHVS_TrichinellosisSignsSymptoms _FDD
Trichinellosis Signs and Symptoms Other	If "Other," please specify other signs or symptoms of Trichinellosis:
Suspected Foods	What suspect foods did the patient eat?	PHVS_SuspectedFoodConsumed_FDD
Pork Type Code	Please specify type of pork:	PHVS_PorkType_FDD
Pork Type Other	If “Other,” please specify other type of pork:
Pork Consumed Date	Date suspect food was consumed:
Pork Larvae Found	Was larvae found in suspect food?	PHVS_PresentAbsentUnkNotExamined_CDC
Pork Source Obtained Code	Where was the suspect meat obtained?	PHVS_MeatPurchaseInfo_FDD
Pork Source Other	If “Other,” please specify where suspect meat was obtained:
Pork Prep Code	How was suspect food prepared or further processed after purchase?	PHVS_FoodProcessingMethod_FDD
Pork Prep Other	If “Other,” please specify other type of processing:
Pork Cook Method Code	What was the method of cooking the suspect food?	PHVS_FoodCookingMethod_FDD
Pork Cook Method Other	If “Other,” please specify other type of cooking method:
Non-Pork Type Code	Please specify type of non-pork:	PHVS_NonPorkType_FDD
Non-Pork Type Other	If “Other,” please specify other type of non-pork:
Non-Pork Consumed Date	Date suspect food was consumed:
Non-Pork Larvae Found Code	Was larvae found in suspect food?	PHVS_PresentAbsentUnkNotExamined_CDC
Non-Pork Source Code	Where was the suspect meat obtained?	PHVS_MeatPurchaseInfo_FDD
Non-Pork Source Other	If “Other,” please specify where suspect meat was obtained:
Non-Pork Prep Code	How was suspect food prepared or further processed after purchase?	PHVS_FoodProcessingMethod_FDD
Non-Pork Prep Other	If “Other,” please specify other type of processing:
Non-Pork Method Code	What was the method of cooking the suspect food?	PHVS_FoodCookingMethod_FDD
Non-Pork Method Other	If “Other,” please specify other type of cooking method:
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification.
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	PHVS_BodySite_CDC
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	PHVS_Specimen_CDC
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	PHVS_ResultStatus_HL7_2x
Resulted Test Name	The lab test that was run on the specimen.	PHVS_LabTestName_CDC
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_LabTestResultQualitative_CDC
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	PHVS_AbnormalFlag_HL7_2x
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	PHVS_LabTestMethods_CDC
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Lab Test Coded Comments	Explanation for missing result (e.g., clotting, quantity not sufficient, etc.)	PHVS_MissingLabResult_CDC
Sent to CDC for Genotyping	Indicate whether the specimens were sent to CDC for genotyping.	PHVS_YesNoUnknown_CDC
Genotyping Sent Date	If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.
Sent For Strain ID	Indicate whether the specimen was sent for strain identification.	PHVS_YesNoUnknown_CDC
Strain Type	If the specimen was sent for strain identification, indicate the strain.	PHVS_MicrobiologicalStrain_CDC
Track Isolate	Track Isolate functionality indicator	PHVS_TrueFalse_CDC
Patient status at specimen collection	Patient status at specimen collection	PHVS_PatientLocationStatusAtSpecimenCollection
Isolate received in state public health lab	Isolate received in state public health lab	PHVS_YesNoUnknown_CDC
Reason isolate not received	Reason isolate not received	PHVS_IsolateNotReceivedReason_NND
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	PHVS_YesNoUnknown_CDC
Travel History	In the 8 weeks before onset of illness, did the subject travel out of their state or country of residence?
International Destination(s) of Recent Travel	International destination or countries the case-patient traveled to in the 8 weeks before onset of illness
Travel State	Domestic destination or state(s) the case-patient traveled to in the 8 weeks before onset of illness
Date of Arrival to Travel Destination	Date of arrival to travel destination
Date of Departure from Travel Destination	Date of departure from travel destination
Epi-Linked	Is this case epi-linked to another confirmed or probable case?
Where Meat Tested	Where was the suspected meat tested?
Meat Comments	Use this field, if needed, to communicate anything unusual about the suspect meat, which is not already covered with the other data elements (e.g., additional details about where eaten, if consumed while traveling outside of the U.S., where wild game was hunted, etc.).

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Sheet 56: Tuberculosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
TB State Case Number	State case number for the case specific to TB investigations (4 digit report year + 2 letter state + 9 digit alphanumeric number)	N/A	P
City or County Case Number	City or county case number assigned to this case	N/A	P
Birth Sex	What was the patient's sex at birth?	PHVS_Sex_MFU	P
Previously Counted Case	Has this case already been counted by another reporting area?	PHVS_CaseCountStatus_TB	P
Previously Reported State Case Number	If case previously counted, provide the state case number from the other reporting area.	N/A	P
Country of Verified Case	If the case was previously reported by another country, specify the country.	PHVS_BirthCountry_CDC	P
Patient Address City	Patient address city	N/A	P
Inside City Limits	Is the patient's residence within city limits?	PHVS_YesNoUnknown_CDC	P
Census Tract of Case-Patient Residence	Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area.	N/A	P
Detailed Race	Provide the detailed race information for the patient.	PHVS_Race_CDC	P
Date Arrived in US	If country of birth is NOT United States, regardless of citizenship, indicate the date when the patient first arrived in the US.	N/A	P
US Born	Was the patient eligible for US citizenship at birth?	PHVS_YesNoUnknown_CDC	P
Primary Guardian(s) Country of Birth	Indicates the birth country of the primary guardian(s) of patient (pediatric [<15 years old] cases only)	PHVS_BirthCountry_CDC	P
Remain in US After Report	If not US reporting area, did patient remain in the United States for >= 90 days after report date?	PHVS_YesNoUnknown_CDC	P
Initial Reason for Evaluation	What was the initial reason the patient was evaluated for TB?	PHVS_PrimaryReasonForEvaluation_TB	P
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case. Please provide a response for each of the main test types (culture, smear, pathology/cytology, NAA, TST, IGRA, HIV, diabetes) If test was not done please indicate so.	PHVS_LabTestType_TB	P
Test Result	Epidemiologic interpretation of the results of the test(s) performed for this case - This is a qualitative test result. (e.g., positive, detected, negative)	PHVS_LabTestInterpretation_TB	P
Date/Time of Lab Result	Date result sent from reporting laboratory. Time of result is an optional addition to date.	N/A	P
Specimen Source Site	This indicates the anatomical source of the specimen tested.	PHVS_MicroscopicExamCultureSite_TB	P
Specimen Collection Date/Time	Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection is an optional addition to date.	N/A	P
Test Result Quantitative	Quantitative test result value	N/A	P
Result Units	Units of measure for the Quantitative Test Result Value	PHVS_UnitofMeasure_TB	P
Type of Chest Study	Indicate the type of chest study performed. Please provide a response for each of the main test types (plain chest radiograph, chest CT Scan) and if test was not done please indicate so.	PHVS_TypeofRadiologyStudy_CDC	P
Result of Chest Study	Result of chest diagnostic testing	PHVS_ResultofRadiologyStudy_TB	P
Evidence of Cavity	Did test show evidence of cavity?	PHVS_YesNoUnknown_CDC	P
Evidence of Miliary TB	Did test show evidence of miliary TB?	PHVS_YesNoUnknown_CDC	P
Date of Chest Study	Date of the chest diagnostic study	N/A	P
Patient Epidemiological Risk Factors	Exposed risk factors for the patient - Please provide a response for all risk factors in the value set with an associated indicator	PHVS_EpidemiologicalRiskFactors_TB	P
Patient Epidemiological Risk Factors Indicator	Provide a response for each value in the patient epidemiological risk factors value set	PHVS_YesNoUnknown_CDC	P
Type of Correctional Facility	If patient was a Resident of Correctional Facility at Diagnostic Evaluation, indicate the type of correctional facility.	PHVS_CorrectionalFacilityType_NND	P
Type of Long-Term Care Facility	If patient was a Resident of Long Term Care Facility at Diagnostic Evaluation, indicate the type of long term care facility.	PHVS_LongTermCareFacilityType_NND	P
Smoking Status	What is the patient's current tobacco smoking status?	PHVS_SmokingStatus_CDC	P
Patient lived outside of US for more than 2 months	Residence or Travel in countries other than the United States, Canada, Australia, New Zealand, or countries in northern or western Europe for >60 consecutive days at any point in the patient's lifetime.	PHVS_YesNoUnknown_CDC	P
Identified During Contact Investigation	Was the patient identified during the contact investigation around the likely source case?	PHVS_YesNoUnknown_CDC	P
Evaluation During Contact Investigation	If patient was identified during contact investigation, was the patient evaluated for TB during the contact investigation?	PHVS_YesNoUnknown_CDC	P
Linked Case Number	State case numbers for epidemiologically linked cases	N/A	P
Date Treatment or Therapy Started	Date the initial treatment regimen was started	N/A	P
Treatment Administration Type	Choose all treatment administration types that apply to the case, such as DOT, eDOT, or SAT.	PHVS_TreatmentAdministrationType_TB	P
Date Treatment or Therapy Stopped	Date treatment stopped	N/A	P
Case Verification Category	Indicates case verification criteria result based on factors such as culture results, smear results, major and additional sites of the disease, x-ray results, TST, IDR, reason therapy was stopped.	PHVS_CaseVerification_TB	P
Status at Diagnosis of TB	Was the patient alive or dead at the time of diagnostic evaluation?	PHVS_GeneralConditionStatus_TB	P
Site of Disease	What was the site of the patient's TB disease?	PHVS_AdditionalDiseaseSite_TB	P
Contact Investigation	Was a contact investigation conducted around this case?	PHVS_YesNoUnknown_CDC	P
Diagnosis Type	Previous TB or LTBI Diagnosis - Provide only 1 response for LTBI, multiple responses for TB are allowed	PHVS_DiagnosisType_TB	P
History of Previous Illness	Did the subject have a history of TB or LTBI?	PHVS_YesNoUnknown_CDC	P
Date of Previous Illness	Date of previous diagnosis	N/A	P
Previous State Case Number	Previous TB or LTBI State Case Number	N/A	P
Completed Treatment for Previous Diagnosis	Completed Treatment for Previous Diagnosis	PHVS_YesNoUnknown_CDC	P
Initially Treated with RIPE	Was the patient initially treated with the recommended four-drug therapy (RIPE)?	PHVS_YesNoUnknown_CDC	P
Reason Not Treated with RIPE	If not initially treated with RIPE, why not?	PHVS_ReasonNotTreatedwithRIPE_TB	P
Reason Therapy Stopped	Indicate the primary reason that therapy was stopped or never started; specify this data when the case is closed.	PHVS_ReasonTherapyStopped_TB	P
Reason Therapy Extended	Select the reason the therapy extended beyond 12 months.	PHVS_TherapyExtendedReason_TB	P
Final Disease Outcome	Final TB disease case outcome	PHVS_FinalTreatmentOutcome_TB	P
Initial Drug Regimen	Initial drug regimen for the patient: Please provide a response for each of the values in the value set using the associated indicator.	PHVS_Medications_TB	P
Initial Drug Regimen Indicator	Indicator response for the initial drug regimen question	PHVS_YesNoUnknown_CDC	P
Isolate Submitted for Genotyping	Was an isolate submitted for genotyping?	PHVS_YesNoUnknown_CDC	P
Accession Number for Genotyping	If an isolate was submitted for genotyping to a CDC laboratory only, list the accession number for genotyping.	N/A	P
Phenotypic Drug Susceptibility Completed	Was phenotypic/growth-based drug susceptibility testing done?	PHVS_YesNoUnknown_CDC	P
Molecular Drug Susceptibility Completed	Was genotypic/molecular drug susceptibility testing done?	PHVS_YesNoUnknown_CDC	P
Antimicrobial Susceptibility Test Type	Antimicrobial Susceptibility Test Type of TB drugs. For the initial susceptibility testing please send a response for each values in the value set. Changes in susceptibility should be reported for each individual drug when change is identified.	PHVS_SusceptibilityTestType_TB	P
Antimicrobial Susceptibility Specimen Collection Date	Antimicrobial Susceptibility Specimen Collection Date	N/A	P
Antimicrobial Susceptibility Result Reported Date	Antimicrobial susceptibility result reported date	N/A	P
Antimicrobial Susceptibility Specimen Type	Antimicrobial Susceptibility Specimen Type (e.g. Exudate, Blood, Serum, Urine)	PHVS_MicroscopicExamCultureSite_TB	P
Antimicrobial Susceptibility Test Interpretation	Antimicrobial Susceptibility Test Interpretation (e.g. Susceptible, Resistant, Intermediate, Not tested)	PHVS_SusceptibilityTestResultQuantitative_TB	P
Antimicrobial Susceptibility Test Method	Antimicrobial Susceptibility Test Method (e.g. E-Test, MIC, Disk Diffusion)	PHVS_SusceptibilityTestMethod_TB	P
Gene Identifier	Gene identifier - Please report the full test results for the samples that have unique features, such as specimen type (sputum or another anatomic site), test type (sequencing or non-sequencing) or mutation (detected or not detected). There is no need to report test results that differ only by date or laboratory and where all other aspects are identical in regards to specimen type, test type, and/or the results of mutation.	PHVS_GeneName_TB	P
Molecular Susceptibility Specimen Collection Date	Molecular Susceptibility Specimen Collection Date	N/A	P
Molecular Susceptibility Date Reported	Molecular Susceptibility Date Reported	N/A	P
Molecular Susceptibility Specimen Type	Molecular Susceptibility Specimen Type	PHVS_MicroscopicExamCultureSite_TB	P
Molecular Susceptibility Test Result	Molecular Susceptibility Test Result	PHVS_MolecularTestResults_TB	P
Molecular Susceptibility Nucleic Acid Change	Molecular Susceptibility Nucleic Acid Change	N/A	P
Molecular Susceptibility Amino Acid Change	Molecular Susceptibility Amino Acid Change	N/A	P
Molecular Susceptibility Indel	Molecular Susceptibility Indel	PHVS_MolecularIndel_TB	P
Molecular Susceptibility Test Method	Molecular Susceptibility Test Method	PHVS_MolecularTestMethods_TB	P
Culture Conversion Documented	Did the patient's sputum become culture negative?	PHVS_YesNoUnknown_CDC	P
Date of First Consistently Negative Culture	Date the first consistently negative sputum culture was collected.	N/A	P
Reason for Not Documenting Sputum Culture Conversion	Indicate the one reason for not documenting the sputum culture conversion.	PHVS_SputumCultureConversionNotDocumentedReason_TB	P
Patient Move During TB Therapy	Did the patient move during therapy?	PHVS_YesNoUnknown_CDC	P
Moved to Where	If the patient moved to a different reporting area during TB therapy, select all that apply to where the patient moved.	PHVS_MovedWhereDuringTherapy_TB	P
Out of State Move	If moved out of state, then specify the new state jurisdiction.	PHVS_State_FIPS_5-2	P
Out of Country Move	If moved out of country, then specify the new country jurisdiction.	PHVS_Country_ISO_3166-1	P
Transnational Referral	If moved out of the US, indicate whether a transnational referral was made.	PHVS_YesNoUnknown_CDC	P
History of Treatment	History of treatment before current episode with second-line TB drugs for the treatment of TB disease (not LTBI)	PHVS_YesNoUnknown_CDC	P
Date MDR Treatment Started	Date MDR TB therapy started for current episode	N/A	P
Drug Used to Treat MDR TB	Drugs ever used for MDR TB treatment, from MDR start date: Please provide a response for each medication in the value set with an associated indicator. Medications should be recorded as part of the regimen beginning with the MDR TB therapy start date.	PHVS_Medications_TB	P
Length of Time Drug Was Administered	Indicate length of time drug was taken or if it was not taken	PHVS_LengthofTimeDrugTaken_TB	P
Date Injectable Medication Stopped	Date injectable medication stopped. If no injectable drugs were used leave blank.	N/A	P
Surgery to Treat MDR TB	Surgery to Treat MDR TB	PHVS_YesNoUnknown_CDC	P
Surgery to Treat MDR TB Date	Surgery to Treat MDR TB Date	N/A	P
Adverse Event Description	Did patient experience any of the following side effects during treatment that resulted in a permanent discontinuation of medication or at the end of treatment were there any of the following side effects related to MDR-TB treatment present? Please provide a response for all side effects in the value set with an associated indicator.	PHVS_SideEffectofTreatment_TB	P
Adverse Event Indicator	Side Effects of Treatment Indicator	PHVS_YesNoUnknown_CDC	P
Adverse Event Manifestation Time	Did the side effect manifest during treatment or at the end of treatment?	PHVS_SideEffectTimetoOnset_TB	P
Usual Occupation and Industry	Usual occupation and industry	TBD	P
Meets Binational Reporting Criteria	Does case meet binational reporting criteria?	PHVS_YesNoUnknown_CDC	P
Patient Treated as MDR Case	Was the Patient Treated as an MDR TB Case (Regardless of DST Results?	PHVS_YesNoUnknown_CDC	P

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Sheet 57: Tularemia

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
Immuncompromised	If patient has any immunocompromising conditions, specify	N/A	P
Date first medical	Date that the patient was first seen by medical person.	N/A	P
Fever/sweats/chills	Did the patient's illness include the symptom of fever/sweats/chills?	PHVS_YesNoUnknown_CDC	P
Confusion/delirium	Did the patient's illness include the symptom of confusion/delirium?	PHVS_YesNoUnknown_CDC	P
Vomiting/diarrhea/abdominal pain	Did the patient's illness include the symptom of vomiting/diarrhea/abdominal pain?	PHVS_YesNoUnknown_CDC	P
Sore throat	Did the patient's illness include the symptom of sore throat?	PHVS_YesNoUnknown_CDC	P
Cough	Did the patient's illness include the symptom of cough?	PHVS_YesNoUnknown_CDC	P
Chest Pain	Did the patient's illness include the symptom of chest pain?	PHVS_YesNoUnknown_CDC	P
Shortness of breath	Did the patient's illness include the symptom of shortness of breath?	PHVS_YesNoUnknown_CDC	P
Other_symptoms	Did the patient's illness include other symptoms of not listed?	PHVS_YesNoUnknown_CDC	P
Other_symptoms_specify	Which other symptoms did the patient's illness include?	N/A	P
Lymphadenopathy	Did the patient have lymphadenopathy?	PHVS_YesNoUnknown_CDC	P
Describe lympadenopathy	If lymphadenopathy present, provide location and description.	N/A	P
Skin lesions	Did the patient have skin lesion?	PHVS_YesNoUnknown_CDC	P
Describe skin lesions	If skin lesion present, provide location and description.	N/A	P
Conjunctivitis	Did the patient have conjunctivitis?	PHVS_YesNoUnknown_CDC	P
Pharyngitis/tonsilitis	Did the patient have pharyngitis/tonsilitis?	PHVS_YesNoUnknown_CDC	P
Chest X-ray	Results of chest x-ray	TBD	P
Antibiotic	Did patient receive an effective antibiotic for illness?	TBD	P
Antibiotic start date	Date each antibiotic started	N/A	P
Illness outcome	Outcome of illness	TBD	P
Primary clinical syndrome	Classification of primary clinical manifestation of infection	TBD	P
F. tularensis cultured	Was F. tularensis cultured?	PHVS_YesNoUnknown_CDC	P
Specimen source	Source of culture	N/A	P
Date specimen collected	Date specimen was collected	N/A	P
F. tularensis detected	Was F. tularensis detected by other tests?	PHVS_YesNoUnknown_CDC	P
Test performed	Test used to detect F. tularensis	N/A	P
Specimen source	Specimen source in which F. tularenisis was detected	N/A	P
Date specimen collected	Date of specimen collection	N/A	P
F. tularensis subspecies	Subspecies of F. tularensis detected	TBD	P
Serology	Serology results	TBD	P
First Serum titer	Titer results	N/A	P
Second Serum titer	Titer results	N/A	P
Date first serum drawn	Date first serum drawn	N/A	P
Date second serum drawn	Date second serum drawn	N/A	P
Epi-linked to other cases	Was this illness epi-linked to any other tularemia cases?	PHVS_YesNoUnknown_CDC	P
Epi-link specify	Describe epi-linked case	N/A	P
Travel associated	Was this illness associated with travel?	PHVS_YesNoUnknown_CDC	P
Travel specify	Describe travel	N/A	P
Animal contact	Did patient have any animal contact in the 2 weeks preceding illness?	PHVS_YesNoUnknown_CDC	P
Domestic animal	Indicate if domestic animal contact occurred and specify domestic animals that patient had contact with in the 2 weeks preceding illness	N/A	P
Type of animal contact	Was animal domestic or wild	TBD	P
Wild animal	Indicate if wild animal contact occurred and specify wild animals that patient had contact with in the 2 weeks preceding illness	N/A	P
Nature of contact	Nature of animal contact	TBD	P
Tick or deerfly bite	Did patient have tick or deerfly bite in the two weeks preceding illness?	TBD	P
Contact with or ingestion of untreated water	Did patient have contact with or ingestion of untreated water in the two weeks preceding illness?	PHVS_YesNoUnknown_CDC	P
Environmental aerosol generating activities	Did patient participate in any environmental aerosol generating activities in the two weeks preceding illness	PHVS_YesNoUnknown_CDC	P
Specify environmental aerosol generating activities	Specify environmental aerosol generating activities	N/A	P
Other exposure	Specify any other exposures in the two weeks preceding illness	N/A	P
Comments	Additional comments	N/A	P

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Sheet 58: Varicella

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Number of lesions in total	Choose the numeric range within which a count of the patient's lesions falls. Note that if "Unknown" is sent, the HL7 Flavor of Null UNK value is sent.	PHVS_NumberOfLesions_VZ
Number of lesions if less than 50	Number of lesions if less than 50
Did the patient receive Varicella-containing vaccine	Indicate whether the patient received varicella-containing vaccine; a value of Yes or No enables other fields in this section, allowing for answers to their questions.	PHVS_YesNoUnknown_CDC
Reason why patient did not receive Varicella-containing vaccine	If the value in Did the patient receive varicella-containing vaccine? is No, choose the reason why the patient did not receive the vaccine; if none of the specific choices in the list apply, choose Other.	PHVS_VaccineNotGivenReasons_CDC
Other reason why patient did not receive Varicella-containing vaccine	If the value specified in Reason why patient did not receive varicella-containing vaccine is Other, indicate the reason (a reason other than those provided in the list).
Number of doses received on or after first birthday	If the value in Did the patient receive varicella-containing vaccine? is Yes, indicate the number of doses received on or after the patient's first birthday.
Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose	Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose. Choose from the list the reason the patient never received the second dose; if none of the specific choices in the list apply, choose Other.”	PHVS_VaccineNotGivenReasons_CDC
Other reason patient did not receive second dose	If the value specified in Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose is Other, indicate the reason (a reason other than those provided in the list).
Rash Onset Date	Date on which the physical manifestations of the illness—the rash—appeared
Rash Location	The distribution of the rash on the body	PHVS_RashDistribution_VZ
Dermatome	If a value of Focal is specified in the Rash Location field, enter the nerve where the rash occurred (lumbar or thoracic, with a number)
Location First Noted	If a value of Generalized is specified for the Rash Location field, choose location where rash was first noted (if any); if none of the specific choices in the list apply, choose Other.	PHVS_RashLocationFirstNoted_VZ
Other Generalized rash location	If a value of Other is specified in the Location First Noted, enter the location (i.e., the location where the rash was first noted is other than one of the values provided in the Location First Noted list)
Macules Present	If the value specified in Total Number of Lesions is < 50, indicate whether macules were present.	PHVS_YesNoUnknown_CDC
Number of Macules	If the value specified in Macules Present is Yes, indicate how many macules were present.
Papules Present	If the value specified in Total Number of Lesions is < 50, indicate whether papules were present.	PHVS_YesNoUnknown_CDC
Number of Papules	If the value specified in Papules Present is Yes, indicate how many papules were present.
Vesicles Present	If the value specified in Total Number of Lesions is < 50, indicate whether vesicles were present.	PHVS_YesNoUnknown_CDC
Number of Vesicles	If the value specified in Vesicles Present is Yes, indicate how many vesicles were present.
Mostly macular/papular	Indicate whether the lesions were mostly macular/papular.	PHVS_YesNoUnknown_CDC
Mostly vesicular	Indicate whether the lesions were mostly vesicular.	PHVS_YesNoUnknown_CDC
Hemorrhagic	Indicate whether the rash was hemorrhagic.	PHVS_YesNoUnknown_CDC
Itchy	Indicate whether the patient complained of itchiness.	PHVS_YesNoUnknown_CDC
Scabs	Indicate whether there were scabs.	PHVS_YesNoUnknown_CDC
Crops/Waves	Indicate whether the lesions appeared in crops or waves.	PHVS_YesNoUnknown_CDC
Did rash crust	Indicate whether the rash crusted.	PHVS_YesNoUnknown_CDC
Number of Days until lesions crusted over	If the value specified in Did the rash crust? is Yes, enter the number of days that transpired for all of the lesions to crust over.
Number of Days rash lasted	If the value specified in Did the rash crust? is No, enter the number of days that the rash was present.
Fever	Indicate whether the patient had a fever during the course of the illness.	PHVS_YesNoUnknown_CDC
Fever Onset Date	If the value specified in Did patient have fever? is Yes, indicate the date when the fever began.
Highest measured temperature	If the value specified in Did patient have fever? is Yes, indicate the highest temperature that was measured.
Temperature Units	Temperature Units (Fahrenheit or Celsius).	PHVS_TemperatureUnit_UCUM
Fever Duration in Days	If the value specified in Did patient have fever? is Yes, indicate the number of days for which the patient had a fever.
Is patient immunocompromised due to medical condition or treatment	Indicate whether the patient was immunocompromised (anergic).	PHVS_YesNoUnknown_CDC
Medical Condition or Treatment	If Yes, indicate the medical condition or treatment associated with the patient being immunocompromised
Did patient visit a healthcare provider during this illness	Indicate whether the patient visited a healthcare provider during the course of this illness.	PHVS_YesNoUnknown_CDC
Did patient develop any complications that were diagnosed by a healthcare provider?	If the value specified in Did patient visit a healthcare provider during this illness? is Yes, indicate whether the patient developed complications (as described).	PHVS_YesNoUnknown_CDC
Skin/soft tissue infection	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was skin or soft tissue infection.	PHVS_YesNoUnknown_CDC
Cerebellitis/ ataxia	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was cerebellitis/ataxia.	PHVS_YesNoUnknown_CDC
Encephalitis	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was encephalitis.	PHVS_YesNoUnknown_CDC
Dehydration	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether the patient was diagnosed as being dehydrated.	PHVS_YesNoUnknown_CDC
Hemorrhagic condition	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was hemorrhagic condition.	PHVS_YesNoUnknown_CDC
Pneumonia	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether pneumonia was a complication.	PHVS_YesNoUnknown_CDC
How was pneumonia diagnosed	If the value in Pneumonia? is Yes, indicate how the pneumonia was diagnosed.	PHVS_DiagnosedPneumoniaBy_VZ
Other complications	If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there were other complications not cited here.	PHVS_YesNoUnknown_CDC
Other complication details	If the value specified in Other Complications? Is Yes, list the other complication(s)
Antiviral treatment	Indicate whether the patient was treated with acyclovir, famvir, or any licensed antiviral.	PHVS_YesNoUnknown_CDC
Name of medication	If the value specified in Antiviral? is yes, list the name of the medication.	PHVS_MedicationReceived _VZ
Name of the Medication if ‘Other’	If Name of Medication is ‘other’, indicate name of medication
Start Date of Medication	Start date of medication.
Stop Date of medication	Stop date of medication.
Autopsy performed	If a value of Yes is specified in Did the patient die from this illness or complications associated with this illness?, indicate whether an autopsy was performed for the death.	PHVS_YesNoUnknown_CDC
Cause of death	If a value of Yes is specified in Did the patient die from this illness or complications associated with this illness?, indicate the official cause of death.
Diagnosed with Varicella before	Indicate whether the patient has a prior diagnosis of varicella.	PHVS_YesNoUnknown_CDC
Age at diagnosis	Age at diagnosis
Age at diagnosis units	Age at diagnosis units	PHVS_AgeUnit_UCUM
Previous Case Diagnosed by	Indicate who diagnosed the illness; if none of the choices apply choose Other.	PHVS_Diagnosed_By_VZ
Previous Case Diagnosed by Other	If the value specified in Previous Case Diagnosed by is Other, indicate who diagnosed the case
Is this case epi-linked to another confirmed or probable case	Indicate whether this case is epi-linked to another case (confirmed or probable).	PHVS_YesNoUnknown_CDC
Type of case this case is epi-linked to	If the value specified in Is this case epi-linked to another confirmed or probable case? is Yes, indicate the kind of case with which the current case is epi-linked.	PHVS_EpilinkedCaseType_VZ
Transmission setting (setting of exposure)	Location where the patient was exposed to the illness; if none of the specific choices in the list apply, choose Other.	PHVS_TransmissionSetting_NND
Other transmission setting	If the value specified in Transmission Setting? is Other, describe the other transmission setting.
Is this case a healthcare worker	Indicate whether the patient who is the subject of the current case is a healthcare worker.	PHVS_YesNoUnknown_CDC
Number of weeks gestation	If the patient was pregnant during the illness, indicate the number of weeks of gestation at the onset of the illness.
Trimester	If the patient was pregnant during the illness, indicate the trimester at the onset of the illness.	PHVS_PregnancyTrimester_CDC
Was laboratory testing done for varicella?	Was laboratory testing done for varicella?	PHVS_YesNoUnknown_CDC
Direct fluorescent antibody (DFA)?	Was direct fluorescent antibody (DFA) testing performed?	PHVS_YesNoUnknown_CDC
Date of DFA	Date of DFA
DFA Result	DFA Result	PHVS_LabTestInterpretation_CDC
PCR specimen?	PCR specimen?	PHVS_YesNoUnknown_CDC
Date of PCR specimen	Date of PCR specimen
Source of PCR specimen	Source of PCR specimen	PHVS_PCRSpecimenSource_VZ
Specify other PCR source	Specify other PCR source
PCR Result	PCR Result	PHVS_LabTestInterpretation_CDC
Specify other PCR result	Specify other PCR result
Culture performed?	Culture performed?	PHVS_YesNoUnknown_CDC
Date of Culture Specimen	Date of Culture Specimen
Culture Result	Culture Result	PHVS_LabTestInterpretation_CDC
Was other laboratory testing done?	Was other laboratory testing done?	PHVS_YesNoUnknown_CDC
Specify Other Test	Specify Other Test	PHVS_LabTestMethod_VZ
Date of Other test	Date of Other test
Other Lab Test Result	Other Lab Test Result	PHVS_LabTestInterpretation_CDC
Other Test Result Value	Other Test Result Value
Serology performed?	Serology performed?	PHVS_YesNoUnknown_CDC
IgM performed?	IgM performed?	PHVS_YesNoUnknown_CDC
Type of IgM Test	Type of IgM Test	PHVS_IgMTestType_VZ
Specify Other IgM Test	Specify Other IgM Test
Date IgM Specimen Taken	Date IgM Specimen Taken
IgM Test Result	IgM Test Result	PHVS_LabTestInterpretation_CDC
IgM Test Result Value	IgM Test Result Value
IgG performed?	IgG performed?	PHVS_YesNoUnknown_CDC
Type of IgG Test	Type of IgG Test	PHVS_IgGTestType_VZ
If "Whole Cell ELISA," specify manufacturer	If "Whole Cell ELISA," specify manufacturer	PHVS_WholeCellELISAManufacturer_VZ
If "gp ELISA" specify manufacturer	If "gp ELISA" specify manufacturer	PHVS_gpELISAManufacturer_VZ
Specify Other IgG Test	Specify Other IgG Test
Date of IgG - Acute	Date of IgG - Acute
IgG - Acute Result	IgG - Acute Result	PHVS_LabTestInterpretation_CDC
IgG - Acute Test Result Value	IgG - Acute Test Result Value
Date of IgG - Convalescent	Date of IgG - Convalescent
IgG - Convalescent Result	IgG - Convalescent Result	PHVS_LabTestInterpretation_CDC
IgG - Convalescent Test Result Value	IgG - Convalescent Test Result Value
Were the specimens sent to the CDC for genotyping (molecular typing)?	Were the specimens sent to the CDC for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Date sent for genotyping	Date sent for genotyping
Was specimen sent for strain (wild- or vaccine-type) identification?	Was specimen sent for strain (wild- or vaccine-type) identification?	PHVS_YesNoUnknown_CDC
Strain Type	Strain Type	PHVS_StrainType_VZ
Vaccine Administered	The type of vaccine administered.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered.
Vaccine Administered Date	The date that the vaccine was administered.
Case Investigation Status Code	Case Investigation Status Code, from NBS MM
Vaccinated per ACIP recommendations	Was subject vaccinated as recommended by ACIP?
Reason not vaccinated per ACIP recommendations	Reason subject not vaccinated as recommended by ACIP
Reason not vaccinated per ACIP, Other	If other, specify reason not vaccinated per ACIP
Treatment duration	Number of days antiviral taken
Specimen Description	Text description of the specimen
Test Type, other	If other, specify lab test
Specimen sent to CDC	Was a specimen sent to CDC for testing?
Type of testing at CDC	What type of testing was done at CDC for this subject?
Type of testing at CDC, other	If other, specify testing done at CDC
Date specimen sent to CDC	Date specimen sent to CDC
Patient Address City	Patient address city, from NBS MM
Vaccine Administered Product Type, Other	If other, specify type of vaccine administered
Vaccine Product Manufacturer, Other	If other, specify vaccine manufacturer
Date of last dose prior to illness onset	Date of last disease-containing vaccination dose prior to illness onset
Vaccination doses prior to onset	Number of disease-containing vaccination doses prior to illness onset
Vaccination Record ID	Vaccination Record ID, from NBS MM
Vaccine Expiration Date	Vaccine expiration date
NDC Brand Name/Bar Code information	NDC from the vaccine's bar code. With the NDC code, vaccine brand name and manufacturer can be obtained.
Vaccine dose number	Indicates the dose number in a series_x000D_
Vaccine Event information source	Indicates whether the vaccine was administered by the provider organization recording the immunization or obtained from a historical record
Immunization Schedule used	Identifies the schedule used for immunization evaluation and forecast.
Exemption/refusal reason	Indicates the reason the patient is either exempt from the immunization or refuses the immunization
Laboratory Confirmed	Was the case laboratory confirmed?
Performing Laboratory Type	Performing laboratory type
Performing Laboratory Type, Other	If other, specify performing laboratory type
VPD Lab Message Patient Identifier	VPD Lab Message Patient Identifier
VPD Lab Message Observation Identifier	VPD Lab Message Observation Identifier
VPD Lab Message Observation Value	VPD Lab Message Observation Value							Drag
Specimen Collection Date	Date of specimen collection
Specimen Source	The medium from which the specimen originated
Numeric Test Result	Numeric quantitative result of the test(s) performed for this case
Numeric Test Result Units	Numeric quantitative result unit of the test(s) performed for this case
Chest X-ray result	Chest X-ray result
Was the rash generalized	Was the rash generalized
Reason for Hospitalization	If the subject was hospitalized because of this event, indicate the reason(s).

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Sheet 59: Vibriosis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)	CDC Priority
AGEMM	Age in months
AGEYY	Age in years
CDCNUM	CDC Number
CITY	City
COUNTY	County
DATECOMP	Date completing form
DOB	Date of birth
ETHNICITY	Hispanic or Latino origin?
FDANUM	FDA Number
FNAME	First 3 letters of first name
LNAME	First 3 letters of last name
OCCUPAT	Occupation
RACE	Race
SEX	Sex
STATE	State of exposure (usually reporting state)
STEPINUM	State Number
STLABNUM	State Lab Number
FEVER	Fever
NAUSEA	Nausea
VOMIT	Vomiting
DIARRHEA	Diarrhea
VISBLOOD	Bloody stool
CRAMPS	Abdominal cramps
HEADACHE	Headache
MUSCPAIN	Muscle Pain
CELLULIT	Cellulitis
BULLAE	Bullae
SHOCK	Shock
OTHER	Other
MAXTEMP	Symptom: Maximum temp of fever
CENFAR	Fever measured in units of C or F
NUMSTLS	Symptom: # of stools/24 hours
CELLSITE	Symptom: Site of cellulitis
BULLSITE	Symtom: Site of Bullae
OTHSPEC2	Symptom: Specify other Symptoms
AMPMSYMP	Seafood Investigation: Onset in am or pm
ANTIBYN	Did patient receive antibiotics?
Descant1	Name of 1st Antibiotic
Descant2	Name of 2nd Antibiotic
Descant3	Name of 3rd Antibiotic
ANTNAM01	Name of 1st Antibiotic (old)
ANTNAM02	Name of 2nd Antibiotic (old)
ANTNAM03	Name of 3rd Antibiotic (old)
ANTNAM04	Name of 4th Antibiotic (old)
BEGANT1	Date began Antibiotic #1
BEGANT2	Date began Antibiotic #2
BEGANT3	Date began Antibiotic #3
BEGANT4	Date began Antibiotic #4
CDCISOL	CDC Isolate No.
DATEADMN	Date admitted to hospital
DATEDIED	Date of death
DATEDISC	Date of discharge from hospital
DATESYMP	Date of symptom onset
DURILL	# days ill
ENDANT1	Date ended Antibiotic #1
ENDANT2	Date ended Antibiotic #2
ENDANT3	Date ended Antibiotic #3
ENDANT4	Date ended Antibiotic #4
GSURGTYP	Pre-existing: Type of gastric surgery
HEMOTYPE	Pre-exisiting: Type of hemotological disease
HHSYMP	Hour of symptom onset
HOSPYN	Hospitalized?
IMMTYPE	Pre-exisiting: Type of Immunodeficiency
LIVTYPE	Pre-exisiting: type of liver disease
MALTYPE	Pre-existing: Type of Malignancy
MISYMP	Minute of symptom exposure
OTHCONSP	Pre-existing: Type of Other condition
PATDIE	Did patient die?
PEPULCER	Pre-existing: Peptic ulcer
ALCOHOL	Pre-existing: Alcoholism
DIABETES	Pre-existing: Diabetes
INSULIN	Pre-existing: on insulin?
GASSURG	Pre-existing: Gastric surgery
HEART	Pre-existing: Heart disease
HEARTFAL	Pre-existing: Heart failure?
HEMOTOL	Pre-existing: Hematologic disease
IMMUNOD	Pre-existing: Immunodeficiency
LIVER	Pre-existing: Liver disease
MALIGN	Pre-existing: Malignancy
RENAL	Pre-existing: Renal disease
RENTYPE	Pre-existing: Type of renal disease
OTHCOND	Pre-existing: Other
TRTANTI	Type of treatment received: antibiotics
TRTCHEM	Type of treatment received: chemotherapy
TRTRADIO	Type of treatment received: radiotherapy
TRTSTER	Type of treatment received: systemic steroids
TRTIMMUN	Type of treatment received: immunosuppressants
TRTACID	Type of treatment received: antacids
TRTULCER	Type of treatment received: H2 Blocker or other ulcer medication
SEQDESC	Describe Sequelae
SEQUELAE	Sequelae?
TRTACISP	If previously treated with Antacids, specifiy
TRTANTSP	If previously treated with Antibiotics, specifiy
TRTCHESP	If previously treated with chemotherapy, specifiy
TRTIMMSP	If previously treated with immunosuppressants, specifiy
TRTRADSP	If previously treated with radiotherapy, specifiy
TRTSTESP	If previously treated with steroids, specifiy
TRTULCSP	If treated with ulcer meds, specifiy
DATESPEC	Date specimen collected
SPECIESNAME	Species
SITE	If other source, specify site from which Vibrio was isolated
STATECON	Was Species confirmed at State PH Lab?
SOURCE	Specimen source
OTHORGAN	Other organism isolated from specimen?
SPECORGAN	Specify other organism isolated
AMBTEMFC	Seafood Investigation: Maximum ambient temp units - F or C
AMNTCONS	Seafood Investigation: Amount of shellfish consumed
AMPMCONS	Seafood Investigation: Shellfish consumed in am or pm
DATEAMBT	Seafood investigation: Date ambient temp measured
DATEFECL	Seafood Investigation: Date of fecal count
DATEH2O	Seafood Investigation: Date water temp measured
DATEHAR1	Seafood Investigation: Date of harvest #1
DATEHAR2	Seafood Investigation: Date of harvest #2
DATERAIN	Seafood Investigation: Date total rain fall recorded
DATESALN	Seafood Investigation: Date salinity measured
DATESEAR	Seafood Investigation: Date restaurant rec'd seafood
FECALCNT	Seafood Investigation: Fecal Coliform Count
H2OSALIN	Seafood Investigation: Results of Salinity test
HARVSIT1	Seafood Investigation: Harvest Site #1
HARVSIT2	Seafood Investigation: Harvest Site #2
HARVST01	Seafood Investigation: Status of Harvest Site #1
HARVST02	Seafood Investigation: Status of Harvest Site #2
HARVSTS1	Seafood Investigation: Specify if Status for Harvest Site #1 = other
HARVSTS2	Seafood Investigation: Specify if Status for Harvest Site #2 = other
HHCONSUM	Seafood Investigation: Hour of seafood consumption
IMPROPER	Seafood Investigtaion: Improper Storage?
MAMTEMP	Seafood Investigation: Maximum ambient temp
MICONSUM	Seafood Investigation: Minute of seafood consumption
RAINFALL	Seafood Investigation: Total rainfall in Inches
RESTINV	Seafood Investigation: Investigation of Restaurant?
SEADISSP	Seafood Investigation: Specify how shellfish distributed
SEADIST	Seafood Investigation: How is shellfish distributed?
SEAHARV	Seafood Investigation: Was shellfish harvested by patient or friend?
SEAIMPOR	Seafood Investigation: Was seafood imported?
SEAIMPSP	Seafood Investigation: Specify country of Import
SEAOBT	Seafood Investigation: where was seafood obtained?
SEAOBTSP	Seafood Investigation: Specify from where seafood was obtained
SEAPREP	Seafood Investigation: How was seafood prepared?
SEAPRSP	Seafood Investigation: Specify how seafood was prepared (if other)
SH2OTEMP	Seafood Investigation: Surface water temperature
SH2OTMFC	Surface water temp units in F or C?
SOURCES	Sources of seafood
SHIPPERS	Shippers who handled suspected seafood (certification numbers)
TAGSAVA	Seafood investigation: Are tags available from suspect lot?
TYPESEAF	Seafood investigation: Type of shellfish consumed
HARVESTSTATE	State in which seafood was harvested
HARVESTREGION	Region in which seafood was harvested
TRVROTHR	Cholera, reason for travel: specify if other
AMPMEXP	Seafood Investigation: Exposure to seawater in am or pm
HANDLING	Exposure: handing/cleaning seafood
SWIMMING	Exposure: Swimming/diving/wading
WALKING	Exposure: Walking on beach/shore/fell on rocks/shells
BOATING	Exposure: Boating/skiing/surfing
CONSTRN	Exposure: Construction/repairs
BITTEN	Exposure: Bitten/stung
ANYWLIFE	Exposure: Contact with other marine/freshwater life
BODYH2O	Exposure: Exposure to a body of water
CONSTRN	Exposure to water via construction
DATEEXPO	Exposure: Date of exposure to seawater
DATEWHI1	Date traveled/entered destination #1
DATEWHI2	Date traveled/entered destination #2
DATEWHI3	Date traveled/entered destination #3
DATEWHO1	Date left/returned home #1
DATEWHO2	Date left/returned home #2
DATEWHO3	Date left/returned home #3
FISHSP	Type of fish
H2OCOMM	Exposure: Comments on water exposure
H2OTYPE	Exposure: Type of water exposure
HHEXPOS	Exposure: Hour of seawater exposure
LOCEXPOS	Exposure: location of water exposure
MIEXPOS	Exposure: Minute of seawater exposure
OTHEREXP	Exposure: Other exposure
OTHERH2O	Exposure: Exposed to other water not listed?
OTHSHSP	Specify other shellfish consumed
OUTBREAK	Is case part of outbreak?
OUTBRKSP	If part of an outbreak, Specify outbreak
CLAMS	Consumption: clams
CRAB	Consumption: crab
LOBSTER	Consumption: lobster
MUSS	Consumption: mussels
OYSTER	Consumption: oysters
SHRIMP	Consumption: shrimp
CRAY	Consumption: crawfish
OTHSH	Consumption: other shellfish
FISH	Consumption: other fish
RCLAM	Raw consumption: clams
RCRAB	Raw consumption: crab
RLOBSTER	Raw consumption: lobster
RMUSS	Raw consumption: muss
ROYSTER	Raw consumption: oyster
RSHRIMP	Raw consumption: shrimp
RCRAY	Raw consumption: crawfish
ROTHSH	Raw consumption: other shellfish
RFISH	Raw consumption: other fish
DATECLAM	Date of seafood consumption: clams
DATECRAB	Date of seafood consumption: crab
DATELOBS	Date of seafood consumption: lobster
DATEMUSS	Date of seafood consumption: mussels
DATEOYSTER	Date of seafood consumption: oysters
DATESHRI	Date of seafood consumption: shrimp
DATECRAY	Date of seafood consumption: crawfish
DATEOTHSH	Date of seafood consumption: other shellfish
DATEFISH	Date of seafood consumption: other fish
SPECEXPO	Specify other seawater/shellfish dripping exposure (if other)
STRESID	State of residence
TRAVEL	Exposure to travel outside home state in previous 7 days?
WHERE01	Travel destination #1
WHERE02	Travel destination #2
WHERE03	Travel destination #3
WOUNDEXP	Did patient incur a wound before/during exposure?
WOUNDSP	If patient incurred wound before/during exposure, describe wound
Culture Confirmation	Was Vibrio confirmed by culture?
CIDT Results	Was there a positive CIDT result?
CIDT Species Results	Name of species identified by CIDT
CIDT Test Name	Name of CIDT test used if applicable
Dining Partner Seafood Consumption	Did dining partners consume same seafood?
Ill Dining Partners	Did dining partners who consumed the same seafood become ill?
Exposure related to occupation	Was your exposure related to your occupation?
Specify Different Exposure Window	If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank.	N/A	P