Cities - Annual

National Notifiable Diseases Surveillance System (NNDSS)

Att 10 - Disease-Specific Data.xlsx

Cities - Annual

OMB: 0920-0728

Document [xlsx]
Download: xlsx | pdf

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
2019 Novel Coronavirus COVID-19
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


Sheet 1: General

Subsequent tabs in this workbook describe the disease-specific data elements that are requested from each program area.







CDC Priority (Legacy):
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.



CDC Priority (New):
Indicates whether the program specifies the field as:


R - Required - This data element is mandatory for sending a message. If the required data element is not present, the message will be rejected. The required data elements alone are not sufficient for national surveillance purposes


1-Priority 1 – Highest priority for reporting. These data elements are critical for national surveillance activities. Jurisdiction’s data collection system should be modified to collect Priority 1 data elements. If this data element is not currently collected and available to send, please discuss with the CDC Program whether you can onboard without that element being available and included in the messages. Some CDC programs may request a plan addressing future inclusion of these data elements, if not able to collect and transmit at onboarding.


2 - Priority 2 – High priority data element that will support national surveillance activities. If this data element is not currently collected and available to send, please plan to update jurisdiction’s data collection system. Some CDC programs may request a plan addressing future inclusion of these data elements, if not able to collect and transmit at onboarding.


3 - Priority 3 – Lower priority data element that should be considered for inclusion in the surveillance system and case notification. Please send if currently collected in the system.



4/23/2020


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

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"

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

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

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

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

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

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

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 (Legacy) CDC Priority (New)
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  
*Poison control center 
* Laboratory report
*Death certificate  *Provider/medical examiner report
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7891 P
Carboxyhemoglobin (COHb) level Laboratory test result (%) N/A P
Intent *Intentional
*Unintentional

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7876 P
Primary Language What is the patient's primary language? PHVS_Language_ISO_639-2_Alpha3 P
Marital Status What is the patient's current marital status? PHVS_MaritalStatus_HL7_2x P
Education Indicate the highest degree or level of school completed at the time of the event. PHVS_Education_CO P
Poison Control Center Record Does the patient have a poison control record indicating exposure to carbon monoxide? PHVS_YesNoUnknown_CDC P
Outcome of Poison Control Center Record If patient has a poison control record, select the outcome identified in the Poison Control Center Record. PHVS_PoisonControlCenterRecord_CO P
Treatment Management Type If patient has a poison control record, indicate how the care was managed. PHVS_TreatmentSite_CO P
Workers Compensation Record Does the patient have a worker's compensation record with a finding, problem, diagnosis or other indication of exposure to carbon monoxide or carbon monoxide poisoning? PHVS_YesNoUnknown_CDC P
Type of Workers Compensation Claim Indicate the type of claim if patient has a worker's compensation claim with a finding, problem, diagnosis or other indication of exposure to carbon monoxide or carbon monoxide poisoning. PHVS_WorkersCompensationRecord_CO P
Fire Related Exposure Was the carbon monoxide exposure related to a fire? PHVS_YesNoUnknown_CDC P
Power Outage Event Was the carbon monoxide exposure related to a power outage? PHVS_YesNoUnknown_CDC P
Extreme Weather Was the carbon monoxide exposure related to an extreme weather event? PHVS_YesNoUnknown_CDC P
Extreme Weather Type Identify the extreme weather event(s) occurring when the patient was exposed to carbon monoxide. PHVS_ExtremeWeatherType_CO P
Warning Announcement Immediately before or during the extreme weather event, did patient hear or read about any warnings on the danger of carbon monoxide poisoning? PHVS_YesNoUnknown_CDC P
Exposure Source If patient was physically and temporally associated with a CO-emitting source, specify the source. PHVS_ExposureSource_CO P
Generator Location If the exposure source is generator, where was it placed while it was running? PHVS_GeneratorLocation_CO P
Generator Distance If the exposure source was a generator, how many feet was the generator placed from the (house/attached garage/detached garage or other location of event)? PHVS_GeneratorDistance_CO P
Carbon Monoxide Alarm Present Patient was in a location where a carbon monoxide alarm was present. PHVS_YesNoUnknown_CDC P
Carbon Monoxide Alarm Sounded The carbon monoxide alarm sounded. PHVS_YesNoUnknown_CDC P
Carbon Monoxide Elevated Exposure Exposure to an elevated level of CO based on a dedicated or multi-gas meter/instrument (e.g., fire department measurement)? PHVS_YesNoUnknown_CDC P
Air Concentration of CO Level (PPM) Air concentration of CO Level in parts per million (PPM) at exposure site. N/A P
Person/Organization Taking CO Reading If air concentration of CO level was taken, indicate the person or organization taking the CO reading. PHVS_PersonOrgTakingReading_CO P
Date of Reading What was the date and time, if known, of the CO reading? N/A P
Exposure Site Category Categorize the location of exposure. PHVS_ExposureSiteCategory_CO P
Public Site of Exposure If a public setting where the exposure occurred, please indicate specific site. PHVS_SiteofExposure_CO P
Residential Site of Exposure If a residential setting where the exposure occurred, please indicate specific site. PHVS_ResidentialSiteofExposure_CO P
Epi-Linked Patient was present and exposed in the same event as that of a carbon monoxide poisoning case. PHVS_YesNoUnknown_CDC P
Date and Time of Incident Please provide the date and time, if known, of the carbon monoxide incident. N/A P
Address of Establishment Where Exposure Occurred Street address of the location or establishment where the carbon monoxide exposure occurred. Please provide street, city, county, state, and zip code. N/A P
City of Establishment Where Exposure Occurred City of the location or establishment where the carbon monoxide occurred. N/A P
State of Establishment Where Exposure Occurred State of the location or establishment where the carbon monoxide occurred. PHVS_State_FIPS_5-2 P
Zip Code of Establishment Where Exposure Occurred Zip code of the location or establishment where the carbon monoxide occurred. N/A P
County of Establishment Where Exposure Occurred County of the location or establishment where the carbon monoxide occurred. N/A P
Event Notes Description of incident. N/A P
Number of Exposed Cases Total number of exposed persons (including case patient). N/A P
Average Number of Cigarettes Smoked per Day During the past 30 days, please specify the average number of cigarettes smoked per day. There are 20 cigarettes per pack. TBD P
Marijuana Smoking Status Does the patient currently smoke marijuana? PHVS_YesNoUnknown_CDC P
Other Substance Type of other substance used (e.g., e-cigarette tobacco, e-cigarette THC) TBD P
Underlying Condition(s) Select the patient's preexisting condition(s). PHVS_UnderlyingConditions_CO P
Signs and Symptoms Signs and symptoms associated with the carbon monoxide exposure or poisoning. PHVS_SignsandSymptoms_CO P
ICD Codes List ICD Codes in patient's report. PHVS_ICDCodesList_CO P
Treatment Provided Was patient treated for carbon monoxide exposure? PHVS_YesNoUnknown_CDC P
Treatment Type Specify the treatment type. PHVS_TreatmentType_CO P
Treatment Location Where did the patient receive treatment? PHVS_TreatmentLocation_CO P
Treatment Date Provide the date of treatment. N/A P
Occupation Related to Exposure Is the patient's carbon monoxide exposure related to their current occupation? PHVS_YesNoUnknown_CDC P

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

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

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) CDC Priority (Legacy) CDC Priority (New)
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


Maternal Local Record ID



Maternal Notification Reporting Jurisdiction




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

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

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

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?

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)

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

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

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?

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

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)

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

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

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

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.

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

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

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

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

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

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

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

Sheet 36: 2019 Novel Coronavirus COVID-19

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
COVID-19 ID ID to link all case information on patient N/A
1
Interviewer Last Name Last name of interviewer N/A
1
Interviewer First Name First name of interviewer N/A
1
Interviewer Organization The affiliation or organization of the interviewer. N/A
1
Interviewer Telephone Telephone number of interviewer N/A
1
Interviewer Email Email of interviewer N/A
1
Probable Classification Reason If probable case classification status, provide reason for classification. TBD
1
Process for Case Identification Under what process was the case first identified? TBD
1
DGMQID If EpiX notification of traveler, provide the DGMQID. N/A
1
Positive Collection Date Date of first positive specimen collection. N/A
1
Hospital Translator If hospitalized, was a translator required? PHVS_YesNoUnknown_CDC
1
Translator Language If translator required in the hospital, specify which language? TBD
1
Intensive Care Unit Admittance Was patient admitted to an intensive care unit (ICU)? PHVS_YesNoUnknown_CDC
1
ICU Admission Date If patient was admitted to an ICU, provide the admission date. N/A
1
ICU Discharge Date If patient was admitted to an ICU, provide the discharge date. N/A
1
Housing Type Select the best description of where the patient lived at the time of illness onset. TBD
1
Health Care Worker Is the patient a health care worker in the U.S.? PHVS_YesNoUnknown_CDC
1
Health Care Worker Job Type If patient is a health care worker, select their occupation. If other, specify in text. TBD
1
Health Care Worker Job Setting If patient is a health care worker, select their job setting. If other, specify in text. TBD
1
Exposure of Interest In the 14 days prior to illness onset, did the patient have any of the following exposures? Select all that apply. TBD
1
State of Travel Exposure If domestic travel outside of state of normal residence, specify the state. N/A
1
Country of Travel Exposure If patient traveled internationally, specify country. N/A
1
Cruise Ship or Vessel If exposed on a cruise ship or vessel, specify the name of the cruise ship. N/A
1
Workplace Critical Infrastructure If the patient was exposed at their workplace, is the workplace critical infrastructure? PHVS_YesNoUnknown_CDC
1
Workplace Exposure If workplace exposure, specify the workplace setting (e.g., long term healthcare setting, hospital, grocery store) TBD
1
Animal Case If an animal with confirmed or suspected COVID-19, specify the animal. N/A
1
Type of Contact with COVID-19 Case If the patient had contact with a known COVID-19 case, specify the type of contact. TBD
1
Contact with U.S. COVID-19 Case Was this person a U.S. case? TBD
1
COVID-19 Case Identifier If patient had contact with a known COVID-19 case, specify the COVID-19 ID(s). N/A
1
Clinical History Collection Mechanism Select which mechanisms were used for the collection of the clinical course, symptoms, past medical history and social history. TBD
1
Symptomatic Symptoms present during course of illness. TBD
1
Symptoms Resolved Did the patient’s symptoms resolve? TBD
1
Clinical Symptoms Indicate the symptoms associated with this illness. TBD
1
Clinical Symptoms Indicator Indicator for each symptom. PHVS_YesNoUnknown_CDC
1
Diagnostic Select the diagnostic tests that were performed. TBD
1
Diagnostic Result Indicator for each diagnostic test result. TBD
1
Treatment Indicate the treatment received. TBD
1
Treatment Indicator Indicator for each treatment. N/A
1
Days of Mechanical Ventilation If patient received mechanical ventilation intubation, specify the total days of treatment. N/A
1
Underlying Risk Factors Specify any of the underlying medical conditions and/or risk behaviors. TBD
1
Underlying Risk Factors Indicator Indicator for each medical condition and risk behaviors. PHVS_YesNoUnknown_CDC
1
Chronic Disease If other chronic diseases, please specify. N/A
1
Underlying Condition If other underlying condition, please specify. N/A
1
Risk Behavior If other underlying risk behavior, please specify N/A
1
Disability If disability (neurologic, neurodevelopmental, intellectual, physical, vision or hearing impairment, please specify. N/A
1
Psychological or Psychiatric Condition If psychological or psychiatric condition, please specify. N/A
1

Sheet 37: 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?

Sheet 38: 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?

Sheet 39: 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

Sheet 40: 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

Sheet 41: 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?

Sheet 42: 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?

Sheet 43: 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

Sheet 44: 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

Sheet 45: 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

Sheet 46: 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.

Sheet 47: 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

Sheet 48: 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

Sheet 49: 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

Sheet 50: 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

Sheet 51: 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

Sheet 52: 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) CDC Priority (Legacy) CDC Priority (New)
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).


Date Treatment was Prescribed Date treatment associated with the condition was prescribed TBD O
Date Treatment was Administered Date treatment associated with the condition was administered TBD O
Medication Administered Name of the antibiotic administered TBD O
Medication Administered Dose Dose of the antibiotic administered TBD O
Treatment Duration Prescribed duration of antibiotic TBD O
Type of Complication Complications associated with the illness being reported TBD O
Type of Complication Indicator Indicator for associated complication TBD O
Treatment Dosage Dose of the treatment associated with the condition TBD O
Treatment Dosage Unit Unit of measure for the treatment associated with the condition TBD O
Treatment Route of Delivery Route of delivery of treatment TBD O
Treatment Drug Frequency Frequency of treatment drug TBD O
Treatment Drug Frequency Unit Unit of measure for the frequency of treatment associated with the condition TBD O
Treatment Duration Units Unit of measure for the duration of treatment associated with the condition TBD O
Drug Use Route of Delivery Route of delivery of drug(s) used TBD O

Sheet 53: 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

Sheet 54: 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

Sheet 55: 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

Sheet 56: 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.).

Sheet 57: 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

Sheet 58: 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

Sheet 59: 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).







Sheet 60: 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
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