Follow-Up Activities for Product-Related Injuries-Interviews

Battery Exposures
Questionnaire # ________

General Instructions - Battery Exposures (updated 10/1/2018):
Most incidents will involve battery ingestion by a child, which resulted in the child's hospitalization.
The respondent will generally be the child's parent or guardian.
Bold type indicates what should be said to the respondent. Instructions for the interviewer will be
prefaced by "Interviewer:" and are written in non-bold type.
Interviewer: Please do not read choices or give examples unless explicitly instructed to do so for a
particular question. Also, if the respondent is unsure, then you can prompt. Do not read the
“Refused” or “Unknown” choices.

Q.1 Interviewer: Complete before dialing.
Enter task number (13 characters).
__________________________

Q.2 Interviewer: Complete before dialing.
Enter Incident Date, to be used in introduction (Ex: October 1, 2018):
__________________________________________________

Q.3 Hello, may I speak with a parent or guardian of [child's name] ?
Interviewer: If a parent or guardian is not available, please ask for a convenient time to call back.
Yes - continue call
No - call back
Refused

1
2
3

Hello, I am [name] from [contracting agency], calling on behalf of the U.S. Consumer Product Safety
Commission. We are trying to learn more about battery exposure injuries in children to prevent
similar incidents from occurring in the future.
I would like to ask you some questions about a child's visit to the emergency room on [ANSWER
TO Q. 3], which involved a battery exposure.
The interview should take about 10 minutes. All answers will be kept confidential and no names
will be associated with your answers. The informatoin collected will be used only to prevent future
incidents and injuries. Your participation is voluntary.

Q.4 Are you familiar with the battery exposure incident that I just mentioned?
[Interviewer: If the parent or guardian is not familiar with the incident, ask to speak to an adult who
IS familiar with the incident. Enter callback info - including name and phone number, if different - on
the Record of Call Sheet.]
Yes - Continue interview
No - Call different respondent
Incident did not involve a battery, specify other product
Refused

1
2
3
4

Q.5 If the incident did not involve a battery, please clarify what the product was.
__________________________________________________________________________________________

Q.6 What is your relationship to the child involved in the incident?
Parent or Guardian
Other

Q.7 Specify other relationship to the child
__________________________________________________

1
2

Q.8 What was the child’s age at the time of the incident?
____

Q.9 Did you witness the child coming into contact with the battery?
[Interviewer: For example, did the respondent see the child put the battery in his/her mouth or ear or
nose?]
Yes
No

1
2

Q.10 Indicate if battery ingestion, or insertion into the ear or nose.
Ingestion
Insertion into ear or nose

1
2

Q.11 Did you witness the child showing symptoms from the battery exposure?
Yes
No

1
2

Q.12 As background information on the child, could you tell me if he/she had any developmental
issues before this incident, either mental or physical?
Yes
No
Unknown
Refuse to Answer

1
2
3
4

Q.13 Please describe the issue(s).
__________________________________________________________________________________________

Q.14 Please describe the incident, starting with what the child was doing just before he/she came
into contact with the battery, until the time he/she went to the emergency room.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.15 Thank you. Now I'd like to go over some details about how the child came into contact with
the battery.
Yes
No
Unknown

1
2
3

Q.16 Before the incident occurred, was the battery housed in another product?
[Interviewer: Examples would be a toy, remote control, battery charging device, etc.]
Yes (skip to Q26 - What product was the battery in?)
No
Unknown

1
2
3

Q.17 Before the incident occurred, was the battery in its original packaging?
Yes
No
Unknown

1
2
3

Q.18 Were there any warnings on the battery packaging?
Yes
No
Unknown

1
2
3

Q.19 Had the battery packaging been opened prior to this incident?
Yes
No
Unknown

1
2
3

Q.20 Was the battery packaging child resistant?
Yes
No
Unknown

1
2
3

Q.21 Were scossors or a tool required to open the package?
Yes
No
Unknown

1
2
3

Q.22 Were there multiple batteries in the package?
Yes
No
Unknown

1
2
3

Q.23 If so, did the other batteries have safety tabs or stickers attached to them?
Yes
No
Unknown

1
2
3

Q.24 What product was the battery in? [Interviewer: Choose one. If you enter a single-digit number
response (ex: "5"), you will need to press "Enter" for it to be selected (its font will change). ]
Hearing Aid
Jewelry (incl. "play" jewelry)
Remote control device
Watch
Calculator
Portable light (flashlight, booklight, laser pointer, etc.)
Clock
Game
Toy
Camera
Greeting card
Book
Thermometer
Other
Unknown

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15

Q.25 Specify "Toy"
__

Q.26 Specify "Other" product
__________________________________________________________________________________________

Q.27 About how old was the product when the incident occurred?
____________________________________________________________

Q.28 For this product, is a tool (or coin) required to open the battery compartment?
Yes
No
Unknown

1
2
3

Q.29 How does the battery compartment open?
One or more screws must be loosened
Unscrew a component to open (e.g., flashlights, penlights)
Must perform two independent and simultaneous motions (e.g. press tab with finger and slide door open, push and
turn component)
Other
Unknown

1
2
3
4
5

Q.30 Specify “Other” way to open the battery compartment
__

Q.31 Was the product broken at any time before the child was exposed to the battery?
Yes
No
Unknown

1
2
3

Q.32 Was the product repaired before the child was exposed to the battery?
Yes
No
Unknown

1
2
3

Q.33 Please describe how the product was repaired .
__________________________________________________________________________________________

Q.34 Just before the incident occurred, was the battery compartment intentionally left open? For
example, someone may have been in the middle of replacing the batteries in the product.
Yes
No
Unknown

1
2
3

Q.35 Is there anything else about the product that you would like to mention?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.36 Who separated the battery from the product?
The child him/herself
Another child
An adult
Other
Unknown

1
2
3
4
5

Q.37 Specify "Other" individual who separated the battery from the product, or describe how the battery
became separated from the product
__________________________________________________________________________________________

Q.38 If another child separated the battery from the product, was the child older, younger or the

same age as the child who was exposed to the battery?
Older than victim
Younger than victim
Same age as victim
Unknown

1
2
3
4

Q.39 Please tell me anything you know about where the battery was located right before the child's

exposure:
__

Q.40 Did the battery involved in the incident have a safety tab, with a warning or icon, that was

removed prior to incident?
Yes
No
Unknown

1
2
3

Q.41 Which of the following scenarios best describes the child's battery exposure?
[Interviewer: First read the entire list through “Other”, then have the respondent choose one.]
Child put battery in his/her mouth but did not swallow battery
Child swallowed battery
Child choked on battery (airway was at least partially blocked)
Child placed battery in his/her nose, ear or other body part besides mouth
Other
Unknown

1
2
3
4
5
6

Q.42 Specify "Other" hazard scenario of the battery exposure.
__________________________________________________________________________________________

Q.43 Did the battery leak at any time during the child's exposure?
[Interviewer: For example, battery may have leaked during mouthing of battery or after ingestion.]
Yes
No
Unknown

1
2
3

Q.44 If so, how was it determined that the battery leaked?
Told by medical staff / was documented in medical record
I observed it
Someone else observed it
Other

Q.45 Specify "Other" way that it was determined that the battery leaked
__

1
2
3
4

Q.46 If you observed the leakage and the battery was in the child’s mouth, how did you distinguish

the battery fluid from the child’s saliva?
__

Q.47 Was there evidence of corrosion of the battery?
Yes
No
Unknown

1
2
3

Q.48 If yes, please describe the corrosion.
__

Q.49 At this point, I'd like to get some detailed information from you about the battery. So if you
need to step away for a moment to find the battery, or a battery similar to the one involved in
the incident, I can give you a minute to do that. Otherwise, I will need to rely on your memory.
[Interviewer: Choose a response below, depending on whether the respondent retrieves the battery]
Did the respondent retrieve a battery for direct reference?

Yes
No

1
2

Q.50 Was the battery a rechargeable type?
Yes
No
Unknown

1
2
3

Q.51 What size was the battery?
[Interviewer: Please read the list of battery sizes through “Other”, then ask the respondent to select
one.
If respondent is uncertain about the difference between a "button" or “coin” size battery, please refer
to the photo provided and offer the following descriptions:
Button battery: squat cylinder shape, smaller than a nickel, LESS than a half-inch/1 cm wide
Coin battery (e.g., nickel size): flat round disc-shape, size of a nickel or wider, MORE than a halfinch/1 cm wide
If you enter a single-digit number for a response (ex: "5"), you will need to press "Enter" for it to be
selected (its font will change).]
Button (less than a half-inch/1 cm wide)
Coin (half-inch/1 cm wide or more)
AA (double "A")
AAA (triple "A")
AAAA (quadruple "A")
C
D
9-volt (rectangular)
Other
Unknown

1
2
3
4
5
6
7
8
9
10

Q.52 Specify "Other" battery size.
________________________________________________________________________________

Q.53 What was the voltage of the battery?
[Interviewer: This information is typically found on the battery, ending in “V”.]
______________________________

Q.54 What was the battery manufacturer or brand name?
[Interviewer: This information is typically found on the battery.]
__________________________________________________________________________________________

Q.55 What was the model name and number of the battery?
[Interviewer: This information is typically found on the battery. On button or coin batteries, the
information is located on the positive (+) terminal of the battery. Do not read the following examples
unless asked:
-

CR 2032: lithium
CR 2016: lithium
SR516: silver
LR44 or AG13: alkaline]
__________________________________________________________________________________________

Q.56 What material or mate?
Lithium (Li)
Silver oxide (Ag2O)
Zinc (Z)
Manganese dioxide (MnO2)
Nickel (Ni)
Cadmium (Cd / Cad)
Other
Unknown

1
2
3
4
5
6
7
8

Q.57 Specify any "Other" material in the battery.
________________________________________

Thank you for your patience. My final set of questions is about the child's symptoms and any
medical treatment received for the battery exposure.

Q.58 During the incident, did the child have any of the following symptoms?
[Interviewer: Read each choice (excl. “Unknown”). Mark all responses that apply.]
Vomiting
Drooling
Difficulty swallowing / gagging
Wheezing / difficulty breathing
Choking
Coughing
Loss of appetite / refusal to eat
Lethargy/Loss of energy
Chest discomfort
Burns, internal or external
Other
Unknown

1
2
3
4
5
6
7
8
9
10
11
12

Q.59 Specify any "Other" symptoms.
__________________________________________________________________________________________

Q.60 Please describe any medical treatment the child received at the emergency room and any
additional treatment he/she received for the battery exposure.
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.61 Did the child have an x-ray?
Yes
No
Unknown

1
2
3

Yes
No
Unknown

1
2
3

Q.62 Was the battery found by the x-ray?

Q.63 In what area of the child's body was the battery found?
Esophagus/Throat (i.e., the tube that connects the mouth with the stomach)
Stomach (not including the intestines)
Intestines (includes small and large, "colon", etc.)
Other
Unknown

1
2
3
4
5

Q.64 Specify "Other" area of the child's body where the battery was found.
__________________________________________________________________________________________

Q.65 Was the child admitted to a hospital?
Yes
No
Unknown

1
2
3

Q.66 What was the reason given for the hospitalization?

__________________________________________________________________________________________
__________________________________________________________________________________________

Q.67 How many nights was the child hospitalized? If there were multiple hospitalizations, please
include the total number of nights the child stayed in a hospital.
[Interviewer: Write down the answer in whatever unit of time the respondent uses, e.g., "2 nights",
"3 months", "2 weeks"]
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.68 Was the child ever sent home from the ER or a hospitalization while he/she was

still in contact with the battery?
[Interviewer: For example, child may have been sent home to wait for an ingested
battery to pass on its own.]
Yes
No
Unknown

1
2
3

Q.69 How much time passed between when child was first exposed to the battery and when the
exposure ended?
[Interviewer: For example, in the case of ingestion, the battery may have naturally passed or been
surgically removed. Write down the respondent's answer using the time units they give.]
__________________________________________________________________________________________

Q.70 Did the child experience any of the following complications from the battery exposure?
[Interviewer: Read each choice excl. “No complications” and “Unknown”, then check it if it applies.
Check all that apply. As you enter each number corresponding to a response, the font will change,
showing that the response was selected. ]
Bleeding/Hemorrhaging
Damage to the esophagus (ulceration, perforation, etc.)
Pneumonia
Paralysis of vocal cords
Other
No complications
Unknown

1
2
3
4
5
6
7

Q.71 Specify any "Other" complications.
__________________________________________________________________________________________

Q.72 How were the complications treated?

__________________________________________________________________________________________
__________________________________________________________________________________________

Q.73 Would you be willing to provide a copy of the medical report to us?

[Interviewer: If yes, provide your contact information to the respondent so that he or she can
provide you with the documentation for inclusion in the IDI report. Remind them that their
information will remain confidential.]
Thank you again for your patience. We are almost finished.
Yes
No

1
2

Q.74 Due to the cultural diversity in the U.S., we sometimes have difficulty communicating

important product safety information to consumers. The following race and ethnicity
questions will help us to better educate the public on consumer product safety.
Do you consider the child in this incident to be Hispanic or Latino?
Yes
No
Unknown
Refuse to answer

1
2
3
4

Q.75 What race or races do you consider the patient to be?
[Interviewer: Please read race choices aloud and ask respondent to
select ALL categories that apply.
The "Other" response may be selected by itself or in addition to the pre-defined race categories.
As you enter the number for each response, the font will change, showing that the response was
selected.
If the respondent only states "biracial" or "multiracial", please prompt for specifics (country of origin,
nationality, etc.). Otherwise, simply check "Other" and record "biracial" or "multiracial" as the answer
to the next question (Specify "Other" race").]
White
Black or African American
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Asian
Other
Unknown
Refuse to answer

Q.76 Specify any "Other" race of the child
________________________________________

1
2
3
4
5
6
7
8

Q.77 Is there anything else you would like to add regarding this incident?
__________________________________________________________________________________________
__________________________________________________________________________________________
__________________________________________________________________________________________

Q.78 On behalf of the Consumer Product Safety Commission, I thank you very much for your help.
If I missed anything, may I call you back at this number?
[Interviewer: If the respondent prefers you to call back at another number, record it on the Record of
Call sheet.]
Yes
No

1
2

Q.79 Thank you for your time.

[Interviewer: Enter the interview completion date (mm/dd/yyyy).]
[Interviewer: If call back needed, enter call back information on Record of Call Sheet.]
____________________

End of Call. Interviewer: If call back needed, enter call back information on Record of Call Sheet.

Q.80 Date
__________________

Q.81 Duration
____________

Q.82 Interviewer
________