Attachment 5 Disease-Specific Data

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Overview

General
Animal Rabies
Anthrax
Arboviral
Babesiosis
Botulism
Brucellosis
Cholera
Congenital Rubella Syndrome
Congenital Syphilis
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Giardia
Haemophilus Influenzae
Hansen's
Hepatitis
Hemolytic Uremic Syndrome
Human Rabies
Invasive Pneumococcal Disease
Legionellosis
Leptospirosis
Listeria
Lyme
Malaria
Measles
Melioidosis
Mumps
Neisseria meningitidis
Novel Influenza A
Ped Flu Deaths
Pertussis
Plague
Polio
Polio Nonparalytic
Psittacosis
QFever
Rubella
Salmonella
SARS
Shigella
STD (not congenital)
STEC
STSS
TBRD
Tetanus
Trichinellosis
Typhoid
Varicella
Vibriosis

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Sheet 1: General

Attachment 5: Disease-Specific Data
Form Approved OMB OMB No. 0920-0728, Exp. Date __________
	Public reporting burden of this collection of information is estimated to average 10 hours per year (for States and Cities) or 5 hours per year (for Territories), including the time for reviewing instructions and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D­74, Atlanta, Georgia 30333; ATTN: PRA (0920-0728).
Subsequent tabs in this workbook describe the disease-specific data elements that are requested from each program area.

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Sheet 2: Animal Rabies

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

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Sheet 3: Anthrax

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

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Sheet 4: Arboviral

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
StateID	State-assigned investigation identification code
Year	Current year (new)
State	State of residence
County	County of residence
Week	Week of report (new)
OnsetDate	Date of onset of symptoms consistent with arboviral infection
ImportedFrom	Likely location of acquisition of arboviral infection
CountryOfOrigin	Country in which infection was likely acquired
StateOfOrigin	State in which infection was likely acquired
ForeignResident	(New)
Arbovirus	Type of arboviral infection
CaseStatus	Case classification according to CDC/CSTE surveillance case definitions
Age	Age at time of case investigation
AgeUnit	Age units
BirthDate	Date of Birth
Sex	Current sex
Race	Race
Ethnicity	Ethnicity
ClinicalSyndrome	General clinical presentation
Fever	Clinical Sign/Symptom
Headache	Clinical Sign/Symptom
Rash	Clinical Sign/Symptom
NauseaVomiting	Clinical Sign/Symptom
Diarrhea	Clinical Sign/Symptom
Myalgia	Clinical Sign/Symptom
ArthralgiaArthritis	Clinical Sign/Symptom
ParesisParalysis	Clinical Sign/Symptom
StiffNeck	Clinical Sign/Symptom
AlteredMentalStatus	Clinical Sign/Symptom
Seizures	Clinical Sign/Symptom
StateLocalPublicHealthLab	Testing performed at:
CDCLab	Testing performed at:
CommercialLab	Testing performed at:
Serum1Collected	Was Serum1 collected?
Serum1CollectedDate	When was Serum1 collected?
Serum2Collected	Was Serum2 collected?
Serum2CollectedDate	When was Serum2collected?
CSFCollected	Was CSF collected?
CSFCollectedDate	When was CSF collected?
CSFPLeocytosis
SerumIgM
SerumPRNT
SerumPCRorNAT
SerumPairedAntibody
CSFIgM
CSFPRNT
CSFPCRorNAT
Hospitalized	Patient was hospitalized as a result of arboviral illness
Fatality	Patient died as a result of arboviral infection
DateOfDeath	Date of death
LabAcquired	Patient likely acquired infection due to occupational exposure in a laboratory setting
NonLabAcquired	Patient likely acquired infection due to occupational exposure in a non-laboratory setting
BloodDonor	Patient donated blood within 30 days prior to illness onset
BloodTransfusion	Patient received a blood transfusion within 30 days prior to illness onet
OrganDonor	Patient donated a solid organ within 30 days prior to illness onset
OrganTransplant	Patient received a solid organ transplant within 30 days prior to illness onset
BreastFedInfant	Patient was a breastfed infant at time of illness onset
InfectedInUtero	Patient likely acquired infection in utero
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

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Sheet 5: Babesiosis

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

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Sheet 6: Botulism

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

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Sheet 7: Brucellosis

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

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Sheet 8: Cholera

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
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

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Sheet 9: 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

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Sheet 10: Congenital Syphilis

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

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Sheet 11: Cryptosporidiosis

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

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Sheet 12: Cyclosporiasis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
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)

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Sheet 13: Diphtheria

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

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Sheet 14: Giardia

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

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Sheet 15: Haemophilus Influenzae

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
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

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Sheet 16: Hansen's

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

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Sheet 17: Hepatitis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
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	I