Att 7 - Vaccine Data_10152019

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Attachment 8: Vaccine Data
Data Element Name

Data Element Description

Vaccine administered product type

Indicates which product (vaccine) was administered

Vaccine administered date

Indicates the date that the vaccine was administered.

Vaccine dose number

Indicates the dose number in series

Vaccine product manufacturer

Indicates the company which manufactured the vaccine

Vaccine Lot Number
Vaccine Lot Expiration Date
Vaccine Event information source

Indicates the lot number for the vaccine administered
Indicates the expiry date for the vaccine administered
Indicates whether the vaccine was administered by the
provider organization recording the immunization or
obtained from a historical record
Identifies the schedule used for immunization evaluation and
forecast.
Indicates the reason the patient is either exempt from the
immunization or refuses the immunization
NDC from the vaccine's bar code can be used to obtain
vaccine brand name and manufacturer.
Vaccination record identifier
Did the subject ever receive a vaccine against this disease?

Immunization Schedule used
Exemption/refusal reason

National Drug Code (NDC)
Vaccination Record Identifier
Did the Subject Ever Receive a
Vaccine Against This Disease
Vaccination Doses Prior to Onset
Date of Last Dose Prior to Illness
Onset
Vaccinated per ACIP
Recommendations
Reason Not Vaccinated Per ACIP
Recommendations
Vaccine History Comments
Number of Doses Received Before
1st Birthday

Value Set Code
PHVS_VaccinesAdministere
d_VZ

N/A
N/A
PHVS_ManufacturersOfVac
cinesMVX_CDC_NIP
N/A
N/A
PHVS_VaccineEventInform
ation Source_NND

N/A
N/A

N/A
N/A
PHVS_YesNoUnknown_CD
C
Number of vaccine doses against this disease prior to illness N/A
onset
Date of last vaccine dose against this disease prior to illness N/A
onset
Was subject vaccinated as recommended by the Advisory
PHVS_YesNoUnknown_CD
Committee on Immunization Practices (ACIP)?
C
Reason subject not vaccinated as recommended by ACIP
PHVS_VaccineNotGivenRe
asons_CDC
Comments about the subject's vaccination history
N/A
The number of vaccine doses against this disease which the N/A
subject received before their first birthday.

Attachment 8: Vaccine Data
Number of Doses Received On or
After 1st Birthday
Did Mother Ever Receive a Vaccine
Against This Disease
Source of Mother's Vaccine
Information
12/28/2020

The number of vaccine doses against this disease which the N/A
subject received on or after their first birthday
PHVS_YesNoUnknown_CD
Was the mother immunized with Rubella vaccine?
C
Source of mother's Rubella-containing vaccine information PHVS_ImmunizationInfor
mationSource_CRS