Attachment 5 Disease-Specific Data_12182014.xlsx

Attachment 5 Disease-Specific Data_12182014.xlsx

National Notifiable Diseases Surveillance System (NNDSS)

OMB: 0920-0728

Document [xlsx]
Download: xlsx | pdf

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


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.

Sheet 2: Animal Rabies

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

Sheet 3: Anthrax

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

Sheet 4: Arboviral

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
StateID State-assigned investigation identification code
Year Current year (new)
State State of residence
County County of residence
Week Week of report (new)
OnsetDate Date of onset of symptoms consistent with arboviral infection
ImportedFrom Likely location of acquisition of arboviral infection
CountryOfOrigin Country in which infection was likely acquired
StateOfOrigin State in which infection was likely acquired
ForeignResident (New)
Arbovirus Type of arboviral infection
CaseStatus Case classification according to CDC/CSTE surveillance case definitions
Age Age at time of case investigation
AgeUnit Age units
BirthDate Date of Birth
Sex Current sex
Race Race
Ethnicity Ethnicity
ClinicalSyndrome General clinical presentation
Fever Clinical Sign/Symptom
Headache Clinical Sign/Symptom
Rash Clinical Sign/Symptom
NauseaVomiting Clinical Sign/Symptom
Diarrhea Clinical Sign/Symptom
Myalgia Clinical Sign/Symptom
ArthralgiaArthritis Clinical Sign/Symptom
ParesisParalysis Clinical Sign/Symptom
StiffNeck Clinical Sign/Symptom
AlteredMentalStatus Clinical Sign/Symptom
Seizures Clinical Sign/Symptom
StateLocalPublicHealthLab Testing performed at:
CDCLab Testing performed at:
CommercialLab Testing performed at:
Serum1Collected Was Serum1 collected?
Serum1CollectedDate When was Serum1 collected?
Serum2Collected Was Serum2 collected?
Serum2CollectedDate When was Serum2collected?
CSFCollected Was CSF collected?
CSFCollectedDate When was CSF collected?
CSFPLeocytosis

SerumIgM

SerumPRNT

SerumPCRorNAT

SerumPairedAntibody

CSFIgM

CSFPRNT

CSFPCRorNAT

Hospitalized Patient was hospitalized as a result of arboviral illness
Fatality Patient died as a result of arboviral infection
DateOfDeath Date of death
LabAcquired Patient likely acquired infection due to occupational exposure in a laboratory setting
NonLabAcquired Patient likely acquired infection due to occupational exposure in a non-laboratory setting
BloodDonor Patient donated blood within 30 days prior to illness onset
BloodTransfusion Patient received a blood transfusion within 30 days prior to illness onet
OrganDonor Patient donated a solid organ within 30 days prior to illness onset
OrganTransplant Patient received a solid organ transplant within 30 days prior to illness onset
BreastFedInfant Patient was a breastfed infant at time of illness onset
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

FeverMedication Did patient receive medication for fever?
ImmuneSuppressTreatment Is patient on immunosuppressive therapy?
ImmuneSuppressCondition Does patient have an immunosuppressive condition?
ImmuneSuppressDesc Description of immunosuppressive condition
OtherAfebrileCause Other afebrile causes
ChillsRigors Did patient have chills or rigors?
FatigueMalaise Did patient exhibit fatigue or malaise?
Ataxia Did patient have ataxia?
ParkinsonismCogwheel Was Parkinsonism cogwheel rigidity present?
SevereShock Did patient exhibit severe shock?
SevereHemorrhage Did patient have severe hemorrhaging?
OtherSymptoms Other symptoms of interest
Arthralgia Did patient exhibit arthralgia?
Arthritis Did patient exhibit arthritis?

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)

Sheet 6: Botulism

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

Sheet 7: Brucellosis

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

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

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

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

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)

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)

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?

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)

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

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

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 If subject has diabetes, date of diabetes diagnosis.
Ever Receive a Vaccine Did the subject ever receive the hepatitis A vaccine? PHVS_YesNoUnknown_CDC
Total Doses of Vaccine Number of doses of hepatitis A vaccine the subject received.
Date of Last Dose Year the subject received the last dose of hepatitis A vaccine.
Ever Receive Immune Globulin Has the subject ever received immune globulin? PHVS_YesNoUnknown_CDC
Date of Last IG Dose Date the subject received the last dose of immune globulin.
Mother's Race Race of the subject's mother. PHVS_RaceCategory_CDC
Mother's Ethnicity Ethnicity of the patient's mother. PHVS_EthnicityGroup_CDC_Unk
Mother Born Outside U.S. Was mother born outside of the United States of America? PHVS_YesNoUnknown_CDC
Mother's Birth Country What is the birth country of the mother? PHVS_Country_CDC
Mother Confirmed Positive Prior To Delivery Was the mother confirmed HBsAg positive prior to or at time of delivery? PHVS_YesNoUnknown_CDC
Mother Confirmed Positive After Delivery Was the mother confirmed HBsAg positive after delivery? PHVS_YesNoUnknown_CDC
Mother Confirmed Positive Date Date of mother's earliest HBsAg positive test result.
Total Doses of Vaccine Number of doses of hepatitis vaccine the child received.
Ever Receive Immune Globulin Has the child ever received immune globulin? PHVS_YesNoUnknown_CDC
Date the child received HBIG Date the child received the last dose of immune globulin.
Vaccine Dose Number The vaccine dose number in series of vaccination for hepatitis.
Vaccine Administered Date The date that the vaccine was administered.
Contact With Confirmed or Suspected Case For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis B virus infection?

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis C virus infection?
PHVS_YesNoUnknown_CDC
Contact Type For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis B virus infection?

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis C virus infection?
PHVS_ContactType_HepatitisBandC
Contact Type Indicator For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection.

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection.
PHVS_YesNoUnknown_CDC
Sexual Preference What is/was the subject's sexual preference? PHVS_SexualPreference_NETSS
Number of Male Sexual Partners Prior to the onset of symptoms, number of male sex partners the person had.

For Acute Hep B, the time period prior to onset of symptoms is 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 6 months.

Number of Female Sexual Partners Prior to the onset of symptoms, number of female sex partners the person had.

For Acute Hep B, the time period prior to onset of symptoms is 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 6 months.

Number of Sex Partners How many sex partners (approximately) has subject ever had?
Treated for STD Was the subject ever treated for a sexually transmitted disease? PHVS_YesNoUnknown_CDC
Year of Recent Treatment for STD Year the patient received the most recent treatment for a sexually transmitted disease.

Ever IDU Has the patient ever injected drugs not prescribed by a doctor, even if only once or a few times? PHVS_YesNoUnknown_CDC
Ever Had Contact with Hepatitis Was the patient ever a contact of a person who had hepatitis? PHVS_YesNoUnknown_CDC
Ever Contact Type If the patient was ever a contact of a person who had hepatitis, what was the type of contact? PHVS_ContactType_HepatitisBandC
IV Drug Use Prior to the onset of symptoms, did the patient inject drugs not prescribed by a doctor?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Recreational Drug Use Prior to the onset of symptoms, did the patient use street drugs but not inject?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Long-Term Hemodialysis Was the patient ever on long-term hemodialysis? PHVS_YesNoUnknown_CDC
Hemodialysis Prior to the onset of symptoms, did the patient udergo hemodialysis?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Contaminated Stick Prior to the onset of symptoms, did the patient have an accidental stick or puncture with a needle or other object contaminated with blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Transfusion before 1992 Did the patient receive a blood transfusion prior to 1992? PHVS_YesNoUnknown_CDC
Transplant before 1992 Did the patient receive an organ transplant prior to 1992? PHVS_YesNoUnknown_CDC
Clotting Factor before1987 Did the patient receive clotting factor concentrates prior to 1987? PHVS_YesNoUnknown_CDC
Blood Transfusion Prior to the onset of symptoms, did the patient receive blood or blood products (transfusion)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Blood Transfusion Date Date the subject began receiving blood or blood products (transfusion) prior to symptom onset.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.

Outpatient IV Infusions and/or Injections Prior to the onset of symptoms, did the patient receive any IV infusions and/or injections in an outpatient setting?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Other Blood Exposure Prior to the onset of symptoms, did the patient have other exposure to someone else's blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Ever a Medical / Dental Blood Worker Was the patient ever employed in a medical or dental field involving direct contact with human blood? PHVS_YesNoUnknown_CDC
Medical / Dental Blood Worker Prior to the onset of symptoms, was the patient employed in a medical or dental field involving direct contact with human blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Medical / Dental Blood Worker - Frequency of Blood Contact Subject's frequency of blood contact as an employee in a medical or dental field involving direct contact with human blood.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_BloodContactFrequency_Hepatitis
Public Safety Blood Worker Prior to the onset of symptoms, was the subject employed as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Public Safety Blood Worker - Frequency of Blood Contact Subject's frequency of blood contact as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_BloodContactFrequency_Hepatitis
Tattoo Prior to the onset of symptoms, did the patient receive a tattoo?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Location Tattoo Received from Location(s) where the patient received a tattoo PHVS_TattooObtainedFrom_Hepatitis
Piercing Prior to the onset of symptoms, did the patient receive a piercing (other than ear)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Location Piercing Received from Location(s) where the patient received a piercing (other than ear) PHVS_TattooObtainedFrom_Hepatitis
Dental Work / Oral Surgery Prior to the onset of symptoms, did the patient have dental work or oral surgery?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Surgery Other Than Oral Prior to the onset of symptoms, did the patient have surgery (other than oral surgery)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Tested for Hepatitis D Was the patient tested for Hepatitis D PHVS_YesNoUnknown_CDC
Hepatitis Delta Infection Did patient have a co-infection with Hepatitis D? PHVS_YesNoUnknown_CDC
Prior Negative Hepatitis Test Did the patient have a negative hepatitis-related test in the previous 6 months?

For Hep B: Did patient have a negative HBsAg test in the previous 6 months?

For Hep C: Did patient have a negative HCV antibody test in the previous 6 months?
PHVS_YesNoUnknown_CDC
Verified Test Date If patient had a negative hepatitis-related test test in the previous 6 months, please enter the test date.
Hospitalized Prior to the onset of symptoms, was the patient hospitalized?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Long Term Care Resident Prior to the onset of symptoms, was the patient a resident of a long-term care facility?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Ever Incarcerated Was the patient ever incarcerated? PHVS_YesNoUnknown_CDC
Incarcerated More Than 24 hours Prior to the onset of symptoms, was the patient incarcerated for longer than 24 hours?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC
Diabetes Does subject have diabetes? PHVS_YesNoUnknown_CDC
Diabetes Diagnosis Date If subject has diabetes, date of diabetes diagnosis.
Type of Incarceration Facility Type of facility where the patient was incarcerated for longer than 24 hours before symptom onset. PHVS_IncarcerationType_Hepatitis
Incarceration Type Indicator
PHVS_YesNoUnknown_CDC
Incarcerated More Than 6 months Was the patient ever incarcerated for longer than six months during his or her lifetime? PHVS_YesNoUnknown_CDC
Year of Most Recent Incarceration Year the patient was most recently incarcerated for longer than six months.
Length of Incarceration Length of time the patient was most recently incarcerated for longer than six months.
Received Medication for Condition Has the subject ever received medication for the type of Hepatitis being reported? PHVS_YesNoUnknown_CDC
Mother's Birth Country What is the birth country of the mother? PHVS_Country_CDC
Did the subject ever receive a vaccine? Did the subject ever receive a hepatitis B vaccine? PHVS_YesNoUnknown_CDC
Total Doses of Vaccine Number of doses of hepatitis B vaccine the patient received.
Date of Last Dose Year the patient received the last dose of hepatitis B vaccine.
Tested for HBsAg Antibodies Was the patient tested for antibody to HBsAg (anti-HBs) within one to two months after the last dose? PHVS_YesNoUnknown_CDC
HBsAg Antibodies Positive Was the serum anti-HBs >= 10ml U/ml? (Answer 'Yes' if lab result reported as positive or reactive.) PHVS_YesNoUnknown_CDC

Sheet 18: Hemolytic Uremic Syndrome

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

Sheet 19: Human Rabies

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

Sheet 20: Invasive Pneumococcal Disease

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Long Term Care Facilty Resident Does the patient reside in a long term care facility? PHVS_YesNoUnknown_CDC
Culture Date Date the first positive culture was obtained.
Bacterial Infection Syndrome Types of infection(s) that are caused by the bacterial organism. PHVS_BacterialInfectionSyndrome_IPD
Sterile Specimen Type Sterile body site(s) from which the organism was isolated. PHVS_SterileSpecimen_IPD
Did Underlying Condition(s) exist? Did the subject have any pre-existing medical conditions before the start of the illness/condition? PHVS_YesNoUnknown_CDC
Underlying Condition(s) Listing of pre-existing conditions as related to the condition/illness PHVS_UnderlyingConditions_IPD
Oxacillin Zone Size Oxacillin zone size for cases of Streptococcus pneumoniae
Oxacillin Interpretation Oxacillin interpretation for cases of Streptococcus pneumoniae PHVS_OxacillinInterpretation_IPD
Antimicrobial Agent Antimicrobial agent tested PHVS_AntimicrobialAgent_IPD
Antimicrobial Susceptibility Test Method Antimicrobial susceptibility testing method used PHVS_AntimicrobialSuceptiblilityTestMethod_IPD
Antimicrobial Susceptibility Test Result S/I/R/U result, indicating whether the microorganism is susceptible or not susceptible (intermediate or resistant) to the antimicrobial being tested. PHVS_SusceptibilityResult_CDC
Minimum Inhibitory Concentration Range MIC (minimum inhibitory concentration) range.
Serotyping Results Available Are serotyping results available for S pneumoniae isolate? PHVS_YesNoUnknown_CDC
Lab Result Coded Value If Serotyping results are available for S pneumoniae isolate, please specify. PHVS_SerotypeMethod_IPD
Serotype Method Serotyping Method Used PHVS_SerotypeMethod_IPD
23-Valent Pneumo Poly Vaccine Has patient ≥2yrs received 23-valent pneumococcal polysaccharide vaccine (Pneumovax)? PHVS_YesNoUnknown_CDC
7-Valent Pneumo Conjugate Vaccine If less than eighteen years of age, did the patient receive 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar)? PHVS_YesNoUnknown_CDC
13-Valent Pneumo Conjugate Vaccine If less than eighteen years of age, did the patient receive 13-valent pneumococcal conjugate vaccine (PCV13)? PHVS_YesNoUnknown_CDC
Vaccine Administered The type of vaccine administered PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered
Vaccine Administered Date The date that the vaccine was administered

Sheet 21: Legionellosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Diagnosis Disease caused by a Legionella species
Hospitalization for treatment Was patient hospitalized during treatment for legionellosis?
Admission date Date of admission to hospital
Hospital name Name of hospital to which admitted
Hospital address City and state of hospital
Illness outcome Outcome of illness
Nights away from home In the 10 days before onset, did the patient spend any nights away from home (excluding healthcare settings)?
Accommodation name Name of lodging where patient stayed other than usual resident
Accommodation address Address of lodging away from home
Accommodation city City of lodging away from home
Accommodation state State of lodging away from home
Accommodation zip Zipcode of lodging away from home
Accommodation country Country of lodging away from home
Accommodation room number Room number at lodging where patient stayed other than usual resident
Arrival Date Date of stay arrival
Departure Date Date of stay departure
Reported CDC If yes, was this case reported to CDC at [email protected]? 1
Whirlpool/Spa vicinity In the 10 days before onset, did the patient get in or spend time near a whirlpool spa (i.e., hot tub)?
Respiratory trherapy equipment use In the 10 days before onset, did the patient use a nebulizer, CPAP, BiPAP or any other respiratory therapy equipment for the treatment of sleep apnea, COPD, asthma or for any other reason?
Humidifier use If yes, does this device use a humidifier?
Water type If yes, what type of water is used in the device? This is a multi-select field.
Healthcare setting visit/stay In the 10 days before onset, did the patient visit or stay in a healthcare setting (e.g., hospital, long term care/rehab/skilled nursing facility, clinic)?
Healthcare setting/facility Type of healthcare setting/facility
Exposure type Type of exposure in HC setting/facility
Facility name Name of healthcare facility
Transplant center Is this a transplant center?
Visit reason Reason for visit to HC facility
HC facility city City of HC facility
HC facility state State of HC facility
Admission date Start date of HC facility admission/visit
End date End date of HC facility admission/visit
Healthcare exposure Was this case associated with a healthcare exposure?
Assisted living facility exposure In the 10 days before onset, did the patient visit or stay in an assisted living facility or senior living facility?
AL facility type Type of assisted living facility exposure
AL exposure type Type of assisted living facility
AL facility name Name of AL facility
AL city Name of city of AL facility
AL state Name of state of AL facility
AL start date Start date of AL facility admission/visit
AL end date End date of AL facility admission/visit
Urine Ag positive Was the urine antigen positive?
Urine Ag collection date Date urine antigen was collected
Culture positive Was the culture positive?
Culture collection date Date culture was collected
Culture site Site of culture specimen
Culture species Species isolated from culture
Culture serogroup Serogroup of species from culture
Ab titer Was there a fourfold rise in Ab titer?
Acute titer Initial Ab titer to L. pneumophila serogroup 1
Acute collected Initial Ab titer specimen collection date
Convalescent titer Convalescent Ab titer to L. pneumophila serogroup 1
Convalescent collected Convalescent Ab specimen collection date
Ab titer other Was there a fourfold rise in Ab titer for other than L. pneumophila serogroup 1 or to multiple species or serogroups of Legionella using pooled antigen?
Acute titer other Initial Ab titer to other than L. pneumophila serogroup 1
Acute collected other Initial Ab titer specimen collection date for species other than L. pneumophila serogroup 1
Convalescent titer other Convalescent Ab titer to species other than L. pneumophila serogroup 1
Convalescent collected other Convalescent Ab specimen collection date for species other than L. pneumophila serogroup 1
Species other Species identified for other than L. pneumophila serogroup 1
Serogroup other Serogroup identified for other than L. pneumophila serogroup 1
DFA/IHC positive Was the DFA or IHC positive?
DFA/IHC collection date Date specimen for DFA/IHC collected
DFA/IHV specimen site Site of DFA/IHC specimen
Species other - DFA/IHC Species identified by DFA/IHC for other than L. pneumophila serogroup 1
Serogroup other - DFA/IHC Serogroup identified by DFA/IHC for other than L. pneumophila serogroup 1
Nucleic Acid Assay - other Was a nucleic acid assay (e.g., PCR) performed?
Nucleic Acid Assay collection date Date nucleic acid assay specimen collected
Nucleic Acid Assay specimen site Site of nucleic acid assay specimen
Species other - nucleic acid assay Species identified by nucleic acid assay for other than L. pneumophila serogroup 1
Serogroup other - nucleic acid assay Serogroup identified by nucleic acid assay for other than L. pneumophila serogroup 1
Whirlpool Spa, Location If Yes, describe where
Whirlpool Spa, Dates If Yes, list dates
Occupation Subject’s Occupation
Interviewer’s Name Interviewer’s Name
Interviewer’s Affiliation Interviewer’s Affiliation
Interviewer’s telephone number Interviewer’s telephone number
Name of State Health Department Official who reviewed this report Name of State Health Department Official who reviewed this report
Title of State Health Department Official who reviewed this report Title of State Health Department Official who reviewed this report
Telephone Number of State Health Department Official who reviewed this report Telephone Number of State Health Department Official who reviewed this report

Sheet 22: Leptospirosis

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

Sheet 23: Listeria

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Patient ID CDC assigned unique ID
Completed By Person completing LI form
Date Completed Date LI form completed
Case Year Year of specimen collection
Gender Gender
State of Residence State of residence
Age Age of case-patient
Date of Birth Date of birth
State Epi ID State or local epi case ID
CDC/eFORS ID CDC/eFORS ID
Ethnicity Ethnicity
African American/Black African American/Black
Asian Asian
Native Hawaiian/Other Pacific Islander Native Hawaiian or Other Pacific Islander
Native American Native American/Alaska Native
White White
Unknown Unknown race
Pregnancy Is Listeria case associate with pregnancy
BloodNP Blood specimen grew Listeria, non-pregnant case
BloodNPDate Date blood specimen collected, non-pregnant case
BloodNPLab Lab submitting blood specimen, non-pregnant case
BloodNPIDNumber State public health isolate ID number, blood, non-pregnant case
CSFNP CSF speciment grew Listeria, non-pregnant case
CSFNPDate Date CSF specimen collected, non-pregnant case
CSFNPLab Lab submitting CSF specimen, non-pregnant case
CSFNPIDNumber State public health isolate ID number, CSF, non-pregnant case
StoolNP Stool specimen grew Listeria, non-pregnant case
StoolNPDate Date stool specimen collected, non-pregnant case
StoolNPLab Lab submitting stool specimen, non-pregnant case
StoolNPIDNumber State public health isolate ID number, stool, non-pregnant case
OtherNP Other specimen grew Listeria, non-pregnant case
OtherNPSpec Specify other specimen source, non-pregnant case
OtherNPDate Date other specimen collected, non-pregnant case
OtherNPLab Lab submitting other specimen, non-pregnant case
OtherNPIDNumber State public health isolate ID number, other specimen, non-pregnant case
OtherNP2 Second "Other" specimen grew Listeria, non-pregnant case
OtherNP2Spec Specify second "other" specimen source, non-pregnant case
OtherNP2Date Date second "other" specimen collected, non-pregnant case
NotherNP2Lab Lab submitting second "other" specimen, non-pregnant case
OtherNP2IDNumber State public health isolate ID number, second "other" specimen, non-pregnant case
BacteremiaNP Type of illness-Bacteremia/sepsis, non-pregnant case
MeningitisNP Type of illness-Meningitis, non-pregnant case
FebrilegastroenteritisNP Type of illness-Febrile gastroenteritis, non-pregnant case
OtherIllnessNP Type of illness-Other, non-pregnant case
OtherNP specify Specify other illness, non-pregnant case
UnknownNP Type of illness-Unknown, non-pregnant case
HospitalizedNP Was patient hospitalized for listeriosis, non-pregnant case
AdmitNP Hospital admit date, non-pregnant case
DischargeNP Hospital discharge date, non-pregnant case
StillhospitalizedNP Patient still hospitalized, non-pregnant case
OutcomeNP Patient's outcome, non-pregnant case
BloodMotherAP Blood specimen from mother grew Listeria, pregnancy-associated case
BloodMotherAPDate Date blood specimen from mother collected, pregnancy-associated case
BloodMotherAPLab Lab submitting blood specimen from mother, pregnancy-associated case
BloodMotherAPIDNumber State public health isolate ID number, blood specimen from mother, pregnancy-associated case
BloodNeonateAP Blood specimen from neonate grew Listeria, pregnancy-associated case
BloodNeonateAPDate Date blood specimen from neonate collected, pregnancy-associated case
BloodNeonateAPLab Lab submitting blood specimen from neonate, pregnancy-associated case
BloodNeonateAPIDNumber State public health isolate ID number, blood specimen from neonate, pregnancy-associated case
CSFMotherAP CSF specimen from mother grew Listeria, pregnancy-associated case
CSFMotherAPDate Date CSF specimen from mother collected, pregnancy-associated case
CSFMotherAPLab Lab submitting CSF specimen from mother, pregnancy-associated case
CSFMotherAPIDNumber State public health lab isolate ID number, CSF specimen from mother, pregnancy-associated
CSFNeonateAP CSF specimen from neonate grew Listeria, pregnancy-associated case
CSFNeonateAPDate Date CSF specimen from neonate collected, pregnancy-associated case
CSFNeonateAPLab Lab submitting CSF specimen from neonate, pregnancy-associated case
CSFNeonateAPIDNumber State public health isolate ID number, CSF specimen from neonate, pregnancy-associated
StoolMotherAP Stool specimen from mother grew Listeria, pregnancy-associated case
StoolMotherAPDate Date stool specimen from mother collected, pregnancy-associated case
StoolMotherAPLab Lab submitting stool specimen from mother, pregnancy-associated case
StoolMotherAPIDNumber State public health isolate ID number, stool specimen from mother, pregnancy-associated case
PlacentaAP Placenta specimen grew Listeria, pregnancy-associated case
PlacentaAPDate Date placenta specimen collected, pregnancy-associated case
PlacentaAPLab Lab submitting placenta specimen, pregnancy-associated case
PlacentaAPIDNumber State public health lab isolate ID number, placenta specimen, pregnancy-associated case
AmnioticAP Amniotic fluid specimen grew Listeria, pregnancy-associated case
AmnioticAPDate Date amniotic fluid collected, pregnancy-associated case
AmnioticAPLab Lab submitting amniotic fluid specimen, pregnnacy-associated case
AmnioticAPIDNumber State public health lab isolate ID number, amniotic fluid specimen, pregnancy-associated case
OtherAP Other specimen grew Listeria, pregnancy-associated case
OtherAPSpec Specify other specimen source, pregnancy-associated case
OtherAPDate Date other specimen collected, pregnancy-associated case
OtherAPLab Lab submitting other specimen, pregnancy-associated case
OtherAPIDNumber State public health lab isolate ID number, other specimen, pregnancy-associated case
Other2AP Second "other" specimen grew Listeria, pregnancy-associated case
Other2APSpec Specify second "other" specimen source, pregnancy-associated case
Other2APDate Date second "other" specimen collected, pregnancy-associated case
Other2APLab Lab submitting second "other" specimen, pregnancy-associated case
Other2APIDNumber State public health lab isolate ID number, second "other" specimen, pregnancy-associated case
StillPregnantT1 Outcome of pregnancy: Still pregnant (single gestation or twin 1), pregnancy-associated
StillPregT1Gest If still pregnant, weeks of gestation (single gestation or twin 1), pregnancy-associated
StillPregT1Date If still pregnant, date (single gestation or twin 1), pregnancy-associated
StillPregnantT2 Outcome of pregnancy: Still pregnant (twin 2), pregnancy-associated
StillPregnantT2Gest If still pregnant, weeks of gestation (twin 2), pregnancy-associated
StillPregnantT2Date If still pregnant, date (twin 2), pregnancy-associated
FetaldeathT1 Outcome of pregnancy: Fetal death (misscarriage or stillbirth; single gestation or twin 1), pregnancy-associated
FetalDeathT1Gest If fetal death, weeks gestation (single gestation or twin 1), pregnancy-associated
FetalDeathT1Date If fetal death, date (single gestation or twin 1), pregnancy-associated
FetalDeathT2 Outcome of pregnancy: Fetal death (misscarriage or stillbirth; twin 2), pregnancy-associated
FetalDeathT2Gest If fetal death, weeks gestation (twin 2), pregnancy-associated
FetalDeathT2Date If fetal death, date (twin 2), pregnancy-associated
AbortionT1 Outcome of pregnancy: Induced abortion (single gestation or twin 1), pregnancy-associated
AbortionT1Gest If abortion, weeks gestation (single gestation or twin 1), pregnancy-associated
AbortionT1Date If abortion, date (single gestation or twin 1), pregnancy-associated
AbortionT2 Outcome of pregnancy: Induced abortion (twin 2), pregnancy-associated
AbortionT2Gest If abortion, weeks gestation (twin 2), pregnancy-associated
AbortionT2Date If abortion, date (twin 2), pregnancy-associated
DeliveryT1 Outcome of pregnancy: Delivery (live birth; single gestation or twin 1), pregnancy-associated
DeliveryT1Gest If delivery, weeks gestation (single gestation or twin 1), pregnancy-associated
DeliveryT1Date If delivery, date (single gestation or twin 1), pregnancy-associated
DeliveryT2 Outcome of pregnancy: Delivery (live birth; twin 2), pregnancy-associated
DeliveryT2Gest If delivery, weeks gestation (twin 2), pregnancy-associated
DeliveryT2Date If delivery, date (twin 2), pregnancy-associated
OtherT1AP Outcome of pregnancy: Other (single gestation or twin 1), pregnancy-associated
APOtherT1spec If other pregnancy outcome, specify (single gestation or twin 1), pregnancy-associated
APOtherT1Date If other pregnancy outcome, date (single gestation or twin 1), pregnancy-associated
APOtherT1Gest If other pregnancy outcome, weeks gestation (single gestation or twin 1), pregnancy-associated
OtherT2AP Outcome of pregnancy: Other (twin 2), pregnancy-associated
APOtherT2spec If other pregnancy outcome, specify (twin 2), pregnancy-associated
APOtherT2Gest If other pregnancy outcome, weeks gestation (twin 2), pregnancy-associated
APOtherT2Date If other pregnancy outcome, date (twin 2), pregnancy-associated
APBacteremiaMother Type of illness in mother: Bacteremia/sepsis, pregnancy-associated
APMeningitisMother Type of illness in mother: Meningitis, pregnancy-associated
APFebrileGastroMother Type of illness in mother: Febrile gastroenteritis, pregnancy-associated
APAmnionitis Type of illness in mother: Amnionitis, pregnancy-associated
APFlulikeMother Type of illness in mother: Non-specific "flu-like" illness, pregnancy-associated
APNoneMother Type of illness in mother: None, pregnancy-associated
APOtherMother Type of illness in mother: Other, pregnancy-associated
ApOtherSpecMom If other type of illness in mother, specify, pregnancy-associated
APUnknownMother Type of illness in mother: Unknown, pregnancy-associated
APBacteremiaT1 Type of illness in neonate (twin 1): Bacteremia/sepsis, pregnancy-associated
APMeningitisT1 Type of illness in neonate (twin 1): Meningitis, pregnancy-associated
APPneumoniaT1 Type of illness in neonate (twin 1): Pneumonia, pregnancy-associated
APGranulomatosisT1 Type of illness in neonate (twin 1):Granulomatosis infantisepticum, pregnancy-associated
APNoneT1 Type of illness in neonate (twin 1): None, pregnancy-associated
APOtherT1 Type of illness in neonate (twin 1): Other, pregnancy-associated
APOtherillT1spec If other type of illness in neonate (twin 1), specify, pregnancy-associated
APUnknownT1 Type of illness in neonate (twin 1): Unknown, pregnancy-associated
APBactermiaT2 Type of illness in neonate (twin 2): Bacteremia/sepsis, pregnancy-associated
APMeningitisT2 Type of illness in neonate (twin 2): Meningitis, pregnancy-associated
APPneumoniaT2 Type of illness in neonate (twin 2): Pneumonia, pregnancy-associated
APGranulomatosisT2 Type of illness in neonate (twin 2): Granulomatosis infantisepticum, pregnancy-associated
APNoneT2 Type of illness in neonate (twin 2): None, pregnancy-associated
APOtherT2 Type of illness in neonate (twin 2): Other, pregnancy-associated
APOtherillT2spec If other type of illness in neonate (twin 2), specify, pregnancy-associated
APUnknownT2 Type of illness in neonate (twin 2): Unknown, pregnancy-associated
APMotherHospitalized Was mother hospitalized for listerosis? pregnancy-associated
APAdmitMother Admit date, mother, pregnancy-associated
APDischargeMother Discharge date, mother, pregnancy-associated
APStillHospitalizedMother Mother still hospitalized, pregnancy-associated
APT1Hospitalized Was neonate (twin 1) hospitalized for listeriosis? pregnancy-associated
APT1Admit Admit date, neonate (twin 1), pregnancy-associated
APT1Discharge Discharge date, neonate (twin 1), pregnancy-associated
APT1StillHospitalized Neonate (twin 1) still hospitalized, pregnancy-associated
APT2Hospitalized Was neonate 2 (twin 2) hospitalized for listeriosis? pregnancy-associated
APT2Admit Admit date, neonate (twin 2), pregnancy-associated
APT2Discharge Discharge date, neonate (twin 2), pregnancy-associated
APT2StillHospitalized Neonate 2 (twin 2) still hospitalized, pregnancy-associated
APOutcomeMother Mother's outcome, pregnancy-associated
APOutcomeT1 Neonate's (twin 1's) outcome, pregnancy-associated
APOutcomeT2 Neonate 2's (twin 2's) outcome, pregnancy-associated
InterviewDate Date of interview
InterviewInitials Initials of interviewer
Interviewee Interviewee
Relationship If surrogate, relationship to patient
OtherSpec If other relationship to patient, specify
Onset Onset of illness
HospitalizedBefore Hospitalized (admitted to a hospital overnight) during 4 weeks before illness began
HAdmit If hospitalized prior to onset, admit date
HDischarge If hospitalized prior to onset, discharge date
Hname Name of hospital admitted to in 4 weeks before illness began
StillHosp Still hospitalized, if hospitalized in 4 weeks before illness began
NursingHomeBefore Resident in nursing home or other long term care facility during 4 weeks before illness began
Admitdate Date admitted to nursing home (if resident in 4 weeks prior to onset)
DischargeDate Dicharge date from nursing home (if resident in 4 weeks prior to onset)
StillHosporNH Still in nursing home, if in nursing home 4 weeks before illness began
NHName Name of nursing home resident of in 4 weeks before illness began
TravelState During the 4 weeks before your illness, doid you travel to a state outside your state of residence?
StatesVisited If traveled to state outside your state of residence in 4 weeks before illness, please list states visited
TravelInternat During the 4 weeks before your illness, did you travel outside the US?
Countries If traveled outside the US in 4 weeks before illness, what countries did you visit?
DateDepart If traveled outside the US in 4 weeks before illness, what was your departure date?
DateReturn If traveled outside the US in 4 weeks before illness, what date did you return?
Fever Fever
Chills Chills
Headache Headache
MuscleAches Muscle Aches
StiffNeck Stiff Neck
Diarrhea Diarrhea (≥3 loose stools/day)
Vomiting Vomiting
PretermLabor Preterm Labor
Other Other symptoms
OtherSp Specify other symptoms
Other2 Other symptoms
Other2Sp Specify other symptoms
TestDelivered Date first positive Listeria isolate collected/delivery date (preg cases)
4weeksbefore Four weeks before first positive Listeria isolate collected
SpecCollection Specimen collection date/delivery date (preg cases)
GroceryPurchase Did you eat food purchased from any grocery stores during the 4 week time period
Grocery1 Name of grocery store 1
Grocery1Address Street address, city, county, state of grocery store 1
Grocery2 Name of grocery store 2
Grocery2Address Street address, city, county, state of grocery store 2
Grocery3 Name of grocery store 3
Grocery3Address Street address, city, county, state of grocery store 3
Grocery4 Name of grocery store 4
Grocery4Address Street address, city, county, state of grocery store 4
Grocery5 Name of grocery store 5
Grocery5Address Street address, city, county, state of grocery store 5
Grocery6 Name of grocery store 6
Grocery6Address Street address, city, county, state of grocery store 6
Grocery7 Name of grocery store 7
Grocery7Address Street address, city, county, state of grocery store 7
FarmersMarketPurchase Did you eat food purchased from any delicatessens, small local markets, other small shops, or farmers' markets during the 4 week period?
FarmersMarket1 Name of delicatessen, small local market, other small shop, or farmers markets 1
FarmersMarket1Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 1
FarmersMarket2 Name of delicatessen, small local market, other small shop, or farmers markets 2
FarmersMarket2Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 2
FarmersMarket3 Name of delicatessen, small local market, other small shop, or farmers markets 3
FarmersMarket3Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 3
FarmersMarket4 Name of delicatessen, small local market, other small shop, or farmers markets 4
FarmersMarket4Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 4
FarmersMarket5 Name of delicatessen, small local market, other small shop, or farmers markets 5
FarmersMarket5Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 5
FarmersMarket6 Name of delicatessen, small local market, other small shop, or farmers markets 6
FarmersMarket6Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 6
FarmersMarket7 Name of delicatessen, small local market, other small shop, or farmers markets 7
FarmersMarket7Address Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 7
RestaurantPurchase Did you eat food from any restaurants, including sit-down, fast-food, and take-out restaurants during the 4 week period?
Restaurant1 Name of restaurant 1
Restaurant1Address Street address, city, county, state of restaurant 1
Restaurant1Date Dining date restaurant 1
Restaurant2 Name of restaurant 2
Restaurant2Address Street address, city, county, state of restaurant 2
Restaurant2Date Dining date restaurant 2
Restaurant3 Name of restaurant 3
Restaurant3Address Street address, city, county, state of restaurant 3
Restaurant3Date Dining date restaurant 3
Restaurant4 Name of restaurant 4
Restaurant4Address Street address, city, county, state of restaurant 4
Restaurant4Date Dining date restaurant 4
Restaurant5 Name of restaurant 5
Restaurant5Address Street address, city, county, state of restaurant 5
Restaurant5Date Dining date restaurant 5
Restaurant6 Name of restaurant 6
Restaurant6Address Street address, city, county, state of restaurant 6
Restaurant6Date Dining date restaurant 6
Restaurant7 Name of restaurant 7
Restaurant7Address Street address, city, county, state of restaurant 7
Restaurant7Date Dining date restaurant 7
OtherVenuePurchase Did you eat food purchased or obtained from any other venues, such as school cafeteria, concession stands, street vendors, institutions (e.g., hospital food), local farms, or private vendors during the 4 week period?
OtherVenue1 Name of other venue 1
OtherVenue1Address Street address, city, county, state of venue 1
OtherVenue1Date Dining date venue 1
OtherVenue2 Name of other venue 2
OtherVenue2Address Street address, city, county, state of venue 2
OtherVenue2Date Dining date venue 2
OtherVenue3 Name of other venue 3
OtherVenue3Address Street address, city, county, state of venue 3
OtherVenue3Date Dining date venue 3
OtherVenue4 Name of other venue 4
OtherVenue4Address Street address, city, county, state of venue 4
OtherVenue4Date Dining date venue 4
OtherVenue5 Name of other venue 5
OtherVenue5Address Street address, city, county, state of venue 5
OtherVenue5Date Dining date venue 5
OtherVenue6 Name of other venue 6
OtherVenue6Address Street address, city, county, state of venue 6
OtherVenue6Date Dining date venue 6
OtherVenue7 Name of other venue 7
OtherVenue7Address Street address, city, county, state of venue 7
OtherVenue7Date Dining date venue 7
HamEat In the 4 week period did you eat any ham deli, cold cut, or luncheon meat?
HamOften If ate ham, how often?
HamGrocery Was ham purchased at a grocery store?
HamDeli Was ham purchased at a deli/small market ?
HamRest Was ham purchased at a restaurant?
HamOther Was ham purchased at an other venue?
Ham1 Name of store/restaurant/venue where ham purchased 1
Ham2 Name of store/restaurant/venue where ham purchased 2
Ham3 Name of store/restaurant/venue where ham purchased 3
Ham4 Name of store/restaurant/venue where ham purchased 4
HamBrand1 Type or brand of ham purchased 1
HamBrand2 Type or brand of ham purchased 2
HamBrand3 Type or brand of ham purchased 3
HamBrand4 Type or brand of ham purchased 4
HamDeliCounter Was ham purchased from a deli counter at any of the sites?
BolognaEat In the 4 week period did you eat any bologna deli, cold cut, or luncheon meat?
BolognaOften If ate bologna, how often?
BolognaGrocery Was bologna purchased at grocery store?
BolognaDeli Was bologna purchased at a deli/small market?
BolognaRest Was bologna purchased at a restaurant?
BolognaOther Was bologna purchased at an other venue?
Bologna1 Name of store/restaurant/venue where bologna purchased 1
Bologna2 Name of store/restaurant/venue where bologna purchased 2
Bologna3 Name of store/restaurant/venue where bologna purchased 3
Bologna4 Name of store/restaurant/venue where bologna purchased 4
BolognaBrand1 Type or brand of bologna 1
BolognaBrand2 Type or brand of bologna 2
BolognaBrand3 Type or brand of bologna 3
BolognaBrand4 Type or brand of bologna 4
BolognaDeliCounter Was bologna purchased from a deli counter at any of the sites?
TurketEat In the 4 week period did you eat any turkey deli, cold cut, or luncheon meat?
TurkeyOften If ate turkey, how often?
TurkeyGrocery Was turkey purchased at a grocery store?
TurkeyDeli Was turkey purchased at a deli/small market?
TurkeyRest Was turkey purchased at a restaurant?
TurkeyOther Was turkey purchased at an other venue?
Turkey1 Name of store/restaurant/venue where turkey purchased 1
Turkey2 Name of store/restaurant/venue where turkey purchased 2
Turkey3 Name of store/restaurant/venue where turkey purchased 3
Turkey4 Name of store/restaurant/venue where turkey purchased 4
TurkeyBrand1 Type or brand of turkey 1
TurkeyBrand2 Type or brand of turkey 2
TurkeyBrand3 Type or brand of turkey 3
TurkeyBrand4 Type or brand of turkey 4
TurkeyDeliCounter Was turkey purchased from a deli counter at any of the sites?
OthturkeyEat In the 4 week period did you eat any other turkey deli, cold cut, or luncheon meat?
OthTurkeyOften If ate other turkey, how often?
OthTurkeyGrocery Was other turkey purchased at a grocery store?
OthTurkeyDeli Was other turkey purchased at a deli/small market?
OthTurkeyRest Was other turkey purchased at a restaurant?
OthTurkeyOther Was other turkey purchased at an other venue?
OthTurkey1 Name of store/restaurant/venue where other turkey purchased 1
OthTurkey2 Name of store/restaurant/venue where other turkey purchased 2
OthTurkey3 Name of store/restaurant/venue where other turkey purchased 3
OthTurkey4 Name of store/restaurant/venue where other turkey purchased 4
OthTurkeyBrand1 Type or brand of other turkey 1
OthTurkeyBrand2 Type or brand of other turkey 2
OthTurkeyBrand3 Type or brand of other turkey 3
OthTurkeyBrand4 Type or brand of other turkey 4
OthTurkeyDeliCounter Was other turkey purchased from a deli counter at any of the sites?
ChickenDeliEat In the 4 week period did you eat any chicken deli, cold cut, or luncheon meat?
ChickenDeliOften If ate chicken, how often?
ChickenDeliGrocery Was chicken purchased at a grocery store?
ChickenDeliDeli Was chicken purchased at a deli/small market?
ChickenDeliRest Was chicken purchased at a restaurant?
ChickenDeliOther Was chicken purchased at an other venue?
ChickenDeli1 Name of store/restaurant/venue where chicken purchased 1
ChickenDeli2 Name of store/restaurant/venue where chicken purchased 2
ChickenDeli3 Name of store/restaurant/venue where chicken purchased 3
ChickenDeli4 Name of store/restaurant/venue where chicken purchased 4
ChickenDeliBrand1 Type or brand of chicken 1
ChickenDeliBrand2 Type or brand of chicken 2
ChickenDeliBrand3 Type or brand of chicken 3
ChickenDeliBrand4 Type or brand of chicken 4
ChickenDeliDeliCounter Was chicken purchased from a deli counter at any of the sites?
PastramiEat In the 4 week period did you eat any pastrami deli, cold cut, or luncheon meat?
PastramiOften If ate pastrami, how often?
PastramiGrocery Was pastrami purchased at a grocery store?
PastramiDeli Was pastrami purchased at a deli/small market?
PastramiRest Was pastrami purchased at a restaurant?
PastramiOther Was pastrami purchased at an other venue?
Pastrami1 Name of store/restaurant/venue where pastrami purchased 1
Pastrami2 Name of store/restaurant/venue where pastrami purchased 2
Pastrami3 Name of store/restaurant/venue where pastrami purchased 3
Pastrami4 Name of store/restaurant/venue where pastrami purchased 4
PastramiBrand1 Type or brand of pastrami 1
PastramiBrand2 Type or brand of pastrami 2
PastramiBrand3 Type or brand of pastrami 3
PastramiBrand4 Type or brand of pastrami 4
PastramiDeliCounter Was pastrami purchased from a deli counter at any of the sites?
OtherDeliEat In the 4 week period did you eat any other deli, cold cut, or luncheon meat?
OtherDeliSpec Specify other deli meat eaten
OtherDeliOften If at other deli meat, how often?
OtherDeliGrocery Was other deli meat purchased at a grocery store?
OtherDeliDeli Was other deli meat purchased at a deli/small market?
OtherDeliRest Was other deli meat purchased at a restaurant?
OtherDeliOther Was other deli meat purchased at an other venue?
OtherDeli1 Name of store/restaurant/venue where other deli meat purchased 1
OtherDeli2 Name of store/restaurant/venue where other deli meat purchased 2
OtherDeli3 Name of store/restaurant/venue where other deli meat purchased 3
OtherDeli4 Name of store/restaurant/venue where other deli meat purchased 4
OtherDeliBrand1 Type or brand of other deli meat 1
OtherDeliBrand2 Type or brand of other deli meat 2
OtherDeliBrand3 Type or brand of other deli meat 3
OtherDeliBrand4 Type or brand of other deli meat 4
OtherDeliCounter Was other deli meat purchased from a deli counter at any of the sites?
PateEat In the 4 week period did you eat any pate?
PateOften If yes, how often was pate eaten?
PateGrocery Was pate purchased at a grocery store?
PateDeli Was pate purchased at a deli/small market?
PateRest Was pate purchased at a restaurant?
PateOther Was pate purchased at an other venue?
Pate1 Name of store/restaurant/other venue where pate purchased 1
Pate2 Name of store/restaurant/other venue where pate purchased 2
Pate3 Name of store/restaurant/other venue where pate purchased 3
Pate4 Name of store/restaurant/other venue where pate purchased 4
PateBrand1 Type or brand of pate 1
PateBrand2 Type or brand of pate 2
PateBrand3 Type or brand of pate 3
PateBrand4 Type or brand of pate 4
PateDeliConter Was pate purchased from a deli counter at any of the sites?
HotDogEat In the 4 week period did you eat any hot dogs?
HotDogOften If yes, how often did you eat hot dogs?
HotDogGrocery Were hotdogs purchased at a grocery store?
HotDogDeli Were hotdogs purchased at a deli/small market?
HotDogRest Were hotdogs purchased at a resutarant?
HotDogOther Were hotdogs purchased at an other venue?
HotDog1 Name of store/restaurant/other venue where hotdogs purchased 1
HotDog2 Name of store/restaurant/other venue where hotdogs purchased 2
HotDog3 Name of store/restaurant/other venue where hotdogs purchased 3
HotDog4 Name of store/restaurant/other venue where hotdogs purchased 4
HotDogBrand1 Type or brand of hotdog 1
HotDogBrand2 Type or brand of hotdog 2
HotDogBrand3 Type or brand of hotdog 3
HotDogBrand4 Type or brand of hotdog 4
HotDogDeliCounter Were hot dogs purchased from a deli counter at any of the sites?
HotDogHeated Were hot dogs heated before consumption?
BrieAte In the 4 week period, did you eat any brie?
BrieOften If ate brie, how often?
BrieGrocery Was brie purchased at a grocery store?
BrieDeli Was brie purchased at a deli/small market?
BrieRest Was brie purchased at a restaurant?
BrieOther Was brie purchased at an other venue?
Brie1 Name of store/restaurant/other venue where brie purchased 1
Brie2 Name of store/restaurant/other venue where brie purchased 2
Brie3 Name of store/restaurant/other venue where brie purchased 3
Brie4 Name of store/restaurant/other venue where brie purchased 4
BrieBrand1 Type or brand of brie 1
BrieBrand2 Type or brand of brie 2
BrieBrand3 Type or brand of brie 3
BrieBrand4 Type or brand of brie 4
BrieDeliCounter Was brie purchased from a deli counter at any of the sites?
FetaAte In the 4 week period, did you eat any feta?
FetaOften If ate feta, how often?
FetaGrocery Was feta purchased from a grocery store?
FetaDeli Was feta purchased from a deli/small market?
FetaRest Was feta purchased from a restaurant?
FetaOther Was feta purchased at an other venue?
Feta1 Name of store/restaurant/other venue where feta purchased 1
Feta2 Name of store/restaurant/other venue where feta purchased 2
Feta3 Name of store/restaurant/other venue where feta purchased 3
Feta4 Name of store/restaurant/other venue where feta purchased 4
FetaBrand1 Type or brand of feta 1
FetaBrand2 Type or brand of feta 2
FetaBrand3 Type or brand of feta 3
FetaBrand4 Type or brand of feta 4
FetaDeliCounter Was feta purchased from a deli counter at any of the sites?
CamambAte In the 4 week period did you eat any camembert?
CamemOften If ate camembert, how often?
CamemGrocery Was camembert purchased at a grocery store?
CamemDeli Was camembert purchased from a deli/small market?
CamemRest Was camembert purchased from a restaurant?
CamemOther Was camembert purchased from an other venue?
Camem1 Name of store/restaurant/other venue where camembert purchased 1
Camem2 Name of store/restaurant/other venue where camembert purchased 2
Camem3 Name of store/restaurant/other venue where camembert purchased 3
Camem4 Name of store/restaurant/other venue where camembert purchased 4
Camembrand1 Type or brand of camembert 1
Camembrand2 Type or brand of camembert 2
Camembrand3 Type or brand of camembert 3
Camembrand4 Type or brand of camembert 4
Camemdelicounter Was camembert purchased at a deli counter at any of these sites?
GoatAte In the 4 weeks period did you eat any goat cheese?
GoatOften If ate goat cheese, how often?
Goatgrocery Was goat cheese purchased at a grocery store?
Goatdeli Was goat cheese purchased at a deli?
Goatrest Was goat cheese purchased at a restaurant?
Goatother Was goat cheese purchased at an other venue?
Goat1 Name of store/restaurant/other venue where goat cheese purchased 1
Goat2 Name of store/restaurant/other venue where goat cheese purchased 2
Goat3 Name of store/restaurant/other venue where goat cheese purchased 3
Goat4 Name of store/restaurant/other venue where goat cheese purchased 4
GoatBrand1 Type or brand of goat cheese 1
GoatBrand2 Type or brand of goat cheese 2
GoatBrand3 Type or brand of goat cheese 3
GoatBrand4 Type or brand of goat cheese 4
GoatDeliCounter Was goat cheese purchased at a deli counter at any of the sites?
BlugorgAte In the 4 week period did you eat any blue or gorgonzola cheese?
BlugorgOften If ate blue or gorgonzola cheese, how often?
BlugorgGrocery Was blue or gorgonzola cheese purchased at a grocery store?
BlugorgDeli Was blue or gorgonzola cheese purchased at a deli?
BlugorgRest Was blue or gorgonzola cheese purchased at a restaurant?
BlugorgOther Was blue or gorgonzola cheese purchased at an other venue?
Blugorg1 name of store/restaurant/other venue where blue or gorgonzola cheese purchased 1
Blugorg2 name of store/restaurant/other venue where blue or gorgonzola cheese purchased 2
Blugorg3 name of store/restaurant/other venue where blue or gorgonzola cheese purchased 3
Blugorg4 name of store/restaurant/other venue where blue or gorgonzola cheese purchased 4
BlugorgBrand1 Type or brand of blue or gorgonzola cheese 1
BlugorgBrand2 Type or brand of blue or gorgonzola cheese 2
BlugorgBrand3 Type or brand of blue or gorgonzola cheese 3
BlugorgBrand4 Type or brand of blue or gorgonzola cheese 4
BlugorgDeliCounter Was blue or gorgonzola cheese purchased at a deli counter at any of the sites?
MexAte In the 4 week period did you eat any Mexican-style cheese?
MexOften If ate Mexican-style cheese, how often?
MexGrocery Was Mexican-style cheese purchased at a grocery store?
MexDeli Was Mexican-style cheese purchased at a deli/small market?
MexRest Was Mexican-style cheese purchased at a restaurant?
MexOther Was Mexican-style cheese purchased at an other venue?
Mex1 Name of store/restaurant/other venue where Mexican-style cheese purchased 1
Mex2 Name of store/restaurant/other venue where Mexican-style cheese purchased 2
Mex3 Name of store/restaurant/other venue where Mexican-style cheese purchased 3
Mex4 Name of store/restaurant/other venue where Mexican-style cheese purchased 4
MexBrand1 Type or brand of Mexican-style cheese 1
MexBrand2 Type or brand of Mexican-style cheese 2
MexBrand3 Type or brand of Mexican-style cheese 3
MexBrand4 Type or brand of Mexican-style cheese 4
MexDeliCounter Was Mexican-style cheese purchased at a deli counter at any of the sites?
FarmAte In the 4 week period did you eat any Farmers cheese?
FarmOften If ate Farmers cheese, how often?
FarmGrocery Was Farmers cheese purchased at a grocery store?
FarmDeli Was Farmers cheese purchased at a deli/small market?
FarmRest Was Farmers cheese purchased at a restaurant?
FarmOther Was Farmers cheese purchased at an other venue?
Farm1 Name of store/restaurant/other venue where Farmers cheese purchased 1
Farm2 Name of store/restaurant/other venue where Farmers cheese purchased 2
Farm3 Name of store/restaurant/other venue where Farmers cheese purchased 3
Farm4 Name of store/restaurant/other venue where Farmers cheese purchased 4
FarmBrand1 Type or brand of Farmers cheese 1
FarmBrand2 Type or brand of Farmers cheese 2
FarmBrand3 Type or brand of Farmers cheese 3
FarmBrand4 Type or brand of Farmers cheese 4
FarmDeliCounter Was Farmers cheese purchased at a deli counter at any of the sites?
RawAte In the 4 week period did you eat any raw cheese?
RawOften If ate raw cheese, how often?
RawGrocery Was raw cheese purchased at a grocery store?
RawDeli Was raw cheese purchased at a deli/small market?
RawRest Was raw cheese purchased at a restaurant?
RawOther Was raw cheese purchased at an other venue?
Raw1 Name of store/restaurant/other venue where raw cheese purchased 1
Raw2 Name of store/restaurant/other venue where raw cheese purchased 2
Raw3 Name of store/restaurant/other venue where raw cheese purchased 3
Raw4 Name of store/restaurant/other venue where raw cheese purchased 4
RawBrand1 Type or brand of raw cheese 1
RawBrand2 Type or brand of raw cheese 2
RawBrand3 Type or brand of raw cheese 3
RawBrand4 Type or brand of raw cheese 4
RawDeliConter Was raw cheese purchased at a deli counter at any of the sites?
OtherchAte In the 4 week period did you eat any other soft white cheese (not cream, cottage, or ricotta)?
Otherchspec If ate other soft white cheese, specify
OtherchOften If ate other soft white cheese, how often?
Otherchgrocery Was other soft white cheese purchased at a grocery store?
Otherchdeli Was other soft white cheese purchased at a deli/small market?
OtherchRest Was other soft white cheese purchased at a restaurant
OtherchOther Was other soft white cheese purchased at an other venue?
Other1 Name of store/restaurant/other venue where soft white cheese purchased 1
Other2 Name of store/restaurant/other venue where soft white cheese purchased 2
Other3 Name of store/restaurant/other venue where soft white cheese purchased 3
Other4 Name of store/restaurant/other venue where soft white cheese purchased 4
OtherBrand1 Type or brand of other soft white cheese 1
OtherBrand2 Type or brand of other soft white cheese 2
OtherBrand3 Type or brand of other soft white cheese 3
OtherBrand4 Type or brand of other soft white cheese 4
OtherChDeliCounter Was other soft white cheese purchased at a deli counter at any of the sites?
PotatoEat In the 4 weeks period did you eat any ready-to-eat, deli-style potato salad?
PotatoOften If ate potato salad, how often?
PotatoGrocery Was potato salad purchased from a grocery store?
PotatoDeli Was potato salad purchased from a deli/small market?
PotatoRest Was potato salad purchased from a restaurant?
PotatoOther Was potato salad purchased at an other venue?
Potato1 Name of store/restaurant/other venue where potato salad purchased 1
Potato2 Name of store/restaurant/other venue where potato salad purchased 2
Potato3 Name of store/restaurant/other venue where potato salad purchased 3
Potato4 Name of store/restaurant/other venue where potato salad purchased 4
PotatoBrand1 Type or brand of potato salad 1
PotatoBrand2 Type or brand of potato salad 2
PotatoBrand3 Type or brand of potato salad 3
PotatoBrand4 Type or brand of potato salad 4
PotatoDeliCounter Was potato salad purchased from a deli counter at any of the sites?
PastaEat In the 4 weeks period did you eat any ready-to-eat, deli-style pasta salad?
PastaOften If at pasta salad, how often?
PastaGrocery Was pasta salad purchased from a grocery store?
PastaDeli Was pasta salad purchased from a deli/small market?
PastaRest Was pasta salad purchased from a restaurant?
PastaOther Was pasta salad purchased from an other venue?
Pasta1 Name of store/restaurant/other venue where pasta salad purchased 1
Pasta2 Name of store/restaurant/other venue where pasta salad purchased 2
Pasta3 Name of store/restaurant/other venue where pasta salad purchased 3
Pasta4 Name of store/restaurant/other venue where pasta salad purchased 4
PastaBrand1 Type or brand of pasta salad 1
PastaBrand2 Type or brand of pasta salad 2
PastaBrand3 Type or brand of pasta salad 3
PastaBrand4 Type or brand of pasta salad 4
PastaDeliCounter Was pasta salad purchased from a deli counter at any of the sites?
TunaAte In the 4 weeks period did you eat any ready-to-eat, deli-style tuna salad?
TunaOften If ate tuna salad, how often?
TunaGrocery Was tuna salad purchase from a grocery store?
TunaDeli Was tuna salad purchase from a deli/small market?
TunaRest Was tuna salad purchase from a restaurant?
TunaOther Was tuna salad purchase from an other venue?
Tuna1 Name of store/restaurant/other venue where tuna salad purchased 1
Tuna2 Name of store/restaurant/other venue where tuna salad purchased 2
Tuna3 Name of store/restaurant/other venue where tuna salad purchased 3
Tuna4 Name of store/restaurant/other venue where tuna salad purchased 4
TunaBrand1 Type or brand tuna salad 1
TunaBrand2 Type or brand tuna salad 2
TunaBrand3 Type or brand tuna salad 3
TunaBrand4 Type or brand tuna salad 4
TunaDeliCounter Was tuna salad purchased from a deli counter at any of the sites?
BeanAte In the 4 weeks period did you eat any ready-to-eat, deli-style bean salad?
BeanOften If ate bean salad, how often?
BeanGrocery Was bean salad purchased from a grocery store?
BeanDeli Was bean salad purchased from a deli/small market?
BeanRest Was bean salad purchased from a restaurant?
BeanOther Was bean salad purchased from an other venue?
Bean1 Name of store/restaurant/other venue where bean salad purchased 1
Bean2 Name of store/restaurant/other venue where bean salad purchased 2
Bean3 Name of store/restaurant/other venue where bean salad purchased 3
Bean4 Name of store/restaurant/other venue where bean salad purchased 4
BeanBrand1 Type or brand of bean salad 1
BeanBrand2 Type or brand of bean salad 2
BeanBrand3 Type or brand of bean salad 3
BeanBrand4 Type or brand of bean salad 4
BeanDeliCounter Was bean salad purchased from a deli counter at any of the sites?
HummusAte In the 4 week period did you eat any ready-to-eat, deli-style hummus?
HummusOften If at hummus, how often?
HummusGrocery Was hummus purchased from a grocery store?
HummusDeli Was hummus purchased from a deli/small market?
HummusRest Was hummus purchased from a restaurant?
HummusOther Was hummus purchased from an other venue?
Hummus1 Name of store/restaurant/other venue where hummus purchased 1
Hummus2 Name of store/restaurant/other venue where hummus purchased 2
Hummus3 Name of store/restaurant/other venue where hummus purchased 3
Hummus4 Name of store/restaurant/other venue where hummus purchased 4
HummusBrand1 Type or brand of hummus 1
HummusBrand2 Type or brand of hummus 2
HummusBrand3 Type or brand of hummus 3
HummusBrand4 Type or brand of hummus 4
HummusDeliCounter Was hummus purchased at a deli counter at any of the sites?
ColeAte In the 4 week period did you eat any ready-to-eat, deli-style cole slaw?
ColeOften If ate cole slaw, how often?
ColeGrocery Was cole slaw purchased from a grocery store?
ColeDeli Was cole slaw purchased from a deli/small market?
ColeRest Was cole slaw purchased from a restaurant?
ColeOther Was cole slaw purchased from an other venue?
Cole1 Name of store/restaurant/other venue where cole slaw purchased 1
Cole2 Name of store/restaurant/other venue where cole slaw purchased 2
Cole3 Name of store/restaurant/other venue where cole slaw purchased 3
Cole4 Name of store/restaurant/other venue where cole slaw purchased 4
ColeBrand1 Type or brand of cole slaw 1
ColeBrand2 Type or brand of cole slaw 2
ColeBrand3 Type or brand of cole slaw 3
ColeBrand4 Type or brand of cole slaw 4
ColeDeliCounter Was any cole slaw purchased from a deli counter at any of the sites?
SeafoodAte In the 4 week period did you eat any ready-to-eat, deli-style seafood salad?
SeafoodOften If ate seafood salad, how often?
SeafoodGrocery Was seafood salad purchased from a grocery store?
SeafoodDeli Was seafood salad purchased from a deli/small market?
SeafoodRest Was seafood salad purchased from a restaurant?
SeafoodOther Was seafood salad purchased from an other venue?
Seafood1 Name of store/restaurant/other venue where seafood salad purchased 1
Seafood2 Name of store/restaurant/other venue where seafood salad purchased 2
Seafood3 Name of store/restaurant/other venue where seafood salad purchased 3
Seafood4 Name of store/restaurant/other venue where seafood salad purchased 4
SeafoodBrand1 Type or brand of seafood salad 1
SeafoodBrand2 Type or brand of seafood salad 2
SeafoodBrand3 Type or brand of seafood salad 3
SeafoodBrand4 Type or brand of seafood salad 4
SeafoodDeliCounter Was any seafood salad purchased at a deli counter at any of the sites?
FruitAte In the 4 week period did you eat any ready-to-eat, deli-style fruit salad?
FruitOften If ate fruit salad, how often?
FruitGrocery Was fruit salad purchased at a grocery store?
FruitDeli Was fruit salad purchased at a deli/small market?
FruitRest Was fruit salad purchased at a restaurant?
FruitOther Was fruit salad purchased at an other venue?
Fruit1 Name of store/restaurant/other venue where fruit salad purchased 1
Fruit2 Name of store/restaurant/other venue where fruit salad purchased 2
Fruit3 Name of store/restaurant/other venue where fruit salad purchased 3
Fruit4 Name of store/restaurant/other venue where fruit salad purchased 4
FruitBrand1 Type or brand fruit salad 1
FruitBrand2 Type or brand fruit salad 2
FruitBrand3 Type or brand fruit salad 3
FruitBrand4 Type or brand fruit salad 4
FruitDeliCounter Was fruit salad purchased pre-cut?
OtherRTEAte In the 4 week period did you eat any other ready-to-eat meat, vegetable, or fruit salad not made at home?
OtherRTESpecify If ate other ready-to-eat meat, vegetable, or fruit salad not made at home, specify
OtherRTEOften If ate other ready-to-eat meat, vegetable, or fruit salad not made at home, how often?
OtherRTEGrocery Was other ready-to-eat meat, vegetable, or fruit salad not made at home purchased at a grocery store?
OtherRTEDeli Was other ready-to-eat meat, vegetable, or fruit salad not made at home purchased at a deli/small market?
OtherRTERest Was other ready-to-eat meat, vegetable, or fruit salad not made at home purchased at a restaurant?
OtherRTEOther Was other ready-to-eat meat, vegetable, or fruit salad not made at home purchased at an other venue?
OtherRTE1 Name of store/restaurant/other venue where other ready-to-eat meat, vegetable, or fruit salad purchased 1
OtherRTE2 Name of store/restaurant/other venue where other ready-to-eat meat, vegetable, or fruit salad purchased 2
OtherRTE3 Name of store/restaurant/other venue where other ready-to-eat meat, vegetable, or fruit salad purchased 3
OtherRTE4 Name of store/restaurant/other venue where other ready-to-eat meat, vegetable, or fruit salad purchased 4
OtherRTEBrand1 Type or brand of other ready-to-eat meat, vegetable, or fruit salad 1
OtherRTEBrand2 Type or brand of other ready-to-eat meat, vegetable, or fruit salad 2
OtherRTEBrand3 Type or brand of other ready-to-eat meat, vegetable, or fruit salad 3
OtherRTEBrand4 Type or brand of other ready-to-eat meat, vegetable, or fruit salad 4
OtherRTEDeliCounter Was other ready-to-eat meat, vegetable, or fruit salad purchased at a deli counter at any of the sites?
ShrimpAte In the 4 wek period did you eat any precooked shrimp?
shrimpOften If ate precooked shrimp, how often?
ShrimpGrocery Was shrimp purchased at a grocery store?
ShrimpDeli Was shrimp purchased at a deli/small market?
ShrimpRest Was shrimp purchased at a restaurant?
ShrimpOther Was shrimp purchased at an other venue?
Shrimp1 Name of store/restaurant/other venue where shrimp purchased 1
Shrimp2 Name of store/restaurant/other venue where shrimp purchased 2
Shrimp3 Name of store/restaurant/other venue where shrimp purchased 3
Shrimp4 Name of store/restaurant/other venue where shrimp purchased 4
ShrimpBrand1 Type or brand of shrimp 1
ShrimpBrand2 Type or brand of shrimp 2
ShrimpBrand3 Type or brand of shrimp 3
ShrimpBrand4 Type or brand of shrimp 4
ShrimpDeliCounter Was shrimp purchased at a deli counter at any of the sites?
CrabAte In the 4 week period did you eat any precooked crab including imitation crab meat?
CrabOften If ate precooked crab, how often?
CrabGrocery Was crab purchased at a grocery store?
CrabDeli Was crab purchased at a deli/small market?
CrabRest Was crab purchased at a restaurant?
CrabOther Was crab purchased at an other venue?
Crab1 Name of store/restaurant/other venue where crab purchased 1
Crab2 Name of store/restaurant/other venue where crab purchased 2
Crab3 Name of store/restaurant/other venue where crab purchased 3
Crab4 Name of store/restaurant/other venue where crab purchased 4
CrabBrand1 Type or brand of crab 1
CrabBrand2 Type or brand of crab 2
CrabBrand3 Type or brand of crab 3
CrabBrand4 Type or brand of crab 4
CrabDeliCounter Was crab purchased at a deli counter at any of the sites?
SmokedAte In the 4 week period did you eat any smoked or cured fish that was not from a can (e.g. smoked salmon or lox)?
SmokedOften If ate smoked or cured fish, how often?
SmokedGrocery Was smoked or cured fish purchased at a grocery store?
SmokedDeli Was smoked or cured fish purchased at a deli/small market?
SmokedRest Was smoked or cured fish purchased at a restaurant?
SmokedOther Was smoked or cured fish purchased at an other venue?
Smoked1 Name of store/restaurant/other venue where smoked or cured fish purchased 1
Smoked2 Name of store/restaurant/other venue where smoked or cured fish purchased 2
Smoked3 Name of store/restaurant/other venue where smoked or cured fish purchased 3
Smoked4 Name of store/restaurant/other venue where smoked or cured fish purchased 4
SmokedBrand1 Type or brand smoked/cured fish 1
SmokedBrand2 Type or brand smoked/cured fish 2
SmokedBrand3 Type or brand smoked/cured fish 3
SmokedBrand4 Type or brand smoked/cured fish 4
SmokedDeliCounter Was smoked or cured fish purchased at a deli counter at any of the sites?
HoneydewAte In the 4 week period did you eat any honeydew?
HoneydewOften If ate honeydew, how often?
HoneydewGrocery Was honeydew purchased at a grocery store?
HoneydewDeli Was honeydew purchased at a deli/small market?
HoneydewRest Was honeydew purchased at a restaurant?
HoneydewOther Was honeydew purchased at an other venue?
Honeydew1 Name of store/restaurant/other venue where honeydew purchased 1
Honeydew2 Name of store/restaurant/other venue where honeydew purchased 2
Honeydew3 Name of store/restaurant/other venue where honeydew purchased 3
Honeydew4 Name of store/restaurant/other venue where honeydew purchased 4
HonewdewBrand1 Type or brand honeydew 1
HonewdewBrand2 Type or brand honeydew 2
HonewdewBrand3 Type or brand honeydew 3
HonewdewBrand4 Type or brand honeydew 4
HoneydewDeliCounter Was the honeydew purchased pre-cut?
CantAte In the 4 week period did you eat any cantaloupe?
CantOften If ate cantaloupe, how often?
CantGrocery Was cantaloupe purchased at a grocery store?
CantDeli Was cantaloupe purchased at a deli/small market?
CantRest Was cantaloupe purchased at a restaurant?
CantOther Was cantaloupe purchased at an other venue?
Cant1 Name of store/restaurant/other venue where cantaloupe purchased 1
Cant2 Name of store/restaurant/other venue where cantaloupe purchased 2
Cant3 Name of store/restaurant/other venue where cantaloupe purchased 3
Cant4 Name of store/restaurant/other venue where cantaloupe purchased 4
CantBrand1 Type or brand of cantaloupe 1
CantBrand2 Type or brand of cantaloupe 2
CantBrand3 Type or brand of cantaloupe 3
CantBrand4 Type or brand of cantaloupe 4
CanteDeliCounter Was the cantaloupe purchased pre-cut?
WaterAte In the 4 week period did you eat any watermelon?
WaterOften If ate watermelon, how often?
WaterGrocery Was watermelon purchased at a grocery store?
WaterDeli Was watermelon purchased at a deli/small market?
WaterRest Was watermelon purchased at a restaurant?
WaterOther Was watermelon purchased at an other venue?
Water1 Name of store/restaurant/other venue where watermelon purchased 1
Water2 Name of store/restaurant/other venue where watermelon purchased 2
Water3 Name of store/restaurant/other venue where watermelon purchased 3
Water4 Name of store/restaurant/other venue where watermelon purchased 4
WaterBrand1 Type or brand of watermelon 1
WaterBrand2 Type or brand of watermelon 2
WaterBrand3 Type or brand of watermelon 3
WaterBrand4 Type or brand of watermelon 4
WaterDeliCounter Was the watermelon purchased pre-cut?
WmilkAte In the 4 week period did you eat any whole milk?
WmilkOften If ate whole milk, how often?
WmilkGrocery Was whole milk purchased at a grocery store?
WmilkDeli Was whole milk purchased at a deli/small market?
WmilkRest Was whole milk purchased at a restaurant?
WmilkOther Was whole milk purchased at an other venue?
Wmilk1 Name of store/restaurant/other venue where whole milk purchased 1
Wmilk2 Name of store/restaurant/other venue where whole milk purchased 2
Wmilk3 Name of store/restaurant/other venue where whole milk purchased 3
Wmilk4 Name of store/restaurant/other venue where whole milk purchased 4
WmilkBrand1 Type or brand whole milk 1
WmilkBrand2 Type or brand whole milk 2
WmilkBrand3 Type or brand whole milk 3
WmilkBrand4 Type or brand whole milk 4
WMilkRaw Was any whole milk unpasteurized (raw)?
2MilkAte In the 4 week period did you eat any 2% milk?
2MilkOften If ate 2% milk, how often?
2MilkGrocery Was 2% milk purchased at a grocery store?
2MilkDeli Was 2% milk purchased at a deli/small market?
2MilkRest Was 2% milk purchased at a restaurant?
2MilkOther Was 2% milk purchased at an other venue?
2Milk1 Name of store/restaurant/other venue where 2% milk purchased 1
2Milk2 Name of store/restaurant/other venue where 2% milk purchased 2
2Milk3 Name of store/restaurant/other venue where 2% milk purchased 3
2Milk4 Name of store/restaurant/other venue where 2% milk purchased 4
2MilkBrand1 Type or brand 2% milk 1
2MilkBrand2 Type or brand 2% milk 2
2MilkBrand3 Type or brand 2% milk 3
2MilkBrand4 Type or brand 2% milk 4
2MilkRaw Was any 2% milk unpasteurized (raw)?
1MilkAte In the 4 week period did you eat any 1% milk?
1MilkOften If ate 1% milk, how often?
1MilkGrocery Was 1% milk purchased at a grocery store?
1MilkDeli Was 1% milk purchased at a deli/small market?
1MilkRest Was 1% milk purchased at a restaurant?
1MilkOther Was 1% milk purchased at an other venue?
1Milk1 Name of store/restaurant/other venue where 1% milk purchased 1
1Milk2 Name of store/restaurant/other venue where 1% milk purchased 2
1Milk3 Name of store/restaurant/other venue where 1% milk purchased 3
1Milk4 Name of store/restaurant/other venue where 1% milk purchased 4
1MilkBrand1 Type or brand 1% milk 1
1MilkBrand2 Type or brand 1% milk 2
1MilkBrand3 Type or brand 1% milk 3
1MilkBrand4 Type or brand 1% milk 4
1MilkRaw Was any 1% milk unpasteurized (raw)?
SkimMilkAte In the 4 week period did you eat any skim milk?
SkimMilkOften If ate skim milk, how often?
SkimMilkGrocery Was skim milk purchased at a grocery store?
SkimMilkDeli Was skim milk purchased at a deli/small market?
SkimMilkRest Was skim milk purchased at a restaurant?
SkimMilkOther Was skim milk purchased at an other venue?
SkimMilk1 Name of store/restaurant/other venue where skim milk purchased 1
SkimMilk2 Name of store/restaurant/other venue where skim milk purchased 2
SkimMilk3 Name of store/restaurant/other venue where skim milk purchased 3
SkimMilk4 Name of store/restaurant/other venue where skim milk purchased 4
SkimMilkBrand1 Type or brand skim milk 1
SkimMilkBrand2 Type or brand skim milk 2
SkimMilkBrand3 Type or brand skim milk 3
SkimMilkBrand4 Type or brand skim milk 4
SkimMilkRaw Was any skim milk unpasteurized (raw)?
OtherMilkAte In the 4 week period did you eat any other milk?
OtherMilkSpec If ate other milk, specify type of milk
OtherMilkOften If ate other milk, how often?
OtherMilkGrocery Was other milk purchased at a grocery store?
OtherMilkDeli Was other milk purchased at a deli/small market?
OtherMilkRest Was other milk purchased at a restaurant?
OtherMilkOther Was other milk purchased at an other venue?
OtherMilk1 Name of store/restaurant/other venue where other milk purchased 1
OtherMilk2 Name of store/restaurant/other venue where other milk purchased 2
OtherMilk3 Name of store/restaurant/other venue where other milk purchased 3
OtherMilk4 Name of store/restaurant/other venue where other milk purchased 4
OtherMilkBrand1 Type or brand other milk 1
OtherMilkBrand2 Type or brand other milk 2
OtherMilkBrand3 Type or brand other milk 3
OtherMilkBrand4 Type or brand other milk 4
OtherMilkRaw Was any other milk unpasteurized (raw)?
ButterAte In the 4 week period did you eat any butter?
ButterOften If ate butter, how often?
ButterGrocery Was butter purchased at a grocery store?
ButterDeli Was butter purchased at a deli/small market?
ButterRest Was butter purchased at a restaurant?
ButterOther Was butter purchased at an other venue?
Butter1 Name of store/restaurant/other venue where butter purchased 1
Butter2 Name of store/restaurant/other venue where butter purchased 2
Butter3 Name of store/restaurant/other venue where butter purchased 3
Butter4 Name of store/restaurant/other venue where butter purchased 4
ButterBrand1 Type or brand butter 1
ButterBrand2 Type or brand butter 2
ButterBrand3 Type or brand butter 3
ButterBrand4 Type or brand butter 4
CreamAte In the 4 week period did you eat any cream?
CreamOften If ate cream, how often?
CreamGrocery Was cream purchased at a grocery store?
CreamDeli Was cream purchased at a deli/small market?
CreamRest Was cream purchased at a restaurant?
CreamOther Was cream purchased at an other venue?
Cream1 Name of store/restaurant/other venue where cream purchased 1
Cream2 Name of store/restaurant/other venue where cream purchased 2
Cream3 Name of store/restaurant/other venue where cream purchased 3
Cream4 Name of store/restaurant/other venue where cream purchased 4
CreamBrand1 Type or brand cream 1
CreamBrand2 Type or brand cream 2
CreamBrand3 Type or brand cream 3
CreamBrand4 Type or brand cream 4
IcecreamAte In the 4 week period did you eat any ice cream?
IcecreamOften If ate ice cream, how often?
IcecreamGrocery Was ice cream purchased at a grocery store?
IcecreamDli Was ice cream purchased at a deli/small market?
IcecreamRest Was ice cream purchased at a restaurant?
IcecreamOther Was ice cream purchased at an other venue?
Icecream1 Name of store/restaurant/other venue where ice cream purchased 1
Icecream2 Name of store/restaurant/other venue where ice cream purchased 2
Icecream3 Name of store/restaurant/other venue where ice cream purchased 3
Icecream4 Name of store/restaurant/other venue where ice cream purchased 4
IcecreamBrand1 Type or brand ice cream 1
IcecreamBrand2 Type or brand ice cream 2
IcecreamBrand3 Type or brand ice cream 3
IcecreamBrand4 Type or brand ice cream 4
SourcreamAte In the 4 week period did you eat any sour cream?
SourcreamOften If ate sour cream, how often?
SourcreamGrocery Was sour cream purchased at a grocery store?
SourcreamDeli Was sour cream purchased at a deli/small market?
SourcreamRest Was sour cream purchased at a restaurant?
SourcreamOther Was sour cream purchased at an other venue?
Sourcream1 Name of store/restaurant/other venue where sour cream purchased 1
Sourcream2 Name of store/restaurant/other venue where sour cream purchased 2
Sourcream3 Name of store/restaurant/other venue where sour cream purchased 3
Sourcream4 Name of store/restaurant/other venue where sour cream purchased 4
SourcreamBrand1 Type or brand sour cream 1
SourcreamBrand2 Type or brand sour cream 2
SourcreamBrand3 Type or brand sour cream 3
SourcreamBrand4 Type or brand sour cream 4
YogurtAte In the 4 week period did you eat any yogurt?
YogurtOften If ate yogurt, how often?
YogurtGrocery Was yogurt purchased at a grocery store?
YogurtDeli Was yogurt purchased at a deli/small market?
YogurtRest Was yogurt purchased at a restaurant?
YogurtOther Was yogurt purchased at an other venue?
Yogurt1 Name of store/restaurant/other venue where yogurt purchased 1
Yogurt2 Name of store/restaurant/other venue where yogurt purchased 2
Yogurt3 Name of store/restaurant/other venue where yogurt purchased 3
Yogurt4 Name of store/restaurant/other venue where yogurt purchased 4
YogurtBrand1 Type or brand yogurt 1
YogurtBrand2 Type or brand yogurt 2
YogurtBrand3 Type or brand yogurt 3
YogurtBrand4 Type or brand yogurt 4

Sheet 24: Lyme

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Erythema Migrans Indicates whether the patient had erythema migrans (physician diagnosed EM at least 5 cm in diameter). PHVS_YesNoUnknown_CDC
Swelling Indicates whether the patient had arthritis characterized by brief attacks of joint swelling. PHVS_YesNoUnknown_CDC
Bell’s Palsy or other cranial neuritis Indicates whether the patient had Bell's palsy or other cranial neuritis. PHVS_YesNoUnknown_CDC
Radiculoneuropathy Indicates whether the patient had radiculoneuropathy. PHVS_YesNoUnknown_CDC
Lymphocytic meningitis Indicates whether the patient had lymphocytic meningitis. PHVS_YesNoUnknown_CDC
Encephalitis/Encephalomyelitis Indicates whether the patient had encephalitis/encephalomyelitis. PHVS_YesNoUnknown_CDC
2nd or 3rd degree atrioventricular block Indicates whether the patient had 2nd or 3rd degree atrioventricular block. PHVS_YesNoUnknown_CDC
OtherSpeci Name of another laboratory test performed TEXT
Results Result of other specific laboratory tests performed P/N/E/ND/U
EIA_IFA test type Type of EIA performed Whole cell antigen EIA/ELISA/ELFA; Defined antigen EIA/ELISA/ELFA;Antigen capture EIA/ELISA/ELFA; IFA; Unknown; Other; not done
EIA_IFA test result Result of EIA IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done
Immunoblot result Result of immunblot IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done
IgM_21kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgM_39kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgM_41kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_18kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_21kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_28kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_30kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_39kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_41kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_45kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_58kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_66kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done
IgG_93kDa Immunoblot specific test result; linked to laboratory criteria positive; negative; unknown; not done

Sheet 25: Malaria

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

Sheet 26: Measles

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

Sheet 27: Melioidosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
State Case ID States use this field to link NEDSS investigations back to their own state investigations.
Date of First Report to CDC Date the case was first reported to the CDC
Notification Result Status Status of the notification. PHVS_ResultStatus_NETSS
Condition Code Condition or event that constitutes the reason the notification is being sent PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS
Case Class Status Code Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. PHVS_CaseClassStatus_NND
MMWR Week MMWR Week for which case information is to be counted for MMWR publication.
MMWR Year MMWR Year (YYYY) for which case information is to be counted for MMWR publication.
Reporting State State reporting the notification. PHVS_State_FIPS_5-2
Reporting County County reporting the notification. PHVS_County_FIPS_6-4
National Reporting Jurisdiction National jurisdiction reporting the notification to CDC. PHVS_NationalReportingJurisdiction_NND
Reporting Source Type Code Type of facility or provider associated with the source of information sent to Public Health. PHVS_ReportingSourceType_NND
Reporting Source ZIP Code ZIP Code of the reporting source for this case.
Date First Reported PHD Earliest date the case was reported to the public health department whether at the local, county, or state public health level.
Person Reporting to CDC - Name Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Phone Number Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Title Job title / description of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Person Reporting to CDC - Affiliation Affiliated Facility of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.
Subject Address County County of residence of the subject PHVS_County_FIPS_6-4
Subject Address State State of residence of the subject PHVS_State_FIPS_5-2
Age units at case investigation Subject age units at time of case investigation PHVS_AgeUnit_UCUM_NETSS
Country of Birth Country of Birth PHVS_CountryofBirth_CDC
Time in U.S. Length of time this subject has been living in the U.S. (if born out of the U.S.
Date entered U.S. Date entered U.S. in YYYYMM format (if born out of the U.S.)
Travel or Live Outside U.S. Did the subject travel or live outside the U.S.A.? PHVS_YesNoUnknown_CDC
Country of Exposure or Country Where Disease was Acquired

Note: use exposure or acquired consistently across variables
Indicates the country in which the disease was potentially acquired. PHVS_Country_ISO_3166-1
Subject’s Sex Subject’s current sex PHVS_Sex_MFU
Race Category Field containing one or more codes that broadly refer to the subject’s race(s). PHVS_RaceCategory_CDC
Ethnic Group Code Based on the self-identity of the subject as Hispanic or Latino PHVS_EthnicityGroup_CDC_Unk
Country of Usual Residence Where does the person usually* live (defined as their residence)

*For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf .
PHVS_CountryofBirth_CDC
Earliest Date Reported to County Earliest date reported to county public health system
Earliest Date Reported to State Earliest date reported to state public health system
Diagnosis Date Earliest date of diagnosis (clinical or laboratory) of condition being reported to public health system
Date of Onset of symptoms Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system
Date sample collected Provide date test was performed in YYYYMM format
Date test performed Provide date test was performed in YYYYMM format
Type of test utilized to identify case Indicate the type of test performed to confirm case
Test Result Epidemiologic interpretation of the results of the tests performed for this case PHVS_LabTestInterpretation_melioidosis
Hospitalized Indicate whether subject was or is currently hospitalized due to this illness PHVS_YesNoUnknown_CDC
Did patient expire? Indicate whether subject died of this illness PHVS_YesNoUnknown_CDC
Current antimicrobial Treatment Indicate all antimicrobial drugs used to treat subject
PHVS_MedicationTreatment_Melioidosis
Date current antimicrobial Treatment Indicate the date antimicrobial treatment started
PHVS_MedicationTreatment_Date_Melioidosis
Diabetes Does subject have diabetes? PHVS_YesNoUnknown_CDC
Chronic renal disease Does subject have chronic renal disease? PHVS_YesNoUnknown_CDC
Chronic lung disease Does subject have chronic lung disease? PHVS_YesNoUnknown_CDC
Liver disease or chronic alcohol abuse Does subject have liver disease or chronic alcohol abuse? PHVS_YesNoUnknown_CDC
Thalassemia Does subject have thalassemia? PHVS_YesNoUnknown_CDC
Non HIV-related immune suppression Does subject have non HIV-related immune suppression? PHVS_YesNoUnknown_CDC
Military service Has subject ever served overseas in in the military? PHVS_YesNoUnknown_CDC
Military service Date If yes, date of service in YYYYMM format.
Laboratory exposure Was subject ever exposed to burkolderia through lab work? PHVS_YesNoUnknown_CDC
Laboratory exposure Date If yes, date of exposure in YYYYMM format.
Contact with soil or water in melioidosis-endemic areas Has subject ever been in contact with soil or water in melioidosis-endemic areas? PHVS_YesNoUnknown_CDC
Contact with soil or water in melioidosis-endemic areas service Date If yes, date of contact in YYYYMM format.
Contact with someone with the same disease Did subject have contact with someone diagnosed with melioidosis? PHVS_YesNoUnknown_CDC
Were you at any recent mass gathering? Was subject present at any recent mass gathering? PHVS_YesNoUnknown_CDC

Sheet 28: Mumps

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

Sheet 29: Neisseria meningitidis

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
SEROGROUP Serogroup of the culture. TBD
OTHSERO Other serogroup of the culture.
COLLEGE Is patient currently attending college? This question is only applicable if the patient is 15-24 years of age. PHVS_YesNoUnknown_CDC
CASEID How was the case identified? TBD
OTHSTRST Other sterile site from which species was isolated.
OTHID Other case identification method.
SCHOOLYR Patient's year in college. (freshman, sophomore, etc.) TBD
STUDTYPE Patient's status in college as defined by the university. TBD
HOUSE Patient's current living situation. TBD
OTHHOUSE Other housing option.
SCHOOLNM Full name of the college or university the patient is currently attending.
POLYVAC Has patient received the polysaccharide meningococcal vaccine? PHVS_YesNoUnknown_CDC
SECCASE Is this case of Neiserria meningitidis a secondary case? PHVS_YesNoUnknown_CDC
SECCASETY Type of secondary contact for a case of Neisseria meningitidis. TBD
OTHSECCASE Other field available if the secondary case type selected is other.
NMSULFRES Neisseria meningitidis resistance to Sulfa. PHVS_YesNoUnknown_CDC
NMRIFARES Neisseria meningitidis resistance to Rifampin. PHVS_YesNoUnknown_CDC
DIAGDATE Date the sample was collected for diagnostic testing if a culture was not done.
PCRSOURCE Specifies the PCR source for how the case was identified. TBD
IHCSPEC1 Specifies the first IHC specimen.
IHCSPEC2 Specifies the second IHC specimen.
IHCSPEC3 Specifies the third IHC specimen.
MENGVAC Specifies whether the patient has received a meningococcal vaccine.

Sheet 30: Novel Influenza A

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

Sheet 31: Ped Flu Deaths

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

Sheet 32: Pertussis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the patient have a cough? Did the patient's illness include the symptom of cough? PHVS_YesNoUnknown_CDC
Cough Onset Date Cough onset date
Paroxysmal Cough Did the patient's illness include the symptom of paroxysmal cough? PHVS_YesNoUnknown_CDC
Whoop Did the patient's illness include the symptom of whoop? PHVS_YesNoUnknown_CDC
Post-tussive Vomiting Did the patient's illness include the symptom of post-tussive vomiting? PHVS_YesNoUnknown_CDC
Apnea Did the patient's illness include the symptom of apnea? PHVS_YesNoUnknown_CDC
Date of Final Interview Date of the patient's final interview
Did the patient have a cough at final interview? Was there a cough at the patient's final interview? PHVS_YesNoUnknown_CDC
Total Cough Duration What was the duration (in days) of the patient's cough?
Result of chest X-ray for pneumonia Result of chest x-ray for pneumonia PHVS_ChestXrayResult_CDC
Did the patient have generalized or focal seizures due to pertussis? Did the patient have generalized or focal seizures due to pertussis? PHVS_YesNoUnknown_CDC
Did the patient have acute encephalopathy due to pertussis? Did the patient have acute encephalopathy due to pertussis? PHVS_YesNoUnknown_CDC
Were antibiotics given? Were antibiotics given to the patient? PHVS_YesNoUnknown_CDC
Antibiotic Name What antibiotic did the patient receive? PHVS_AntibioticReceived_Pertussis
Antibiotic Start Date Date the patient first started taking the antibiotic
Number of days antibiotic actually taken. Number of days the patient actually took the antibiotic referenced
Second antibiotic patient received? If Other, please specify antibiotic PHVS_AntibioticReceived_Pertussis
Date second antibiotic started Date second antibiotic started
Number of days second antibiotic actually taken Number of days second antibiotic actually taken
Was laboratory testing done for pertussis? Was laboratory testing done for pertussis? PHVS_YesNoUnknown_CDC
Test Type Epidemiologic interpretation of the type of test(s) performed for this case PHVS_LabTestProcedure_Pertussis
Test Result Epidemiologic interpretation of the results of the tests performed for this case. PHVS_LabTestInterpretation_Pertussis
Date Collected Date of specimen collection
Did the subject ever receive a disease-containing vaccine? Did the patient ever receive a pertussis-containing vaccine? PHVS_YesNoUnknown_CDC
Vaccine Administered The type of vaccine administered. PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine. PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered.
Vaccine Administered Date The date that the vaccine was administered.
Is this case epi-linked to a laboratory-confirmed case? Is this case epi-linked to a laboratory-confirmed case? PHVS_YesNoUnknown_CDC
Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? PHVS_YesNoUnknown_CDC
Transmission Setting Transmission setting (Where did this case acquire pertussis?) PHVS_TransmissionSetting_NND
Was there documented transmission from this case of pertussis to a new setting? (not in household) Was there documented transmission (outside of the household) for transmission from this case? PHVS_YesNoUnknown_CDC
Number of contacts of this case recommended to receive antibiotic prophylaxis Number of contacts of this case recommended to receive antibiotic prophylaxis
Age of person contracted patient contracted pertussis from Age of the person from whom this patient contracted pertussis
Age Type Age Type Age_Type
Setting where patient contracted pertussis Transmission setting (Where did this patient acquire pertussis?) PHVS_TransmissionSetting_NND
Specify In which setting was pertussis acquired. setting in which pertussis was acquired
Specify In which setting was there secondary spread In which setting was there secondary spread
Name Of Contacts Name Of Contacts
Birth Date of contacts Birth Date of contacts
Contact Relationship to Subject Relationship of contact PHVS_Relationship_Flu
Case? Case
Contact Case ID Unique case identifier of the contact. This would be the same as INV168 (Case Local ID)
Cough Onset Date(If Present Cough Onset Date(If Present
Number of PCVs* Number of PCVs*
Date of Last PCV Date of Last PCV
Parent’s Name (If Applicable) Parent’s Name (If Applicable)
Parent’s Phone # (If Applicable) Parent’s Phone # (If Applicable)

Sheet 33: Plague

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Primary plague type Classification of primary clinical manifestation of infection Bubonic/Septicemic/Pneumonic/Other
Animal Contact Contact with sick or dead animals Animal bite/Animal scratch/Coughed on by animal/handled animal
Flea bite Flea bite Known flea bite/Likely flea bite/No flea bite/Unknown

Sheet 34: Polio

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Paralysis onset date Date of onset of paralysis
Clinical course Clinical course
CSF date Date of CSF results
WBCs White blood cell test results for cerebral spinal fluid
RBCs Red blood cell test results for cerebral spinal fluid
%Lymph %lymphs test results for CSF
%polys %polys test results for CSF
Protein Protein test results for CSF
Glucose Glucose test results for CSF
60-day follow up date Date of 60-day follow up
Paralysis site Sites of paralysis
Specific sites Specific sites of paralysis
60-day residual 60-day paralysis residual
TOPV immunization history TOPV within 30 days prior to onset of symptoms?
Date of TOPV TOPV immunization date
Lot number TOPV vaccine lot number
IPV-containing vaccine Total doses ever received of IPV-containing vaccine
Date 1 IPV First IPV vaccine date