Attachment 5 Disease-Specific Data_12182014.xlsx

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Overview

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

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Sheet 1: General

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

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Sheet 2: Animal Rabies

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

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Sheet 3: Anthrax

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

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Sheet 4: Arboviral

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
StateID	State-assigned investigation identification code
Year	Current year (new)
State	State of residence
County	County of residence
Week	Week of report (new)
OnsetDate	Date of onset of symptoms consistent with arboviral infection
ImportedFrom	Likely location of acquisition of arboviral infection
CountryOfOrigin	Country in which infection was likely acquired
StateOfOrigin	State in which infection was likely acquired
ForeignResident	(New)
Arbovirus	Type of arboviral infection
CaseStatus	Case classification according to CDC/CSTE surveillance case definitions
Age	Age at time of case investigation
AgeUnit	Age units
BirthDate	Date of Birth
Sex	Current sex
Race	Race
Ethnicity	Ethnicity
ClinicalSyndrome	General clinical presentation
Fever	Clinical Sign/Symptom
Headache	Clinical Sign/Symptom
Rash	Clinical Sign/Symptom
NauseaVomiting	Clinical Sign/Symptom
Diarrhea	Clinical Sign/Symptom
Myalgia	Clinical Sign/Symptom
ArthralgiaArthritis	Clinical Sign/Symptom
ParesisParalysis	Clinical Sign/Symptom
StiffNeck	Clinical Sign/Symptom
AlteredMentalStatus	Clinical Sign/Symptom
Seizures	Clinical Sign/Symptom
StateLocalPublicHealthLab	Testing performed at:
CDCLab	Testing performed at:
CommercialLab	Testing performed at:
Serum1Collected	Was Serum1 collected?
Serum1CollectedDate	When was Serum1 collected?
Serum2Collected	Was Serum2 collected?
Serum2CollectedDate	When was Serum2collected?
CSFCollected	Was CSF collected?
CSFCollectedDate	When was CSF collected?
CSFPLeocytosis
SerumIgM
SerumPRNT
SerumPCRorNAT
SerumPairedAntibody
CSFIgM
CSFPRNT
CSFPCRorNAT
Hospitalized	Patient was hospitalized as a result of arboviral illness
Fatality	Patient died as a result of arboviral infection
DateOfDeath	Date of death
LabAcquired	Patient likely acquired infection due to occupational exposure in a laboratory setting
NonLabAcquired	Patient likely acquired infection due to occupational exposure in a non-laboratory setting
BloodDonor	Patient donated blood within 30 days prior to illness onset
BloodTransfusion	Patient received a blood transfusion within 30 days prior to illness onet
OrganDonor	Patient donated a solid organ within 30 days prior to illness onset
OrganTransplant	Patient received a solid organ transplant within 30 days prior to illness onset
BreastFedInfant	Patient was a breastfed infant at time of illness onset
InfectedInUtero	Patient likely acquired infection in utero
Pregnant	Patient acquired infection during pregnancy
AFP	Patient suffered acute flaccid paralysis
IdentifiedByBloodDonorScreening	Infection identified through blood donor screening
DateOfDonation	Date of blood donation
LabTestingBy	Source of diagnostic testing
TransmissionOrigin
TransmissionMode
BloodTissueBorneTransmission
DomesticTravelDestinationLast
DomesticTravelDestination2ndLast
DomesticTravelDestination3rdLast
ForeignTravelDestinationLast
ForeignTravelDestination2ndLast
ForeignTravelDestination3rdLast
DateUSReturn
DurationDaysTravelOutsideUS
ReasonTravel
PreTravelHealthConsultation
CountryBirth
ResidenceStatus
DurationMonthsVisitOrLiveUS
MilitaryStatus
ClinicalSyndrome2
DurationDaysHospitalized
ICUAdmission
SevereEncephalitis
SevereSeizure
SevereMeningitis
SevereAcuteFlaccidParalysis
SevereGuillainBarreSyndrome
SevereHemorrhageShock
SeverePlasmaLeakage
SevereAcuteLiverFailure
SevereAcuteMyocarditis
SevereMultiSystemOrganFailure
SevereOtherSevereSigns
SevereUnknown
PreExistingAsthma
PreExistingChronicHeart
PreExistingChronicLiver
PreExistingChronicRenal
PreExistingDiabetesMellitus
PreExistingSickleCell
PreExistingHyperlipidemia
PreExistingHypertension
PreExistingObesity
PreExistingPregnancy
PreExistingThyroidDisease
PreExistingOther
PreExistingUnknown
S1DENVCollected
S1DENVCollectedDate
S1IgMAntiDENV
S1MolecularDENV
S1OtherDENVMethod
S1OtherDENVResult
S2DENVCollected
S2DENVCollectedDate
S2IgMAntiDENV
S2MolecularDENV
S2OtherDENVMethod
S2OtherDENVResult
OtherSpecCollected
OtherSpecType
OtherSpecCollectedDate
OtherSpecDENVMethod
OtherSpecDENVResult
DENVSeroType
Published
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?

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Sheet 5: Babesiosis

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

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Sheet 6: Botulism

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

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Sheet 7: Brucellosis

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

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Sheet 8: Cholera

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
AGEMM	Age in months
AGEYY	Age in years
CDCNUM	CDC Number
CITY	City
COUNTY	County
DATECOMP	Date completing form
DOB	Date of birth
ETHNICITY	Hispanic or Latino origin?
FDANUM	FDA Number
FNAME	First 3 letters of first name
LNAME	First 3 letters of last name
OCCUPAT	Occupation
RACE	Race
SEX	Sex
STATE	State of exposure (usually reporting state)
STEPINUM	State Number
STLABNUM	State Lab Number
FEVER	Fever
NAUSEA	Nausea
VOMIT	Vomiting
DIARRHEA	Diarrhea
VISBLOOD	Bloody stool
CRAMPS	Abdominal cramps
HEADACHE	Headache
MUSCPAIN	Muscle Pain
CELLULIT	Cellulitis
BULLAE	Bullae
SHOCK	Shock
OTHER	Other
MAXTEMP	Symptom: Maximum temp of fever
CENFAR	Fever measured in units of C or F
NUMSTLS	Symptom: # of stools/24 hours
CELLSITE	Symptom: Site of cellulitis
BULLSITE	Symtom: Site of Bullae
OTHSPEC2	Symptom: Specify other Symptoms
AMPMSYMP	Seafood Investigation: Onset in am or pm
ANTIBYN	Did patient receive antibiotics?
Descant1	Name of 1st Antibiotic
Descant2	Name of 2nd Antibiotic
Descant3	Name of 3rd Antibiotic
ANTNAM01	Name of 1st Antibiotic (old)
ANTNAM02	Name of 2nd Antibiotic (old)
ANTNAM03	Name of 3rd Antibiotic (old)
ANTNAM04	Name of 4th Antibiotic (old)
BEGANT1	Date began Antibiotic #1
BEGANT2	Date began Antibiotic #2
BEGANT3	Date began Antibiotic #3
BEGANT4	Date began Antibiotic #4
CDCISOL	CDC Isolate No.
DATEADMN	Date admitted to hospital
DATEDIED	Date of death
DATEDISC	Date of discharge from hospital
DATESYMP	Date of symptom onset
DURILL	# days ill
ENDANT1	Date ended Antibiotic #1
ENDANT2	Date ended Antibiotic #2
ENDANT3	Date ended Antibiotic #3
ENDANT4	Date ended Antibiotic #4
GSURGTYP	Pre-existing: Type of gastric surgery
HEMOTYPE	Pre-exisiting: Type of hemotological disease
HHSYMP	Hour of symptom onset
HOSPYN	Hospitalized?
IMMTYPE	Pre-exisiting: Type of Immunodeficiency
LIVTYPE	Pre-exisiting: type of liver disease
MALTYPE	Pre-existing: Type of Malignancy
MISYMP	Minute of symptom exposure
OTHCONSP	Pre-existing: Type of Other condition
PATDIE	Did patient die?
PEPULCER	Pre-existing: Peptic ulcer
ALCOHOL	Pre-existing: Alcoholism
DIABETES	Pre-existing: Diabetes
INSULIN	Pre-existing: on insulin?
GASSURG	Pre-existing: Gastric surgery
HEART	Pre-existing: Heart disease
HEARTFAL	Pre-existing: Heart failure?
HEMOTOL	Pre-existing: Hematologic disease
IMMUNOD	Pre-existing: Immunodeficiency
LIVER	Pre-existing: Liver disease
MALIGN	Pre-existing: Malignancy
RENAL	Pre-existing: Renal disease
RENTYPE	Pre-existing: Type of renal disease
OTHCOND	Pre-existing: Other
TRTANTI	Type of treatment received: antibiotics
TRTCHEM	Type of treatment received: chemotherapy
TRTRADIO	Type of treatment received: radiotherapy
TRTSTER	Type of treatment received: systemic steroids
TRTIMMUN	Type of treatment received: immunosuppressants
TRTACID	Type of treatment received: antacids
TRTULCER	Type of treatment received: H2 Blocker or other ulcer medication
SEQDESC	Describe Sequelae
SEQUELAE	Sequelae?
TRTACISP	If previously treated with Antacids, specifiy
TRTANTSP	If previously treated with Antibiotics, specifiy
TRTCHESP	If previously treated with chemotherapy, specifiy
TRTIMMSP	If previously treated with immunosuppressants, specifiy
TRTRADSP	If previously treated with radiotherapy, specifiy
TRTSTESP	If previously treated with steroids, specifiy
TRTULCSP	If treated with ulcer meds, specifiy
DATESPEC	Date specimen collected
SPECIESNAME	Species
SITE	If other source, specify site from which Vibrio was isolated
STATECON	Was Species confirmed at State PH Lab?
SOURCE	Specimen source
OTHORGAN	Other organism isolated from specimen?
SPECORGAN	Specify other organism isolated
AMBTEMFC	Seafood Investigation: Maximum ambient temp units - F or C
AMNTCONS	Seafood Investigation: Amount of shellfish consumed
AMPMCONS	Seafood Investigation: Shellfish consumed in am or pm
DATEAMBT	Seafood investigation: Date ambient temp measured
DATEFECL	Seafood Investigation: Date of fecal count
DATEH2O	Seafood Investigation: Date water temp measured
DATEHAR1	Seafood Investigation: Date of harvest #1
DATEHAR2	Seafood Investigation: Date of harvest #2
DATERAIN	Seafood Investigation: Date total rain fall recorded
DATESALN	Seafood Investigation: Date salinity measured
DATESEAR	Seafood Investigation: Date restaurant rec'd seafood
FECALCNT	Seafood Investigation: Fecal Coliform Count
H2OSALIN	Seafood Investigation: Results of Salinity test
HARVSIT1	Seafood Investigation: Harvest Site #1
HARVSIT2	Seafood Investigation: Harvest Site #2
HARVST01	Seafood Investigation: Status of Harvest Site #1
HARVST02	Seafood Investigation: Status of Harvest Site #2
HARVSTS1	Seafood Investigation: Specify if Status for Harvest Site #1 = other
HARVSTS2	Seafood Investigation: Specify if Status for Harvest Site #2 = other
HHCONSUM	Seafood Investigation: Hour of seafood consumption
IMPROPER	Seafood Investigtaion: Improper Storage?
MAMTEMP	Seafood Investigation: Maximum ambient temp
MICONSUM	Seafood Investigation: Minute of seafood consumption
RAINFALL	Seafood Investigation: Total rainfall in Inches
RESTINV	Seafood Investigation: Investigation of Restaurant?
SEADISSP	Seafood Investigation: Specify how shellfish distributed
SEADIST	Seafood Investigation: How is shellfish distributed?
SEAHARV	Seafood Investigation: Was shellfish harvested by patient or friend?
SEAIMPOR	Seafood Investigation: Was seafood imported?
SEAIMPSP	Seafood Investigation: Specify country of Import
SEAOBT	Seafood Investigation: where was seafood obtained?
SEAOBTSP	Seafood Investigation: Specify from where seafood was obtained
SEAPREP	Seafood Investigation: How was seafood prepared?
SEAPRSP	Seafood Investigation: Specify how seafood was prepared (if other)
SH2OTEMP	Seafood Investigation: Surface water temperature
SH2OTMFC	Surface water temp units in F or C?
SOURCES	Sources of seafood
SHIPPERS	Shippers who handled suspected seafood (certification numbers)
TAGSAVA	Seafood investigation: Are tags available from suspect lot?
TYPESEAF	Seafood investigation: Type of shellfish consumed
HARVESTSTATE	State in which seafood was harvested
HARVESTREGION	Region in which seafood was harvested
BIOTYPE	Cholera Only: biotype?
CHOLVACC	Cholera Only: Patient ever received cholera vaccine
DATEVACC	Cholera Only: Date cholera vaccine received
ORALVACC	Cholera Only: Oral cholera vaccine received
PAREVACC	Cholera Only: Parenteral cholera vaccine received
ELISA	Cholera Only: Elisa test performed for Cholera toxin testing?
LATEX	Cholera Only: Latex Agglut. performed for Cholera toxin testing?
RISKRAW	Cholera Only: Raw seafood
RISKCOOK	Cholera Only: Cooked seafood
RISKTRAV	Cholera Only: Foreign travel
RISKPERS	Cholera Only: Other person(s) with cholera or cholera-like illness
RISKVEND	Cholera Only: Stree-vended food
RISKOTHER	Cholera Only: Other
RISKSPEC	Cholera Only: Other risk specified
SEROTYPE	Cholera Only: Cholera Serotype
SPECTOXN	Cholera Only: Specify other toxin test used for Cholera (if other)
TOXGENIC	Cholera Only: is it toxigenic?
TRVOTHR	Cholera prevention education: specify other source of education
TRVPREV	Cholera prevention education prior to travel?
TRVPREV1	Cholera prevention: Pre-travel clinic
TRVPREV2	Cholera prevention: Airport
TRVPREV3	Cholera prevention: Newspaper
TRVPREV4	Cholera prevention: Friends
TRVPREV5	Cholera prevention: Private physician
TRVPREV6	Cholera prevention: Health department
TRVPREV7	Cholera prevention: Travel agency
TRVPREV8	Cholera prevention: CDC travelers' hotline
TRVPREV9	Cholera prevention: Other
TRVREAS1	Reason for travel: Visit friends/relatives
TRVREAS2	Reason for travel: Business
TRVREAS3	Reason for travel: Tourism
TRVREAS4	Reason for travel: Military
TRVREAS5	Reason for travel: Other
TRVREAS6	Reason for travel: Unknown
TRVROTHR	Cholera, reason for travel: specify if other
AMPMEXP	Seafood Investigation: Exposure to seawater in am or pm
HANDLING	Exposure: handing/cleaning seafood
SWIMMING	Exposure: Swimming/diving/wading
WALKING	Exposure: Walking on beach/shore/fell on rocks/shells
BOATING	Exposure: Boating/skiing/surfing
CONSTRN	Exposure: Construction/repairs
BITTEN	Exposure: Bitten/stung
ANYWLIFE	Exposure: Contact with other marine/freshwater life
BODYH2O	Exposure: Exposure to a body of water
CONSTRN	Exposure to water via construction
DATEEXPO	Exposure: Date of exposure to seawater
DATEWHI1	Date traveled/entered destination #1
DATEWHI2	Date traveled/entered destination #2
DATEWHI3	Date traveled/entered destination #3
DATEWHO1	Date left/returned home #1
DATEWHO2	Date left/returned home #2
DATEWHO3	Date left/returned home #3
FISHSP	Type of fish
H2OCOMM	Exposure: Comments on water exposure
H2OTYPE	Exposure: Type of water exposure
HHEXPOS	Exposure: Hour of seawater exposure
LOCEXPOS	Exposure: location of water exposure
MIEXPOS	Exposure: Minute of seawater exposure
OTHEREXP	Exposure: Other exposure
OTHERH2O	Exposure: Exposed to other water not listed?
OTHSHSP	Specify other shellfish consumed
OUTBREAK	Is case part of outbreak?
OUTBRKSP	If part of an outbreak, Specify outbreak
CLAMS	Consumption: clams
CRAB	Consumption: crab
LOBSTER	Consumption: lobster
MUSS	Consumption: mussels
OYSTER	Consumption: oysters
SHRIMP	Consumption: shrimp
CRAY	Consumption: crawfish
OTHSH	Consumption: other shellfish
FISH	Consumption: other fish
RCLAM	Raw consumption: clams
RCRAB	Raw consumption: crab
RLOBSTER	Raw consumption: lobster
RMUSS	Raw consumption: muss
ROYSTER	Raw consumption: oyster
RSHRIMP	Raw consumption: shrimp
RCRAY	Raw consumption: crawfish
ROTHSH	Raw consumption: other shellfish
RFISH	Raw consumption: other fish
DATECLAM	Date of seafood consumption: clams
DATECRAB	Date of seafood consumption: crab
DATELOBS	Date of seafood consumption: lobster
DATEMUSS	Date of seafood consumption: mussels
DATEOYSTER	Date of seafood consumption: oysters
DATESHRI	Date of seafood consumption: shrimp
DATECRAY	Date of seafood consumption: crawfish
DATEOTHSH	Date of seafood consumption: other shellfish
DATEFISH	Date of seafood consumption: other fish
SPECEXPO	Specify other seawater/shellfish dripping exposure (if other)
STRESID	State of residence
TRAVEL	Exposure to travel outside home state in previous 7 days?
WHERE01	Travel destination #1
WHERE02	Travel destination #2
WHERE03	Travel destination #3
WOUNDEXP	Did patient incur a wound before/during exposure?
WOUNDSP	If patient incurred wound before/during exposure, describe wound

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Sheet 9: Congenital Rubella Syndrome

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Date of Last Evaluation by a Healthcare Provider	The date the patient was last evaluated by a healthcare provider
Primary cause of death from death certificate	The primary cause of subject's death, as noted on the death certificate
Secondary cause of death from death certificate	The secondary cause of subject's death, as noted on the death certificate.
Was an autopsy performed?	Was an autopsy performed on the subject's body?	PHVS_YesNoUnknown_CDC
Final Anatomical Diagnosis of Death from Autopsy Report	The final anatomical cause of subject's death
If not a case of CRS, select reason	The reason this was not a case of CRS.	PHVS_NoCaseReason_CRS
Gestational Age at Birth (in weeks)	The subject's gestational age (in weeks) at birth
Age at Diagnosis	The subject's age at the time of diagnosis.
Age (unit) at Diagnosis	The age units at the time of diagnosis	PHVS_AgeUnit_UCUM
Birth Weight	The subject's birth weight
Birth Weight (unit)	The subject's birth weight units	PHVS_WeightUnit_UCUM
Cataracts (Complication)	Did/does the subject have cataracts?	PHVS_YesNoUnknown_CDC
Hearing Impairment (loss) (Complication)	Did/does the subject have hearing impairment (loss)?	PHVS_YesNoUnknown_CDC
Congenital Heart Disease (Complication)	Did the subject have a congenital heart disease?	PHVS_YesNoUnknown_CDC
Patent Ductus Arteriosus (Complication)	Did/does the subject have patent ductus arteriosus?	PHVS_YesNoUnknown_CDC
Peripheral Pulmonic Stenosis (Complication)	Did/does the subject have peripheral pulmonic stenosis?	PHVS_YesNoUnknown_CDC
Congenital Glaucoma (Complication)	Did/does the subject have congenital glaucoma?	PHVS_YesNoUnknown_CDC
Pigmentary Retinopathy (Complication)	Did/does the subject have pigmentary retinopathy?	PHVS_YesNoUnknown_CDC
Developmental Delay or Mental Retardation (Complication)	Did/does the subject have developmental delay or mental retardation?	PHVS_YesNoUnknown_CDC
Meningoencephalitis (Complication)	Did the subject have meningoencephalitis?	PHVS_YesNoUnknown_CDC
Microencephaly (Complication)	Did the subject have microencephaly?	PHVS_YesNoUnknown_CDC
Purpura (Complication)	Did the subject have purpura?	PHVS_YesNoUnknown_CDC
Enlarged Spleen (Complication)	Did/does the subject have an enlarged spleen?	PHVS_YesNoUnknown_CDC
Enlarged Liver (Complication)	Did/does the subject have an enlarged liver?	PHVS_YesNoUnknown_CDC
Radiolucent Bone Disease (Complication)	Did the subject have radiolucent bone disease?	PHVS_YesNoUnknown_CDC
Neonatal Jaundice (Complication)	Did the subject have jaundice?	PHVS_YesNoUnknown_CDC
Low Platelets (Complication)	Did/does the subject have low platelets?	PHVS_YesNoUnknown_CDC
Dermal Erythropoieses (Blueberry Muffin Syndrome) (Complication)	Did subject have dermal erythropoisesis?	PHVS_YesNoUnknown_CDC
Other Complication(s)	Did the subject develop other conditions as a complication of this illness?	PHVS_YesNoUnknown_CDC
Specify Other Complication(s)	Please specify the other complication(s) the subject developed, during or as a result of this illness.
Was laboratory testing done for Rubella on this subject?	Was laboratory testing done for Rubella on this subject?	PHVS_YesNoUnknown_CDC
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case	PHVS_LabTestProcedure_Rubella
Test Result	Epidemiologic interpretation of the results of the tests performed for this case	PHVS_LabTestInterpretation_VPD
Sample Analyzed Date	The date the lab test was performed
Test Method	The technique or method used to perform the test and obtain the test results.	PHVS_LabTestMethod_CDC
Date Collected	Date of specimen collection
Specimen Source	The medium from which the specimen originated.	PHVS_SpecimenSource_VPD
Was CRS virus genotype sequenced?	Identifies whether the CRS virus was genotype sequenced	PHVS_YesNoUnknown_CDC
Was Rubella genotype sequenced?	Identifies whether the Rubella virus was genotype sequenced	PHVS_YesNoUnknown_CDC
Were the specimens sent to CDC for genotyping (molecular typing)?	Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)?	PHVS_YesNoUnknown_CDC
Specimen type sent to CDC for genotyping	Specimen type sent to CDC for genotyping	PHVS_SpecimenSource_VPD
Date sent for genotyping	The date the specimens were sent to the CDC laboratories for genotyping.
Type of Genotype Sequence	Identifies the genotype sequence of the Rubella virus	PHVS_Genotype_Rubella
Did the mother have a rash?	Did the mother have a maculopapular rash?	PHVS_YesNoUnknown_CDC
What was the mother's rash onset date?	What was the mother's rash onset date?
Mother's Rash Duration (in days)	How many days did the mother's rash being reported in this investigation last?
Did the mother have a fever?	Did the mother have a fever?	PHVS_YesNoUnknown_CDC
What was the mother's fever onset date?	What was the mother's rash onset date?
Mother's Fever Duration (in days)	How many days did the mother's rash being reported in this investigation last?
Did the mother have arthralgia/arthritis?	Did the mother have arthralgia/arthritis?	PHVS_YesNoUnknown_CDC
Did the mother have lymphadenopathy?	Did the mother have lymphadenopathy?	PHVS_YesNoUnknown_CDC
Other clinical features of maternal illness	Mother's other clinical features of maternal illness
Mother's birth country	The mother's country of birth	PHVS_Country_ISO_3166-1
Length of time mother has been in the US	Length of time (in years) the mother has been in the U.S.
Mother's age at delivery	The age of the mother when the infant (subject) was delivered
Mother's occupation at time of conception	The mother's occupation at time of this conception	PHVS_Occupation_CDC
Did the mother attend a family planning clinic prior to conception of this infant?	Did the mother attend a family planning clinic prior to conception of this infant?	PHVS_YesNoUnknown_CDC
Number of children less than 18 years of age living in household during this pregnancy?	The number of the mother's children less then 18 years of age living in household during this pregnancy
Were any of the children living in the household immunized with Rubella-containing vaccine?	Were any of the mother's children less than 18 years of age immunized with the rubella vaccine?	PHVS_YesNoUnknown_CDC
Number of children less than 18 years of age immunized with the rubella vaccine	The number of the mother's children less than 18 years of age immunized with the rubella vaccine
Was prenatal care obtained for this pregnancy?	Was prenatal care obtained for this pregnancy?	PHVS_YesNoUnknown_CDC
Date of first prenatal visit for this pregnancy	Date of the first prenatal visit for this pregnancy
Where was prenatal care for this pregnancy obtained?	Where was the prenatal care for this pregnancy obtained?	PHVS_PrenatalCareProvider_Rubella
Did the mother have serological testing prior to this pregnancy?	Did the mother have serological testing prior to this pregnancy?	PHVS_YesNoUnknown_CDC
Was there a rubella-like illness during this pregnancy?	Was there a rubella-like illness during this pregnancy?	PHVS_YesNoUnknown_CDC
Month of pregnancy in which symptoms first occurred	The month of pregnancy that Rubella-like symptoms appeared
Rubella Lab Testing Mother	Was Rubella lab testing performed for the mother in conjunction with this pregnancy?	PHVS_YesNoUnknown_CDC
Was Rubella diagnosed by a physician at time of illness?	Was the mother diagnosed with Rubella by a physician at time of illness?	PHVS_YesNoUnknown_CDC
If Rubella was not diagnosed by a physician, diagnosed by whom?	If the mother was not diagnosed with Rubella by a physician, then diagnosed by whom?
Was Rubella serologically confirmed at time of illness?	Was Rubella serologically confirmed (mother) at time of illness?	PHVS_YesNoUnknown_CDC
Serologically Confirmed Date	The date Rubella was serologically confirmed (mother)
Serologically Confirmed Result	The result of the Rubella serological confirmation (mother)	PHVS_LabTestInterpretation_VPD
Mother Reported Rubella Case	Has the mother ever been reported as a Rubella case?	PHVS_YesNoUnknown_CDC
Does the mother know where she might have been exposed to Rubella?	Did the mother know where she might have been exposed to Rubella?	PHVS_YesNoUnknown_CDC
If location of exposure is unknown, did the mother travel outside the US during the first trimester of pregnancy	If the Rubella exposure is unknown, did the mother travel outside the US during the first(1st) trimester of pregnancy?	PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel	List any international destinations of recent travel	PHVS_Country_ISO_3166-1
Date left for travel	The date the mother left for all international travel
Date returned from travel	The date the mother returned to United States from travel
Was the mother directly exposed to a confirmed case?	Was the mother directly exposed to a confirmed Rubella case?	PHVS_YesNoUnknown_CDC
If mother directly exposed to a confirmed Rubella case, specify the relationship	The mother's relationship to the confirmed Rubella case	PHVS_Relationship_VPD
Mother's date of exposure to a confirmed rubella case	The mother's exposure date to the confirmed rubella case
Has mother given birth in the US previously?	Has mother given birth in the US previously?	PHVS_YesNoUnknown_CDC
If mother has given birth in US, list dates (years)	List years in which mother has given birth in US previously
Number of previous pregnancies	Mother's number of previous pregnancies
Number of live births (total)	Mother's total number of live births
If mother has given birth in US, number of births delivered in U.S.	Mother's number of births delivered in U.S.
Mother immunized with rubella-containing vaccine?	Was the mother immunized with Rubella vaccine?	PHVS_YesNoUnknown_CDC
Source of mother's Rubella-containing vaccine information	Source of mother's Rubella immunization information	PHVS_ImmunizationInformationSource_CRS
Source of mother's rubella-containing vaccine	Source of mother's Rubella vaccine	PHVS_PrenatalCareProvider_Rubella
Vaccine Administered	The type of vaccine administered, (e.g., Varivax, MMRV). First question of a repeating group of vaccine questions.	PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer	Manufacturer of the vaccine. Second question of a repeating group of vaccine questions.	PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number	The vaccine lot number of the vaccine administered. Third question of a repeating group of vaccine questions.
Vaccine Administered Date	The date that the vaccine was administered. Fourth question of a repeating group of vaccine questions.
US Acquired	Sub-classification of disease or condition acquired in the US	PHVS_CaseClassificationExposureSource_NND

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Sheet 10: Congenital Syphilis

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

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Sheet 11: Cryptosporidiosis

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

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Sheet 12: Cyclosporiasis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Cabbage	Was fresh cabbage consumed in the 14 days prior to onset of illness?	PHVS_FreshProduce_FDD
Interview Status	Interview Status	PHVS_InterviewStatus_CDC
Travel Destination Type	Travel Destination Type	PHVS_TravelDestinationType_FDD
Travel Mode	Travel Mode	PHVS_TravelMode_CDC
Travel Purpose	Purpose of Travel	PHVS_TravelPurpose_FDD
Date of departure	Departure Date
Date of arrival	Arrival Date
Destination code	FIPS code assigned to city/state/country
Destination description	Name of city/state/country
Person Knows of Similarly Ill Persons	Does the patient know of any similarly ill persons?	FDD_Q_77 (PHIN_Questions_FDD)
Diarrhea Indicator	Did the patient have diarrhea?	PHVS_YesNoUnknown_CDC
Max Stools per 24 Hrs	If "Yes,” please specify maximum number of stools per 24 hours:
Weight Loss	Did patient experience weight loss?	PHVS_YesNoUnknown_CDC
Baseline Weight	If “Yes,” please specify baseline weight:
Baseline Weight Units	specify baseline weight in lbs or kgs	PHVS_WeightUnit_UCUM
Weight Lost	Specify how much weight was lost:
Weight Lost Units	Specify weight loss in lbs or kgs	PHVS_WeightUnit_UCUM
Fever	Did patient have a fever?	PHVS_YesNoUnknown_CDC
Temperature	If "Yes," please specify temperature (observation includes units)
Temperature Units	Specify temperature in fahrenheit or centigrade	PHVS_TemperatureUnit_UCUM
Cyclosporiasis Symptom Code(s)	Did the patient have any of the following signs or symptoms of Cyclosporiasis? (MULTISELECT)	PHVS_CyclosporiasisSignsSymptoms_FDD
Cyclosporiasis Symptoms Other	If “Other,” please specify other signs or symptoms of Cyclosporiasis:
Cyclosporiasis Confirmed By CDC	Was the case confirmed at the CDC lab?	PHVS_YesNoUnknown_CDC
Treated For Cyclosporiasis	Was the patient treated for Cyclosporiasis?	PHVS_YesNoUnknown_CDC
Sulfa Allergy	Does the patient have a sulfa allergy?	PHVS_YesNoUnknown_CDC
Fresh Berries Code(s)	What fresh berries were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshBerries_FDD
Fresh Berries Other	If “Other,” please specify other type of fresh berries:
Fresh Herbs Code(s)	What fresh herbs were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshHerbs_FDD
Fresh Herbs Other	If “Other,” please specify other type of fresh herbs:
Lettuce Last 14 Days Code(s)	What fresh lettuce was eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_LettuceType_FDD
Lettuce Last 14 Days Other	If “Other,” please specify other type of fresh lettuce:
Produce Last 14 Days Code(s)	What other types of fresh produce were eaten in the 14 days prior to onset of illness? (MULTISELECT)	PHVS_FreshProduce_FDD
Produce Last 14 Days Other	If “Other,” please specify other type of fresh produce:
Fruit Other Than Berries Specify	If "Fruit, other than berries," please specify type of fruit other than berries:
Attend Events 14 Days Prior to Onset	Did patient attend any events in the 14 days prior to onset of illness?	PHVS_YesNoUnknown_CDC
Event Specify	If “Yes,” please specify the event:
Event Date	Date of event:
Eat at Restaurant 14 Days Prior to Onset	Did patient eat at restaurant(s) in the 14 days prior to onset of illness?	PHVS_YesNoUnknown_CDC
Restaurant(s) Specify	If “Yes,” please specify the name of the restaurant(s):
Reporting Lab Name	Name of Laboratory that reported test result.
Reporting Lab CLIA Number	CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.
Local record ID (case ID)	Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification.
Filler Order Number	A laboratory generated number that identifies the test/order instance.
Ordered Test Name	Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.
Date of Specimen Collection	The date the specimen was collected.
Specimen Site	This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc.	PHVS_BodySite_CDC
Specimen Number	A laboratory generated number that identifies the specimen related to this test.
Specimen Source	The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc.	PHVS_Specimen_CDC
Specimen Details	Specimen details if specimen information entered as text.
Date Sample Received at Lab	Date Sample Received at Lab (accession date).
Sample Analyzed date	The date and time the sample was analyzed by the laboratory.
Lab Report Date	Date result sent from Reporting Laboratory.
Report Status	The status of the lab report.	PHVS_ResultStatus_HL7_2x
Resulted Test Name	The lab test that was run on the specimen.	PHVS_LabTestName_CDC
Numeric Result	Results expressed as numeric value/quantitative result.
Result Units	The unit of measure for numeric result value.	PHVS_UnitsOfMeasure_CDC
Coded Result Value	Coded qualitative result value (e.g., Positive, Negative).	PHVS_LabTestResultQualitative_CDC
Organism Name	The organism name as a test result. This element is used when the result was reported as an organism.	PHVS_Microorganism_CDC
Lab Result Text Value	Textual result value, used if result is neither numeric nor coded.
Result Status	The Result Status is the degree of completion of the lab test.	PHVS_ObservationResultStatus_HL7_2x
Interpretation Flag	The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low.	PHVS_AbnormalFlag_HL7_2x
Reference Range From	The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.
Reference Range To	The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.
Test Method	The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture.	PHVS_LabTestMethods_CDC
Lab Result Comments	Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.
Date received in state public health lab	Date the isolate was received in state public health laboratory.
Lab Test Coded Comments	Explanation for missing result (e.g., clotting, quantity not sufficient, etc.)	PHVS_MissingLabResult_CDC
Sent to CDC for Genotyping	Indicate whether the specimens were sent to CDC for genotyping.	PHVS_YesNoUnknown_CDC
Genotyping Sent Date	If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.
Sent For Strain ID	Indicate whether the specimen was sent for strain identification.	PHVS_YesNoUnknown_CDC
Strain Type	If the specimen was sent for strain identification, indicate the strain.	PHVS_MicrobiologicalStrain_CDC
Track Isolate	Track Isolate functionality indicator	PHVS_TrueFalse_CDC
Patient status at specimen collection	Patient status at specimen collection	PHVS_PatientLocationStatusAtSpecimenCollection
Isolate received in state public health lab	Isolate received in state public health lab	PHVS_YesNoUnknown_CDC
Reason isolate not received	Reason isolate not received	PHVS_IsolateNotReceivedReason_NND
Reason isolate not received (Other)	Reason isolate not received (Other)
Date received in state public health lab	Date received in state public health lab
State public health lab isolate id number	State public health lab isolate id number
Case confirmed at state public health lab	Case confirmed at state public health lab	PHVS_YesNoUnknown_CDC
AgClinic	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?
AgClinicTestType	Name of antigen-based test used at clinical laboratory
AgeMnth	Age of case-patient in months if patient is <1yr
AgeYr	Age of case-patient in years
AgSphl	What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory? Results from rapid card testing or EIA would be entered here.
AgSphlTestType	Name of antigen-based test used at state public health laboratory
BloodyDiarr	Did the case-patient have bloody diarrhea (self reported) during this illness?
Diarrhea	Did the case-patient have diarrhea (self-reported) during this illness?
DtAdmit2	Date of hospital admission for second hospitalization for this illness
DtDisch2	Date of hospital discharge for second hospitalization for this illness
DtEntered	Date case was entered into site's database
DtRcvd	Date case-pateint's specimen was received in laboratory for initial testing
DtRptComp	Date case report form was completed
DtSpec	Case-patient's specimen collection date
DtUSDepart	If case-patient patient traveled internationally, date of departure from the U.S.
DtUSReturn	If case-patient traveled internationally, date of return to the U.S.
EforsNum	CDC FDOSS outbreak ID number
Fever	Did the case-patient have fever (self-reported) during this illness?
HospTrans	If case-patient was hospitalized, was s/he transferred to another hospital?
Immigrate	Did case-patient immigrate to the U.S.? (within 15 days of illness onset)
Interview	Was the case-patient interviewed by public health (i.e. state or local health department) ?
LabName	Name of submitting laboratory
LocalID	Ccase-patient's medical record number
OtherCdcTest	For other pathogens: What was the result of specimen testing using another test at CDC? Results from DFA, IFA or other tests would be entered here.
OtherClinicTest	What was the result of specimen testing using another test at a clinical laboratory? Results from DFA, IFA or other tests would be entered here.
OtherClinicTestType	Name of other test used at a clinical laboratory
OtherSphlTest	What was the result of specimen testing using another test at a state public health laboratory? Results from DFA, IFA or other tests would be entered here.
OtherSphlTestType	Name of other test used at a state public health laboratory
OutbrkType	Type of outbreak that the case-patient was part of
PatID	Case-patient identification number
PcrCdc	What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PcrClinic	What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)
PcrClinicTestType	Name of PCR assay used
PcrSphl	What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).
PersonID	Unique identification number for person or patient
ResultID	Unique identifier for laboratory result
RptComp	Is all of the information for this case complete?
SentCDC	Was specimen or isolate forwarded to CDC for testing or confirmation?
SLabsID	State lab identification number
SpecSite	Case patient's specimen collection source
StLabRcvd	Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)
TravelDest	If case-patient traveled internationally, to where did they travel?
TravelInt	Did the case patient travel internationally? (within 15 days of onset)

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Sheet 13: Diphtheria

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

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Sheet 14: Giardia

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

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Sheet 15: Haemophilus Influenzae

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
DAYCARE	If <6 years of age, is the patient in daycare?	PHVS_YesNoUnknown_CDC
FACNAME	Name of the daycare facility.	PHVS_YesNoUnknown_CDC
NURSHOME	Does the patient reside in a nursing home or other chronic care facility?	PHVS_YesNoUnknown_CDC
NHNAME	Name of the nursing home or chronic care facility.
SYNDRM	Types of infection that are caused by the organism. This is a multi-select field.	TBD
SPECSYN	Other infection that is caused by the organism.
SPECIES	Bacterial species that was isolated from any normally sterile site.	TBD
OTHBUG1	Other bacterial species that was isolated from any normally sterile site.	TBD
STERSITE	Sterile sites from which the organism was isolated. This is a multi-select field.	TBD
OTHSTER	Other sterile site from which the organism was isolated.
DATE	Date the first positive culture was obtained. (This is considered diagnosis date.)
NONSTER	Nonsterile sites from which the organism was isolated. This is a multi-select field.	TBD
UNDERCOND	Did the patient have any underlying conditions?	PHVS_YesNoUnknown_CDC
COND	Underlying conditions that the subject has. This is a multi-select field.	TBD
OTHMALIG	Other malignancy that the subject had as an underlying condition.
OTHORGAN	Detail of the organ transplant that the subject had as an underlying condition.
OTHILL	Other prior illness that the subject had as an underlying condition.
OTHOTHSPC	Another Bacterial Species not listed in the Other Bacterial Species drop-down list.
Specify Internal Body Site	Internal Body Site where the organism was located.	TBD
Other Prior Illness 2	Other prior illness that the subject had as an underlying condition.
Other Prior Illness 3	Other prior illness that the subject had as an underlying condition.
Other Nonsterile Site	Other nonsterile site from which the organism was isolated.
INSURANCE	Patient's type of insurance (multi-selection).	TBD
INSURANCEOTH	Patient's other type of insurance.
WEIGHTLB	Weight of the patient in pounds.
WEIGHTOZ	Weight of the patient in ounces.
WEIGHTKG	Weight of the patient in kilograms.
HEIGHTFT	Height of the patient in feet.
HEIGHTIN	Height of the patient in inches.
HEIGHTCM	Height of the patient in centimeters.
WEIGHTUNK	Indicator that the weight of the patient is unknown.	PHVS_TrueFalse_CDC
HEIGHTUNK	Indicator that the height of the patient is unknown.	PHVS_TrueFalse_CDC
SEROTYPE	Serotype of the culture.	TBD
HIBVACC	If <15 years of age and serotype is 'b' or 'unk', did the patient receive Haemophilus Influenzae b vaccine?	PHVS_YesNoUnknown_CDC
MEDINS	Type of medical insurance the family has.	TBD
OTHINS	Other medical insurance type.
HIBCON	Is there a known previous contact with Hib disease within the preceding two months?	PHVS_YesNoUnknown_CDC
CONTYPE	Type of previous contact with Hib disease within the preceding two months.
SIGHIST	Patient's significant past medical history.	TBD
PREWEEKS	Number of weeks of a preterm birth (less than 37 weeks).
SPECHIV	Specify immunosupression/HIV.
OTHSIGHIST	Specify other prior condition.
ACUTESER	Is acute serum available?	PHVS_YesNoUnknown_CDC
ACUTESERDT	Date of acute serum availability.
CONVSER	Is convalescent serum available?	PHVS_YesNoUnknown_CDC
CONVSERDT	Date of convalescent serum availability.
BIRTHCTRY	Person's country of birth.	PHVS_Country_ISO_3166-1
Other Serotype	Another serotype not included in the serotype dropdown list.
Was the patient < 15 years of age at the time of first positive culture?	Indicator whether the patient was less than 15 years of age at the time of first positive culture.	PHVS_YesNoUnknown_CDC

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Sheet 16: Hansen's

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

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Sheet 17: Hepatitis

Label/Short Name	Description	Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Reason for Testing	Listing of the reason(s) the subject was tested for hepatitis.	PHVS_ReasonForTest_Hepatitis
Symptomatic	Was the subject symptomatic for hepatitis?	PHVS_YesNoUnknown_CDC
Date of Illness Onset	Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system
Jaundiced (Symptom)	Was the subject jaundiced?	PHVS_YesNoUnknown_CDC
Due Date	Subject's pregnancy due date
Previously Aware of Condition	Was the subject aware they had Hepatitis prior to lab testing?	PHVS_YesNoUnknown_CDC
Provider of Care for Condition	Does the subject have a provider of care for Hepatitis? This is any healthcare provider that monitors or treats the patient for viral hepatitis.	PHVS_YesNoUnknown_CDC
Liver Enzyme Test Type	Liver Enzyme Test Type	PHVS_LabTestTypeEnzymes_Hepatitis
Liver Enzyme Test Result Date	Liver Enzyme Test Result Date
Liver Enzyme Upper Limit Normal	Liver Enzyme Upper Limit Normal
Liver Enzyme Test Result	Liver Enzyme Test Result
Test Type	Epidemiologic interpretation of the type of test(s) performed for this case.	PHVS_LabTestType_Hepatitis
Test Result	Epidemiologic interpretation of the results of the test(s) performed for this case.	PHVS_PosNegUnk_CDC
anti-HCV signal to cut-off ratio	Used to specify the anti-HCV signal to cut-off ratio if antibody to Hepatitis C virus was the test performed.
Is this case Epi-linked to another confirmed or probable case?	Specify if this case is Epidemiologically-linked to another confirmed or probable case of hepatitis?	PHVS_YesNoUnknown_CDC
Contact With Confirmed or Suspected Case	During the 2-6 weeks prior to the onset of symptoms, was the subject a contact of a person with confirmed or suspected hepatitis virus infection?	PHVS_YesNoUnknown_CDC
Contact Type	During the 2-6 weeks prior to the onset of symptoms, type of contact the subject had with a person with confirmed or suspected hepatitis virus infection	PHVS_ContactType_HepatitisA
Contact Type Indicator	During the 2-6 weeks prior to the onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis virus infection	PHVS_YesNoUnknown_CDC
In Day Care	During the 2-6 weeks prior to the onset of symptoms, was the subject a child or employee in daycare center, nursery, or preschool?	PHVS_YesNoUnknown_CDC
Day Care Contact	During the 2-6 weeks prior to the onset of symptoms, was the subject a household contact of a child or employee in a daycare center, nursery, or preschool?	PHVS_YesNoUnknown_CDC
Identified Day Care Case	Was there an identified hepatitis case in the childcare facility?	PHVS_YesNoUnknown_CDC
Sexual Preference	What is/was the subject's sexual preference?	PHVS_SexualPreference_NETSS
Number of Male Sexual Partners	During the 2-6 weeks prior to the onset of symptoms, number of male sex partners the person had.
Number of Female Sexual Partners	During the 2-6 weeks prior to the onset of symptoms, number of female sex partners the person had.
IV Drug Use	During the 2-6 weeks prior to the onset of symptoms, did the subject inject drugs not prescribed by a doctor?	PHVS_YesNoUnknown_CDC
Recreational Drug Use	During the 2-6 weeks prior to the onset of symptoms, did the subject use street drugs but not inject?	PHVS_YesNoUnknown_CDC
Travel or Live Outside U.S. or Canada	During the 2-6 weeks prior to the onset of symptoms, did the subject travel or live outside the U.S.A. or Canada?	PHVS_YesNoUnknown_CDC
Countries Traveled or Lived Outside U.S. or Canada	The country(s) to which the subject traveled or lived (outside the U.S.A. or Canada) prior to symptom onset.	PHVS_Country_ISO_3166-1
Principal reason for travel	What was the principal reason for travel?	PHVS_TravelReason_HepatitisA
Household Travel Outside U.S. or Canada	During the 3 months prior to the onset of symptoms, did anyone in the subject's household travel outside the U.S.A. or Canada?	PHVS_YesNoUnknown_CDC
Household Countries Traveled to Outside U.S. or Canada	The country(s) to which anyone in the subject's household traveled (outside the U.S.A. or Canada) prior to symptom onset.	PHVS_Country_ISO_3166-1
Common-Source Outbreak	Is the subject suspected as being part of a common-source outbreak?	PHVS_YesNoUnknown_CDC
Foodborne Outbreak- infected food handler	Subject is associated with a foodborne outbreak that is asscociated with an infected food handler.	PHVS_YesNoUnknown_CDC
Foodborne Outbreak - NOT an infected food handler	Subject is associated with a foodborne outbreak that is not associated with an infected food handler.	PHVS_YesNoUnknown_CDC
Food Item of Associated Outbreak	Food item with which the foodborne outbreak is associated.
Waterborne Outbreak	Subject is associated with a waterborne outbreak .	PHVS_YesNoUnknown_CDC
Unidentified Source Outbreak	Subject is associated with an outbreak that does not have an identifed source.	PHVS_YesNoUnknown_CDC
Food Handler	During the 2 weeks prior to the onset of symptoms or while ill, was the subject employed as a food handler?	PHVS_YesNoUnknown_CDC
Diabetes	Does subject have diabetes?	PHVS_YesNoUnknown_CDC
Diabetes Diagnosis Date	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

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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)

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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

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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

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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

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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.

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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

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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

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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

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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

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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

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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

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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.

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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?

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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?

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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)

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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

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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