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. |
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 |
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" |
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? |
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) |
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 |
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 |
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 |
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 |
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 |
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) |
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) |
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? |
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) |
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 |
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 |
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 |
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) |
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 |
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 |
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 |
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. |
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 |
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 |
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 |
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 |
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 |
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 |
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. |
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? |
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? |
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) |
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 |
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 |