Cities - Weekly - non-automated

National Notifiable Diseases Surveillance System (NNDSS)

Att 10 - Disease-Specific Data_CR_08022022.xlsx

Cities - Weekly - non-automated

OMB: 0920-0728

Document [xlsx]
Download: xlsx | pdf

Overview

General
Alpha-gal Syndrome
Animal Rabies
Anthrax
Arboviral
Babesiosis
Botulism
Brucellosis
Campylobacter
Candida auris
Carbon Monoxide Poisoning
Cholera
Congenital Rubella Syndrome
Congenital Syphilis
CP-CRE
Cryptosporidiosis
Cyclosporiasis
Diphtheria
Giardia
Haemophilus Influenzae
Hansen's
Hantavirus Pulmonary Syndrome
Hepatitis
Hemolytic Uremic Syndrome
Human Rabies
Invasive Pneumococcal Disease
Legionellosis
Leptospirosis
Listeria
Latent TB Infection
Lyme
Malaria
Measles
Melioidosis
MIS
Monkeypox
Mumps
Neisseria meningitidis
2019 Novel Coronavirus COVID-19
Novel Influenza A
Ped Flu Deaths
Pertussis
Plague
Polio
Polio Nonparalytic
Psittacosis
QFever
STSS
Rubella
S.Paratyphi Infection
S. Typhi Infection
Salmonellosis
SARS
Shigella
STD (not congenital)
STEC
TBRD
Tetanus
Trichinellosis
Tuberculosis
Tularemia
Varicella
Vibriosis


Sheet 1: General

Subsequent tabs in this workbook describe the disease-specific data elements that are requested from each program area.







CDC Priority (Legacy):
Indicates whether the program specifies the field as:


R - Required - Mandatory for sending the message.  If data element is not present, the message will error out.


P - Preferred - This is an optional variable and there is no requirement to send this information to CDC.  However, if this variable is already being collected by the state/territory, or if the state/territory is planning to collect this information because it is deemed important for your own programmatic needs, CDC would like this information sent.  CDC preferred variables are the most important of the optional variables to be earmarked for CDC analysis/assessment, even if sent from a small number of states.


O - Optional - This is an optional variable and there is no requirement to send this information to CDC.  This variable is considered nice-to-know if the state/territory already collects this information or is planning to collect this information, but has a lower level of importance to CDC than the preferred classification of optional data elements.



CDC Priority (New):
Indicates whether the program specifies the field as:


R - Required - This data element is mandatory for sending a message. If the required data element is not present, the message will be rejected. The required data elements alone are not sufficient for national surveillance purposes


1-Priority 1 – Highest priority for reporting. These data elements are critical for national surveillance activities. Jurisdiction’s data collection system should be modified to collect Priority 1 data elements. If this data element is not currently collected and available to send, please discuss with the CDC Program whether you can onboard without that element being available and included in the messages. Some CDC programs may request a plan addressing future inclusion of these data elements, if not able to collect and transmit at onboarding.


2 - Priority 2 – High priority data element that will support national surveillance activities. If this data element is not currently collected and available to send, please plan to update jurisdiction’s data collection system. Some CDC programs may request a plan addressing future inclusion of these data elements, if not able to collect and transmit at onboarding.


3 - Priority 3 – Lower priority data element that should be considered for inclusion in the surveillance system and case notification. Please send if currently collected in the system.



08/02/2022


Sheet 2: Alpha-gal Syndrome

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Date of most recent occurrence Date of most recent reaction that prompted this report (mm/dd/yyyy) N/A
1
Prior occurrence Has the patient had prior reactions? PHVS_YesNoUnknown_CDC
2
Date of first occurrence Date of first reaction (mm/dd/yyyy) N/A
2
Signs and Symptoms Signs and symptoms associated with the illness being reported TBD
1
Signs and Symptoms Indicator Indicator for associated sign and symptom TBD

Allergy to food (finding) Has the patient ever experienced signs or symptoms of an allergic reaction after consumption of any of the following? TBD
1
Allergy to drug (finding) Has the patient ever experienced signs or symptoms of an allergic reaction after receiving any of the following pharmaceutical or medical products? TBD
1
Anaphylaxis (disorder) Has the patient ever experienced anaphylaxis due to this condition? PHVS_YesNoUnknown_CDC
2
Tick bite In the 12 months before first diagnosis, did the patient notice any tick bites? PHVS_YesNoUnknown_CDC
2
Performing laboratory name Testing laboratory TBD
3

Sheet 3: Animal Rabies

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

Sheet 4: Anthrax

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


Medical Record ID TBD N/A
TBD
State Postal Code TBD N/A
TBD
Occupation State TBD TBD
TBD
Occupation County TBD TBD
TBD
Is the Subject a First Responder Is the Subject a First Responder PHVS_YesNoUnknown_CDC
TBD
What category of vaccine did the subject get What category of vaccine did the subject get TBD
TBD
Date last received Date last received anthrax vaccine N/A
TBD
Booster Vaccine If received a full series of pre-exposure vaccine, is the subject up-to-date on the annual booster vaccine PHVS_YesNoUnknown_CDC
TBD
Medication Received If the case patient received post exposure antimicrobials, indicate the antimicrobials received TBD
TBD
Start Date of Treatment or Therapy What was the date that the case patient starting taking antimicrobials N/A
TBD
Date Treatment or Therapy Stopped What was the date that the case patient stopped taking antimicrobials N/A
TBD
Signs and Symptoms Signs and symptoms associated with Anthrax TBD TBD
Signs and Symptoms Indicator Indicator for associated signs and symptoms PHVS_YesNoUnknown_CDC
TBD
Diet TBD TBD
TBD
Smoking Status What is the patient's current tobacco smoking status? TBD
TBD
Laboratory State State where laboratory is located PHVS_State_FIPS_5-2
TBD
Laboratory City TBD N/A
TBD
CSID CDC specimen ID number from the 50.34 submission form. Example format (10-digit number): 3000123456. N/A
TBD
Specimen Collected before antibiotics Was the specimen used for testing collected before antibiotics was taken? PHVS_YesNoUnknown_CDC
TBD
Transferred from Initial Hospital Transferred from Initial Hospital PHVS_YesNoUnknown_CDC
TBD
Antimicrobials given for illness Antimicrobials given for illness PHVS_YesNoUnknown_CDC
TBD
Antimicrobial Name Antimicrobial Name TBD
TBD
Antimicrobial Start Date Antimicrobial Start Date N/A
TBD
Antimicrobial End Date Antimicrobial End Date N/A
TBD
Number of Days of Treatment Number of Days of Treatment N/A
TBD
Actual Route of Administration - Attempted or Completed What is the route of antibiotic administration? TBD
TBD
Date AIG Given Date AIG Given N/A
TBD
Date Raxibacumab Given Date Raxibacumab Given N/A
TBD
On vasopressors for any length of time On vasopressors for any length of time PHVS_YesNoUnknown_CDC
TBD
Route of Infection Suspected primary route of infection at time of evaluation (select all that apply): TBD
1
International Destination(s) of Recent Travel List all international destinations (country) traveled during the 14 days prior to illness onset PHVS_Country_ISO_3166-1
2
Travel State List all domestic destinations (state) traveled to during the 14 days prior to illness onset PHVS_State_FIPS_5-2
2
Public Transportation Route Specify public transportation route (e.g. name/number) N/A
3
Date Using Public Transportation Specify date(s) using public transportation N/A
3
Exposure Source Indicate the type of exposure the patient had in the 14 days prior to illness onset. TBD
1
Type of Animal Exposure Types of exposure to animal. TBD
3
Animal Type If exposure type is Animal contact, specify animal the subject had contact with in the 14 days prior to illness onset. If the subject had contact with multiple animals complete separate repeating groups for each one. TBD
2
Lab Name If worked in a clinical, microbiological, or animal research laboratory, specify lab. N/A
2
Contact Type If linked to confirmed case or contact with similar illness or sign and symptoms, indicate type of contact. TBD
2
Location of Contact If linked to confirmed case or contact with similar illness or sign and symptoms, indicate geographic location where contact occurred (e.g. city, country, state). N/A
2
Illicit Drug Specify If subject had contact with illicit drugs, specify the name or type of the drug. N/A
2
Location Name Location name of place or event. N/A
2
Location Address Location address of place or event (e.g. country, city, state, county.) N/A
3
Attendance Date List all date(s) of event or place attendance. N/A
2
Locations Routinely Visited Specify the name of a place that was routinely visited in the 14 days prior to illness onset, such as a place of worship, volunteer, gym, etc. N/A
3
Time of Day List the time period during the day when the place was visited TBD
3
Date of last dose Date last received anthrax vaccine N/A
2
Post-exposure or Treatment Indicates if medication received is for post-exposure or anthrax treatment. TBD
1
Alcohol use frequency In the past 30 days, how often does the patient take alcoholic drinks? TBD
3
Alcohol use quantity On the days when the case patient drank, about how many drinks did the case patient drink on average? N/A
3
Hospital Procedure If subject was hospitalized, were any of the following procedures or treatments done? TBD
3
Diagnostic Test Findings Results from procedures or treatments done in the hospital. TBD
3
Treatment Type Listing of treatment or medical intervention the subject received for this illness. TBD
3
Treatment Type Indicator Indicate if treatment was administered. PHVS_YesNoUnknown_CDC
3

Sheet 5: Arboviral

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


InfectedInUteroOrPerinatal Patient likely acquired infection in utero or perinatal


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?


Conjunctivitis Did the patient have conjunctivitis?


RetroOrbitalPain Did the patient have retro orbital pain?


TourniquetTestPositive Did the patient have a tourniquet test positive?


Leukopenia Did the patient have leukopenia?


AbdominalPainTenderness Did the patient have abdominal pain tenderness?


PersistingVomiting Did the patient have persisting vomiting?


ExtravascularFluidAccumulation Did the patient have extravascular fluid accumulation?


MucosalBleeding Did the patient have mucosal bleeding?


LiverEnlargement Did the patient have liver enlargement?


IncreasingHematocritDecPLT Did the patient have increasing hematocrit dec PLT?


SevereBleeding Did the patient have severe bleeding?


SevereOrganInvolvement Did the patient have severe organ involvement?


Mother-Infant Case ID Linkage Mother and infant case IDs


Mother's Last Menstrual Period Before Delivery Mother's last menstrual period (LMP) before delivery


Pregnancy Complications Complications of pregnancy


Pregnancy Outcome Pregnancy outcomes


Newborn Complications Compliations for newborn


Other Arboviral Disease Transmission Mode Other Arboviral unusual and rare disease transmission modes


Type of Complication If the subject experienced severe complications due to this illness, specify the complication(s). TBD
2
Type of Complications Indicator Indicator for associated complication PHVS_YesNoUnknown_CDC
2
Signs and Symptoms Sign and symptoms associated with the illness being reported TBD
2
Signs and Symptoms Indicator Indicator for associated signs and symptoms PHVS_YesNoUnknown_CDC
2
Clinical Finding Clinical findings associated with the illness being reported TBD
2
Clinical Finding Indicator Indicator for associated clinical findings PHVS_YesNoUnknown_CDC
2
Transmission Mode Detail For rare arboviral transmission modes, indicate the determined source of infection following investigation of the case. TBD
2
Manufacturer of Last Dose Prior to Illness Onset Manufacturer of last vaccine dose against this disease prior to illness onset TBD
2

Sheet 6: Babesiosis

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


Blood Recipient/Blood Transfusion In the year before symptom onset or diagnosis, did the subject receive a blood transfusion? PHVS_YesNoUnknown_CDC

Blood Donor In the year before symptom onset or diagnosis, did the subject donate blood? PHVS_YesNoUnknown_CDC

Mother's Local Record ID Provide the local record ID used for reporting mother's case (DE Identifier "N/A: OBR-3" in the Generic portion of the message). This will be used for linking the reported congenital case to the mother's reported case. N/A
3

Sheet 7: Botulism

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

Sheet 8: Brucellosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
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 available are clinical specimens or isolates still available for further testing? PHVS_YesNoUnknown_CDC

Clinical Presentation Clinical presentation associated with the illness being reported TBD
TBD
Clinical Presentation Indicator Indicator for associated clinical presentation PHVS_YesNoUnknown_CDC
TBD
Date of Clinical Presentation The date and time, if available, of onset of clinical presentation N/A
TBD
Medication Administered Name of antibiotic administered to subject/patient for this illness TBD
TBD
Medication Administered Dose Dose of the antibiotic received N/A
TBD
Date Treatment or Therapy Started Date the treatment or therapy was started N/A
TBD
Treatment Duration Prescribed duration (in days) of antibiotic treatment N/A
TBD
Type of animal What type of animal did the patient have contact with, or acquire food products from? TBD
TBD
Animal Ownership Who owns the animals? TBD
TBD
Type of contact What type of activity was the case/patient engaged in that led to contact with the animal(s)? TBD
TBD
Country of Product Acquisition Where was the food product acquired? TBD
TBD
Disease Presentation The duration in which the disease presented TBD
TBD
Food Product consumed What type of animal-based food product did the patient consume? TBD
TBD
Contact Type If linked to confirmed case or contact with similar illness or signs and symptoms, indicate type of contact. TBD
TBD
Similar Illness Contact Did the case/patient know anyone else with a similar illness? TBD
TBD
Physician Name Name of the physician or clinician who diagnosed and/or treated the subject N/A
3
Physician Phone Phone number of the patient's clinician/provider of care N/A
3
Treatment Drug Indicator Were antimicrobials prescribed or administered to the subject for this illness or following an exposure? PHVS_YesNoUnknown_CDC
2
Antibiotic dose units Dose units of the antimicrobial prescribed or administered PHVS_UnitsOfMeasure_CDC
2
Medication Stop Date What was the date that the case patient stopped taking antimicrobials N/A
3
International Destination(s) of Recent Travel List all international destination (country) traveled to during six months before symptom onset or diagnosis PHVS_Country_ISO_3166-1
1
Travel State List all domestic destination (state) traveled to during six months before symptom onset or diagnosis. PHVS_State_FIPS_5-2
2
Travel County List all intrastate destination (county) traveled to during six months before symptom onset or diagnosis. PHVS_County_FIPS_6-4
3
Specimen Collected Prior to Therapy Was the specimen for culture collected prior to antimicrobial therapy? PHVS_YesNoUnknown_CDC
2

Sheet 9: Campylobacter

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Reported  symptoms and signs of illness Symptoms and signs associated with illness


Travel in 10 days prior to illness Did the case have travel outside of the U.S. in the 10 days before the illness began?


Consumption of undercooked/ raw meat Did the case eat undercooked or raw meat before the illness began?


Consumption of undercooked/ raw poultry Did the case eat undercooked or raw poultry before the illness began?


Drinking untreated water Did the case drink untreated water before the illness began?


Contact with untreated recreational water Did the case have contact with untreated recreational water before the illness began?


Consumption of raw milk or unpasteurized dairy Did the case consume raw milk or unpasteurized dairy before the illness began?


Contact with pets, farm animals with Campylobacter species Did the case have contact with pets or farm animals from which Campylobacter species were isolated?


Contact with confirmed/probable case of Campylobacteriosis Did the case have contact with another probable or confirmed case of Campylobacteriosis?


Consumption or exposure to implicated vehicle Did the case consume or have exposure to a vehicle implicated in an outbreak or a location in which an implicated food vehicle was prepared or eaten?


WGS (Whole-Genome Sequencing) ID The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case


Probable – Laboratory Diagnosed Probable case is laboratory diagnosed PHVS_YesNo_HL7_2x P
Probable – Epi Linked Probable case is epi linked PHVS_YesNo_HL7_2x P
PulseNet ID State lab ID submitted to PulseNet N/A
1
Travel State Domestic destination, state(s) traveled to PHVS_State_FIPS_5-2
3
International Destination(s) of Recent Travel International destination or countries the patient traveled to PHVS_Country_ISO_3166-1
3
Date of Arrival to Travel Destination Date of arrival to travel destination N/A
3
Date of Departure from Travel Destination Date of departure from travel destination N/A
3
Reason for travel related to current illness Reason for travel related to current illness PHVS_TravelPurpose_FDD
3

Sheet 10: Candida auris

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority
Previously Counted Case Was patient previously counted as a colonization/screening case? PHVS_YesNoUnknown_CDC P
Previously Reported State Case Number If patient was previously counted as a colonization/screening case or a CP-CRE case, please provide the related case ID(s) N/A P
Tracheostomy Tube at Specimen Collection Did patient have a tracheostomy tube at the time of specimen collection? PHVS_YesNoUnknown_CDC P
Ventilator Use at Specimen Collection Was patient on a ventilator at the time of specimen collection? PHVS_YesNoUnknown_CDC P
Long-term Care Resident Did the patient have a stay in a long-term care facility in the 90 days before specimen collection date? PHVS_YesNoUnknown_CDC P
Type of Long-term Care Facility If patient had a stay in a long-term care facility in the 90 days before specimen collection date, indicate the type of long-term care facility. PHVS_LongTermCareFacilityType_C.auris P
Healthcare Outside Resident State Indicate if the patient received overnight healthcare within the United States, but outside of the patient's resident state in the year prior to the date of specimen collection. PHVS_YesNoUnknown_CDC P
Travel Outside USA Prior to Illness Onset within Program Specific Timeframe Did the patient travel internationally in the past 1 year from the date of specimen collection? PHVS_YesNoUnknown_CDC P
International Destination(s) of Recent Travel List the names of the country(ies) outside of the United States the patient traveled to in the year prior to the date of specimen collection, if the patient traveled outside of the United States during that time. PHVS_Country_ISO_3166-1 P
Healthcare Outside USA Indicate if the patient received overnight healthcare outside of the United States in the year prior to the date of specimen collection. PHVS_YesNoUnknown_CDC P
Country(ies) of Healthcare Outside USA List the names of the country(ies) outside of the United States where the patient received overnight healthcare in the year prior to the date of specimen collection, if the patient received overnight healthcare outside of the United States during that time. PHVS_Country_ISO_3166-1 P
Type of Location Where Specimen Collected Indicate the physical location type of the patient when the specimen was collected PHVS_SpecimenCollectionSettingType_C.auris P
County of Facility County of facility where specimen was collected PHVS_County_FIPS_6-4 P
State of Facility State of facility where specimen was collected PHVS_State_FIPS_5-2 P
Infection with Another MDRO Does the patient have infection or colonization with another MDRO? PHVS_YesNoUnknown_CDC P
Co-infection Type If patient has infection or colonization with another MDRO, indicate the MDRO. PHVS_TypeCoInfection_C.auris P
State Lab specimen ID State lab specimen ID N/A P
WGS ID Number NCBI SRA Accession number (SRX#) We would describe this as: The accession number generated by NCBI’s Sequence Read Archive when sequence data are uploaded to NCBI. This provides both the sequence data and metadata on how the sample was sequenced. N/A P

Sheet 11: Carbon Monoxide Poisoning

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Smoking status Current smoker (yes, no, unknown) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7749 P
Source of data for case ascertainment *Hospital/emergency department  
*Poison control center 
* Laboratory report
*Death certificate  *Provider/medical examiner report
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7891 P
Carboxyhemoglobin (COHb) level Laboratory test result (%) N/A P
Intent *Intentional
*Unintentional

https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.7876 P
Primary Language What is the patient's primary language? PHVS_Language_ISO_639-2_Alpha3 P
Marital Status What is the patient's current marital status? PHVS_MaritalStatus_HL7_2x P
Education Indicate the highest degree or level of school completed at the time of the event. PHVS_Education_CO P
Poison Control Center Record Does the patient have a poison control record indicating exposure to carbon monoxide? PHVS_YesNoUnknown_CDC P
Outcome of Poison Control Center Record If patient has a poison control record, select the outcome identified in the Poison Control Center Record. PHVS_PoisonControlCenterRecord_CO P
Treatment Management Type If patient has a poison control record, indicate how the care was managed. PHVS_TreatmentSite_CO P
Workers Compensation Record Does the patient have a worker's compensation record with a finding, problem, diagnosis or other indication of exposure to carbon monoxide or carbon monoxide poisoning? PHVS_YesNoUnknown_CDC P
Type of Workers Compensation Claim Indicate the type of claim if patient has a worker's compensation claim with a finding, problem, diagnosis or other indication of exposure to carbon monoxide or carbon monoxide poisoning. PHVS_WorkersCompensationRecord_CO P
Fire Related Exposure Was the carbon monoxide exposure related to a fire? PHVS_YesNoUnknown_CDC P
Power Outage Event Was the carbon monoxide exposure related to a power outage? PHVS_YesNoUnknown_CDC P
Extreme Weather Was the carbon monoxide exposure related to an extreme weather event? PHVS_YesNoUnknown_CDC P
Extreme Weather Type Identify the extreme weather event(s) occurring when the patient was exposed to carbon monoxide. PHVS_ExtremeWeatherType_CO P
Warning Announcement Immediately before or during the extreme weather event, did patient hear or read about any warnings on the danger of carbon monoxide poisoning? PHVS_YesNoUnknown_CDC P
Exposure Source If patient was physically and temporally associated with a CO-emitting source, specify the source. PHVS_ExposureSource_CO P
Generator Location If the exposure source is generator, where was it placed while it was running? PHVS_GeneratorLocation_CO P
Generator Distance If the exposure source was a generator, how many feet was the generator placed from the (house/attached garage/detached garage or other location of event)? PHVS_GeneratorDistance_CO P
Carbon Monoxide Alarm Present Patient was in a location where a carbon monoxide alarm was present. PHVS_YesNoUnknown_CDC P
Carbon Monoxide Alarm Sounded The carbon monoxide alarm sounded. PHVS_YesNoUnknown_CDC P
Carbon Monoxide Elevated Exposure Exposure to an elevated level of CO based on a dedicated or multi-gas meter/instrument (e.g., fire department measurement)? PHVS_YesNoUnknown_CDC P
Air Concentration of CO Level (PPM) Air concentration of CO Level in parts per million (PPM) at exposure site. N/A P
Person/Organization Taking CO Reading If air concentration of CO level was taken, indicate the person or organization taking the CO reading. PHVS_PersonOrgTakingReading_CO P
Date of Reading What was the date and time, if known, of the CO reading? N/A P
Exposure Site Category Categorize the location of exposure. PHVS_ExposureSiteCategory_CO P
Public Site of Exposure If a public setting where the exposure occurred, please indicate specific site. PHVS_SiteofExposure_CO P
Residential Site of Exposure If a residential setting where the exposure occurred, please indicate specific site. PHVS_ResidentialSiteofExposure_CO P
Epi-Linked Patient was present and exposed in the same event as that of a carbon monoxide poisoning case. PHVS_YesNoUnknown_CDC P
Date and Time of Incident Please provide the date and time, if known, of the carbon monoxide incident. N/A P
Address of Establishment Where Exposure Occurred Street address of the location or establishment where the carbon monoxide exposure occurred. Please provide street, city, county, state, and zip code. N/A P
City of Establishment Where Exposure Occurred City of the location or establishment where the carbon monoxide occurred. N/A P
State of Establishment Where Exposure Occurred State of the location or establishment where the carbon monoxide occurred. PHVS_State_FIPS_5-2 P
Zip Code of Establishment Where Exposure Occurred Zip code of the location or establishment where the carbon monoxide occurred. N/A P
County of Establishment Where Exposure Occurred County of the location or establishment where the carbon monoxide occurred. N/A P
Event Notes Description of incident. N/A P
Number of Exposed Cases Total number of exposed persons (including case patient). N/A P
Average Number of Cigarettes Smoked per Day During the past 30 days, please specify the average number of cigarettes smoked per day. There are 20 cigarettes per pack. TBD P
Marijuana Smoking Status Does the patient currently smoke marijuana? PHVS_YesNoUnknown_CDC P
Other Substance Type of other substance used (e.g., e-cigarette tobacco, e-cigarette THC) TBD P
Underlying Condition(s) Select the patient's preexisting condition(s). PHVS_UnderlyingConditions_CO P
Signs and Symptoms Signs and symptoms associated with the carbon monoxide exposure or poisoning. PHVS_SignsandSymptoms_CO P
ICD Codes List ICD Codes in patient's report. PHVS_ICDCodesList_CO P
Treatment Provided Was patient treated for carbon monoxide exposure? PHVS_YesNoUnknown_CDC P
Treatment Type Specify the treatment type. PHVS_TreatmentType_CO P
Treatment Location Where did the patient receive treatment? PHVS_TreatmentLocation_CO P
Treatment Date Provide the date of treatment. N/A P
Occupation Related to Exposure Is the patient's carbon monoxide exposure related to their current occupation? PHVS_YesNoUnknown_CDC P
Work Site of Exposure If a work setting where the exposure occurred, please indicate specific site. TBD
2
Severe Weather Was the carbon monoxide exposure related to a severe weather event? PHVS_YesNoUnknown_CDC
1
Severe Weather Type Identify the severe weather event(s) occurring when the patient was exposed to carbon monoxide. TBD
1
Intent of Exposure Was the intent of the carbon monoxide exposure self-harm/assault (intentional) or accidental (unintentional)? TBD
1
Carbon Monoxide Level in Air Carbon monoxide level in air measured in parts per million (PPM) at exposure site N/A
3
Start Date of Treatment or Therapy Provide the date and time of when the treatment started. N/A
2
Underlying Condition(s) Indicator Indicator for underlying condition(s) PHVS_YesNoUnknown_CDC
2
Signs and Symptoms Indicator Indicator for associated sign and symptom PHVS_YesNoUnknown_CDC
1
Specimen Collection Date/Time Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection should be sent if available. N/A
2
Start Date of Treatment or Therapy Provide the date and time of when the treatment started. N/A
2
Type of Workers Compensation Claim Indicate if the worker's compensation claim is submitted or paid with a finding, problem, diagnosis or other indication of exposure to carbon monoxide or carbon monoxide poisoning. TBD
2
Test Type Please specify Carboxyhemoglobin Level or Pulse CO-oximetry Measurement test. TBD
1
Test Result Quantitative Please send the test results for the selected test type. The unit of test result is percent (%). N/A
2
Specimen Collection Date/Time Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection should be sent if available. N/A
2

Sheet 12: Cholera

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


Specify Different Exposure Window If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A P
PulseNet ID State lab ID submitted to PulseNet N/A
1
WGS ID Number Whole Genome Sequencing (WGS) ID Number N/A
1

Sheet 13: Congenital Rubella Syndrome

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

Sheet 14: Congenital Syphilis

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


Maternal Local Record ID



Maternal Notification Reporting Jurisdiction




Sheet 15: CP-CRE

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority
Type of case Type of case (i.e., was case identified based on testing of a clinical specimen or screening specimen) N/A P
State lab isolate id Lab isolate identifier from public health lab for mechanism testing N/A P
Phenotypic Test Method Phenotypic Test Name (phenotypic methods for carbapenemase production) N/A P
Phenotypic Test Result Result of Phenotypic test N/A P
Genotypic Test Name Test performed to identify carbapenemase  (molecular methods for resistance mechanism) N/A P
Genotypic Test Result Result of test to identify carbapenemase N/A P
County of facility County of facility where specimen was collected PHVS_County_FIPS_6-4 O
State of facility State of facility where specimen was collected PHVS_State_FIPS_5-2 O
Travel Outside USA Prior to Illness Onset within Program Specific Timeframe Did the patient travel internationally in the past 1 year from the date of specimen collection? PHVS_YesNoUnknown_CDC P
International Destination(s) of Recent Travel This data element is used to capture the names of the country(ies) outside of the United States the patient traveled to in the year prior to the date of specimen collection, if the patient has traveled outside of the United States during that time. PHVS_Country_ISO_3166-1 P
Healthcare Outside USA This data element is used to capture if the patient received healthcare outside of the United States in the year prior to the date of specimen collection. PHVS_YesNoUnknown_CDC P
Country(ies) of Healthcare Outside USA This data element is used to capture the names of the country(ies) outside of the United States where the patient received healthcare in the year prior to the date of specimen collection, if the patient traveled outside of the United States during that time. PHVS_Country_ISO_3166-1 P
Gene Identifier Gene identifier PHVS_GeneName_CP-CRE P
Previously Counted Case Was patient previously counted as a colonization/screening case? PHVS_YesNoUnknown_CDC P
Previously Reported State Case Number If patient was previously counted as colonization/screening case please provide related case ID(s) N/A P
WGS ID Number NCBI SRA Accession number (SRX#) We would describe this as: The accession number generated by NCBI’s Sequence Read Archive when sequence data are uploaded to NCBI. This provides both the sequence data and metadata on how the sample was sequenced. N/A P

Sheet 16: Cryptosporidiosis

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


Specify Different Exposure Window If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A P
CryptoNet ID Unique CryptoNet ID (formed by concatenating [Case Year]-[State Lab ID]-[Specimen Type]-[Reporting State]-[Reporting Country]) where Specimen Type is: ES for Environmental, HS for Human, or AS for Animal. N/A
1
WGS ID Number Whole Genome Sequencing (WGS) ID Number N/A
1
Travel State Domestic destination, state(s) traveled to PHVS_State_FIPS_5-2
3
International Destination(s) of Recent Travel International destination or countries the patient traveled to PHVS_Country_ISO_3166-1
3
Date of Arrival to Travel Destination Date of arrival to travel destination N/A
3
Date of Departure from Travel Destination Date of departure from travel destination N/A
3
Reason for travel related to current illness Reason for travel related to current illness PHVS_TravelPurpose_FDD
3
Travel Outside USA Prior to Illness Onset within Program Specific Timeframe Did the case patient travel internationally? PHVS_YesNoUnknown_CDC
2
Did The Case Travel Domestically Prior To Illness Onset? Indicates whether the case traveled domestically prior to illness onset and within program specific timeframe PHVS_YesNoUnknown_CDC
2
Specify Different Travel Exposure Window If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A
2

Sheet 17: Cyclosporiasis

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


Travel In the two weeks before onset of illness, did the case-patient travel out of their state or US?


Travel State Domestic destination or state(s) the case-patient traveled to in the two weeks before onset of illness


Medication Administered What treatment did the case-patient receive?


Performing Laboratory Type Performing laboratory type


Other Organism from Specimen If other non-Cyclospora organism(s) identified from stool specimen(s), indicate the organism


Specify Different Travel Exposure Window If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A P
Did The Case Travel Domestically Prior To Illness Onset? Did the case patient travel domestically within program specific timeframe? PHVS_YesNoUnknown_CDC P
Specify Different Exposure Window If the epidemiologic exposure window used by the jurisdiction is different from that stated in the exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A P
Reason for travel related to current illness Reason for travel related to current illness PHVS_TravelPurpose_FDD
3
Fresh Lettuce Packaging For each fresh lettuce exposure reported, indicate the type of packaging of the fresh lettuce TBD
1

Sheet 18: Diphtheria

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

Sheet 19: Giardia

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

Sheet 20: Haemophilus Influenzae

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority
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
Bacterial Infection Syndrome Types of infection caused by organism PHVS_InfectionType_RIBD P
Pregnancy Status at the Time of First Positive Culture At the time of first positive culture, was the patient pregnant or postpartum? (The postpartum period is defined as the 30 days following a delivery or miscarriage) PHVS_PregnacyStatus_RIBD P
Pregnancy Outcome If pregnant or postpartum, what was the outcome of fetus? PHVS_FetalOutcome_RIBD P
Gestational Age If patient <1 month of age, indicate gestational age (in weeks) N/A P
Birth Weight If patient <1 month of age, indicate birth weight N/A P
Birth Weight Units Birth Weight Units PHVS_WeightUnit_UCUM P
Previous Contact With Hib Disease Is there a known previous contact(s) with Hib disease within the preceding two months? PHVS_YesNoUnknown_CDC P
Hib Contact Type Type of previous contact(s) with Hib disease within the preceding two months. PHVS_ContactType_RIBD P
Previous Contact With Non-b or Nontypeable H. influenzae Case Did patient have known previous contact(s) with a non-b or nontypeable case of H. influenzae disease within the preceding 2 months? PHVS_YesNoUnknown_CDC P
Non-b or Nontypeable Contact Type Specify type of contact(s) with non-b or nontypeable case of H. influenzae PHVS_ContactType_RIBD P
Recurrent Disease with Same Pathogen this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.) PHVS_YesNoUnknown_CDC P
Previous State ID (Recurrent Case) StateID of 1st occurrence for this pathogen and person. N/A P
Case Report Form Status Case Report Form Status PHVS_FormStatus_RIBD P
Illness Onset Age Illness onset age N/A P
Illness Onset Age Units Illness onset age units PHVS_AgeUnit_UCUM P
Residence Where was the patient a resident at time of initial culture? PHVS_ResidenceLocation_RIBD P
Premature Infant Premature at birth (for children ≤2 years old) PHVS_YesNoUnknown_CDC P
Epi-Linked to a Laboratory-Confirmed Case Is this case epi-linked to a laboratory-confirmed case? PHVS_YesNoUnknown_CDC P
ABCs Case ABCs case? PHVS_YesNoUnknown_CDC P
ABCs State ID ABCs State ID N/A P
Laboratory Testing Performed Was laboratory testing done to confirm the diagnosis? PHVS_YesNoUnknown_CDC P
Laboratory Confirmed Was the case laboratory confirmed? PHVS_YesNoUnknown_CDC P
Test Manufacturer Test Manufacturer N/A P
Lab Accession Number Lab Accession Number (including CDC Lab ID) N/A P
Did the Subject Ever Receive a Vaccine Against This Disease Did the subject ever receive a vaccine against this disease? PHVS_YesNoUnknown_CDC P
Date of Last Dose Prior to Illness Onset Date of last vaccine dose against this disease prior to illness onset N/A P
Vaccination Doses Prior to Onset Number of vaccine doses against this disease prior to illness onset N/A P
Vaccine History Comments Vaccine History Comments N/A P
Age at Vaccination The persons age at the time the vaccine was given N/A P
Age at Vaccination Units The age units of the person at the time the vaccine was given PHVS_AgeUnit_UCUM P
Vaccine History Information Source What sources were used for vaccination history? PHVS_InformationSource_RIBD P
Vaccine Information Source Indicator Vaccination History Information Source Indicator PHVS_YesNoUnknown_CDC P
Susceptibility Test Was any susceptibility data available? PHVS_YesNoUnknown_CDC P

Sheet 21: Hansen's

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

History of Previous Illness Was the patient previously diagnosed with Hansen's disease? Yes No Unknown (YNU)
TBD
Date of Previous Illness Date of previous Hansen's Disease diagnosis N/A
TBD
Number of doctors seen How many doctors has the patient seen for this problem? Yes No Unknown (YNU)
TBD
Biopsy Performed Was a biopsy performed on the patient as a result of Hansen's disease? Yes No Unknown (YNU)
TBD
Biopsy Results TBD TBD
TBD
Biopsy Interpretation Indicate the results of the biopsy TBD
TBD
Date of Previous Biopsy If biopsy was performed on the patient, indicate the date of biopsy. N/A
TBD
Previous Residence List all places in the US. and all foreign countries a PATIENT resided (including military service) BEFORE leprosy was diagnosed. TBD
TBD
Relation to Known or Suspected Contact TBD TBD
TBD
Household contacts Examined Have any household contacts of the patient been examined Yes No Unknown (YNU)
TBD
Additional Cases TBD TBD
TBD
Skin Smear Interpretation If skin smears were performed, please select the results. TBD TBD
Date of Skin Smear Date of Skin Smear TBD
TBD
Medication Administered What antibiotic was administered to the patient for Leprosy TBD
TBD
Previous Treatment Was the patient previously treated for Hansen's Disease Yes No Unknown (YNU)
TBD
Previous Treatment Duration If the patient was previously treated, how many months was the patient treated. N/A
TBD
Date Treatment or Therapy Started Date the treatment was initiated N/A
TBD
Contacts Received Prophylaxis Have any household contacts of the patient started prophylaxis? Yes No Unknown (YNU)
TBD
Number of Household Contacts Total number of known or suspected household contacts. N/A
TBD
Family/Household Contacts Previously Diagnosed Have any family members or household contacts been previously diagnosed with HD Yes No Unknown (YNU)
TBD
Number of Family/Household Previously Diagnosed List number of diagnosed previously with Hansen's Disease. N/A
TBD
Relationship to Known or Suspected Contact If answer yes to previous question regarding family member diagnosed, please check relationship. N/A
TBD
Additional Cases If household contacts of the patient were examined, were any additional cases found Yes No Unknown (YNU)
TBD
Patient Status Indicate the patient's case status TBD
TBD
History of Post-exposure Prophylaxis Does the case patient have a history of being of post-exposure prophylaxis for Hansen's disease or tuberculosis (TB) Yes No Unknown (YNU)
TBD
Location of Initial Diagnosis Indicate the location of the initial diagnosis of Hansen's Disease PHVS_LocationofInitialDiagnosis_Hansen
3
Medication Stop Date What was the date that the case patient stopped taking antimicrobials N/A
2
Post-exposure or Treatment Indicates if medication received is for post-exposure or Hansen's treatment. TBD
2
Post-Exposure Prophylaxis Medication If answer is yes to the previous question regarding household contacts of the patient receiving prophylaxis, please specify PEP N/A
2
History of Treatment for Latent or Active TB Does the case patient have a history of being on treatment for latent or active TB? PHVS_YesNoUnknown_CDC
3
Medication Frequency Frequency of medication administered for this condition. N/A
2
Medication Frequency Unit Unit of measure for the frequency of medication administered (e.g. daily, weekly, monthly). TBD
2
Medication Duration Duration of medication treatment or post-exposure prophylaxis. N/A
2
Medication Duration Units Unit of measure for the duration of medication administered (e.g. days, weeks, months). TBD
2
Medication Recipient Specify recipient of medication for Hansen's disease (e.g. household contact, case subject). TBD
1
Medication Dose Dosage of medication received. N/A
2
Medication Dosage Unit Unit of measure for medication received (e.g. milligram [mg], milligram/kilogram [mg/kg]) TBD
2

Sheet 22: Hantavirus Pulmonary Syndrome

Label/Short Name Description
Last Name Patient's last name
First Name Patient's first name
Middle Initial Patient's middle initial
Occupation Patient's occupation
History of rodent exposure 8 weeks prior to illness onset Did patient have history of rodent exposure during 8 week period prior to illness onset?
If yes, type of rodent exposure If rodent exposure occurred, what was the type of exposure?
Exposre occurred while cleaning Did exposure occur while cleaning?
Exposure occurred while working Did exposure occur while working?
Exposre during recreational activity (camping, hiking) Did exposure occur during a recreational activity?
Other exposure? (explain below) Other types of exposure? (Explain)
Fever >101F (38.3C) Did patient have a fever >101F (38.3C)?
Thrombocytopenia (<150,000) Did patient have thrombocytopenia (<150,000)?
Elevated hematocrit Did patinent have elevated hematocrit?
Elevated creatinine Did patinet have elevated creatinine?
Outcome of illness What was the outcome of the illness?
Autopsy performed If patient died, was autopsy performed?
Autopsy findings Describe autopsy findings
Did patient seek care before admission Did patient seek care before admission?
Date of pre-hospital treatment Date of pre-hospital treatment
Outcome of treatment (sent home, diagnosed as flu, etc): What was the outcome of treatment (sent home, diagnosed as flu, etc)?
Supplemental oxygen required Did the patient require supplemental oxygen?
Was patient on ECMO Was patient on extracorporeal membrane oxygenation (ECMO)?
Was patient intubated Was the patient intubated?
CXR with unexplained bilateral interstitial infiltrates or suggestive of ARDS Did patient have chest x-ray (CXR) with unexplained bilateral interstitial infiltrates or suggestive of acute respiratory distress syndrome (ARDS)?
Notes on clinical course of illness Describe clinical course of illness
Specimen collection date Specimen collection date
Type of specimen Type of specimen collected
If specimen tested, at which laboratory If specimen tested, at which laboratory?
Test results (i.e. titer, IgM, IgG) Test results (i.e. titer, IgM, IgG)
Name of patient’s physician Name of patient’s physician
Physician's email Physician's email
Physician's phone number Physician's phone number
Elevated Hematocrit (>50) Was Elevated Hematocrit >50?
Elevated Creatinine (>1.2 mg/dL) Was Elevated Creatinine >1.2 mg/dL?
Proteinuria Was Proteinuria detected?  
Hematuria Was Hematuria detected?
Exposure occurred from pet rodent Did exposure occur from a pet rodent?
Street address What is the patient’s street address?

Sheet 23: Hepatitis

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

Maternal HBeAg result, date Maternal HBeAg result, date


Maternal HBV DNA (or genotype), result, date Maternal HBV DNA (or genotype), result, date


Maternal Alanine aminotransferase (ALT) Maternal Alanine aminotransferase (ALT)


Maternal antiviral therapy, if any Maternal antiviral therapy, if any


Maternal Coinfection with human immunodeficiency virus or hepatitis C virus Maternal Coinfection with human immunodeficiency  virus or hepatitis C virus


Maternal State/Territory of residence at time of infant’s diagnosis Maternal State/Territory of residence at time of infant’s diagnosis


Infant Birthweight Infant Birthweight


Infant Time of birth (military time) Infant Time of birth (military time)


Infant State/Territory of birth Infant State/Territory of birth


HCV RNA (NAAT) test results HCV RNA (NAAT) test results and timing of test performance


HCV genotype test results HCV genotype test results and timing of test performance


HCV antigen test results HCV antigen test results and timing of test performance


hepatitis A RNA Nucleic acid amplification test (NAAT; such as PCR or genotyping) for hepatitis A virus RNA PHVS_LabTestResultQualitative_CDC P
Date of hepatitis A RNA test Date of hepatitis A RNA test N/A P
Total bilirubin Total bilirubin levels N/A P
Date of bilirubin test Date of bilirubin test N/A P
Experienced homelessness In the 2-6 weeks prior to symptom onset, was the patient homeless? PHVS_YesNoUnknown_CDC P
CSTE Case Definition Did the patient meet the CSTE case definition(s) for any of the following in a previous reporting year? (select all that apply) TBD
2
Information Source for Data Source of Laboratory Test: (select all that apply) TBD
2
Signs and Symptoms Signs and symptoms associated with the illness being reported TBD
1
Signs and Symptoms Indicator Response for each of the signs and symptoms. Yes No Unknown (YNU) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888
1
Date of Symptom Onset The date and time, if available, of the symptom onset (clinical manifestation) N/A
1
Date of Jaundice Onset What was the date of jaundice onset? N/A
1
Case Patient a Healthcare Worker Was the patient employed as a healthcare worker during the TWO WEEKS prior to onset of symptoms to ONE WEEK after onset of JAUNDICE? (If no jaundice, use two weeks after onset of symptoms) Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

2
Patient Epidemiological Risk Factors Exposed risk factors for the patient - Please provide a response for all risk factors in the value set with an associated indicator.
In the 15 to 50 days before symptom onset date for hepatitis A.
In the 60 to 150 days (2 to 5 months) before symptom onset date for hepatitis B.
In the 14 to 182 days (2 weeks to 6 months) before symptom onset date for hepatitis C.
TBD
1
Patient Epidemiological Risk Factors Indicator Provide a response for each value in the patient epidemiological risk factors value set. Yes No Unknown (YNU) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888
1
Contact Type If the patient was a contact of a person with confirmed or suspected hepatitis virus infection, was the contact: (select all that apply) TBD
2
Men who have Sex with Men Was the patient a man who reported sexual activity with men? Yes No Unknown (YNU) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888
1
Multiple Sex Partners Did the patient report multiple sex partners? Yes No Unknown (YNU) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888
1
Previous STD History Was the patient diagnosed with a sexually transmitted disease? Yes No Unknown (YNU) https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888
2
Antiviral Medication Did the gestational parent receive hepatitis B antiviral therapy during the third trimester of pregnancy? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Birth Weight (unit) The patient's birth weight units TBD
1
Vaccinated within 12 Hours of Birth Did the patient receive the hepatitis B vaccine within 12 hours of birth? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Treatment within 12 Hours of Birth Did the patient receive the hepatitis B immune globulin within 12 hours of birth? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Seroconversion If hepatitis B case, did the patient meet the acute hepatitis B seroconversion criteria? (i.e., documented negative HBsAg laboratory test result within 6 months prior to a positive test [HBsAg, HBeAg, or nucleic acid test for HBV DNA (including qualitative, quantitative, and genotype testing)] in someone without a prior diagnosis of HBV infection)
If hepatitis C case, did the patient meet the acute hepatitis C seroconversion criteria? (e.g., documented negative anti-HCV followed within 12 months by a positive anti-HCV test; or documented negative anti-HCV or negative HCV detection test [in someone without a prior diagnosis of HCV infection] followed within 12 months by a positive HCV detection test; or, in the case of presumed reinfection, at least two sequential negative HCV detection tests [in someone with a prior diagnosis of HCV infection] followed by a positive HCV detection test).
Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Occupation and Industry Category Was the patient employed as a food handler or a healthcare worker during the TWO WEEKS prior to onset of symptoms to ONE WEEK after the onset of JAUNDICE? (If no jaundice, use two weeks after onset of symptoms) TBD
2
Occupation and Industry Category Indicator Please indicate for each occupation: Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

2
Positive Results 6 Months Apart Did the patient have two positive results at least 6 months apart from any of the following tests: (1) HBsAg; (2) nucleic acid test for HBV DNA (including qualitative, quantitative, and genotype testing); (3) HBeAg?  (Any combination of these positive tests performed at least 6 months apart is acceptable) Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Mother's Local Record ID Provide the local record ID used for reporting mother's case of hepatitis (DE Identifier "N/A: OBR-3"). This will be used for linking the reported perinatal case to the mother's reported hepatitis case. N/A
3
Mother Nucleic Acid Test For hepatitis B, perinatal, did the gestational parent receive nucleic acid testing for HBV DNA during pregnancy?
For hepatitis C, perinatal, did the gestational parent receive nucleic acid testing for HCV RNA (including qualitative or quantitative PCR, or genotype testing) during pregnancy?
Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

2
Mother Nucleic Acid Test Result For hepatitis B, perinatal, if the gestational parent received nucleic acid testing for HBV DNA during pregnancy, then indicate the result.
For hepatitis C, perinatal, if the gestational parent received nucleic acid testing for HCV RNA (including qualitative or quantitative PCR, or genotype testing) during pregnancy, then indicate the result.
TBD
2
Mother Nucleic Acid Test Viral Load If the gestational parent received nucleic acid testing for HBV DNA during pregnancy, then indicate the viral load: TBD
2
Mother HBeAg Test Did the gestational parent receive HBeAg testing  during pregnancy? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

2
Mother HBeAg Test Result If the gestational parent received HBeAg testing  during pregnancy, indicate the result. TBD
2
Infant HBsAg Test Did the patient receive an HBsAg test between age 1–24 months (only if ≥4 weeks after the last dose of hepatitis B vaccine)? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant HBsAg Test Result If the patient received an HBsAg test between age 1–24 months (only if ≥4 weeks after the last dose of hepatitis B vaccine), indicate the result. TBD
1
Infant HBsAg Positive Date If positive, then indicate the date of the first positive HBsAg test between age 1-24 months. N/A
1
Infant HBeAg Test Did the patient receive an HBeAg test between age 9–24 months? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant HBeAg Test Result If the patient received an HBeAg test between age 9–24 months, indicate the result. TBD
1
Infant HBeAg Positive Date If positive, then indicate the date of the first positive HBeAg test between age 9-24 months. N/A
1
Infant HBV DNA Test Did the patient receive an HBV DNA test between age 9–24 months? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant HBV DNA Test Result If the patient received an HBV DNA test between age 9–24 months, indicate the result. TBD
1
Infant HBV DNA Positive Date If detected/positive, then indicate the date of the first positive HBV DNA test between age 9-24 months. N/A
1
Infant anti-HCV Test Did the patient receive an anti-HCV test between age 18-36 months? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant anti-HCV Test Result If the patient received an anti-HCV test between age 18-36 months, indicate the result. TBD
1
Infant anti-HCV Positive Date If positive, then indicate the date of the first positive anti-HCV test between age 18-36 months. N/A
1
Infant Nucleic Acid Test Did the patient receive nucleic acid testing for HCV RNA (including qualitative or quantitative PCR, or genotype testing) between age 2-36 months? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant Nucleic Acid Test Result If the patient received nucleic acid testing for HCV RNA (including qualitative or quantitative PCR, or genotype testing) between age 2-36 months, indicate the result. TBD
1
Infant Nucleic Acid Positive Date If detected/positive, then indicate the date of the first positive nucleic acid test for HCV RNA between age 2-36 months. N/A
1
Infant HCV Antigen Test Did the patient receive HCV antigen test between age 2-36 months? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Infant HCV Antigen Test Result If the patient received HCV antigen test between age 2-36 months, indicate the result. TBD
1
Infant HCV Antigen Positive Date If positive, then indicate the date of the first positive HCV antigen test between age 2-36 months. N/A
1
Tissue or organ transplant Did the patient receive tissue or organ transplant(s)? Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

2
Non-injection Drug Use Did the patient use non-injection drugs not prescribed by a doctor or engage in nonmedical use of prescription drugs?

V1.0 only: During the 2-6 weeks prior to the onset of symptoms, did the subject inject drugs not prescribed by a doctor?
Yes No Unknown (YNU)
https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888

1
Specimen From Mother or Infant Is the specimen from the gestational parent or the infant? PHVS_SpecimenFromMotherOrInfant_CRS
1
Transplant Date Date(s) of organ transplant(s). NA
2
Subject of Lab Test Performed Indication to specify whether the Lab Test Performed was for the mother or infant. PHVS_MotherInfantIndicator_NND
1
Previously Infected Individual Did the subject meet the case definition for a previous case investigation of this disease or condition? Yes No Unknown (YNU)
2
Previous State Case Number If the subject previously met the case definition for the disease or illness, what was the previously submitted sending system-assigned local ID (case ID) of the case investigation with which the subject is associated? N/A
2
Other Reported Case(s) Select all of the newly reported case(s) of the hepatitides confirmed within the current reporting year other than the primary condition reported for this case notification. PHVS_NotifiableConditions_Hepatitis
2
Type of Outbreak If the person is suspected of being part of an outbreak, please select the source of the outbreak. PHVS_CSOutbreak_HepatitisB (Per condition)
1
Other Reported Cases(s) Prior Years Select the relevant conditions for which the patient met the CSTE case definition(s) in any previous reporting year. Select all that apply. TBD
1
Test Conversion Did the patient meet the program criteria for test conversion for the condition of interest? PHVS_YesNoUnknown_CDC
1
Birth Sex Sex assigned at birth TBD (to align with USCDI standards)
1
Sexual Orientation A person’s identification of their emotional, romantic, sexual, or affectional attraction to another person TBD (to align with USCDI standards)
1
Gender Identity A person’s internal sense of being a man, woman, both, or neither TBD (to align with USCDI standards)
1
Alanine Aminotransferase (ALT) Result What was the patient’s ALT level (IU/L)?

Note: The result of the ALT test performed on the same specimen as the positive hepatitis A, B or C lab result(s) or associated with the positive hepatitis A, B or C lab result(s).

CDC’s preference is for the qualitative result to be submitted when available rather than the quantitative option.
PHVS_AlanineATResult_Hepatitis
2
Vaccine Series Completed Was the vaccine series completed? PHVS_YesNoUnknown_CDC
2
Donor Screening Patient was determined to have viral hepatitis during screening for blood, organ, or tissue donation. Please indicate the donation type. PHVS_DonorScreening_Hepatitis
2
Travel Outside USA Prior to Illness Onset (within Program Specific Timeframe) Did the patient travel or live internationally in the 15 to 50 days before symptom onset date?

Note: If the symptom onset date is unknown, then the date that the patient first tested positive for hepatitis A virus (HAV) can be used as a proxy for symptom onset date.
PHVS_YesNoUnknown_CDC
1
Specify Different Travel Exposure Window If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A (text field)
1
International Destination(s) of Recent Travel International destination or countries the patient traveled to or lived in, in the 15 to 50 days before symptom onset date PHVS_Country_ISO_3166-1
1
Date of Arrival to Travel Destination Date of arrival to travel destination N/A (Date)
3
Date of Departure from Travel Destination Date of departure from travel destination N/A (Date)
3

Sheet 24: Hemolytic Uremic Syndrome

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

Sheet 25: Human Rabies

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

Sheet 26: Invasive Pneumococcal Disease

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

Clinical syndrome Clinical diagnoses associated with a case of IPD

Method(s) of laboratory testing Type of laboratory test used to diagnose pneumococcal infection from a sterile site isolate

Name of CIDT test and manufacturer Name of culture independent laboratory test used and manufacturer of the test

CLIA number of laboratory CLIA number of the laboratory that conducted the testing

In Day Care Does this patient attend a day care facility? PHVS_YesNoUnknown_CDC P
Underlying Condition(s) Listing of underlying causes or prior illnesses PHVS_UnderlyingConditions_RIBD P
Underlying Conditions Indicator Underlying Conditions Indicator PHVS_YesNoUnknown_CDC P
Illness Onset Age Illness onset age N/A P
Illness Onset Age Units Illness onset age units PHVS_AgeUnit_UCUM P
Hospital ICU During any part of the hospitalization, did the subject stay in an Intensive Care Unit (ICU) or a Critical Care Unit (CCU)? PHVS_YesNoUnknown_CDC P
Residence Where was the patient a resident at time of initial culture? PHVS_ResidenceLocation_RIBD P
Pregnancy Status at the Time of First Positive Culture At the time of first positive culture, was the patient pregnant or postpartum? (The postpartum period is defined as the 30 days following a delivery or miscarriage) PHVS_PregnacyStatus_RIBD P
Pregnancy Outcome If pregnant or postpartum, what was the outcome of fetus? PHVS_FetalOutcome_RIBD P
Gestational Age If patient <1 month of age, indicate gestational age (in weeks) N/A P
Birth Weight If patient <1 month of age, indicate birth Weight N/A P
Birth Weight Units Birth Weight Units PHVS_WeightUnit_UCUM P
Premature Infant Premature at birth (for children ≤2 years old) PHVS_YesNoUnknown_CDC P
Insurance Insurance PHVS_InsuranceType_RIBD P
Epi-Linked to a Laboratory-Confirmed or Probable Case Is this case Epi linked to a confirmed or probable case? PHVS_YesNoUnknown_CDC P
ABCs Case ABCs case? PHVS_YesNoUnknown_CDC P
ABCs State ID ABCs State ID N/A P
Recurrent Disease with Same Pathogen Does this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.) PHVS_YesNoUnknown_CDC P
Previous State ID (Recurrent Case) StateID of 1st occurrence for this pathogen and person. N/A P
Laboratory Testing Performed Was laboratory testing done to confirm the diagnosis? PHVS_YesNoUnknown_CDC P
Laboratory Confirmed Was the case laboratory confirmed? PHVS_YesNoUnknown_CDC P
Test Manufacturer Test Manufacturer N/A P
Lab Accession Number Lab Accession Number (including CDC Lab ID) N/A P
Did the Subject Ever Receive a Vaccine Against This Disease Did the subject ever receive a vaccine against this disease? PHVS_YesNoUnknown_CDC P
Date of Last Dose Prior to Illness Onset Date of last vaccine dose against this disease prior to illness onset N/A P
Vaccination Doses Prior to Onset Number of vaccine doses against this disease prior to illness onset N/A P
Vaccine History Comments Vaccine History Comments N/A P
Age at Vaccination The persons age at the time the vaccine was given N/A P
Age at Vaccination Units The age units of the person at the time the vaccine was given PHVS_AgeUnit_UCUM P
Vaccine History Information Source What sources were used for vaccination history? PHVS_InformationSource_RIBD P
Vaccine Information Source Indicator Vaccination History Information Source Indicator PHVS_YesNoUnknown_CDC P
Susceptibility Test Was any susceptibility data available? PHVS_YesNoUnknown_CDC P

Sheet 27: Legionellosis

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

Illness Onset Age Age at illness onset N/A P
Illness Onset Age Units Age units at illness onset PHVS_AgeUnit_UCUM P
Accomodation Comments Comments or information about nights away from home not collected elsewhere N/A P
Address of Healthcare Facility Street Address of healthcare facility visited by the patient in the 10 days before onset N/A P
Zip Code of Healthcare Facility Zip code of healthcare facility visited by the patient in the 10 days before onset N/A P
Healthcare Setting Exposure Comments Comments or information about healthcare setting exposure not collected elsewhere N/A P
Healthcare Facility Water Management Program Did the healthcare facility have a water management program to reduce the risk of Legionella growth and spread in place? PHVS_YesNoUnknown_CDC P
Street Address of Assisted/Senior Living Facility Street address of assisted/senior living facility visited/lived in by the patient during exposure N/A P
Zip Code of Assisted/Senior Living Facility Zip code of assisted/senior living facility visited/lived in by the patient during exposure N/A P
Assisted/Senior Living Facility Comments Comments or information about assisted/senior living facility exposure not collected elsewhere N/A P
Assisted/Senior Living Facility Water Management Program Did the assited/senior living facility have a water management program to reduce the risk of Legionella growth and spread in place? PHVS_YesNoUnknown_CDC P
Exposure Was the patient exposed to any of the following during the 10 days prior to onset? PHVS_LegionellaExposure_RIBD P
Exposure Indicator Exposure Indicator PHVS_YesNoUnknown_CDC P
Location of Exposure Location of exposure (e.g. facility name, city , state) N/A P
Date(s) of Exposure Date(s) of exposure N/A P
Recent Cruise Travel In the 10 days before onset, did patient take a cruise? PHVS_YesNoUnknown_CDC P
Name of Cruiseline Name of cruiseline patient sailed with PHVS_CruiseLine_RIBD P
Name of Ship Name of ship patient sailed on N/A P
Cruise Departure City Cruise departure city N/A P
Cruise Departure State Cruise departure state PHVS_State_FIPS_5-2 P
Cruise Departure Country Cruise departure country PHVS_Country_ISO_3166-1 P
Date of Cruise Departure Cruise departure date N/A P
Cruise Return City Cruise return city N/A P
Cruise Return State Cruise return state PHVS_State_FIPS_5-2 P
Cruise Return Country Cruise return country PHVS_Country_ISO_3166-1 P
Date of Cruise Return Cruise return date N/A P
Cabin Number Patient's cruise ship cabin number N/A P
Port of Call City Port of call city N/A P
Port of Call Country Port of call country PHVS_Country_ISO_3166-1 P
Port of Call State Port of call state PHVS_State_FIPS_5-2 P
Port of Call Date Date for port of call N/A P
CDC NORS Outbreak ID# CDC National Outbreak Reporting System (NORS) Outbreak ID# N/A P
Did Underlying Condition(s) Exist Did the patient have any underlying causes or prior illnesses? PHVS_YesNoUnknown_CDC P
Underlying Condition(s) Listing of underlying causes or prior illnesses PHVS_UnderlyingConditions_RIBD P
Underlying Conditions Indicator Underlying conditions indicator PHVS_YesNoUnknown_CDC P
Titer Test Type If this is a titer, indicate if this is an initial/acute or convalescent titer (Titer Test Type) PHVS_TiterTestType_RIBD P
Test Manufacturer Test Manufacturer N/A P
Test Brand Name Test Brand Name N/A P

Sheet 28: Leptospirosis

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