| 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 |
| 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 |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| AnimalID | Unique ID for animal submitted for rabies diagnosis | |
| Date Collected | Date animal collected for rabies diagnosis | |
| Species | Species of animal submitted for rabies diagnosis | PHVS_AnimalSpecies_AnimalRabies |
| Sex | Sex of animal | PHVS_Sex_MFU |
| Age | Age category of animal | PHVS_AnimalAgeCategory_NND |
| Vax Status | Rabies vaccination status of animal submitted for rabies diagnosis | PHVS_YesNoUnknown_CDC |
| Human Exposure | Was there a potential human exposure to the animal submitted | PHVS_YesNoUnknown_CDC |
| Animal Exposure | Was there a potential domestic animal exposure ot the animal submitted | PHVS_YesNoUnknown_CDC |
| Latitude | Latitutde of Animal Collection | |
| Longitude | Longitude of animal collection | |
| Address | Street Address of animal collection | |
| City | City of animal collection | PHVS_City_USGS_GNIS |
| County | County of animal collection | PHVS_County_FIPS_6-4 |
| State | State of animal collection | PHVS_State_FIPS_5-2 |
| ZipCode | Zip Code of animal collection | |
| DFAResult | Results of direct flourescent antibody test | PHVS_PosNegUnk_CDC |
| Date DFA | Date tested by DFA | |
| DRIT Result | Results of direct rapid immunohistochemistry test | PHVS_PosNegUnk_CDC |
| Date DRIT | Date tested by DRIT | |
| Variant | Rabies virus variant if typed | PHVS_VirusVariantType_AnimalRabies |
| DateTyped | Date rabies virus typed |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | 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 |
| 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 |
| 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 |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Botulism Lab Confirmed | Was botulism laboratory confirmed from patient specimen? | PHVS_YesNoUnknown_CDC |
| C. Botulinum Isolated | Was C. botulinum/ C. baratii/ or C. butyricum isolated in culture from patient specimen? | PHVS_YesNoUnknown_CDC |
| Botulinum toxin Isolated | Was botulinum toxin confirmed from patient specimen? | PHVS_YesNoUnknown_CDC |
| Toxin Type Clin | If clinical specimen positive, what was its toxin type? | |
| Transmission Category | What was the transmission category (e.g., foodborne, wound, infant, other/unknown)? | |
| Botulism Food Source Code | If food is known or thought to be the source, please specify food type: | PHVS_BotulismFoodSourceType_FDD |
| Botulism Food Source Other | If “Other,” please specify other food type: | |
| Food Tested | Was food tested? | PHVS_YesNoUnknown_CDC |
| Food Tested Method | The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture. | Should include mouse bioassay, PCR, ELISA, Culture |
| Food Botulism Positive | Was food positive for botulism? | PHVS_YesNoUnknown_CDC |
| Food Bot Positive_Specify | If food positive, what was the food item? | |
| Food Toxin Type Code | If food was positive, what was its toxin type? | PHVS_BotulinumToxinType_FDD |
| Food Toxin Type Other | If “Other,” please specify other toxin type: | |
| Non-food Vehicle | If not foodborne botulism, what was the vehicle/exposure (e.g., black tar heroin) | |
| Botulism Other Indicator | Does the patient have Other Clinical based Botulism? | PHVS_YesNo_HL7_2x |
| Botulism Laboratory Confirmed | Was botulism laboratory confirmed from patient specimen? | PHVS_YesNoUnknown_CDC |
| Epi-linked | If botulism not laboratory confirmed from patient specimen or food, was case epi-linked to a confirmed botulism case? | |
| Comments | Space to add in general comments | |
| Reporting Lab Name | Name of Laboratory that reported test result. | |
| Reporting Lab CLIA Number | CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test. | |
| Local record ID (case ID) | Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification. | |
| Filler Order Number | A laboratory generated number that identifies the test/order instance. | |
| Ordered Test Name | Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information. | |
| Date of Specimen Collection | The date the specimen was collected. | |
| Specimen Site | This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc. | PHVS_BodySite_CDC |
| Specimen Number | A laboratory generated number that identifies the specimen related to this test. | |
| Specimen Source | The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc. | PHVS_Specimen_CDC |
| Specimen Details | Specimen details if specimen information entered as text. | |
| Date Sample Received at Lab | Date Sample Received at Lab (accession date). | |
| Sample Analyzed date | The date and time the sample was analyzed by the laboratory. | |
| Lab Report Date | Date result sent from Reporting Laboratory. | |
| Report Status | The status of the lab report. | PHVS_ResultStatus_HL7_2x |
| Resulted Test Name | The lab test that was run on the specimen. | PHVS_LabTestName_CDC |
| Numeric Result | Results expressed as numeric value/quantitative result. | |
| Result Units | The unit of measure for numeric result value. | PHVS_UnitsOfMeasure_CDC |
| Coded Result Value | Coded qualitative result value (e.g., Positive, Negative). | PHVS_LabTestResultQualitative_CDC |
| Organism Name | The organism name as a test result. This element is used when the result was reported as an organism. | PHVS_Microorganism_CDC |
| Lab Result Text Value | Textual result value, used if result is neither numeric nor coded. | |
| Result Status | The Result Status is the degree of completion of the lab test. | PHVS_ObservationResultStatus_HL7_2x |
| Interpretation Flag | The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low. | PHVS_AbnormalFlag_HL7_2x |
| Reference Range From | The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results. | |
| Reference Range To | The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results. | |
| Test Method | The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture. | PHVS_LabTestMethods_CDC Should include mouse bioassay, PCR, ELISA, Culture |
| Lab Result Comments | Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report. | |
| Date received in state public health lab | Date the isolate was received in state public health laboratory. | |
| Track Isolate | Track Isolate functionality indicator | PHVS_TrueFalse_CDC |
| Patient status at specimen collection | Patient status at specimen collection | PHVS_PatientLocationStatusAtSpecimenCollection |
| Isolate received in state public health lab | Isolate received in state public health lab | PHVS_YesNoUnknown_CDC |
| Reason isolate not received | Reason isolate not received | PHVS_IsolateNotReceivedReason_NND |
| Reason isolate not received (Other) | Reason isolate not received (Other) | |
| Date received in state public health lab | Date received in state public health lab | |
| State public health lab isolate id number | State public health lab isolate id number | |
| Case confirmed at state public health lab | Case confirmed at state public health lab | PHVS_YesNoUnknown_CDC |
| Case confirmed at CDC lab | Case confirmed at CDC lab |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| 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 |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Childhood Primary Series? | Did the patient receive primary a vaccination series? | |
| Number of Doses if <18 years old | If patient <18 years old, how many doses of vaccine were received? | |
| Boosters as Adult? | Did the patient receive vaccine booster doses as an adult? | |
| Last Dose | What is the date of patient's last dose of vaccine? | |
| Clinical Description | Description of patient's clinical picture | |
| Fever? | Did/does the patient have a fever? | |
| If Yes, Temp | The units of measure of the highest measured temperature in Celsius. | |
| Sore Throat? | Did/does the patient have a sore throat? | |
| Difficulty Swallowing? | Did/does the patient have difficulty swallowing? | |
| Membrane? | Did/does the patient have a pseudomembrane? | |
| If Yes, Tonsils? | Were/are the tonsils the site of the membrane? | |
| If Yes, Soft Palate? | Was/is the soft palate the site of the membrane? | |
| If Yes, Hard Palate? | Was/is the hard palate the site of the membrane? | |
| If Yes, Larynx? | Was/is the larynx the site of the membrane? | |
| If Yes, Nares? | Were/are the nares the site of the membrane? | |
| If Yes, Nasopharynx? | Was/is the nasopharynx the site of the membrane? | |
| If Yes, Conjunctiva? | Was/is conjunctiva the site of the membrane? | |
| If Yes, Skin? | Was/is the skin site of the membrane? | |
| Change in Voice? | Did/does the patient experience shortness of breath? | |
| Shortness of Breath? | Did/does the patient have voice change? | |
| Weakness? | Did/does the patienthave weakness? | |
| Fatigue? | Did/does the patient have fatique? | |
| Other? | Did/does the patient have any other symptoms? | |
| Soft Tissue Swelling? | Did/does the patient have soft tissue swelling? | |
| Neck Edema? | Did/does the patient have neck edema? | |
| If Yes | If neck edema, was it bilateral, left side only, or right side only? | |
| If Yes, Extent | If neck edema, extent of the neck edema | |
| Stridor? | Did/does the patient have stridor? | |
| Wheezing? | Did/does the patient have wheezing? | |
| Palatal Weakness? | Did/does the patient have weakness? | |
| Tachycardia? | Did/does the patient have tachycardia? | |
| EKG Abnormalities? | Did/does the patient have EKG abnormalities? | |
| Complications? | Did/does the patient have complications due to this illness? | |
| Airway Obstruction? | Did/does the patient have airway obstruction as a complication of this illness? | |
| AO Onset Date | Patient's onset date for airway obstruction | |
| Intubation Required? | Was intubation of the patient required? | |
| Myocarditis? | Did/does the patient have myocarditis as a complication of this illness? | |
| Myocarditis Onset Date | Patient's onset date for myocarditis | |
| (Poly)neuritis? | Did/does the patient have (poly)neuritis as a complication of this illness? | |
| (Poly)neuritis Onset date | Patient's onset date for (poly)neuritis | |
| Other? | Did/does the patient experience any other complications due to this illness? | |
| Describe | Description of other complications due to this illness. | |
| Diphtheria Culture | Was a specimen for diphtheria culture obtained? | |
| Culture Date | If yes, date culture specimen obtained | |
| Culture Result | What is the result for culture specimen? | |
| Lab Name | Specify laboratory performing culture | |
| Biotype | If culture result positive, specify biotype | |
| Toxigenicity Test | If culture positive, what is the result of toxigenicity testing? | |
| Specimen Sent to CDC | Was a specimen sent to the CDC Diphtheria Lab for confirmation/molecular typing? | |
| Specimen Type | Indicate type of specimen sent to CDC | |
| Serum Specimen for Ab Testing | Was a serum specimen for diphtheria antitoxin antibodies obtained? | |
| PCR Result | Specify the PCR result | |
| Antibiotic Treatment | Was patient treated with antibiotics? | |
| Outpatient Treatment | Did patient receive treatment as an outpatient? | |
| Date Initiated | If yes, what is the date outpatient treatment initiated? | |
| Antibiotic as Outpatient | What antibiotic did the patient receive? | |
| OP Therapy Duration | What was the duration of therapy (in days)? | |
| Antibiotic Therapy in Hospital | Was antibiotic therapy obtained in a hospital? | |
| Inpatient Treatment | Did patient receive treatment as an inpatient? | |
| Antibiotic as Inpatient | What antibiotic did the patient receive? | |
| IP Therapy Duration | What was the duration of therapy (in days)? | |
| Antibiotics Before Culture | Did patient receive antibiotics in the 24 hours before culture specimen taken? | |
| Country of Residence | What is patient's country of residence? | |
| Other Country | If other than US, what is the country? | |
| US Arrival Date | What is the date of patient's arrivaal in the US? | |
| International Travel | Did patient have history of international travel 2 weeks prior to symptom onset? | |
| Country(s) Visited | What country(s) were visited? | |
| International Departure Date | Date the patient left for international travel | |
| International Return Date | Date the patient returned from international travel | |
| Interstate Travel | Did patient have history of interstate travel 2 weeks prior to symptom onset? | |
| State(s) Visited | What state(s) were visited? | |
| Interstate Departure Date | Date the patient left for interstate travel | |
| Interstate Return Date | Date the patient returned from intestate travel | |
| Exposure to Case or Carrier? | Was patient exposed to a known case or carrier of diphtheria? | |
| Exposure to International Travelers? | Did the patient have a known exposure to any international travelers? | |
| Exposure to Immigrants? | Did the patient have a known exposure to any immigrants? | |
| DAT Administered | Units of DAT administered | |
| Final Diagnosis | What was the final clinical diagnosis for this patient? | |
| Final Diagnosis Confirmation | How was the final diagnosis confirmed? |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Animal Contact Questions Indicator | If contact with animal, then display the following questions | Yes No Indicator (HL7) |
| Animal Contact Indicator | Did patient come in contact with an animal? | Yes No Unknown (YNU) |
| Animal Type Code(s) | Type of animal: (MULTISELECT) | Animal Type (FDD) |
| Animal Type Other | If “Other,” please specify other type of animal: | |
| Amphibian Other | If “Other Amphibian,” please specify other type of amphibian: | |
| Reptile Other | If “Other Reptile,” please specify other type of reptile: | |
| Mammal Other | If "Other Mammal," please specify other type of mammal: | |
| Animal Contact Location | Name or Location of Animal Contact: | |
| Acquired New Pet | Did the patient acquire a pet prior to onset of illness? | Yes No Unknown (YNU) |
| Applicable Incubation Period | Applicable incubation period for this illness is | |
| Associated with Daycare Indicator | If Patient associated with a day care center: | Yes No Indicator (HL7) |
| Day Care Attendee | Attend a day care center? | Yes No Unknown (YNU) |
| Day Care Worker | Work at a day care center? | Yes No Unknown (YNU) |
| Live with Day Care Attendee | Live with a day care center attendee? | Yes No Unknown (YNU) |
| Day Care Type | What type of day care facility? | Day CareType (FDD) |
| Day Care Facility Name | What is the name of the day care facility? | |
| Food Prepared at this Daycare | Is food prepared at this facility? | Yes No Unknown (YNU) |
| Diapered Infants at this Daycare | Does this facility care for diapered persons? | Yes No Unknown (YNU) |
| Drinking Water Exposure Indicator | If patient has had Drinking Water exposure, then display the following questions | Yes No Indicator (HL7) |
| Home Tap Water Source Code | What is the source of tap water at home? | Tap Water Source (FDD) |
| Home Well Treatment Code | If “Private Well,” how was the well water treated at home? | Well Water Treatment (FDD) |
| Home Tap Water Source Other | If “Other,” specify other source of tap water at home: | |
| School/Work Tap Water Source Code | What is the source of tap water at school/work? | Tap Water Source (FDD) |
| SchoolWork Well Treatment Code | If “Private Well,” how was the well water treated at school/work? | Well Water Treatment (FDD) |
| School/Work Tap Water Source Other | If “Other,” specify other source of tap water at school/work: | |
| Drink Untreated Water 14 days Prior to Onset | Did patient drink untreated water 14 days prior to onset of illness? | Yes No Unknown (YNU) |
| Food Handler | If patient is a Food Handler, then display the following questions | Yes No Indicator (HL7) |
| Food Handler after Illness Onset | Did patient work as a food handler after onset of illness? | Yes No Unknown (YNU) |
| Food HandlerLast Worked Date | What was the last date worked as a food handler after onset of illness? | |
| Food Handler Location | Where was patient a food handler? | |
| Recreational Water Exposure Questions Indicator | If patient has had recreational water exposure, then display the following | Yes No Indicator (HL7) |
| Recreational Water Exposure 14 Days Prior to Onset | Was there recreational water exposure in the 14 days prior to illness? | Yes No Unknown (YNU) |
| Recreational Water Exposure Type Code(s) | What was the recreational water exposure type? (MULTISELECT) | Recreational Water (FDD) |
| Recreational Water Exposure Type Other | If "Other," please specify other recreational water exposure type: | |
| Swimming Pool Type Code(s) | If "Swimming Pool," please specify swimming pool type: (MULTISELECT) | Swimming Pool Type (FDD) |
| Swimming Pool Type Other | If "Other," please specify other swimming pool type: | |
| Recreational Water Location Name | Name or location of water exposure: | |
| Related Case Indicator | If related cases are associated to this case, then display the following questions | Yes No Indicator (HL7) |
| Patient Knows of Similarly Ill Persons | Does the patient know of any similarly ill persons? | Yes No Unknown (YNU) |
| Health Department Investigated | If "Yes," did the health department collect contact information about other similarly ill persons and investigate further? | Yes No Unknown (YNU) |
| Other Related Cases | Are there other cases related to this one? | Other Related Cases |
| Travel Questions Indicator | If patient has traveled, then display the following questions | Yes No Indicator (HL7) |
| Travel Prior To Onset | Did the patient travel prior to onset of illness? | Yes No Unknown (YNU) |
| Incubation Period | Applicable incubation period for this illness is 14 days | |
| Travel Purpose Code(s) | What was the purpose of the travel? (MULTISELECT) | Travel Purpose |
| Travel Purpose Other | If “Other,” please specify other purpose of travel: | |
| Destination 1 Type: | Destination 1 Type: | Travel Destination Type |
| (Domestic) Destination 1: | (Domestic) Destination 1: | State |
| (International) Destination 1 | (International) Destination 1 | Country |
| Mode of Travel: (1) | Mode of Travel: (1) | Travel Mode |
| Date Of Arrival (1) | Date of Arrival: (1) | |
| Date of Departure (1) | Date of Departure (1) | |
| Destination 2 Type | Destination 2 Type | Travel Destination Type |
| (Domestic) Destination 2 | (Domestic) Destination 2 | State |
| (International) Destination 2 | (International) Destination 2 | Country |
| Mode of Travel: (2) | Mode of Travel: (2) | Travel Mode |
| Date of Arrival: (2) | Date of Arrival: (2) | |
| Date of Departure (2) | Date of Departure (2) | |
| Destination 3 Type: | Destination 3 Type: | Travel Destination Type |
| (Domestic) Destination 3: | (Domestic) Destination 3: | State |
| (International) Destination 3 | (International) Destination 3 | Country |
| Mode of Travel: (3) | Mode of Travel: (3) | Travel Mode |
| Date of Arrival: (3) | Date of Arrival: (3) | |
| Date of Departure (3) | Date of Departure (3) | |
| Other Destination Txt | If more than 3 destinations, specify details here: | |
| Reporting Lab Name | Name of Laboratory that reported test result. | |
| Reporting Lab CLIA Number | CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test. | |
| Local record ID (case ID) | Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it ap | |
| Filler Order Number | A laboratory generated number that identifies the test/order instance. | |
| Ordered Test Name | Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information. | Ordered Test |
| Date of Specimen Collection | The date the specimen was collected. | |
| Specimen Site | This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc. | Specimen |
| Specimen Number | A laboratory generated number that identifies the specimen related to this test. | |
| Specimen Source | The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc. | Specimen |
| Specimen Details | Specimen details if specimen information entered as text. | |
| Date Sample Received at Lab | Date Sample Received at Lab (accession date). | |
| Sample Analyzed date | The date and time the sample was analyzed by the laboratory. | |
| Lab Report Date | Date result sent from Reporting Laboratory. | |
| Report Status | The status of the lab report. | Result Status (HL7) |
| Resulted Test Name | The lab test that was run on the specimen. | Lab Test Result Name (FDD) |
| Numeric Result | Results expressed as numeric value/quantitative result. | |
| Result Units | The unit of measure for numeric result value. | Units Of Measure |
| Coded Result Value | Coded qualitative result value. | Lab Test Result Qualitative |
| Organism Name | The organism name as a test result. This element is used when the result was reported as an organism. | Microorganism (FDD) |
| Lab Result Text Value | Textual result value, used if result is neither numeric nor coded. | |
| Result Status | The Result Status is the degree of completion of the lab test. | Observation Result Status (HL7) |
| Interpretation Flag | The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low. | Abnormal Flag (HL7) |
| Reference Range From | The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results. | |
| Reference Range To | The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results. | |
| Test Method | The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture. | Observation Method |
| Lab Result Comments | Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report. | |
| Date received in state public health lab | Date the isolate was received in state public health laboratory. | |
| Lab Test Coded Comments | Explanation for missing result (e.g., clotting, quantity not sufficient, etc.) | Missing Lab Result Reason |
| Genotyping/ Subtyping | Indicate whether the specimens were genotyped and/or subtyped | Yes No Unknown (YNU) |
| Genotyping Sent Date | If the specimen was sent to the CDC for genotyping, date on which the specimens were sent. | |
| Genotype/Subtype location | Indicate where Genotype and/or subtype testing was performed | |
| Genotype | If the specimen was sent for genotype identification, indicate the genotype | |
| Subtype | If the specimen was sent for subtype idenfication, indicate the subtype | |
| Track Isolate | Track Isolate functionality indicator | Yes No Indicator (HL7) |
| Patient status at specimen collection | Patient status at specimen collection | Patient Location Status at Specimen Collection |
| Isolate received in state public health lab | Isolate received in state public health lab | Yes No Unknown (YNU) |
| Reason isolate not received | Reason isolate not received | Isolate Not Received Reason |
| Reason isolate not received (Other) | Reason isolate not received (Other) | |
| Date received in state public health lab | Date received in state public health lab | |
| State public health lab isolate id number | State public health lab isolate id number | |
| Case confirmed at state public health lab | Case confirmed at state public health lab | Yes No Unknown (YNU) |
| AgClinic | What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory? | |
| AgClinicTestType | Name of antigen-based test used at clinical laboratory | |
| AgeMnth | Age of case-patient in months if patient is <1yr | |
| AgeYr | Age of case-patient in years | |
| AgSphl | What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory? | |
| AgSphlTestType | Name of antigen-based test used at state public health laboratory | |
| BloodyDiarr | Did the case-patient have bloody diarrhea (self reported) during this illness? | |
| Diarrhea | Did the case-patient have diarrhea (self-reported) during this illness? | |
| DtAdmit2 | Date of hospital admission for second hospitalization for this illness | |
| DtDisch2 | Date of hospital discharge for second hospitalization for this illness | |
| DtEntered | Date case was entered into site's database | |
| DtRcvd | Date case-pateint's specimen was received in laboratory for initial testing | |
| DtRptComp | Date case report form was completed | |
| DtSpec | Case-patient's specimen collection date | |
| DtUSDepart | If case-patient patient traveled internationally, date of departure from the U.S. | |
| DtUSReturn | If case-patient traveled internationally, date of return to the U.S. | |
| EforsNum | CDC FDOSS outbreak ID number | |
| Fever | Did the case-patient have fever (self-reported) during this illness? | |
| HospTrans | If case-patient was hospitalized, was s/he transferred to another hospital? | |
| Immigrate | Did case-patient immigrate to the U.S.? (within 15 days of illness onset) | |
| Interview | Was the case-patient interviewed by public health (i.e. state or local health department) ? | |
| LabName | Name of submitting laboratory | |
| LocalID | Case-patient's medical record number | |
| OtherCdcTest | What was the result of specimen testing using another test at CDC? | |
| OtherClinicTest | What was the result of specimen testing using another test at a clinical laboratory? | |
| OtherClinicTestType | Name of other test used at a clinical laboratory | |
| OtherSphlTest | What was the result of specimen testing using another test at a state public health laboratory? | |
| OtherSphlTestType | Name of other test used at a state public health laboratory | |
| OutbrkType | Type of outbreak that the case-patient was part of | |
| PatID | Case-patient identification number | |
| PcrCdc | What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping). | |
| PcrClinic | What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation) | |
| PcrClinicTestType | Name of PCR assay used | |
| PcrSphl | What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping). | |
| PersonID | Unique identification number for person or patient | |
| ResultID | Unique identifier for laboratory result | |
| RptComp | Is all of the information for this case complete? | |
| SentCDC | Was specimen or isolate forwarded to CDC for testing or confirmation? | |
| SLabsID | State lab identification number | |
| SpeciesClinic | What was the species result at clinical lab? | |
| SpeciesSphl | What was the species result at SPHL? | |
| SpecSite | Case patient's specimen collection source | |
| StLabRcvd | Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence) | |
| TravelDest | If case-patient traveled internationally, to where did they travel? | |
| TravelInt | Did the case patient travel internationally? (within 15 days of onset) |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | 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 |
| 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 |
| 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? |
| 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. |
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| 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. |
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| 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. |
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| 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 |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| CASEID | Case patient's ID | |
| FIRST_IDENT | How was patient's illness first identified by public health (state or local health department or EIP)? | |
| DATE_AS | Date case entered into data system (Complete if FIRST_IDENT=1) | |
| OTHR_IDENT_DESC | Describe other way patient's illness first identified by public health (Complete if FIRST_IDENT=4). | |
| HDD | Was this case captured through Hospital Discharge Data? | |
| HDD_DATE | Date case entered into data system (Complete if HDD=1) | |
| DATEHUS | Date of HUS diagnosis | |
| OUTBREAK | Is this case outbreak-related? | |
| DIARRHEA | Did patient have diarrhea during the 3 weeks before HUS diagnosis? | |
| DONSET | Date of diarrhea (Complete if DIARRHEA=1) | |
| STOOLBLOOD | Did stools contain visible blood at any time? (Complete if DIARRHEA=1) | |
| DTREATED | Was diarrhea treated with antimicrobial medications/ (Complete if DIARRHEA=1) | |
| A1ANTI | Type of antimicrobial (Complete if DTREATED=1) | |
| CONTACT | Did the patient have contact with another person with diarrhea or HUS during the 3 weeks before HUS diagnosis (include daycare, household, etc)? (Complete if DIARRHEA=2) | |
| OTHREA | Was patient treated with an antimicrobial medication for any other reason than diarrhea during the 3 weeks before HUS diagnosis? | |
| A3ANTI | Type of antimicrobial (Complete if OTHREA=1) | |
| A4REAS | Reason for antimicrobial (Complete if OTHREA=1) | |
| GASTRO | Was other gastrointestinal illness present during 3 weeks before HUS diagnosis? | |
| UTI | Did patient have a urinary tract infection during 3 weeks before HUS diagnosis? | |
| RTI | Did patient have a respiratory tract infection during 3 weeks before HUS diagnosis? | |
| ACUTE | Did patient have other acute illness during 3 weeks before HUS diagnosis? | |
| DACUTE | Describe other acute illness (Complete if ACUTE=1) | |
| PREG | Was patient pregnant during 3 weeks before HUS diagnosis? | |
| KIDN | Did patient have kidney disease during 3 weeks before HUS diagnosis? | |
| IMMCOMP | Did patient have an ummunocompromising condition or was the patient taking medication during 3 weeks before HUS diagnosis? | |
| MALIG | Did patient have a malignancy during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1) | |
| TRANSPL | Did patient have transplanted organ or bone marrow during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1) | |
| HIV | Did patient have HIV infection during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1) | |
| STER | Was patient using steroids (parenteral or oral) during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1) | |
| IMMOTHER | Describe other immunocompromising condition during 3 weeks before HUS diagnosis? (Complete if IMMCOMP=1) | |
| CRE | Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum creatinine (expressed as mg/dL) | |
| BUN | Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum BUN (expressed as mg/dL) | |
| WBC | Laboratory values within 7 days before and 3 days after HUS diagnosis: Highest serum WBC (expressed as K/mm3) | |
| HGB | Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest hemoglobin (expressed as g/dL) | |
| HCT | Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest hematocrit (expressed as %) | |
| PLT | Laboratory values within 7 days before and 3 days after HUS diagnosis: Lowest platelet count (expressed as K/mm3) | |
| RCFRAG | Were there microangiopathic changes (i.e., schistocytes, helmet cells or red cell fragments) at any time within 7 days before HUS diagnosis to hospital discharge (if patient was not hospitalized or discharged within 3 days of HUS diagnosis, then outpatient lab results from 7 days before to 3 days after diagnosis should be used, if available) | |
| BURINE | Other laboratory findings within 7 days before and 3 days after HUS diagnosis: Blood (or heme) in urine | |
| PURINE | Other laboratory findings within 7 days before and 3 days after HUS diagnosis: Protein in urine | |
| RBCURINE | Other laboratory findings within 7 days before and 3 days after HUS diagnosis: RBC in urine by microscopy | |
| STOOLSPEC | Was a stool specimen obtained from this patient? | |
| TESTSHIGA | Was stool tested for Shiga toxin at any clinical laboratory? | |
| N11BRESULT | Result of Shiga toxin testing (Complete if TESTSHIGA=1) | |
| STSPEC | Collection date of first specimen tested (Complete if TESTSHIGA=1) | |
| STECPOS | Collection date of first positive specimen (Complete if TESTSHIGA=1) | |
| CULTO157 | Was stool cultured for E. coli O157 (on selective or differential media e.g. SMAC, CHROMagar O157, CTSMAC) at any CLINICAL laboratory? | |
| DATEO157 | Date stool cultured for E. coli O157 (Complete if CULTO157=1) | |
| O157ISOL | Was E.coli O157 isolated? (Complete if CULTO157=1) | |
| DATEO157POS | Collection date 1st positive specimen culture for O157 (Complete if O157POS=1) | |
| HANT | Result of H antigen testing (Complete if O157ISOL=1) | |
| HANT_OTHER | Other H antigen (Complete if HANT=5) | |
| STOOL_CDC_PHL | Was a stool sample, or any type of specimen or isolate originating from stool sent to a public health laboratory (state or CDC)? | |
| SPEC_DATEPHLSTEC | Date of specimen collection (Complete if STOOL_CDC_PHL=1) | |
| STEC_ISOL | Was E.coli or non-O157 STEC identified? (Complete if STOOL_CDC_PHL=1) | |
| O | What was the O antigen for strain 1? (Complete if STEC_ISOL=1) | |
| H | What was the H antigen for strain 1? (Complete if STEC_ISOL=1) | |
| O2 | What was the O antigen for strain 2? (Complete if STEC_ISOL=1) | |
| H2 | What was the H antigen for strain 2? (Complete if STEC_ISOL=1) | |
| IMS | Was immunomagnetic separation (IMS) used to identify common STEC serogroups? | |
| IMS_SERO | What serogroup(s) did the IMS procedure target? (Complete if IMS=1) | |
| OTHERPATH | Was another pathogen isolated from stool (at PHL or clinical lab)? | |
| PATH1 | Name pathogen isolated from stool (Complete if OTHERPATH=1) | |
| PATH1D | Date other pathogen isolated from stool | |
| PATH2 | Name of second pathogen isolated from stool (Complete if OTHERPATH=1) | |
| PATH2D | Date second other pathogen isolated from stool | |
| PATHNOS | Was pathogen isolated from source other than stool (at PHL or clinical lab)? | |
| DESPATH | Name pathogen isolated from source other than stool (Complete if PATHNOS=1) | |
| SPECPATH | Specimen source of pathogen isolated from source other than stool (Complete if PATHNOS=1) | |
| DATEPATH | First date of isolation of pathogen from source other than stool (Complete if PATHNOS=1) | |
| STATELAB | If O157 or other STEC was isolated, was the isolate sent to state laboratory? | |
| F9MENUREF | If isolate sent to state laboratory, what was the state laboratory ID (Complete if STATELAB=1) | |
| CDC | If O157 or other STEC was isolated, was the isolate sent to CDC? | |
| CDC_ID | If isolate sent to CDC, what was the CDC laboratory ID (Complete if CDC=1) | |
| REFLAB | If O157 or other STEC was isolated, was the isolate sent to another reference lab? | |
| SPECIFY_REFLAB | If isolate sent to reference lab, what was the name of the reference lab? (Complete if REFLAB=1) | |
| FNCATCH | Is the patient a resident of the FoodNet catchment area? | |
| PERSONID | What is the FoodNet PERSONID? (Complete if FNCATCH=1) | |
| ANTIO157 | Has patient serum or plasma been sent to CDC for testing for antibodies to O157 or other STEC? | |
| SLABID_SERUM | What is the state laboratory ID or the serum? (Complete if ANTIO157=1) | |
| OTHERSLABSID_SERUM | Other laboratory ID numbers for serum sent to CDC (Complete if ANTIO157=1) | |
| LPS_TYPE1 | LPS type | |
| IGG_1 | IgG titer | |
| IGG_INTERP | Interpretation of IgG titer | |
| IGM_1 | IgM titer | |
| IGM1_INTERP | Interpretation of IgM titer | |
| LPS_TYPE2 | Second LPS type | |
| IGG_2 | Second IgG titer | |
| IGG_INTERP2 | Interpretation of second IgG titer | |
| IGM_2 | Second IgM titer | |
| IGM1_INTERP2 | Interpretation of second IgM titer | |
| LPS_TYPE3 | Third LPS type | |
| IGG_3 | Third IgG titer | |
| IGG_INTERP3 | Interpretation of third IgG titer | |
| IGM_3 | Third IgM titer | |
| IGM1_INTERP3 | Interpretation of third IgM titer | |
| ADMISR | Date of first hospital admission | |
| DISCHR | Date of last hospital discharge | |
| PNE | Did pneumonia occur as a complication during this hospital admission? | |
| DPNE | Date of onset of pneumonia (Complete if PNE=1) | |
| SZR | Did seizure occur as a complication during this hospital admission? | |
| DSZR | Date of onset of seizure (Complete if SZR=1) | |
| PAR | Did paralysis or hemiparesis occur as a complication during this hospital admission? | |
| DPAR | Date of onset of paralysis or hemiparesis (Complete if PAR=1) | |
| BLN | Did blindness occur as a complication during this hospital admission? | |
| DBLN | Date of onset of blindness (Complete if BLN=1) | |
| NER | Did other major neurologic sequelae occur as a complication during this hospital admission? | |
| DNER | Date of other major neurologic sequalae (Complete if NER=1) | |
| DESCR1 | Describe other major neurologic sequelae (Complete if NER=1) | |
| PDIAL | Was peritoneal dialysis performed during hospital stay? | |
| HDIAL | Was hemodialysis performed during hospital stay? | |
| PRBC | Was packed RBC or whole blood used in dialysis? (Complete if PDIAL=1 or HDIAL=1) | |
| PLTT | Were platelets used in dialysis? (Complete if PDIAL=1 or HDIAL=1) | |
| FFPL | Was fresh frozen plasma used in dialysis? (Complete if PDIAL=1 or HDIAL=1) | |
| PHRES | Was plasmapheresis performed during hospital stay? | |
| SURG | Was laparotomy or other abdominal surgery performed during hospital stay? Do not include insertion of dialysis catheter. | |
| SURGDES | Describe other abdominal surgery | |
| CONDDC | Patient's condition at hospital discharge | |
| DEAD | Date of death (Complete if CONDDC=1) | |
| REQDIAL | Was patient discharged requiring dialysis? (Complete if CONDDC=2) | |
| NEURODEF | Was patient discharged with neurologic deficits? (Complete if CONDDC=2) |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| City | Patients City of Residence | PHVS_City_USGS_GNIS |
| State | Patients State of Residence | PHVS_State_FIPS_5-2 |
| Country | Patients Country of Residence | PHVS_Country_ISO_3166-1 |
| Occupation | Patients Occupation | PHVS_Occupation_CDC |
| Gender | Patients Gender | PHVS_Sex_MFU |
| Age | Patients Age | |
| Race | Patients Race | PHVS_RaceCategory_CDC_Unk |
| Ethnicity | Patients Ethnicity | PHVS_EthnicityGroup_CDC_Unk |
| Animal Exposure | Did patient have a history of an animal exposure | PHVS_YesNoUnknown_CDC |
| Animal Species | What type of animal was involved in the Exposure | PHVS_AnimalSpecies_AnimalRabies |
| Animal State | What state did the animal exposure occur in | PHVS_State_FIPS_5-2 |
| Animal Country | What country did the animal exposure occur in | PHVS_Country_ISO_3166-1 |
| Type of Exposure | What type of exposure occurred | |
| Vaccination status | Was the patient vaccinated for rabies prior to onset of symptoms | PHVS_YesNoUnknown_CDC |
| Travel | Did the patient have a recent (prior 12 months) history of travel? | PHVS_YesNoUnknown_CDC |
| Travel State | What state did the patient travel to | PHVS_State_FIPS_5-2 |
| Travel Country | What country did the patient travel to | PHVS_Country_ISO_3166-1 |
| Travel DateStart | When did the trip begin | |
| Travel DateEnd | When did the trip end | |
| Onset | Date Symptoms began | |
| Hospitalized | Date patient hospitalized | |
| Death | Date patient died | |
| Variant | What rabies virus variant was responsible for the infection | PHVS_VirusVariantType_AnimalRabies |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | 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 |
| 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 |
| 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 | |||