| 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. | ||
| 1/20/2023 |
| 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 | |
| Travel Outside USA Prior to Illness Onset within Program Specific Timeframe | Did the subject travel internationally in the six months prior to illness onset? | PHVS_YesNoUnknown_CDC | 1 | |
| Did the Case Travel Domestically Prior to Illness Onset | Did the subject travel domestically in the six months prior to illness onset? | 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 | 3 | |
| Date of Arrival to Travel Destination | Date of arrival to travel destination | 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) | 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 (Legacy) | CDC Priority (New) |
| 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 | |
| Date Arrived at Healthcare Facility | Start date of visit/admission | N/A | 2 | |
| Date Departed Healthcare Facility | End date of visit/admission | 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) |
| 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 | |
| Surveillance Data Source | Type of facility or provider associated with the source of information sent to Public Health | PHVS_DataReportingSource_CO | 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) |
| State lab isolate id | Lab isolate identifier from public health lab | N/A | 1 | |
| County of facility | County of facility where specimen was collected | PHVS_County_FIPS_6-4 | 1 | |
| State of facility | State of facility where specimen was collected | PHVS_State_FIPS_5-2 | 1 | |
| Travel Outside USA Prior to Illness Onset within Program Specific Timeframe | Did the patient travel internationally in the year prior to the date of specimen collection? | PHVS_YesNoUnknown_CDC | 2 | |
| International Destination(s) of Recent Travel | 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 | 2 | |
| Healthcare Outside USA | Patient received healthcare outside of the United States in the year prior to the date of specimen collection. | PHVS_YesNoUnknown_CDC | 2 | |
| Country(ies) of Healthcare Outside USA | 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 | 2 | |
| Gene Identifier | Gene identifier | TBD | 1 | |
| Previously Counted Case | Was patient previously counted as a colonization/screening case? | PHVS_YesNoUnknown_CDC | 1 | |
| Previously Reported State Case Number | If patient was previously counted as colonization/screening case please provide related case ID(s) | N/A | 1 | |
| WGS ID Number | Genomic sequencing ID number | N/A | 2 | |
| Tracheostomy Tube at Specimen Collection | Did patient have a tracheostomy tube at the time of specimen collection? | PHVS_YesNoUnknown_CDC | 2 | |
| Ventilator Use at Specimen Collection | Was patient on a ventilator at the time of specimen collection? | PHVS_YesNoUnknown_CDC | 2 | |
| 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 | 2 | |
| 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. | TBD | 2 | |
| 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 | 2 | |
| Type of Location Where Specimen Collected | Indicate the physical location type of the patient when the specimen was collected | TBD | 2 | |
| Infection with Another MDRO | Does the patient have infection or colonization with another MDRO? | PHVS_YesNoUnknown_CDC | 2 | |
| Co-infection Type | If patient has infection or colonization with another MDRO, indicate the MDRO. | TBD | 2 | |
| Date Arrived at Healthcare Facility | Start date of visit/admission | N/A | 2 | |
| Date Departed Healthcare Facility | End date of visit/admission | 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) |
| 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. |
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| 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 | |
| Laboratory Test Ordering Facility Type | Type of facility where the hepatitis laboratory screening, diagnostic, or monitoring test was ordered | PHVS_SourceofLaboratoryTest _Hepatitis | 2 |
| 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 | |||
| Symptoms | Select symptoms and signs reported or identified, from "Fever", "Myalgia", "Headache", "Jaundice ", "Hepatitis", "Conjunctival suffusion", "Rash (Maculopapular or petechial)", "Aseptic meningitis", "Gastrointestinal involvement", "Pulmonary complications", "Cardiac involvement", "Renal insufficiency/failure ", "Hemorrhage", "Other (specify)" | |||
| Hospitalization? | Was the case-patient hospitalized (at least overnight) for this Did the case-patient die? Yes No Unk infection? | PHVS_YesNoUnknown_CDC | ||
| Admission Date | Subject’s first admission date to the hospital for the condition covered by the investigation. | |||
| Number of days | If hospitalized, number of days. | |||
| Outcome | Clinical outcome of the patient ("Still hospitalized"; "Discharged"; "Died";"Other") | |||
| Discharge Date | Subject's first discharge date from the hospital for the condition covered by the investigation. | |||
| Deceased Date | If the subject died from this illness or complications associated with this illness, indicate the date of death | |||
| Antibiotics prescribed | Were Antibiotics prescribed for this infection? | PHVS_YesNoUnknown_CDC | ||
| Antibiotics start date | Date started taking antibiotics | |||
| Doxycycline | Was doxycycline prescribed for this infection? | PHVS_YesNoUnknown_CDC | ||
| Penicillin | Was penicillin prescribed for this infection? | PHVS_YesNoUnknown_CDC | ||
| Other antibiotics | List other antibiotics prescribed for this infection | |||
| Reporting Lab Name | Name of Laboratory that reported test result. | |||
| Date Sample Received at Lab | Date Sample Received at Lab (accession date). | |||
| Date specimen collected | The date the specimen was collected. | |||
| Specimen Type | Type of specimen collected ("Blood", "Urine", "Tissue", "CSF", "Other", "Unknown", "Serum") | |||
| Date of Acute Specimen Collection | The date the acute specimen was collected. | |||
| Date of Convalscent Specimen Collection | The date the convalscent specimen was collected. | |||
| Resulted Test Name | The lab test that was run on the specimen ("Microscopic Agglutination Test (MAT)", "PCR", "Culture", "Immunofluorescence", "Darkfield microscopy", "ELISA (specify)", "IHC", "Other, specify") | |||
| Numeric Result | Results expressed as numeric value/quantitative result. | |||
| Result Units | The unit of measure for numeric result value. | PHVS_UnitsOfMeasure_CDC | ||
| Coded Result Value | Coded qualitative result value (e.g., Positive, Negative). | PHVS_PosNegUnk_CDC | ||
| Organism Name | The Organism (i.e., species and serovar) name as a test result. This element is used when the result was reported as an organism. | PHVS_Microorganism_CDC | ||
| Lab Result Text Value | Textual result value, used if result is neither numeric nor coded. | |||
| Result Status | The Result Status is the degree of completion of the lab test. | PHVS_ObservationResultStatus_HL7_2x | ||
| Specimens to CDC | Were specimens or isolates sent to CDC for testing? | PHVS_YesNoUnknown_CDC | ||
| Exposures | Describe exposures to water, animals, or wet soil which the subject had in the 30 days prior to illness onset | |||
| Animal contact | Select which animals the subject has had contact with in the 30 days prior to illness onset, if any ("Farm livestock", "Wildlife", "Dogs", "Rodents", "Other", "No known contact", "Unknown") | |||
| Livestock contact | If the subject had contact with livestock, specify the animal(s) | |||
| Wildlife contact | If the subject had contact with wildlife, specify the animal(s) | |||
| Animal contact other | If animal contact is "Other", describe the animal(s) with which the subject has had contact | |||
| Animal contact location | If the subject had contact with animals, specify the grographic location where the contact occurred | |||
| Water contact | Select which water sources the subject has had contact with in the 30 days prior to illness onset, if any ("Standing fresh water (lake, pond, run-off)", "Flood water", "River", "Wet soil", "Sewage","Water sports", "Other", "No known contact", "Unknown") | |||
| Water contact other | If water contact is "Other", describe the water source(s) which the subject has had contact | |||
| Water contact location | If the subject had contact with water, specify the grographic location where the contact occurred | |||
| Contact Type | If subject had contact with animals, fresh water, or wet soil in the 30 days prior to illness onset, describe the type of contact ("Occupational", "Recreational", "Avocational", "Other") | |||
| Occupational contact | If type of contact with animals or water is "Occupational", select the occupational group ("Farmer (land)", "Farmer (animals)", "Fish worker", "Other", "Unknown") | |||
| Occupational contact other | If the occupational group through which the subject had contact with animals or water is "Other", describe the occupation | |||
| Recreational contact | If type of contact with animals or water is "Recreational", select the recreational activity ("Swimming", "Boating", "Outdoor competition", "Camping/hiking", "Hunting", "Other", "Unknown") | |||
| Recreational contact other | If the recreational activity through which the subject had contact with animals or water is "Other", describe the recreational activity | |||
| Avocational contact | If type of contact with animals or water is "Avocational", select the activity ("Gardening", "Pet-ownership", "Other", "Unknown") | |||
| Avocational contact other | If the Avocational activity through which the subject had contact with animals or water is "Other", describe the avocational activity | |||
| Contact Type Other | If Contact Type is "Other", describe the type of contact with animals, wet soil, or standing water | |||
| Rodent infested housing | Did the patient stay in housing with evidence of rodents in the 30 days prior to illness onset | PHVS_YesNoUnknown_CDC | ||
| Rural residence | Residence in rural area in the 30 days prior to illness onset | PHVS_YesNoUnknown_CDC | ||
| Hisotry of leptospirosis | Does the subject have a hisotry of leptospirosis? | PHVS_YesNoUnknown_CDC | ||
| Travel | Did the subject travel out of the county, state, or country in the 30 days prior to symptom onset? | PHVS_YesNoUnknown_CDC | ||
| Travel location | If the travel is "Yes", provide location(s) of travel in the 30 days prior to symptom onset | |||
| Rainfall | Was there heavy rainfall near the subjects place of residence, worksite, activities, or travel in the 30 days prior to symptom onset? | PHVS_YesNoUnknown_CDC | ||
| Flooding | Was there flooding near the subjects place of residence, worksite, activities, or travel in the 30 days prior to symptom onset? | PHVS_YesNoUnknown_CDC | ||
| Similar illness | Did the patient have similar exposures as a contact diagnosed with leptospirosis in the 30 day period | PHVS_YesNoUnknown_CDC | ||
| Outbreak | Is this patient part of an outbreak? | PHVS_YesNoUnknown_CDC | ||
| Case Outbreak Name | A state-assigned name for an indentified outbreak. | |||
| Person Reporting to CDC - Name | Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Person Reporting to CDC - Phone Number | Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Number of Weeks Gestation at Onset of Illness | If subject was pregnant at time of illness onset, specify the number of weeks gestation at onset of illness (1-45 weeks) | N/A | TBD | |
| Pregnancy Adverse Outcome | If subject was pregnant at time of illness, did the subject have any adverse outcome to the pregnancy (e.g. miscarriage, stillbirth, neonatal illness or death) related to the illness? | PHVS_YesNoUnknown_CDC | TBD | |
| Clinical Manifestation Indicator | For each clinical manifestation reported, indicate (YNU) whether the subject developed the specified manifestation as a result of the illness. | PHVS_YesNoUnknown_CDC | TBD | |
| Medication | What antibiotics were prescribed/administered to the patient for treatment of this illness? | PHVS_YesNoUnknown_CDC | TBD | |
| Hospital Procedure | If subject was hospitalized, were any of the following procedures or treatments done? | N/A | TBD | |
| Sick Animal | Were any animals sick at the time of contact? | PHVS_YesNoUnknown_CDC | TBD | |
| Sick Animal Specified | Specify the sick animal/s the patient had contact with at this location | N/A | TBD | |
| Drinking or Bathing Usage | Did the subject use well water or rainwater collected in cisterns, drums, or other containers for drinking or bathing? | PHVS_YesNoUnknown_CDC | TBD | |
| Treated Well Water or Rainwater | If the subject used well water or collected rainwater for drinking or bathing, was the water boiled, chemically treated, or UV treated prior to use? | TBD | TBD | |
| Flooding Location | Flooding Location | Specify the location where flooding occurred | TBD | |
| Pre-existing conditions | Does the patient have any of the following pre-existing medical conditions? | TBD | TBD | |
| Work Location State | Indicate the state where the subject’s workplace is located | PHVS_State_FIPS_5-2 | TBD | |
| Work Location City | Indicate the city where the subject’s workplace is located | N/A | TBD | |
| Work Location Zip | Indicate the zip code where the subject’s workplace is located | N/A | TBD | |
| Open Wounds | Did the subject have any open wounds or cuts in the 30 days prior to illness onset? | PHVS_YesNoUnknown_CDC | TBD | |
| Type of Rodent | If the subject saw rodents in the 30 days prior to illness onset, what type of rodent(s) were seen? | TBD | TBD | |
| Highest Titer Serovar(s) | If the Microscopic Agglutination Test (MAT) was performed, specify the serovar(s) with the highest titer. | N/A | TBD | |
| Contact with Sewage | Did the subject have contact with sewage in the 30 days prior to illness onset? | PHVS_YesNoUnknown_CDC | TBD | |
| Activity Type | Indicate the types of activity that led to the selected animal, water or mud contact. Multiple activities can be selected for the type of exposure. | TBD | TBD | |
| Exposure Location City | Indicate the county where the selected exposure occurred | N/A | TBD | |
| Exposure Location State | Indicate the state where the selected exposure occurred | PHVS_State_FIPS_5-2 | TBD | |
| Exposure Location Country | Indicate the country where the selected exposure occurred | N/A | TBD | |
| Exposure Location | Indicate the specific location where exposure occurred (e.g. home, work, name of park, name of lake) | N/A | TBD | |
| Patient Address City | Patient Address City | N/A | 2 | |
| Immunocompromised Associated Condition or Treatment | If the patient has an immunosuppressive condition, specify the condition. | N/A | 3 | |
| Days Missed Due to Illness | Number of days of work or school the patient missed due to this illness? | N/A | 3 | |
| Container Lid | If the subject had contact with well water, cistern water, or rainwater collected in a drum or other container, did the well, cistern or other container have a lid? | PHVS_YesNoUnknown_CDC | 3 | |
| Rodent Location | Where did the subject see rodents or evidence of rodents? | TBD | 3 | |
| Travel Outside USA Prior to Illness Onset within Program Specific Timeframe | Did the subject travel internationally in the six months prior to illness onset? | PHVS_YesNoUnknown_CDC | 2 | |
| Did the Case Travel Domestically Prior to Illness Onset | Did the subject travel domestically in the six months prior to illness onset? | 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 | 3 | |
| International Destination(s) of Recent Travel | International destination or countries the subject traveled to | PHVS_Country_ISO_3166-1 | 2 | |
| Travel State | Domestic destination, state(s) traveled to | PHVS_State_FIPS_5-2 | 2 | |
| 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 |
| 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) |
| CaseId | ID assigned by database | |||
| CdcId | ID assigned by CDC | |||
| ReportStatus | Status of report | |||
| FormVersion | Version of form | |||
| FoodNetID | The FoodNet ID for the imported report (if applicable) | |||
| CaseStateID | The State Epi ID to identify the report being imported. | |||
| CaseLocalID | The Local Epi ID to identify the report being imported. | |||
| Interviewer | The name of the interviewer. | |||
| SentLab | Was the isolate sent to the public health laboratory? | |||
| SentLabSpecify | If isolate not sent to state lab, why not and could it still be obtained? | |||
| DateCompletedBy | The date that the form was completed on. | |||
| Gender | Gender | |||
| City | The city of residence where the report/case originated. | |||
| ResidenceCounty | The county of residence where the report/case originated. | |||
| State of Residence | The state of residence where the report/case originated. | |||
| Age | Age of case-patient. | |||
| DateOfBirth | Date of birth | |||
| Ethnicity | Is the case-patient of Hispanic, Latino, or Spanish origin? | |||
| HispanicMexican | Mexican, Mexican American, Chicano | |||
| HispanicPuertoRican | Puerto Rican | |||
| HispanicCuban | Cuban | |||
| HispanicOther | Another Hispanic, Latino, or Spanish Origin | |||
| HispanicSpecify | If another Hispanic, Latino, or Spanish origin, specify. | |||
| HispanicUnknown | Unknown Hispanic ancestry/declined to specify | |||
| RaceAfricanAmerican_Black | African American/Black | |||
| RaceAsian | Asian | |||
| RaceAsianIndian | Asian Indian | |||
| RaceAsianChinese | Chinese | |||
| RaceAsianFilipino | Filipino | |||
| RaceAsianJapanese | Japanese | |||
| RaceAsianKorean | Korean | |||
| RaceAsianVietnamese | Vietnamese | |||
| RaceAsianOther | Other Asian | |||
| RaseAsianOtherSpecify | Other Asian, specify | |||
| RaceNativeHawaiian_OtherPacificIslander | Native Hawaiian or Other Pacific Islander | |||
| RacePacificIslanderHawaiian | Native Hawaiian | |||
| RacePacificIslanderGuamanian | Guamanian or Chamorro | |||
| RacePacificIslanderSomoan | Samoan | |||
| RacePacificIslanderOther | Other Pacific Islander | |||
| RaceNativeAmerican | Native American or Alaska Native | |||
| RaceWhite | White | |||
| RaceWhiteMidEast | Middle Eastern/North African | |||
| RaceWhiteNotMidEast | Not Middle Eastern/North African | |||
| RaceUnknown | Unknown Race | |||
| RaceOther | Other Race | |||
| RaceOtherSpecify | Other Race Specify | |||
| RaceDecline | Declined to answer race question(s) | |||
| Pregnancy | Is Listeria case associate with pregnancy? | |||
| BloodNP | Not Pregnant: Type of specimen that grew Listeria. - Blood | |||
| BloodNPDate | Not Pregnant: Specimen collection date. - Blood | |||
| BloodNPIDNumber | Not Pregnant: State public health lab isolate ID #. - Blood | |||
| CSFNP | Not Pregnant: Type of specimen that grew Listeria. - CSF | |||
| CSFNPDate | Not Pregnant: Specimen collection date. - CSF | |||
| CSFNPIDNumber | Not Pregnant: State public health lab isolate ID #. - CSF | |||
| OtherNP | Not Pregnant: Type of specimen that grew Listeria. - Other | |||
| OtherNPSpec | Not Pregnant: Specify other type of specimen that grew Listeria. | |||
| OtherNPDate | Not Pregnant: Specimen collection date. - Other | |||
| OtherNPIDNumber | Not Pregnant: State public health lab isolate ID #. - Other | |||
| OtherNP2 | Not Pregnant: Type of specimen that grew Listeria. - Other | |||
| OtherNP2Spec | Not Pregnant: Specify other type of specimen that grew Listeria. | |||
| OtherNP2Date | Not Pregnant: Specimen collection date. - Other | |||
| OtherNP2IDNumber | Not Pregnant: State public health lab isolate ID #. - Other | |||
| NPSpecimenFlag | Not Pregnant: Other flag | |||
| BacteremiaNP | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Bloodstream infection/sepsis | |||
| MeningitisNP | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Meningitis | |||
| NpListeriaIllnessMeningo | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Meningoencephalitis | |||
| FebrileGastroenteritisNP | Type of illness-Febrile gastroenteritis, non-pregnant case | |||
| NpListeriaIllnessBrain | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Brain abscess | |||
| NpListeriaIllnessRhomb | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Rhombencephalitis | |||
| NpListeriaIllnessPer | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Peritonitis | |||
| NpListeriaIllnessPneu | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Pneumonia | |||
| NPListeriaIllnessWound | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Wound infection | |||
| NpListeriaIllnessJoint | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Joint infection/septic arthritis | |||
| NPListeriaIllnessBone | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Bone infection/osteomyelitis | |||
| OtherIllnessNP | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Other illness | |||
| OtherIllnessNPSpec | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Other illness specify | |||
| UnknownNP | Not Pregnant: Did patient have any types of illnesses related to the Listeria infection? - Unknown | |||
| HospitalizedNP | Not Pregnant: Was patient hospitalized for listeriosis? | |||
| AdmitNP | Not Pregnant: If patient hospitalized for listeriosis, admit date. | |||
| DischargeNP | Not Pregnant: If patient hospitalized for listeriosis, discharge date. | |||
| StillhospitalizedNP | Not Pregnant: If patient hospitalized for listeriosis, still hospitalized? | |||
| NPHospitalizedListeriosisStillDate | Not Pregnant: If patient hospitalized for listeriosis, still hospitalized last date. | |||
| OutcomeNP | Not Pregnant: Did the patient survive? | |||
| NPOutcomeDied | Not Pregnant: If the patient died, what was the date? | |||
| NPOutcomeListeriosisDeathCert | Not Pregnant: If died, was listeriosis or Listeria infection listed on death certificate? | |||
| NPOutcomeLastAlive | Not Pregnant: If survived, last known date alive. | |||
| BloodMotherAP | Pregnant: Type of specimen that grew Listeria. - Blood from mother | |||
| BloodMotherAPDate | Pregnant: Specimen collection date. -Blood from mother | |||
| BloodMotherAPIDNumber | Pregnant: State public health lab isolate ID #. - Blood from mother | |||
| BloodNeonateAP | Pregnant: Type of specimen that grew Listeria. - Blood from neonate | |||
| BloodNeonateAPDate | Pregnant: Specimen collection date. - Blood from neonate | |||
| BloodNeonateAPIDNumber | Pregnant: State public health lab isolate ID #. - Blood from neonate | |||
| CSFMotherAP | Pregnant: Type of specimen that grew Listeria. - CSF from mother | |||
| CSFMotherAPDate | Pregnant: Specimen collection date. - CSF from mother | |||
| CSFMotherAPIDNumber | Pregnant: State public health lab isolate ID #. - CSF from mother | |||
| CSFNeonateAP | Pregnant: Type of specimen that grew Listeria. - CSF from neonate | |||
| CSFNeonateAPDate | Pregnant: Specimen collection date. - CSF from neonate | |||
| CSFNeonateAPIDNumber | Pregnant: State public health lab isolate ID #. - CSF from neonate | |||
| PlacentaAP | Pregnant: Type of specimen that grew Listeria. - Placenta | |||
| PlacentaAPDate | Pregnant: Specimen collection date. - Placenta | |||
| PlacentaAPIDNumber | Pregnant: State public health lab isolate ID #. - Placenta | |||
| AmnioticAP | Pregnant: Type of specimen that grew Listeria. - Amniotic Fluid | |||
| AmnioticAPDate | Pregnant: Specimen collection date. - Amniotic fluid | |||
| AmnioticAPIDNumber | Pregnant: State public health lab isolate ID #. - Amniotic fluid | |||
| PrSpecimenTypeFetal | Pregnant: Type of specimen that grew Listeria. -Fetal tissue | |||
| PrSpecimenCollectionFetal | Pregnant: Specimen collection date. - Fetal tissue | |||
| PrSpecimenIsolateIDFetal | Pregnant: State public health lab isolate ID #. - Fetal tissue | |||
| OtherAP | Pregnant: Type of specimen that grew Listeria. - Other | |||
| OtherAPSpec | Pregnant: Specify other type of specimen that grew Listeria. - Other | |||
| OtherAPDate | Pregnant: Specimen collection date. - Other | |||
| OtherAPIDNumber | Pregnant: State public health lab isolate ID #. - Other | |||
| Other2AP | Pregnant: Type of specimen that grew Listeria. - Other | |||
| Other2APSpec | Pregnant: Specify other type of specimen that grew Listeria. - Other | |||
| Other2APDate | Pregnant: Specimen collection date. -Other | |||
| Other2APIDNumber | Pregnant: State public health lab isolate ID #. - Other | |||
| APSpecimenFlag | Pregnant: Other flag | |||
| OutsideUSSpecify | If born outside of the US, specify where. | |||
| BornInUS | Denotes that the <case> was born inside the United States. | |||
| OutsideUS | Denotes that the <case> was born outside the United States. | |||
| PrimaryLanguage | Primary language of the <case>, either english, spanish, other (specify) or unknown. | |||
| PrimaryLanguageSpecify | Specify the primary language if it is not available in the original list. | |||
| YearCametoUS | If born outside of the US, specify the year <case> arrived. | |||
| CDC_EFORSID | CDC EFORS ID | |||
| BloodNPLab | Lab submitting blood specimen, non-pregnant case | |||
| CSFNPLab | Lab submitting CSF specimen, non-pregnant case | |||
| OtherNP2Lab | Lab submitting other specimen 2, non-pregnant case | |||
| OtherNPLab | Lab submitting other specimen, non-pregnant case | |||
| StoolNP | Stool specimen grew Listeria, non-pregnant case | |||
| StoolNPDate | Date stool specimen collected, non-pregnant case | |||
| StoolNPLab | Lab submitting stool specimen, non-pregnant case | |||
| StoolNPIDNumber | State public health isolate ID number, stool, non-pregnant case | |||
| BloodMotherAPLab | Lab submitting blood specimen from mother, pregnancy-associated case | |||
| BloodNeonateAPLab | Lab submitting blood specimen from neonate, pregnancy-associated case | |||
| CSFMotherAPLab | Lab submitting CSF specimen from mother, pregnancy-associated case | |||
| CSFNeonateAPLab | Lab submitting CSF specimen from neonate, pregnancy-associated case | |||
| StoolMotherAP | Stool specimen from mother grew Listeria, pregnancy-associated case | |||
| StoolMotherAPDate | Date stool specimen from mother collected, pregnancy-associated case | |||
| StoolMotherAPLab | Lab submitting stool specimen from mother, pregnancy-associated case | |||
| StoolMotherAPIDNumber | State public health isolate ID number, stool specimen from mother, pregnancy-associated case | |||
| PlacentaAPLab | Lab submitting placenta specimen, pregnancy-associated case | |||
| AmnioticAPLab | Lab submitting amniotic fluid specimen, pregnnacy-associated case | |||
| OtherAPLab | Lab submitting other specimen, pregnancy-associated case | |||
| None | Underlying conditions and treatments. - None | |||
| Cancer | Underlying conditions and treatments. - Cancer | |||
| Leukemia | If Cancer, Leukemia | |||
| Lymphoma | If Cancer, Lymphoma | |||
| Hodgkins | If Lymphoma, Hodgkins | |||
| NonHodgkins | If Lymphoma, Non-Hodgkins | |||
| MultipleMyeloma | If Cancer, Multiple Myeloma | |||
| Myeloproliferative | If Cancer, Myeloproliferative disorder | |||
| OtherCancer | If Cancer, Other cancer | |||
| OtherCancerSpecify | If Other Cancer, specify other cancer | |||
| KidneyDialysis | Underlying conditions and treatments. - Kidney dialysis | |||
| CirrhosisLiverDisease | Underlying conditions and treatments. - Cirrhosis/advanced liver disease | |||
| COPD | Underlying conditions and treatments. - Chronic Obstructive Pulmonary Disease | |||
| HeartDisease | Underlying conditions and treatments. - Heart Disease | |||
| HeartDiseaseSpecify | If Heart Disease, specify heart disease | |||
| OrganTransplant | Underlying conditions and treatments. - Organ transplant | |||
| OrganTransplantSpecify | If Organ Transplant, specify organ | |||
| Unknown | Underlying conditions and treatments. - Unknown | |||
| OtherConditions | Underlying conditions and treatments. - Other conditions | |||
| Crohns | Underlying conditions and treatments. - Crohn's | |||
| Diabetes | Underlying conditions and treatments. - Diabetes mellitus | |||
| DiabetesTypeI | If Diabetes mellitus, Type 1 | |||
| DiabetesTypeII | If Diabetes mellitus, Type 2 | |||
| GiantCell | Underlying conditions and treatments. - Giant cell arteritis | |||
| Hemochromatosis | Underlying conditions and treatments. - Hemochromatosis/iron overload | |||
| HIV_AIDS | Underlying conditions and treatments. - HIV/AIDS | |||
| HIV | If HIV/AIDS, HIV (no AIDS) | |||
| AIDS | If HIV/AIDS, AIDS | |||
| Lupus | Underlying conditions and treatments. - Lupus | |||
| RheumatoidArthritis | Underlying conditions and treatments. - Rheumatoid arthritis | |||
| Sarcoidosis | Underlying conditions and treatments. - Sarcoidosis | |||
| SickleCell | Underlying conditions and treatments. - Sickle cell disease | |||
| Splenectomy | Underlying conditions and treatments. - Splenectomy/asplenia | |||
| UlcerativeColitis | Underlying conditions and treatments. - Unlcerative colitis | |||
| Other1 | Underlying conditions and treatments. - Other condition | |||
| Other1Spec | If Other Condition, specify other conditions | |||
| Cond_Pregnancy | Underlying conditions and treatments. - Pregnancy | |||
| ImmunosuppressiveMed | Underlying conditions and treatments. - Immunosuppressive medication | |||
| Steroids | If Immunosuppressive medication, Corticosteroids/steroids | |||
| CancerChemotherapy | If Immunosuppressive medication, Cancer chemotherapy | |||
| OtherImmunosuppresive | If Immunosuppressive medication, Other immunosuppressive therapy | |||
| OtherImmunoSpecify | If Other Immunosuppressive therapy, specify therapy | |||
| Alcohol | Underlying conditions and treatments. - Excessive alcohol use | |||
| IDU | Underlying conditions and treatments. - Injection drug user | |||
| Antacids | Underlying conditions and treatments. - Medications that suppress stomach acid | |||
| AntacidsSpecify | If Medications that suppress stomach acid, specify medications | |||
| InterviewPatientAble | Was patient or surrogate able to be interviewed? | |||
| InterviewPatientReason | If patient or surrogate was not interviewed, why not? | |||
| InterviewPatientReasonSpecify | Other reason patient or surrogate was not interviewed. | |||
| StomachUlcers | StomachUlcers | |||
| Arthritis | Arthritis | |||
| KidneyDisease | KidneyDisease | |||
| StomachSurgery | StomachSurgery | |||
| Hypertension | Hypertension | |||
| ESRD | ESRD | |||
| ChronicDiarrhea | ChronicDiarrhea | |||
| Comments | Comments | |||
| Underlying | Underlying | |||
| Radiation | Radiation | |||
| Antibiotics | Antibiotics | |||
| Other2 | Other symptoms | |||
| Other3 | Name of store/restaurant/other venue where soft white cheese purchased 3 | |||
| Other4 | Name of store/restaurant/other venue where soft white cheese purchased 4 | |||
| Other5 | Name of store/restaurant/other venue where soft white cheese purchased 5 | |||
| Other2Spec | Other 2 specify | |||
| Other3Spec | Other 3 specify | |||
| Other4Spec | Other 4 specify | |||
| Other5Spec | Other 5 specify | |||
| PrInfant1PregnancyOutcome | Pregnant: Infant 1 pregnancy outcome. | |||
| PrInfant1GestationWeeks | Pregnant: Infant 1 weeks of gestation. | |||
| PrInfant1DeliveryType | Pregnant: Infant 1 delivery type. | |||
| PrInfant1PregnancyOutcomeDate | Pregnant: Infant 1 pregnancy outcome date. | |||
| PrInfant1PregnancyOutcomeOtherSpecify | Pregnant: Specify other outcome of pregnancy for infant 1? | |||
| PrInfant2PregnancyOutcome | Pregnant: Infant 1 pregnancy outcome. | |||
| PrInfant2GestationWeeks | Pregnant: Infant 1 weeks of gestation. | |||
| PrInfant2DeliveryType | Pregnant: Infant 1 delivery type. | |||
| PrInfant2PregnancyOutcomeDate | Pregnant: Infant 1 pregnancy outcome date. | |||
| PrInfant2PregnancyOutcomeOtherSpecify | Pregnant: Specify other outcome of pregnancy for infant 1? | |||
| PrMotherIllnessFever | Pregnant: Type(s) of illness in mother.-Fever | |||
| PrMotherIllnessBacteremia | Pregnant: Type(s) of illness in mother.-Bacteremia/sepsis | |||
| PrMotherIllnessMeningitis | Pregnant: Type(s) of illness in mother.-Meningitis | |||
| PrMotherIllnessAmnionitis | Pregnant: Type(s) of illness in mother.-Amnionitis | |||
| PrMotherIllnessFlu | Pregnant: Type(s) of illness in mother.-Non-specific flu-like illness | |||
| PrMotherIllnessNone | Pregnant: Type(s) of illness in mother.-None | |||
| PrMotherIllnessOther | Pregnant: Type(s) of illness in mother.-Other | |||
| PrMotherIllnessOtherSpecify | Pregnant: If Other Illness, specify | |||
| PrMotherIlnnessUnknown | Pregnant: Type(s) of illness in mother.-Unknown | |||
| PrMotherHospLst | Pregnant: Was mother hospitalized for listeriosis? | |||
| PrMotherHospListAdmit | Pregnant: If mother was hospitalized for listeriosis, admit date. | |||
| PrMotherHospDischarge | Pregnant: If mother was hospitalized for listeriosis, discharge date. | |||
| PrMotherHospListStill | Pregnant: If mother was hospitalized for listeriosis, still hopsitalized? | |||
| PrMotherHospListHospital | Pregnant: If mother was hospitalized for listeriosis, name of hospital. | |||
| PrMotherOutcomeSurvived | Pregnant: Did the mother survive? | |||
| PrMotherOutcomeLastAlive | Pregnant: If the mother survived, last known date alive. | |||
| PrMotherOutcomeDeathCert | Pregnant: If the mother died, was listeriosis or Listeria infection listed on death certificate? | |||
| PrInfant1IllnessBacteremia | Pregnant: Type(s) of illness in infant 1.-Bacteremia/sepsis | |||
| PrInfant1IllnessMeningitis | Pregnant: Type(s) of illness in infant 1.-Meningitis | |||
| PrInfant1IllnessPneumonia | Pregnant: Type(s) of illness in infant 1.-Pneumonia | |||
| PrInfant1IllnessNone | Pregnant: Type(s) of illness in infant 1.-None | |||
| PrInfant1IllnessOther | Pregnant: Type(s) of illness in infant 1.-Other | |||
| PrInfant1IllnessSpecify | Pregnant: Specify other type(s) of illness in infant 1. | |||
| PrInfant1IllnessUnknown | Pregnant: Type(s) of illness in infant 1.-Unknown | |||
| PrInfant1Delivered | Pregnant: Where was infant 1 delivered? | |||
| PrInfant1DeliveredAdmit | Pregnant: If infant 1 was delivered at a hospitalized, admit date. | |||
| PrInfant1DeliveredDischarge | Pregnant: If infant 1 was delivered at a hospitalized, discharge date. | |||
| PrInfant1DeliveredStill | Pregnant: If infant 1 was delivered at a hospitalized, still hopsitalized? | |||
| PrInfant1DeliveredHospital | Pregnant: If infant 1 was hospitalized for listeriosis, name of hospital. | |||
| PrInfant1OutcomeSpecify | Pregnant: Specify other location where infant 1 was delivered? | |||
| PrInfant1HospList | Pregnant: Was infant 1 hospitalized for listeriosis? | |||
| PrInfant1HospListAdmit | Pregnant: If infant 1 was hospitalized for listeriosis, admit date. | |||
| PrInfant1HospListDischarge | Pregnant: If infant 1 was hospitalized for listeriosis, discharge date. | |||
| PrInfant1HospStill | Pregnant: If infant 1 was hospitalized for listeriosis, still hopsitalized? | |||
| PrInfant1OutcomeSurvived | Pregnant: Did infant 1 survive? | |||
| PrInfant1OutcomeLastAlive | Pregnant: If infant 1 survived, last known date alive. | |||
| PrInfant1OutcomeDeathCert | Pregnant: If infant 1 died, was listeriosis or Listeria infection listed on death certificate? | |||
| PrInfant2IllnessBacteremia | Pregnant: Type(s) of illness in infant 2.-Bacteremia/sepsis | |||
| PrInfant2IllnessMeningitis | Pregnant: Type(s) of illness in infant 2.-Meningitis | |||
| PrInfant2IllnessPneumonia | Pregnant: Type(s) of illness in infant 2.-Pneumonia | |||
| PrInfant2IllnessNone | Pregnant: Type(s) of illness in infant 2.-None | |||
| PrInfant2IllnessOther | Pregnant: Type(s) of illness in infant 2.-Other | |||
| PrInfant2IllnessSpecify | Pregnant: Specify other type(s) of illness in infant 2. | |||
| PrInfant2IllnessUnknown | Pregnant: Type(s) of illness in infant 2.-Unknown | |||
| PrInfant2Delivered | Pregnant: Where was infant 2 delivered? | |||
| PrInfant2DeliveredAdmit | Pregnant: If infant 2 was delivered at a hospitalized, admit date. | |||
| PrInfant2DeliveredDischarge | Pregnant: If infant 2 was delivered at a hospitalized, discharge date. | |||
| PrInfant2DeliveredStill | Pregnant: If infant 2 was delivered at a hospitalized, still hopsitalized? | |||
| PrInfant2DeliveredHospital | Pregnant: If infant 2 was hospitalized for listeriosis, name of hospital. | |||
| PrInfant2OutcomeSpecify | Pregnant: Specify other location where infant 2 was delivered? | |||
| PrInfant2HospList | Pregnant: Was infant 2 hospitalized for listeriosis? | |||
| PrInfant2HospListAdmit | Pregnant: If infant 2 was hospitalized for listeriosis, admit date. | |||
| PrInfant2HospListDischarge | Pregnant: If infant 2 was hospitalized for listeriosis, discharge date. | |||
| PrInfant2HospListStill | Pregnant: If infant 2 was hospitalized for listeriosis, still hopsitalized? | |||
| PrInfant2OutcomeSurvived | Pregnant: Did infant 2 survive? | |||
| PrInfant2OutcomeLastAlive | Pregnant: If infant 2 survived, last known date alive. | |||
| PrInfant2OutcomeDeathCert | Pregnant: If infant 2 died, was listeriosis or Listeria infection listed on death certificate? | |||
| PrMotherIllnessGastroenteritis | Pregnant: Type(s) of illness in mother.-Gastroenteritis | |||
| PrInfant1IllnessGranulomatosis | Pregnant: Type(s) of illness in infant1.-Granulomatosis | |||
| PrInfant2IllnessGranulomatosis | Pregnant: Type(s) of illness in infant2.-Granulomatosis | |||
| InterviewDate | Date of patient interview. | |||
| Interviewee | Respondent of the patient interview. | |||
| Relationship | If respondent was surrogate, relationship to patient. | |||
| OtherRelationshipSpecify | If respondent was surrogate, relationship to patient specify other. | |||
| Onset | Date illness began. | |||
| IllnessBeginNotApplicable | Date illness began does not apply. | |||
| HospitalizedBefore | During the 4 weeks before illness/delivery date, was admitted to a hospital? | |||
| HAdmit | If admitted to a hospital, admission date. | |||
| HDischarge | If admitted to a hospital, discharge date. | |||
| Hname | If admitted to a hospital, hospital name. | |||
| StillHosp | If admitted to a hospital, still residing there? | |||
| NursingHomeBefore | During the 4 weeks before illness/delivery date, was admitted to a nursing home? | |||
| Admitdate | Date admitted to nursing home (if resident in 4 weeks prior to onset) | |||
| DischargeDate | Dicharge date from nursing home (if resident in 4 weeks prior to onset) | |||
| StillHosporNH | If admitted to a nursing home, still residing there? | |||
| NHName | If admitted to a nursing home, nursing home name. | |||
| TravelState | Did travel outside state of residence? | |||
| StatesVisited | If traveled outside state of residence, names of states. | |||
| TravelInternat | Did travel outside state of the U.S.? | |||
| Countries | If traveled outside U.S., names of countries. | |||
| DateDepart | If traveled outside U.S., departure date. | |||
| DateReturn | If traveled outside U.S., return date. | |||
| Fever | Patient symptom name associated with illness.-Fever | |||
| Chills | Patient symptom name associated with illness.-Chills | |||
| Diarrhea | Patient symptom name associated with illness.-Diarrhea | |||
| Vomiting | Patient symptom name associated with illness.-Vomitting | |||
| PretermLabor | Patient symptom name associated with illness.-Preterm labor | |||
| MuscleAches | Patient symptom name associated with illness.-Muscle Aches | |||
| Headache | Patient symptom name associated with illness.-Headache | |||
| StiffNeck | Patient symptom name associated with illness.-Stiff neck | |||
| AlteredMental | Patient symptom name associated with illness.-Altered mental status | |||
| OtherSx1 | Patient symptom name associated with illness.-Other | |||
| OtherSx1Specify | Specify other patient symptom. | |||
| OtherSx2 | Patient symptom name associated with illness.-Other | |||
| OtherSx2Specify | Specify other patient symptom. | |||
| OtherSxFlag | Other symptom flag | |||
| TestDelivered | Illness/delivery date | |||
| _4weeksbefore | 4-week start date | |||
| SpecCollection | 4-week end date | |||
| HasAllergies | Whether or not <case> had allergies that prevented <case> from eating certain foods. | |||
| Milk | The name of the food that <case> has allergies toward.-Milk | |||
| Eggs | The name of the food that <case> has allergies toward.-Eggs | |||
| Peanuts | The name of the food that <case> has allergies toward.-Peanuts | |||
| TreeNuts | The name of the food that <case> has allergies toward.-Tree Nuts | |||
| Fish | The name of the food that <case> has allergies toward.-Fish | |||
| Soy | The name of the food that <case> has allergies toward.-Soy | |||
| Wheat | The name of the food that <case> has allergies toward.-Wheat | |||
| Shellfish | The name of the food that <case> has allergies toward.-Shellfish | |||
| OtherAllergy | The name of the food that <case> has allergies toward.-Other | |||
| AllergySpecify | If Other (specify) was the given allergy, then specify allergy here. | |||
| HadVegetarianDiet | Whether or not <case> had a vegetarian or vegan diet. | |||
| Vegetarian | If yes to vegetarian or vegan diet, this denotes a vegetarian diet. | |||
| Vegan | If yes to vegetarian or vegan diet, this denotes a vegan diet. | |||
| HadRestrictedDiet | Whether or not <case> had a restricted diet. | |||
| DietDescription | A description of the restricted diet that <case> was on. | |||
| Grocery1 | The name of the store from which the food was acquired | |||
| Grocery1Address | The location of the store from which the food was acquired. | |||
| Grocery2 | The name of the store from which the food was acquired | |||
| Grocery2Address | The location of the store from which the food was acquired. | |||
| Grocery3 | The name of the store from which the food was acquired | |||
| Grocery3Address | The location of the store from which the food was acquired. | |||
| Grocery4 | The name of the store from which the food was acquired | |||
| Grocery4Address | The location of the store from which the food was acquired. | |||
| Grocery5 | The name of the store from which the food was acquired | |||
| Grocery5Address | The location of the store from which the food was acquired. | |||
| Grocery6 | The name of the store from which the food was acquired | |||
| Grocery6Address | The location of the store from which the food was acquired. | |||
| Grocery7 | The name of the store from which the food was acquired | |||
| Grocery7Address | The location of the store from which the food was acquired. | |||
| GroceryFlag | Grocery strore flag | |||
| ShopperCardReleased | Whether or not <case> agreed to release shopper card information. | |||
| ShopperCardStoreName1 | The name of the store associated with the shopper card information. | |||
| ShopperCardNumber1 | The number and/or characters that uniquely identify the shopper card. | |||
| ShopperCardStoreName2 | The name of the store associated with the shopper card information. | |||
| ShopperCardNumber2 | The number and/or characters that uniquely identify the shopper card. | |||
| ShopperCardStoreName3 | The name of the store associated with the shopper card information. | |||
| ShopperCardNumber3 | The number and/or characters that uniquely identify the shopper card. | |||
| ShopperCardNameFlag | Shopper card name flag | |||
| Restaurant1 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant1Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte1 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant1Date_1 | Restaurant 1 date 1 | |||
| Restaurant1Date_2 | Restaurant 1 date 2 | |||
| Restaurant1Date_3 | Restaurant 1 date 3 | |||
| Restaurant1Date_4 | Restaurant 1 date 4 | |||
| Restaurant1Date_5 | Restaurant 1 date 5 | |||
| Restaurant2 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant2Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte2 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant2Date_1 | Restaurant 2 date 1 | |||
| Restaurant2Date_2 | Restaurant 2 date 2 | |||
| Restaurant2Date_3 | Restaurant 2 date 3 | |||
| Restaurant2Date_4 | Restaurant 2 date 4 | |||
| Restaurant2Date_5 | Restaurant 2 date 5 | |||
| Restaurant3 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant3Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte3 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant3Date_1 | Restaurant 3 date 1 | |||
| Restaurant3Date_2 | Restaurant 3 date 2 | |||
| Restaurant3Date_3 | Restaurant 3 date 3 | |||
| Restaurant3Date_4 | Restaurant 3 date 4 | |||
| Restaurant3Date_5 | Restaurant 3 date 5 | |||
| Restaurant4 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant4Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte4 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant4Date_1 | Restaurant 4 date 1 | |||
| Restaurant4Date_2 | Restaurant 4 date 2 | |||
| Restaurant4Date_3 | Restaurant 4 date 3 | |||
| Restaurant4Date_4 | Restaurant 4 date 4 | |||
| Restaurant4Date_5 | Restaurant 4 date 5 | |||
| Restaurant5 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant5Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte5 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant5Date_1 | Restaurant 5 date 1 | |||
| Restaurant5Date_2 | Restaurant 5 date 2 | |||
| Restaurant5Date_3 | Restaurant 5 date 3 | |||
| Restaurant5Date_4 | Restaurant 5 date 4 | |||
| Restaurant5Date_5 | Restaurant 5 date 5 | |||
| Restaurant6 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant6Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte6 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant6Date_1 | Restaurant 6 date 1 | |||
| Restaurant6Date_2 | Restaurant 6 date 2 | |||
| Restaurant6Date_3 | Restaurant 6 date 3 | |||
| Restaurant6Date_4 | Restaurant 6 date 4 | |||
| Restaurant6Date_5 | Restaurant 6 date 5 | |||
| Restaurant7 | The name of the restaurant where <case> may have eaten. | |||
| Restaurant7Address | The location of the restaurant where <case> may have eaten. | |||
| RestaurantFoodsAte7 | The food that <case> may have eaten at the restaurant. | |||
| Restaurant7Date_1 | Restaurant 7 date 1 | |||
| Restaurant7Date_2 | Restaurant 7 date 2 | |||
| Restaurant7Date_3 | Restaurant 7 date 3 | |||
| Restaurant7Date_4 | Restaurant 7 date 4 | |||
| Restaurant7Date_5 | Restaurant 7 date 5 | |||
| RestaurantFlag | Reastaurant flag | |||
| OtherVenue1 | The name of the other location where <case> may have eaten. | |||
| OtherVenue1Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte1 | The food that <case> may have eaten at the other location. | |||
| OtherVenue1Date_1 | Other venue 1 date 1 | |||
| OtherVenue1Date_2 | Other venue 1 date 2 | |||
| OtherVenue1Date_3 | Other venue 1 date 3 | |||
| OtherVenue1Date_4 | Other venue 1 date 4 | |||
| OtherVenue1Date_5 | Other venue 1 date 5 | |||
| OtherVenue2 | The name of the other location where <case> may have eaten. | |||
| OtherVenue2Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte2 | The food that <case> may have eaten at the other location. | |||
| OtherVenue2Date_1 | Other venue 2 date 1 | |||
| OtherVenue2Date_2 | Other venue 2 date 2 | |||
| OtherVenue2Date_3 | Other venue 2 date 3 | |||
| OtherVenue2Date_4 | Other venue 2 date 4 | |||
| OtherVenue2Date_5 | Other venue 2 date 5 | |||
| OtherVenue3 | The name of the other location where <case> may have eaten. | |||
| OtherVenue3Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte3 | The food that <case> may have eaten at the other location. | |||
| OtherVenue3Date_1 | Other venue 3 date 1 | |||
| OtherVenue3Date_2 | Other venue 3 date 2 | |||
| OtherVenue3Date_3 | Other venue 3 date 3 | |||
| OtherVenue3Date_4 | Other venue 3 date 4 | |||
| OtherVenue3Date_5 | Other venue 3 date 5 | |||
| OtherVenue4 | The name of the other location where <case> may have eaten. | |||
| OtherVenue4Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte4 | The food that <case> may have eaten at the other location. | |||
| OtherVenue4Date_1 | Other venue 4 date 1 | |||
| OtherVenue4Date_2 | Other venue 4 date 2 | |||
| OtherVenue4Date_3 | Other venue 4 date 3 | |||
| OtherVenue4Date_4 | Other venue 4 date 4 | |||
| OtherVenue4Date_5 | Other venue 4 date 5 | |||
| OtherVenue5 | The name of the other location where <case> may have eaten. | |||
| OtherVenue5Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte5 | The food that <case> may have eaten at the other location. | |||
| OtherVenue5Date_1 | Other venue 5 date 1 | |||
| OtherVenue5Date_2 | Other venue 5 date 2 | |||
| OtherVenue5Date_3 | Other venue 5 date 3 | |||
| OtherVenue5Date_4 | Other venue 5 date 4 | |||
| OtherVenue5Date_5 | Other venue 5 date 5 | |||
| OtherVenue6 | The name of the other location where <case> may have eaten. | |||
| OtherVenue6Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte6 | The food that <case> may have eaten at the other location. | |||
| OtherVenue6Date_1 | Other venue 6 date 1 | |||
| OtherVenue6Date_2 | Other venue 6 date 2 | |||
| OtherVenue6Date_3 | Other venue 6 date 3 | |||
| OtherVenue6Date_4 | Other venue 6 date 4 | |||
| OtherVenue6Date_5 | Other venue 6 date 5 | |||
| OtherVenue7 | The name of the other location where <case> may have eaten. | |||
| OtherVenue7Address | The location of the other location where <case> may have eaten. | |||
| OtherLocationFoodsAte7 | The food that <case> may have eaten at the other location. | |||
| OtherVenue7Date_1 | Other venue 7 date 1 | |||
| OtherVenue7Date_2 | Other venue 7 date 2 | |||
| OtherVenue7Date_3 | Other venue 7 date 3 | |||
| OtherVenue7Date_4 | Other venue 7 date 4 | |||
| OtherVenue7Date_5 | Other venue 7 date 5 | |||
| OtherVenueFlag | Other venue 7 date 6 | |||
| OtherFoodDetails | Any other food items <case> ate that we didn't talk about already. | |||
| SeasonalFoodDetails | Any seasonal foods or special foods <case> ate during the last 4 weeks. | |||
| FarmersMarket1 | Name of delicatessen, small local market, other small shop, or farmers markets 1 | |||
| FarmersMarket1Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 1 | |||
| FarmersMarket2 | Name of delicatessen, small local market, other small shop, or farmers markets 2 | |||
| FarmersMarket2Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 2 | |||
| FarmersMarket3 | Name of delicatessen, small local market, other small shop, or farmers markets 3 | |||
| FarmersMarket3Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 3 | |||
| FarmersMarket4 | Name of delicatessen, small local market, other small shop, or farmers markets 4 | |||
| FarmersMarket4Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 4 | |||
| FarmersMarket5 | Name of delicatessen, small local market, other small shop, or farmers markets 5 | |||
| FarmersMarket5Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 5 | |||
| FarmersMarket6 | Name of delicatessen, small local market, other small shop, or farmers markets 6 | |||
| FarmersMarket6Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 6 | |||
| FarmersMarket7 | Name of delicatessen, small local market, other small shop, or farmers markets 7 | |||
| FarmersMarket7Address | Street address, city, county, state of delicatessen, small local market, other small shop, or farmers market 7 | |||
| FarmersMarketPurchase | Did you eat food purchased from any delicatessens, small local markets, other small shops, or farmers' markets during the 4 week period? | |||
| GroceryPurchase | Did you eat food purchased from any grocery stores during the 4 week time period | |||
| OtherVenuePurchase | Did you eat food purchased or obtained from any other venues, such as school cafeteria, concession stands, street vendors, institutions (e.g., hospital food), local farms, or private vendors during the 4 week period? | |||
| RestaurantPurchase | Did you eat food from any restaurants, including sit-down, fast-food, and take-out restaurants during the 4 week period? | |||
| InterviewInitials | Initials of interviewer | |||
| FoodComments | Interviewer comments on food consumption history | |||
| InterviewComments | General interviewer comments | |||
| IfEatenHam | Ham | |||
| DeliSlicedHam | Ham | |||
| DetailsHam | Ham | |||
| VenueHam | Ham | |||
| IfEatenBologna | Bologna | |||
| DeliSlicedBologna | Bologna | |||
| DetailsBologna | Bologna | |||
| VenueBologna | Bologna | |||
| IfEatenTurkeyBreast | Turkey breast | |||
| DeliSlicedTurkeyBreast | Turkey breast | |||
| DetailsTurkeyBreast | Turkey breast | |||
| VenueTurkeyBreast | Turkey breast | |||
| IfEatenChicken | Chicken deli meat | |||
| DeliSlicedChicken | Chicken deli meat | |||
| DetailsChicken | Chicken deli meat | |||
| VenueChicken | Chicken deli meat | |||
| IfEatenRoastBeef | Roast beef | |||
| DeliSlicedRoastBeef | Roast beef | |||
| DetailsRoastBeef | Roast beef | |||
| VenueRoastBeef | Roast beef | |||
| IfEatenPastrami | Pastrami | |||
| DeliSlicedPastrami | Pastrami | |||
| DetailsPastrami | Pastrami | |||
| VenuePastrami | Pastrami | |||
| IfEatenLiver | Liverwurst or braunschweiger | |||
| DeliSlicedLiver | Liverwurst or braunschweiger | |||
| DetailsLiver | Liverwurst or braunschweiger | |||
| VenueLiver | Liverwurst or braunschweiger | |||
| IfEatenPate | Pate or meat spread that was not canned | |||
| DetailsPate | Pate or meat spread that was not canned | |||
| VenuePate | Pate or meat spread that was not canned | |||
| IfEatenHeadCheese | Head cheese | |||
| DeliSlicedHeadCheese | Head cheese | |||
| DetailsHeadCheese | Head cheese | |||
| VenueHeadCheese | Head cheese | |||
| IfEatenPepperoni | Pepperoni | |||
| DeliSlicedPepperoni | Pepperoni | |||
| DetailsPepperoni | Pepperoni | |||
| VenuePepperoni | Pepperoni | |||
| IfEatenItalian | Any other Italian-style meats | |||
| DeliSlicedItalian | Any other Italian-style meats | |||
| DetailsItalian | Any other Italian-style meats | |||
| VenueItalian | Any other Italian-style meats | |||
| IfEatenOtherDeli | Other deli/luncheon meat | |||
| DeliSlicedOtherDeli | Other deli/luncheon meat | |||
| SpecifyOtherDeli | Other deli/luncheon meat | |||
| DetailsOtherDeli | Other deli/luncheon meat | |||
| VenueOtherDeli | Other deli/luncheon meat | |||
| IfEatenDeliMeat | Anything from deli area where meat is sliced | |||
| DeliSlicedDeliMeat | Anything from deli area where meat is sliced | |||
| SpecifyDeliMeat | Anything from deli area where meat is sliced | |||
| DetailsDeliMeat | Anything from deli area where meat is sliced | |||
| VenueDeliMeat | Anything from deli area where meat is sliced | |||
| IfEatenSausage | Precooked sausage | |||
| DetailsSausage | Precooked sausage | |||
| VenueSausage | Precooked sausage | |||
| IfEatenCookedChicken | Precooked chicken | |||
| DetailsCookedChicken | Precooked chicken | |||
| VenueCookedChicken | Precooked chicken | |||
| IfEatenCookedMeat | Other precooked meat | |||
| DetailsCookedMeat | Other precooked meat | |||
| VenueCookedMeat | Other precooked meat | |||
| SpecifyCookedMeat | Other precooked meat | |||
| IfEatenCured | Cured or dried meat | |||
| DetailsCured | Cured or dried meat | |||
| VenueCured | Cured or dried meat | |||
| IfEatenHotDog | Hot dogs | |||
| HotDogsHeated | Hot dogs | |||
| DetailsHotDog | Was hot dog heated prior to being eaten? | |||
| VenueHotDog | Hot dogs | |||
| IfEatenFrozenPoultry | Frozen processed poultry | |||
| DetailsFrozenPoultry | Frozen processed poultry | |||
| VenueFrozenPoultry | Frozen processed poultry | |||
| SpecifyFrozenPoultry | Frozen processed poultry | |||
| IfEatenGroundPoultry | Grounch chicken or turkey | |||
| DetailsGroundPoultry | Grounch chicken or turkey | |||
| VenueGroundPoultry | Grounch chicken or turkey | |||
| SpecifyGroundPoultry | Grounch chicken or turkey | |||
| BolognaOften | If ate bologna, how often? | |||
| BolognaDeli | Was bologna purchased at a deli/small market? | |||
| BolognaGrocery | Was bologna purchased at grocery store? | |||
| BolognaOther | Was bologna purchased at an other venue? | |||
| BolognaRestaurant | BolognaRestaurant | |||
| VenueBologna2 | VenueBologna2 | |||
| VenueBologna3 | VenueBologna3 | |||
| VenueBologna4 | VenueBologna4 | |||
| DetailsBologna2 | DetailsBologna2 | |||
| DetailsBologna3 | DetailsBologna3 | |||
| DetailsBologna4 | DetailsBologna4 | |||
| ChickenOften | ChickenOften | |||
| ChickenDeli | ChickenDeli | |||
| ChickenGrocery | ChickenGrocery | |||
| ChickenOther | ChickenOther | |||
| ChickenRestaurant | ChickenRestaurant | |||
| VenueChicken2 | VenueChicken2 | |||
| VenueChicken3 | VenueChicken3 | |||
| VenueChicken4 | VenueChicken4 | |||
| DetailsChicken2 | DetailsChicken2 | |||
| DetailsChicken3 | DetailsChicken3 | |||
| DetailsChicken4 | DetailsChicken4 | |||
| HamOften | If ate ham, how often? | |||
| HamDeli | Was ham purchased at a deli/small market ? | |||
| HamGrocery | Was ham purchased at a grocery store? | |||
| HamOther | Was ham purchased at an other venue? | |||
| HamRestaurant | HamRestaurant | |||
| VenueHam2 | VenueHam2 | |||
| VenueHam3 | VenueHam3 | |||
| VenueHam4 | VenueHam4 | |||
| DetailsHam2 | DetailsHam2 | |||
| DetailsHam3 | DetailsHam3 | |||
| DetailsHam4 | DetailsHam4 | |||
| OtherDeliOften | If at other deli meat, how often? | |||
| OtherDeliDeli | Was other deli meat purchased at a deli/small market? | |||
| OtherDeliGrocery | Was other deli meat purchased at a grocery store? | |||
| OtherDeliOther | Was other deli meat purchased at an other venue? | |||
| OtherDeliRestaurant | OtherDeliRestaurant | |||
| VenueOtherDeli2 | VenueOtherDeli2 | |||
| VenueOtherDeli3 | VenueOtherDeli3 | |||
| VenueOtherDeli4 | VenueOtherDeli4 | |||
| DetailsOtherDeli2 | DetailsOtherDeli2 | |||
| DetailsOtherDeli3 | DetailsOtherDeli3 | |||
| DetailsOtherDeli4 | DetailsOtherDeli4 | |||
| IfEatenOtherTurkey | IfEatenOtherTurkey | |||
| OtherTurkeyOften | OtherTurkeyOften | |||
| OtherTurkeyDeli | OtherTurkeyDeli | |||
| OtherTurkeyGrocery | OtherTurkeyGrocery | |||
| OtherTurkeyOther | OtherTurkeyOther | |||
| OtherTurkeyRestaurant | OtherTurkeyRestaurant | |||
| VenueOtherTurkey | VenueOtherTurkey | |||
| VenueOtherTurkey2 | VenueOtherTurkey2 | |||
| VenueOtherTurkey3 | VenueOtherTurkey3 | |||
| VenueOtherTurkey4 | VenueOtherTurkey4 | |||
| DetailsOtherTurkey | DetailsOtherTurkey | |||
| DetailsOtherTurkey2 | DetailsOtherTurkey2 | |||
| DetailsOtherTurkey3 | DetailsOtherTurkey3 | |||
| DetailsOtherTurkey4 | DetailsOtherTurkey4 | |||
| DeliSlicedOtherTurkey | DeliSlicedOtherTurkey | |||
| PastramiOften | If ate pastrami, how often? | |||
| PastramiDeli | Was pastrami purchased at a deli/small market? | |||
| PastramiGrocery | Was pastrami purchased at a grocery store? | |||
| PastramiOther | Was pastrami purchased at an other venue? | |||
| PastramiRestaurant | PastramiRestaurant | |||
| VenuePastrami2 | VenuePastrami2 | |||
| VenuePastrami3 | VenuePastrami3 | |||
| VenuePastrami4 | VenuePastrami4 | |||
| DetailsPastrami2 | DetailsPastrami2 | |||
| DetailsPastrami3 | DetailsPastrami3 | |||
| DetailsPastrami4 | DetailsPastrami4 | |||
| PateOften | If yes, how often was pate eaten? | |||
| PateDeli | Was pate purchased at a deli/small market? | |||
| PateGrocery | Was pate purchased at a grocery store? | |||
| PateOther | Was pate purchased at an other venue? | |||
| PateRestaurant | PateRestaurant | |||
| VenuePate2 | VenuePate2 | |||
| VenuePate3 | VenuePate3 | |||
| VenuePate4 | VenuePate4 | |||
| DetailsPate2 | DetailsPate2 | |||
| DetailsPate3 | DetailsPate3 | |||
| DetailsPate4 | DetailsPate4 | |||
| DeliSlicedPate | DeliSlicedPate | |||
| TurkeyBreastOften | TurkeyBreastOften | |||
| TurkeyBreastDeli | TurkeyBreastDeli | |||
| TurkeyBreastGrocery | TurkeyBreastGrocery | |||
| TurkeyBreastOther | TurkeyBreastOther | |||
| TurkeyBreastRestaurant | TurkeyBreastRestaurant | |||
| VenueTurkeyBreast2 | VenueTurkeyBreast2 | |||
| VenueTurkeyBreast3 | VenueTurkeyBreast3 | |||
| VenueTurkeyBreast4 | VenueTurkeyBreast4 | |||
| DetailsTurkeyBreast2 | DetailsTurkeyBreast2 | |||
| DetailsTurkeyBreast3 | DetailsTurkeyBreast3 | |||
| DetailsTurkeyBreast4 | DetailsTurkeyBreast4 | |||
| DeliSlicedHotDog | DeliSlicedHotDog | |||
| HotDogOften | If yes, how often did you eat hot dogs? | |||
| HotDogDeli | Were hotdogs purchased at a deli/small market? | |||
| HotDogGrocery | Were hotdogs purchased at a grocery store? | |||
| HotDogOther | Were hotdogs purchased at an other venue? | |||
| HotDogRestaurant | HotDogRestaurant | |||
| VenueHotDog2 | VenueHotDog2 | |||
| VenueHotDog3 | VenueHotDog3 | |||
| VenueHotDog4 | VenueHotDog4 | |||
| DetailsHotDog2 | DetailsHotDog2 | |||
| DetailsHotDog3 | DetailsHotDog3 | |||
| DetailsHotDog4 | DetailsHotDog4 | |||
| IfEatenSprouts | IfEatenSprouts | |||
| DetailsSprouts | DetailsSprouts | |||
| VenueSprouts | VenueSprouts | |||
| IfEatenBean | Sprouts: Bean | |||
| DetailsBean | Sprouts: Bean | |||
| VenueBean | Sprouts: Bean | |||
| IfEatenAlfalfa | Sprouts:Alfalfa | |||
| DetailsAlfalfa | Sprouts:Alfalfa | |||
| VenueAlfalfa | Sprouts:Alfalfa | |||
| IfEatenClover | Sprouts:Clover | |||
| DetailsClover | Sprouts:Clover | |||
| VenueClover | Sprouts:Clover | |||
| IfEatenRadish | Sprouts:Radish | |||
| DetailsRadish | Sprouts:Radish | |||
| VenueRadish | Sprouts:Radish | |||
| IfEatenBroccoli | Sprouts:Broccoli | |||
| DetailsBroccoli | Sprouts:Broccoli | |||
| VenueBroccoli | Sprouts:Broccoli | |||
| IfEatenMixed | Sprouts:Mixed | |||
| DetailsMixed | Sprouts:Mixed | |||
| VenueMixed | Sprouts:Mixed | |||
| IfEatenOtherSprout | Sprouts:Other | |||
| DetailsOtherSprout | Sprouts:Other | |||
| VenueOtherSprout | Sprouts:Other | |||
| SpecifyOtherSprout | Sprouts:Other | |||
| IfEatenCucumber | Cucumber | |||
| DetailsCucumber | Cucumber | |||
| VenueCucumber | Cucumber | |||
| IfEatenPea | Pea pods/snap peas/snow peas | |||
| DetailsPea | Pea pods/snap peas/snow peas | |||
| VenuePea | Pea pods/snap peas/snow peas | |||
| IfEatenSweetPepper | Sweet peppers | |||
| DetailsSweetPepper | Sweet peppers | |||
| VenueSweetPepper | Sweet peppers | |||
| IfEatenHotPepper | Hot chili peppers | |||
| DetailsHotPepper | Hot chili peppers | |||
| VenueHotPepper | Hot chili peppers | |||
| IfEatenScallion | Green onions or scallions | |||
| DetailsScallion | Green onions or scallions | |||
| VenueScallion | Green onions or scallions | |||
| IfEatenCelery | Celery | |||
| DetailsCelery | Celery | |||
| VenueCelery | Celery | |||
| IfEatenCarrot | Mini-carrots | |||
| DetailsCarrot | Mini-carrots | |||
| VenueCarrot | Mini-carrots | |||
| IfEatenMushroom | Fresh mushrooms | |||
| DetailsMushroom | Fresh mushrooms | |||
| VenueMushroom | Fresh mushrooms | |||
| IfEatenPreCutVeg | Pre-cut raw vegetables or vegetabel mixes | |||
| SpecifyPreCutVeg | Pre-cut raw vegetables or vegetabel mixes | |||
| DetailsPreCutVeg | Pre-cut raw vegetables or vegetabel mixes | |||
| VenuePreCutVeg | Pre-cut raw vegetables or vegetabel mixes | |||
| IfEatenBasil | Fresh basil | |||
| DetailsBasil | Fresh basil | |||
| VenueBasil | Fresh basil | |||
| IfEatenCilantro | Fresh cilantro | |||
| DetailsCilantro | Fresh cilantro | |||
| VenueCilantro | Fresh cilantro | |||
| IfEatenParsley | Fresh parsely | |||
| DetailsParsley | Fresh parsely | |||
| VenueParsley | Fresh parsely | |||
| IfEatenHerbs | Other fresh herbs | |||
| SpecifyHerbs | Other fresh herbs | |||
| DetailsHerbs | Other fresh herbs | |||
| VenueHerbs | Other fresh herbs | |||
| IfEatenTomato | Fresh tomatoes | |||
| DetailsTomato | Fresh tomatoes | |||
| VenueTomato | Fresh tomatoes | |||
| IfEatenRedRound | Tomatoes: Red round | |||
| DetailsRedRound | Tomatoes: Red round | |||
| VenueRedRound | Tomatoes: Red round | |||
| IfEatenRoma | Tomatoes: Roma | |||
| DetailsRoma | Tomatoes: Roma | |||
| VenueRoma | Tomatoes: Roma | |||
| IfEatenCherryTom | Tomatoes: Cherry/grape | |||
| DetailsCherryTom | Tomatoes: Cherry/grape | |||
| VenueCherryTom | Tomatoes: Cherry/grape | |||
| IfEatenVineTom | Tomatoes: Vine-ripe, sold on vine | |||
| DetailsVineTom | Tomatoes: Vine-ripe, sold on vine | |||
| VenueVineTom | Tomatoes: Vine-ripe, sold on vine | |||
| IfEatenOtherTom | Tomatoes: Other | |||
| SpecifyOtherTom | Tomatoes: Other | |||
| DetailsOtherTom | Tomatoes: Other | |||
| VenueOtherTom | Tomatoes: Other | |||
| IfEatenLettuce | Any lettuce | |||
| BagLettuce | Was lettuce prepackaged or bagged? | |||
| BagLettuceSpecify | Specify type and brand of bagged lettuce | |||
| DetailsLettuce | Any lettuce | |||
| VenueLettuce | Any lettuce | |||
| IfEatenIceburg | Lettuce:Iceburg | |||
| DetailsIceburg | Lettuce:Iceburg | |||
| VenueIceburg | Lettuce:Iceburg | |||
| IfEatenRomaine | Lettuce:Romaine | |||
| DetailsRomaine | Lettuce:Romaine | |||
| VenueRomaine | Lettuce:Romaine | |||
| IfEatenMesclun | Lettuce:Mesclun | |||
| DetailsMesclun | Lettuce:Mesclun | |||
| VenueMesclun | Lettuce:Mesclun | |||
| IfEatenRadishLettuce | Lettuce:Radish | |||
| DetailsRadishLettuce | Lettuce:Radish | |||
| VenueRadishLettuce | Lettuce:Radish | |||
| IfEatenLeafLettuce | Lettuce:Any other leaf lettuce | |||
| SpecifyLeafLettuce | Lettuce:Any other leaf lettuce | |||
| DetailsLeafLettuce | Lettuce:Any other leaf lettuce | |||
| VenueLeafLettuce | Lettuce:Any other leaf lettuce | |||
| IfEatenPackedLeafy | Other prepackaged leafy green | |||
| SpecifyPackedLeafy | Other prepackaged leafy green | |||
| DetailsPackedLeafy | Other prepackaged leafy green | |||
| VenuePackedLeafy | Other prepackaged leafy green | |||
| IfEatenSalad | Premade green salad | |||
| DetailsSalad | Premade green salad | |||
| VenueSalad | Premade green salad | |||
| IfEatenProduce | Other produce | |||
| SpecifyProduce | Other produce | |||
| DetailsProduce | Other produce | |||
| VenueProduce | Other produce | |||
| SproutsOften | SproutsOften | |||
| SproutsDeli | SproutsDeli | |||
| SproutsGrocery | SproutsGrocery | |||
| SproutsOther | SproutsOther | |||
| SproutsRestaurant | SproutsRestaurant | |||
| VenueSprouts2 | VenueSprouts2 | |||
| VenueSprouts3 | VenueSprouts3 | |||
| VenueSprouts4 | VenueSprouts4 | |||
| DetailsSprouts2 | DetailsSprouts2 | |||
| DetailsSprouts3 | DetailsSprouts3 | |||
| DetailsSprouts4 | DetailsSprouts4 | |||
| DeliCounterSprouts | DeliCounterSprouts | |||
| IfEatenFeta | If eaten feta | |||
| DetailsFeta | Details feta | |||
| RawMilkFeta | Raw milk feta | |||
| VenueFeta | Venue feta | |||
| IfEatenGoat | If eaten goat | |||
| DetailsGoat | Details goat | |||
| RawMilkGoat | Raw milk goat | |||
| VenueGoat | Venue goat | |||
| IfEatenBlue | If eaten blue | |||
| DetailsBlue | Details blue | |||
| RawMilkBlue | Raw milk blue | |||
| VenueBlue | Venue blue | |||
| IfEatenBrie | If eaten brie | |||
| DetailsBrie | Details brie | |||
| RawMilkBrie | Raw milk brie | |||
| VenueBrie | Venue brie | |||
| IfEatenGouda | If eaten gouda | |||
| DetailsGouda | Details gouda | |||
| RawMilkGouda | Raw milk gouda | |||
| VenueGouda | Gouda | |||
| IfEatenShred | IfEatenShred | |||
| DetailsShred | DetailsShred | |||
| RawMilkShred | RawMilkShred | |||
| VenueShred | VenueShred | |||
| IfEatenMozz | IfEatenMozz | |||
| DetailsMozz | DetailsMozz | |||
| RawMilkMozz | RawMilkMozz | |||
| VenueMozz | VenueMozz | |||
| IfEatenCottage | IfEatenCottage | |||
| DetailsCottage | DetailsCottage | |||
| RawMilkCottage | RawMilkCottage | |||
| VenueCottage | VenueCottage | |||
| IfEatenRicotta | IfEatenRicotta | |||
| DetailsRicotta | DetailsRicotta | |||
| RawMilkRicotta | RawMilkRicotta | |||
| VenueRicotta | VenueRicotta | |||
| DetailsGourmet | DetailsGourmet | |||
| IfEatenGourmet | IfEatenGourmet | |||
| RawMilkGourmet | RawMilkGourmet | |||
| VenueGourmet | VenueGourmet | |||
| IfEatenCheeseDeli | IfEatenCheeseDeli | |||
| DetailsCheeseDeli | DetailsCheeseDeli | |||
| RawMilkCheeseDeli | RawMilkCheeseDeli | |||
| VenueCheeseDeli | VenueCheeseDeli | |||
| IfEatenMiddleEast | IfEatenMiddleEast | |||
| DetailsMiddleEast | DetailsMiddleEast | |||
| RawMilkMiddleEast | RawMilkMiddleEast | |||
| VenueMiddleEast | VenueMiddleEast | |||
| IfEatenMexican | IfEatenMexican | |||
| DetailsMexican | DetailsMexican | |||
| RawMilkMexican | RawMilkMexican | |||
| VenueMexican | VenueMexican | |||
| IfEatenFresco | IfEatenFresco | |||
| DetailsFresco | DetailsFresco | |||
| RawMilkFresco | RawMilkFresco | |||
| VenueFresco | VenueFresco | |||
| IfEatenBlanco | IfEatenBlanco | |||
| DetailsBlanco | DetailsBlanco | |||
| RawMilkBlanco | RawMilkBlanco | |||
| VenueBlanco | VenueBlanco | |||
| IfEatenCasero | IfEatenCasero | |||
| DetailsCasero | DetailsCasero | |||
| RawMilkCasero | RawMilkCasero | |||
| VenueCasero | VenueCasero | |||
| IfEatenCuajada | IfEatenCuajada | |||
| DetailsCuajada | DetailsCuajada | |||
| RawMilkCuajada | RawMilkCuajada | |||
| VenueCuajada | VenueCuajada | |||
| IfEatenAsadero | IfEatenAsadero | |||
| DetailsAsadero | DetailsAsadero | |||
| RawMilkAsadero | RawMilkAsadero | |||
| VenueAsadero | VenueAsadero | |||
| IfEatenCotija | IfEatenCotija | |||
| DetailsCotija | DetailsCotija | |||
| RawMilkCotija | RawMilkCotija | |||
| VenueCotija | VenueCotija | |||
| IfEatenPanella | IfEatenPanella | |||
| DetailsPanella | DetailsPanella | |||
| RawMilkPanella | RawMilkPanella | |||
| VenuePanella | VenuePanella | |||
| IfEatenRanchero | IfEatenRanchero | |||
| DetailsRanchero | DetailsRanchero | |||
| RawMilkRanchero | RawMilkRanchero | |||
| VenueRanchero | VenueRanchero | |||
| IfEatenRequeson | IfEatenRequeson | |||
| DetailsRequeson | DetailsRequeson | |||
| RawMilkRequeson | RawMilkRequeson | |||
| VenueRequeson | VenueRequeson | |||
| IfEatenOaxaca | IfEatenOaxaca | |||
| DetailsOaxaca | DetailsOaxaca | |||
| RawMilkOaxaca | RawMilkOaxaca | |||
| VenueOaxaca | VenueOaxaca | |||
| IfEatenOtherMex | IfEatenOtherMex | |||
| DetailsOtherMex | DetailsOtherMex | |||
| RawMilkOtherMex | RawMilkOtherMex | |||
| VenueOtherMex | VenueOtherMex | |||
| SpecifyOtherMex | SpecifyOtherMex | |||
| IfEatenOtherCheese | IfEatenOtherCheese | |||
| DetailsOtherCheese | DetailsOtherCheese | |||
| RawMilkOtherCheese | RawMilkOtherCheese | |||
| VenueOtherCheese | VenueOtherCheese | |||
| SpecifyOtherCheese | SpecifyOtherCheese | |||
| IfEatenRawCheese | IfEatenRawCheese | |||
| DetailsRawCheese | DetailsRawCheese | |||
| RawMilkRawCheese | RawMilkRawCheese | |||
| VenueRawCheese | VenueRawCheese | |||
| IfEatenCheese | IfEatenCheese | |||
| DetailsCheese | DetailsCheese | |||
| RawMilkCheese | RawMilkCheese | |||
| VenueCheese | VenueCheese | |||
| SpecifyCheese | SpecifyCheese | |||
| BlueOften | BlueOften | |||
| BlueDeli | BlueDeli | |||
| BlueGrocery | BlueGrocery | |||
| BlueOther | BlueOther | |||
| BlueRestaurant | BlueRestaurant | |||
| VenueBlue2 | VenueBlue2 | |||
| VenueBlue3 | VenueBlue3 | |||
| VenueBlue4 | VenueBlue4 | |||
| DetailsBlue2 | DetailsBlue2 | |||
| DetailsBlue3 | DetailsBlue3 | |||
| DetailsBlue4 | DetailsBlue4 | |||
| DeliCounterBlue | DeliCounterBlue | |||
| IfEatenBrie_Old | IfEatenBrie_Old | |||
| Brie_OldOften | Brie_OldOften | |||
| Brie_OldDeli | Brie_OldDeli | |||
| Brie_OldGrocery | Brie_OldGrocery | |||
| Brie_OldOther | Brie_OldOther | |||
| Brie_OldRestaurant | Brie_OldRestaurant | |||
| VenueBrie_Old1 | VenueBrie_Old1 | |||
| VenueBrie_Old2 | VenueBrie_Old2 | |||
| VenueBrie_Old3 | VenueBrie_Old3 | |||
| VenueBrie_Old4 | VenueBrie_Old4 | |||
| DetailsBrie_Old1 | DetailsBrie_Old1 | |||
| DetailsBrie_Old2 | DetailsBrie_Old2 | |||
| DetailsBrie_Old3 | DetailsBrie_Old3 | |||
| DetailsBrie_Old4 | DetailsBrie_Old4 | |||
| DeliCounterBrie_Old | DeliCounterBrie_Old | |||
| IfEatenCamembert | IfEatenCamembert | |||
| CamembertOften | CamembertOften | |||
| CamembertDeli | CamembertDeli | |||
| CamembertGrocery | CamembertGrocery | |||
| CamembertOther | CamembertOther | |||
| CamembertRestaurant | CamembertRestaurant | |||
| VenueCamembert1 | VenueCamembert1 | |||
| VenueCamembert2 | VenueCamembert2 | |||
| VenueCamembert3 | VenueCamembert3 | |||
| VenueCamembert4 | VenueCamembert4 | |||
| DetailsCamembert1 | DetailsCamembert1 | |||
| DetailsCamembert2 | DetailsCamembert2 | |||
| DetailsCamembert3 | DetailsCamembert3 | |||
| DetailsCamembert4 | DetailsCamembert4 | |||
| DeliCounterCamembert | DeliCounterCamembert | |||
| IfEatenFarmers | IfEatenFarmers | |||
| FarmersOften | FarmersOften | |||
| FarmersDeli | FarmersDeli | |||
| FarmersGrocery | FarmersGrocery | |||
| FarmersOther | FarmersOther | |||
| FarmersRestaurant | FarmersRestaurant | |||
| VenueFarmers1 | VenueFarmers1 | |||
| VenueFarmers2 | VenueFarmers2 | |||
| VenueFarmers3 | VenueFarmers3 | |||
| VenueFarmers4 | VenueFarmers4 | |||
| DetailsFarmers1 | DetailsFarmers1 | |||
| DetailsFarmers2 | DetailsFarmers2 | |||
| DetailsFarmers3 | DetailsFarmers3 | |||
| DetailsFarmers4 | DetailsFarmers4 | |||
| DeliCounterFarmers | DeliCounterFarmers | |||
| FetaOften | If ate feta, how often? | |||
| FetaDeli | Was feta purchased from a deli/small market? | |||
| FetaGrocery | Was feta purchased from a grocery store? | |||
| FetaOther | Was feta purchased at an other venue? | |||
| FetaRestaurant | FetaRestaurant | |||
| VenueFeta2 | VenueFeta2 | |||
| VenueFeta3 | VenueFeta3 | |||
| VenueFeta4 | VenueFeta4 | |||
| DetailsFeta2 | DetailsFeta2 | |||
| DetailsFeta3 | DetailsFeta3 | |||
| DetailsFeta4 | DetailsFeta4 | |||
| DeliCounterFeta | DeliCounterFeta | |||
| GoatOften | If ate goat cheese, how often? | |||
| GoatDeli | Was goat cheese purchased at a deli? | |||
| GoatGrocery | Was goat cheese purchased at a grocery store? | |||
| GoatOther | Was goat cheese purchased at an other venue? | |||
| GoatRestaurant | GoatRestaurant | |||
| VenueGoat2 | VenueGoat2 | |||
| VenueGoat3 | VenueGoat3 | |||
| VenueGoat4 | VenueGoat4 | |||
| DetailsGoat2 | DetailsGoat2 | |||
| DetailsGoat3 | DetailsGoat3 | |||
| DetailsGoat4 | DetailsGoat4 | |||
| DeliCounterGoat | DeliCounterGoat | |||
| MexicanOften | MexicanOften | |||
| MexicanDeli | MexicanDeli | |||
| MexicanGrocery | MexicanGrocery | |||
| MexicanOther | MexicanOther | |||
| MexicanRestaurant | MexicanRestaurant | |||
| VenueMexican2 | VenueMexican2 | |||
| VenueMexican3 | VenueMexican3 | |||
| VenueMexican4 | VenueMexican4 | |||
| DetailsMexican2 | DetailsMexican2 | |||
| DetailsMexican3 | DetailsMexican3 | |||
| DetailsMexican4 | DetailsMexican4 | |||
| DeliCounterMexican | DeliCounterMexican | |||
| OtherCheeseOften | OtherCheeseOften | |||
| OtherCheeseDeli | OtherCheeseDeli | |||
| OtherCheeseGrocery | OtherCheeseGrocery | |||
| OtherCheeseOther | OtherCheeseOther | |||
| OtherCheeseRestaurant | OtherCheeseRestaurant | |||
| VenueOtherCheese2 | VenueOtherCheese2 | |||
| VenueOtherCheese3 | VenueOtherCheese3 | |||
| VenueOtherCheese4 | VenueOtherCheese4 | |||
| DetailsOtherCheese2 | DetailsOtherCheese2 | |||
| DetailsOtherCheese3 | DetailsOtherCheese3 | |||
| DetailsOtherCheese4 | DetailsOtherCheese4 | |||
| DeliCounterOtherCheese | DeliCounterOtherCheese | |||
| RawCheeseOften | RawCheeseOften | |||
| RawCheeseDeli | RawCheeseDeli | |||
| RawCheeseGrocery | RawCheeseGrocery | |||
| RawCheeseOther | RawCheeseOther | |||
| RawCheeseRestaurant | RawCheeseRestaurant | |||
| VenueRawCheese2 | VenueRawCheese2 | |||
| VenueRawCheese3 | VenueRawCheese3 | |||
| VenueRawCheese4 | VenueRawCheese4 | |||
| DetailsRawCheese2 | DetailsRawCheese2 | |||
| DetailsRawCheese3 | DetailsRawCheese3 | |||
| DetailsRawCheese4 | DetailsRawCheese4 | |||
| DeliCounterRawCheese | DeliCounterRawCheese | |||
| IfEatenMilk | IfEatenMilk | |||
| DetailsMilk | DetailsMilk | |||
| VenueMilk | VenueMilk | |||
| RawUnpasteurizedMilk | RawUnpasteurizedMilk | |||
| IfEatenWholeMilk | IfEatenWholeMilk | |||
| DetailsWholeMilk | DetailsWholeMilk | |||
| VenueWholeMilk | VenueWholeMilk | |||
| IfEaten2Milk | IfEaten2Milk | |||
| Details2Milk | Details2Milk | |||
| Venue2Milk | Venue2Milk | |||
| IfEaten1Milk | IfEaten1Milk | |||
| Details1Milk | Details1Milk | |||
| Venue1Milk | Venue1Milk | |||
| IfEatenSkimMilk | IfEatenSkimMilk | |||
| DetailsSkimMilk | DetailsSkimMilk | |||
| VenueSkimMilk | VenueSkimMilk | |||
| IfEatenOtherMilk | IfEatenOtherMilk | |||
| DetailsOtherMIlk | DetailsOtherMIlk | |||
| VenueOtherMilk | VenueOtherMilk | |||
| SpecifyOtherMilk | SpecifyOtherMilk | |||
| IfEatenNonDairyMilk | IfEatenNonDairyMilk | |||
| DetailsNonDairyMilk | DetailsNonDairyMilk | |||
| VenueNonDairyMilk | VenueNonDairyMilk | |||
| SpecifyNonDairyMilk | SpecifyNonDairyMilk | |||
| IfEatenFrozenYogurt | IfEatenFrozenYogurt | |||
| DetailsFrozenYogurt | DetailsFrozenYogurt | |||
| VenueFrozenYogurt | VenueFrozenYogurt | |||
| IfEatenYogurt | IfEatenYogurt | |||
| RawUnpasteurizedYogurt | RawUnpasteurizedYogurt | |||
| SpecifyYogurt | SpecifyYogurt | |||
| DetailsYogurt | DetailsYogurt | |||
| VenueYogurt | VenueYogurt | |||
| IfEatenYogurtDrink | IfEatenYogurtDrink | |||
| DetailsYogurtDrink | DetailsYogurtDrink | |||
| VenueYogurtDrink | VenueYogurtDrink | |||
| IfEatenButter | IfEatenButter | |||
| DetailsButter | DetailsButter | |||
| VenueButter | VenueButter | |||
| IfEatenCream | IfEatenCream | |||
| DetailsCream | DetailsCream | |||
| VenueCream | VenueCream | |||
| IfEatenIceCreamBars | IfEatenIceCreamBars | |||
| DetailsIceCreamBars | DetailsIceCreamBars | |||
| VenueIceCreamBars | VenueIceCreamBars | |||
| IfEatenIceCream | IfEatenIceCream | |||
| DetailsIceCream | DetailsIceCream | |||
| VenueIceCream | VenueIceCream | |||
| SoftServeIceCream | Was any ice cream soft serve? | |||
| IfEatenSourCream | IfEatenSourCream | |||
| DetailsSourCream | DetailsSourCream | |||
| VenueSourCream | VenueSourCream | |||
| IfEatenShrimp | IfEatenShrimp | |||
| DetailsShrimp | DetailsShrimp | |||
| VenueShrimp | VenueShrimp | |||
| IfEatenShellfish | IfEatenShellfish | |||
| SpecifyShellfish | SpecifyShellfish | |||
| DetailsShellfish | DetailsShellfish | |||
| VenueShellfish | VenueShellfish | |||
| IfEatenFish | IfEatenFish | |||
| DetailsFish | DetailsFish | |||
| VenueFish | VenueFish | |||
| IfEatenRawFish | IfEatenRawFish | |||
| DetailsRawFish | DetailsRawFish | |||
| VenueRawFish | VenueRawFish | |||
| IfEatenSeafood | IfEatenSeafood | |||
| DetailsSeafood | DetailsSeafood | |||
| VenueSeafood | VenueSeafood | |||
| IfEatenHummus | IfEatenHummus | |||
| DetailsHummus | DetailsHummus | |||
| VenueHummus | VenueHummus | |||
| IfEatenSalsa | IfEatenSalsa | |||
| DetailsSalsa | DetailsSalsa | |||
| VenueSalsa | VenueSalsa | |||
| IfEatenGuacamole | IfEatenGuacamole | |||
| DetailsGuacamole | DetailsGuacamole | |||
| VenueGuacamole | VenueGuacamole | |||
| IfEatenDip | IfEatenDip | |||
| DetailsDip | DetailsDip | |||
| VenueDip | VenueDip | |||
| SpecifyDip | SpecifyDip | |||
| HummusOften | If at hummus, how often? | |||
| HummusDeli | Was hummus purchased from a deli/small market? | |||
| HummusGrocery | Was hummus purchased from a grocery store? | |||
| HummusOther | Was hummus purchased from an other venue? | |||
| HummusRestaurant | HummusRestaurant | |||
| VenueHummus2 | VenueHummus2 | |||
| VenueHummus3 | VenueHummus3 | |||
| VenueHummus4 | VenueHummus4 | |||
| DetailsHummus2 | DetailsHummus2 | |||
| DetailsHummus3 | DetailsHummus3 | |||
| DetailsHummus4 | DetailsHummus4 | |||
| DeliCounterHummus | DeliCounterHummus | |||
| IfEatenCrab | IfEatenCrab | |||
| CrabOften | If ate precooked crab, how often? | |||
| CrabDeli | Was crab purchased at a deli/small market? | |||
| CrabGrocery | Was crab purchased at a grocery store? | |||
| CrabOther | Was crab purchased at an other venue? | |||
| CrabRestaurant | CrabRestaurant | |||
| VenueCrab | VenueCrab | |||
| VenueCrab2 | VenueCrab2 | |||
| VenueCrab3 | VenueCrab3 | |||
| VenueCrab4 | VenueCrab4 | |||
| DetailsCrab | DetailsCrab | |||
| DetailsCrab2 | DetailsCrab2 | |||
| DetailsCrab3 | DetailsCrab3 | |||
| DetailsCrab4 | DetailsCrab4 | |||
| DeliCounterCrab | DeliCounterCrab | |||
| ShrimpOften | If ate precooked shrimp, how often? | |||
| ShrimpDeli | Was shrimp purchased at a deli/small market? | |||
| ShrimpGrocery | Was shrimp purchased at a grocery store? | |||
| ShrimpOther | Was shrimp purchased at an other venue? | |||
| ShrimpRestaurant | ShrimpRestaurant | |||
| VenueShrimp2 | VenueShrimp2 | |||
| VenueShrimp3 | VenueShrimp3 | |||
| VenueShrimp4 | VenueShrimp4 | |||
| DetailsShrimp2 | DetailsShrimp2 | |||
| DetailsShrimp3 | DetailsShrimp3 | |||
| DetailsShrimp4 | DetailsShrimp4 | |||
| DeliCounterShrimp | DeliCounterShrimp | |||
| FishOften | FishOften | |||
| FishDeli | FishDeli | |||
| FishGrocery | FishGrocery | |||
| FishOther | FishOther | |||
| FishRestaurant | FishRestaurant | |||
| VenueFish2 | VenueFish2 | |||
| VenueFish3 | VenueFish3 | |||
| VenueFish4 | VenueFish4 | |||
| DetailsFish2 | DetailsFish2 | |||
| DetailsFish3 | DetailsFish3 | |||
| DetailsFish4 | DetailsFish4 | |||
| DeliCounterFish | DeliCounterFish | |||
| WholeMilkOften | WholeMilkOften | |||
| WholeMilkDeli | WholeMilkDeli | |||
| WholeMilkGrocery | WholeMilkGrocery | |||
| WholeMilkOther | WholeMilkOther | |||
| WholeMilkRestaurant | WholeMilkRestaurant | |||
| VenueWholeMilk2 | VenueWholeMilk2 | |||
| VenueWholeMilk3 | VenueWholeMilk3 | |||
| VenueWholeMilk4 | VenueWholeMilk4 | |||
| DetailsWholeMilk2 | DetailsWholeMilk2 | |||
| DetailsWholeMilk3 | DetailsWholeMilk3 | |||
| DetailsWholeMilk4 | DetailsWholeMilk4 | |||
| RawUnpasteurizedWholeMilk | RawUnpasteurizedWholeMilk | |||
| _2MilkOften | _2MilkOften | |||
| _2MilkDeli | _2MilkDeli | |||
| _2MilkGrocery | _2MilkGrocery | |||
| _2MilkOther | _2MilkOther | |||
| _2MilkRestaurant | _2MilkRestaurant | |||
| Venue2Milk2 | Venue2Milk2 | |||
| Venue2Milk3 | Venue2Milk3 | |||
| Venue2Milk4 | Venue2Milk4 | |||
| Details2Milk2 | Details2Milk2 | |||
| Details2Milk3 | Details2Milk3 | |||
| Details2Milk4 | Details2Milk4 | |||
| RawUnpasteurized2Milk | RawUnpasteurized2Milk | |||
| _1MilkOften | _1MilkOften | |||
| _1MilkDeli | _1MilkDeli | |||
| _1MilkGrocery | _1MilkGrocery | |||
| _1MilkOther | _1MilkOther | |||
| _1MilkRestaurant | _1MilkRestaurant | |||
| Venue1Milk2 | Venue1Milk2 | |||
| Venue1Milk3 | Venue1Milk3 | |||
| Venue1Milk4 | Venue1Milk4 | |||
| Details1Milk2 | Details1Milk2 | |||
| Details1Milk3 | Details1Milk3 | |||
| Details1Milk4 | Details1Milk4 | |||
| RawUnpasteurized1Milk | RawUnpasteurized1Milk | |||
| SkimMilkOften | If ate skim milk, how often? | |||
| SkimMilkDeli | Was skim milk purchased at a deli/small market? | |||
| SkimMilkGrocery | Was skim milk purchased at a grocery store? | |||
| SkimMilkOther | Was skim milk purchased at an other venue? | |||
| SkimMilkRestaurant | SkimMilkRestaurant | |||
| VenueSkimMilk2 | VenueSkimMilk2 | |||
| VenueSkimMilk3 | VenueSkimMilk3 | |||
| VenueSkimMilk4 | VenueSkimMilk4 | |||
| DetailsSkimMilk2 | DetailsSkimMilk2 | |||
| DetailsSkimMilk3 | DetailsSkimMilk3 | |||
| DetailsSkimMilk4 | DetailsSkimMilk4 | |||
| RawUnpasteurizedSkimMilk | RawUnpasteurizedSkimMilk | |||
| OtherMilkOften | If ate other milk, how often? | |||
| OtherMilkDeli | Was other milk purchased at a deli/small market? | |||
| OtherMilkGrocery | Was other milk purchased at a grocery store? | |||
| OtherMilkOther | Was other milk purchased at an other venue? | |||
| OtherMilkRestaurant | OtherMilkRestaurant | |||
| VenueOtherMilk2 | VenueOtherMilk2 | |||
| VenueOtherMilk3 | VenueOtherMilk3 | |||
| VenueOtherMilk4 | VenueOtherMilk4 | |||
| DetailsOtherMilk2 | DetailsOtherMilk2 | |||
| DetailsOtherMilk3 | DetailsOtherMilk3 | |||
| DetailsOtherMilk4 | DetailsOtherMilk4 | |||
| RawUnpasteurizedOtherMilk | RawUnpasteurizedOtherMilk | |||
| ButterOften | If ate butter, how often? | |||
| ButterDeli | Was butter purchased at a deli/small market? | |||
| ButterGrocery | Was butter purchased at a grocery store? | |||
| ButterOther | Was butter purchased at an other venue? | |||
| ButterRestaurant | ButterRestaurant | |||
| VenueButter2 | VenueButter2 | |||
| VenueButter3 | VenueButter3 | |||
| VenueButter4 | VenueButter4 | |||
| DetailsButter2 | DetailsButter2 | |||
| DetailsButter3 | DetailsButter3 | |||
| DetailsButter4 | DetailsButter4 | |||
| CreamOften | If ate cream, how often? | |||
| CreamDeli | Was cream purchased at a deli/small market? | |||
| CreamGrocery | Was cream purchased at a grocery store? | |||
| CreamOther | Was cream purchased at an other venue? | |||
| CreamRestaurant | CreamRestaurant | |||
| VenueCream2 | VenueCream2 | |||
| VenueCream3 | VenueCream3 | |||
| VenueCream4 | VenueCream4 | |||
| DetailsCream2 | DetailsCream2 | |||
| DetailsCream3 | DetailsCream3 | |||
| DetailsCream4 | DetailsCream4 | |||
| IceCreamOften | If ate ice cream, how often? | |||
| IceCreamDeli | IceCreamDeli | |||
| IceCreamGrocery | Was ice cream purchased at a grocery store? | |||
| IceCreamOther | Was ice cream purchased at an other venue? | |||
| IceCreamRestaurant | IceCreamRestaurant | |||
| VenueIceCream2 | VenueIceCream2 | |||
| VenueIceCream3 | VenueIceCream3 | |||
| VenueIceCream4 | VenueIceCream4 | |||
| DetailsIceCream2 | DetailsIceCream2 | |||
| DetailsIceCream3 | DetailsIceCream3 | |||
| DetailsIceCream4 | DetailsIceCream4 | |||
| SourCreamOften | If ate sour cream, how often? | |||
| SourCreamDeli | Was sour cream purchased at a deli/small market? | |||
| SourCreamGrocery | Was sour cream purchased at a grocery store? | |||
| SourCreamOther | Was sour cream purchased at an other venue? | |||
| SourCreamRestaurant | SourCreamRestaurant | |||
| VenueSourCream2 | VenueSourCream2 | |||
| VenueSourCream3 | VenueSourCream3 | |||
| VenueSourCream4 | VenueSourCream4 | |||
| DetailsSourCream2 | DetailsSourCream2 | |||
| DetailsSourCream3 | DetailsSourCream3 | |||
| DetailsSourCream4 | DetailsSourCream4 | |||
| YogurtOften | If ate yogurt, how often? | |||
| YogurtDeli | Was yogurt purchased at a deli/small market? | |||
| YogurtGrocery | Was yogurt purchased at a grocery store? | |||
| YogurtOther | Was yogurt purchased at an other venue? | |||
| YogurtRestaurant | YogurtRestaurant | |||
| VenueYogurt2 | VenueYogurt2 | |||
| VenueYogurt3 | VenueYogurt3 | |||
| VenueYogurt4 | VenueYogurt4 | |||
| DetailsYogurt2 | DetailsYogurt2 | |||
| DetailsYogurt3 | DetailsYogurt3 | |||
| DetailsYogurt4 | DetailsYogurt4 | |||
| IfEatenPotato | IfEatenPotato | |||
| DeliCounterPotato | DeliCounterPotato | |||
| DetailsPotato | DetailsPotato | |||
| VenuePotato | VenuePotato | |||
| IfEatenPasta | IfEatenPasta | |||
| DeliCounterPasta | DeliCounterPasta | |||
| DetailsPasta | DetailsPasta | |||
| VenuePasta | VenuePasta | |||
| IfEatenEgg | IfEatenEgg | |||
| DeliCounterEgg | DeliCounterEgg | |||
| DetailsEgg | DetailsEgg | |||
| VenueEgg | VenueEgg | |||
| IfEatenTuna | IfEatenTuna | |||
| DeliCounterTuna | DeliCounterTuna | |||
| DetailsTuna | DetailsTuna | |||
| VenueTuna | VenueTuna | |||
| IfEatenChickenSalad | IfEatenChickenSalad | |||
| DeliCounterChickenSalad | DeliCounterChickenSalad | |||
| DetailsChickenSalad | DetailsChickenSalad | |||
| VenueChickenSalad | VenueChickenSalad | |||
| IfEatenBeanSalad | IfEatenBeanSalad | |||
| DeliCounterBeanSalad | DeliCounterBeanSalad | |||
| DetailsBeanSalad | DetailsBeanSalad | |||
| VenueBeanSalad | VenueBeanSalad | |||
| IfEatenSeafoodSalad | IfEatenSeafoodSalad | |||
| DeliCounterSeafoodSalad | DeliCounterSeafoodSalad | |||
| DetailsSeafoodSalad | DetailsSeafoodSalad | |||
| VenueSeafoodSalad | VenueSeafoodSalad | |||
| IfEatenColeSlaw | IfEatenColeSlaw | |||
| DeliCounterColeSlaw | DeliCounterColeSlaw | |||
| DetailsColeSlaw | DetailsColeSlaw | |||
| VenueColeSlaw | VenueColeSlaw | |||
| IfEatenOtherRTESalad | Other ready to eat meat or vegetable salad | |||
| DeliCounterOtherRTESalad | Other ready to eat meat or vegetable salad: Other | |||
| DetailsOtherRTESalad | Other ready to eat meat or vegetable salad: Details | |||
| VenueOtherRTESalad | Other ready to eat meat or vegetable salad: Venue | |||
| IfEatenSaladBar | IfEatenSaladBar | |||
| DetailsSaladBar | DetailsSaladBar | |||
| VenueSaladBar | VenueSaladBar | |||
| IfEatenSmoothie | IfEatenSmoothie | |||
| DetailsSmoothie | DetailsSmoothie | |||
| VenueSmoothie | VenueSmoothie | |||
| IfEatenTahini | IfEatenTahini | |||
| DetailsTahini | DetailsTahini | |||
| VenueTahini | VenueTahini | |||
| IfEatenTofu | IfEatenTofu | |||
| DetailsTofu | DetailsTofu | |||
| VenueTofu | VenueTofu | |||
| IfEatenRiceNoodle | IfEatenRiceNoodle | |||
| DetailsRiceNoodle | DetailsRiceNoodle | |||
| VenueRiceNoodle | VenueRiceNoodle | |||
| IfEatenSandwich | IfEatenSandwich | |||
| DetailsSandwich | DetailsSandwich | |||
| VenueSandwich | VenueSandwich | |||
| IfEatenNutButter | IfEatenNutButter | |||
| DetailsNutButter | DetailsNutButter | |||
| VenueNutButter | VenueNutButter | |||
| IfEatenNuts | IfEatenNuts | |||
| DetailsNuts | DetailsNuts | |||
| VenueNuts | VenueNuts | |||
| IfEatenSeeds | IfEatenSeeds | |||
| DetailsSeeds | DetailsSeeds | |||
| VenueSeeds | VenueSeeds | |||
| IfEatenOtherCountry | IfEatenOtherCountry | |||
| DetailsOtherCountry | DetailsOtherCountry | |||
| VenueOtherCountry | VenueOtherCountry | |||
| BeanSaladOften | BeanSaladOften | |||
| BeanSaladDeli | BeanSaladDeli | |||
| BeanSaladGrocery | BeanSaladGrocery | |||
| BeanSaladOther | BeanSaladOther | |||
| BeanSaladRestaurant | BeanSaladRestaurant | |||
| VenueBeanSalad2 | VenueBeanSalad2 | |||
| VenueBeanSalad3 | VenueBeanSalad3 | |||
| VenueBeanSalad4 | VenueBeanSalad4 | |||
| DetailsBeanSalad2 | DetailsBeanSalad2 | |||
| DetailsBeanSalad3 | DetailsBeanSalad3 | |||
| DetailsBeanSalad4 | DetailsBeanSalad4 | |||
| ColeSlawOften | ColeSlawOften | |||
| ColeSlawDeli | ColeSlawDeli | |||
| ColeSlawGrocery | ColeSlawGrocery | |||
| ColeSlawOther | ColeSlawOther | |||
| ColeSlawRestaurant | ColeSlawRestaurant | |||
| VenueColeSlaw2 | VenueColeSlaw2 | |||
| VenueColeSlaw3 | VenueColeSlaw3 | |||
| VenueColeSlaw4 | VenueColeSlaw4 | |||
| DetailsColeSlaw2 | DetailsColeSlaw2 | |||
| DetailsColeSlaw3 | DetailsColeSlaw3 | |||
| DetailsColeSlaw4 | DetailsColeSlaw4 | |||
| OtherRTESaladSpecify | OtherRTESaladSpecify | |||
| OtherRTESaladOften | OtherRTESaladOften | |||
| OtherRTESaladDeli | OtherRTESaladDeli | |||
| OtherRTESaladGrocery | OtherRTESaladGrocery | |||
| OtherRTESaladOther | OtherRTESaladOther | |||
| OtherRTESaladRestaurant | OtherRTESaladRestaurant | |||
| VenueOtherRTESalad2 | VenueOtherRTESalad2 | |||
| VenueOtherRTESalad3 | VenueOtherRTESalad3 | |||
| VenueOtherRTESalad4 | VenueOtherRTESalad4 | |||
| DetailsOtherRTESalad2 | DetailsOtherRTESalad2 | |||
| DetailsOtherRTESalad3 | DetailsOtherRTESalad3 | |||
| DetailsOtherRTESalad4 | DetailsOtherRTESalad4 | |||
| PastaOften | If at pasta salad, how often? | |||
| PastaDeli | Was pasta salad purchased from a deli/small market? | |||
| PastaGrocery | Was pasta salad purchased from a grocery store? | |||
| PastaOther | Was pasta salad purchased from an other venue? | |||
| PastaRestaurant | PastaRestaurant | |||
| VenuePasta2 | VenuePasta2 | |||
| VenuePasta3 | VenuePasta3 | |||
| VenuePasta4 | VenuePasta4 | |||
| DetailsPasta2 | DetailsPasta2 | |||
| DetailsPasta3 | DetailsPasta3 | |||
| DetailsPasta4 | DetailsPasta4 | |||
| PotatoOften | If ate potato salad, how often? | |||
| PotatoDeli | Was potato salad purchased from a deli/small market? | |||
| PotatoGrocery | Was potato salad purchased from a grocery store? | |||
| PotatoOther | Was potato salad purchased at an other venue? | |||
| PotatoRestaurant | PotatoRestaurant | |||
| VenuePotato2 | VenuePotato2 | |||
| VenuePotato3 | VenuePotato3 | |||
| VenuePotato4 | VenuePotato4 | |||
| DetailsPotato2 | DetailsPotato2 | |||
| DetailsPotato3 | DetailsPotato3 | |||
| DetailsPotato4 | DetailsPotato4 | |||
| SeafoodSaladOften | SeafoodSaladOften | |||
| SeafoodSaladDeli | SeafoodSaladDeli | |||
| SeafoodSaladGrocery | SeafoodSaladGrocery | |||
| SeafoodSaladOther | SeafoodSaladOther | |||
| SeafoodSaladRestaurant | SeafoodSaladRestaurant | |||
| VenueSeafoodSalad2 | VenueSeafoodSalad2 | |||
| VenueSeafoodSalad3 | VenueSeafoodSalad3 | |||
| VenueSeafoodSalad4 | VenueSeafoodSalad4 | |||
| DetailsSeafoodSalad2 | DetailsSeafoodSalad2 | |||
| DetailsSeafoodSalad3 | DetailsSeafoodSalad3 | |||
| DetailsSeafoodSalad4 | DetailsSeafoodSalad4 | |||
| TunaOften | If ate tuna salad, how often? | |||
| TunaDeli | Was tuna salad purchase from a deli/small market? | |||
| TunaGrocery | Was tuna salad purchase from a grocery store? | |||
| TunaOther | Was tuna salad purchase from an other venue? | |||
| TunaRestaurant | TunaRestaurant | |||
| VenueTuna2 | VenueTuna2 | |||
| VenueTuna3 | VenueTuna3 | |||
| VenueTuna4 | VenueTuna4 | |||
| DetailsTuna2 | DetailsTuna2 | |||
| DetailsTuna3 | DetailsTuna3 | |||
| DetailsTuna4 | DetailsTuna4 | |||
| IfEatenApples | IfEatenApples | |||
| FruitStateApple | FruitStateApple | |||
| PreSlicedApple | PreSlicedApple | |||
| VenueApple | VenueApple | |||
| DetailsApple | DetailsApple | |||
| IfEatenCarApple | IfEatenCarApple | |||
| DetailsCarApple | DetailsCarApple | |||
| VenueCarApple | VenueCarApple | |||
| IfEatenGrape | IfEatenGrape | |||
| DetailsGrape | DetailsGrape | |||
| VenueGrape | VenueGrape | |||
| IfEatenRaisin | IfEatenRaisin | |||
| DetailsRaisin | DetailsRaisin | |||
| VenueRaisin | VenueRaisin | |||
| IfEatenPear | IfEatenPear | |||
| FruitStatePear | FruitStatePear | |||
| DetailsPear | DetailsPear | |||
| VenuePear | VenuePear | |||
| IfEatenPeach | IfEatenPeach | |||
| DetailsPeach | DetailsPeach | |||
| FruitStatePeach | FruitStatePeach | |||
| VenuePeach | VenuePeach | |||
| IfEatenNectarine | IfEatenNectarine | |||
| FruitStateNectarine | FruitStateNectarine | |||
| DetailsNectarine | DetailsNectarine | |||
| VenueNectarine | VenueNectarine | |||
| IfEatenApricot | IfEatenApricot | |||
| FruitStateApricot | FruitStateApricot | |||
| DetailsApricot | DetailsApricot | |||
| VenueApricot | VenueApricot | |||
| IfEatenPlum | IfEatenPlum | |||
| DetailsPlum | DetailsPlum | |||
| FruitStatePlum | FruitStatePlum | |||
| VenuePlum | VenuePlum | |||
| IfEatenStrawberry | IfEatenStrawberry | |||
| DetailsStrawberry | DetailsStrawberry | |||
| FruitStateStrawberry | FruitStateStrawberry | |||
| VenueStrawberry | VenueStrawberry | |||
| IfEatenRaspberry | IfEatenRaspberry | |||
| DetailsRaspberry | DetailsRaspberry | |||
| FruitStateRaspberry | FruitStateRaspberry | |||
| VenueRaspberry | VenueRaspberry | |||
| IfEatenBlueberry | IfEatenBlueberry | |||
| FruitStateBlueberry | FruitStateBlueberry | |||
| DetailsBlueberry | DetailsBlueberry | |||
| VenueBlueberry | VenueBlueberry | |||
| IfEatenBlackberry | IfEatenBlackberry | |||
| FruitStateBlackberry | FruitStateBlackberry | |||
| DetailsBlackberry | DetailsBlackberry | |||
| VenueBlackberry | VenueBlackberry | |||
| IfEatenCherry | IfEatenCherry | |||
| FruitStateCherry | FruitStateCherry | |||
| DetailsCherry | DetailsCherry | |||
| VenueCherry | VenueCherry | |||
| IfEatenHoneydew | IfEatenHoneydew | |||
| DetailsHondeydew | DetailsHondeydew | |||
| PreSlicedHoneydew | PreSlicedHoneydew | |||
| VenueHoneydew | VenueHoneydew | |||
| IfEatenCantaloupe | IfEatenCantaloupe | |||
| PreSlicedCantaloupe | PreSlicedCantaloupe | |||
| DetailsCantaloupe | DetailsCantaloupe | |||
| VenueCantaloupe | VenueCantaloupe | |||
| IfEatenWatermelon | IfEatenWatermelon | |||
| PreSlicedWatermelon | PreSlicedWatermelon | |||
| DetailsWatermelon | DetailsWatermelon | |||
| VenueWatermelon | VenueWatermelon | |||
| IfEatenPineapple | IfEatenPineapple | |||
| PreSlicedPineapple | PreSlicedPineapple | |||
| DetailsPineapple | DetailsPineapple | |||
| VenuePineapple | VenuePineapple | |||
| IfEatenMango | IfEatenMango | |||
| PreSlicedMango | PreSlicedMango | |||
| FruitStateMango | FruitStateMango | |||
| DetailsMango | DetailsMango | |||
| VenueMango | VenueMango | |||
| IfEatenPapaya | IfEatenPapaya | |||
| FruitStatePapaya | FruitStatePapaya | |||
| DetailsPapaya | DetailsPapaya | |||
| VenuePapaya | VenuePapaya | |||
| IfEatenAvocado | IfEatenAvocado | |||
| DetailsAvocado | DetailsAvocado | |||
| VenueAvocado | VenueAvocado | |||
| FruitStateAvocado | FruitStateAvocado | |||
| IfEatenFruitSalad | IfEatenFruitSalad | |||
| DetailsFruitSalad | DetailsFruitSalad | |||
| VenueFruitSalad | VenueFruitSalad | |||
| IfEatenOtherFruit | IfEatenOtherFruit | |||
| SpecifyOtherFruit | SpecifyOtherFruit | |||
| FruitStateOtherFruit | FruitStateOtherFruit | |||
| DetailsOtherFruit | DetailsOtherFruit | |||
| VenueOtherFruit | VenueOtherFruit | |||
| IfEatenSorbet | IfEatenSorbet | |||
| DetailsSorbet | DetailsSorbet | |||
| VenueSorbet | VenueSorbet | |||
| IfEatenZoo | Spent time at a petting zoo | |||
| DetailsZoo | Spent time at a petting zoo: Details | |||
| VenueZoo | Spent time at a petting zoo: Venue | |||
| IfEatenPetFood | Fed cat or dog raw pet food | |||
| DetailsPetFood | Fed cat or dog raw pet food: Details | |||
| VenuePetFood | Fed cat or dog raw pet food: Venue | |||
| IfEatenPetTreats | Fed cat or dog refrigerated, frozen, or freeze-dried treats | |||
| DetailsPetTreats | Fed cat or dog refrigerated, frozen, or freeze-dried treats: Venue | |||
| VenuePetTreats | Fed cat or dog refrigerated, frozen, or freeze-dried treats: Details | |||
| FruitSaladOften | FruitSaladOften | |||
| FruitSaladDeli | FruitSaladDeli | |||
| FruitSaladGrocery | FruitSaladGrocery | |||
| FruitSaladOther | FruitSaladOther | |||
| FruitSaladRestaurant | FruitSaladRestaurant | |||
| VenueFruitSalad2 | VenueFruitSalad2 | |||
| VenueFruitSalad3 | VenueFruitSalad3 | |||
| VenueFruitSalad4 | VenueFruitSalad4 | |||
| DetailsFruitSalad2 | DetailsFruitSalad2 | |||
| DetailsFruitSalad3 | DetailsFruitSalad3 | |||
| DetailsFruitSalad4 | DetailsFruitSalad4 | |||
| DeliCounterFruitSalad | DeliCounterFruitSalad | |||
| CantaloupeOften | CantaloupeOften | |||
| CantaloupeDeli | CantaloupeDeli | |||
| CantaloupeGrocery | CantaloupeGrocery | |||
| CantaloupeOther | CantaloupeOther | |||
| CantaloupeRestaurant | CantaloupeRestaurant | |||
| VenueCantaloupe2 | VenueCantaloupe2 | |||
| VenueCantaloupe3 | VenueCantaloupe3 | |||
| VenueCantaloupe4 | VenueCantaloupe4 | |||
| DetailsCantaloupe2 | DetailsCantaloupe2 | |||
| DetailsCantaloupe3 | DetailsCantaloupe3 | |||
| DetailsCantaloupe4 | DetailsCantaloupe4 | |||
| HoneydewOften | If ate honeydew, how often? | |||
| HoneydewDeli | Was honeydew purchased at a deli/small market? | |||
| HoneydewGrocery | Was honeydew purchased at a grocery store? | |||
| HoneydewOther | Was honeydew purchased at an other venue? | |||
| HoneydewRestaurant | HoneydewRestaurant | |||
| VenueHoneydew2 | VenueHoneydew2 | |||
| VenueHoneydew3 | VenueHoneydew3 | |||
| VenueHoneydew4 | VenueHoneydew4 | |||
| DetailsHoneydew2 | DetailsHoneydew2 | |||
| DetailsHoneydew3 | DetailsHoneydew3 | |||
| DetailsHoneydew4 | DetailsHoneydew4 | |||
| WatermelonOften | WatermelonOften | |||
| WatermelonDeli | WatermelonDeli | |||
| WatermelonGrocery | WatermelonGrocery | |||
| WatermelonOther | WatermelonOther | |||
| WatermelonRestaurant | WatermelonRestaurant | |||
| VenueWatermelon2 | VenueWatermelon2 | |||
| VenueWatermelon3 | VenueWatermelon3 | |||
| VenueWatermelon4 | VenueWatermelon4 | |||
| DetailsWatermelon2 | DetailsWatermelon2 | |||
| DetailsWatermelon3 | DetailsWatermelon3 | |||
| DetailsWatermelon4 | DetailsWatermelon4 | |||
| CaseStatusAPMother | Case classification of Pregnant mother | PHVS_CaseClassStatus_NND | TBD | |
| CaseStatusAPNeonate | Case classification of Neonate | PHVS_CaseClassStatus_NND | TBD | |
| CaseStatusNP | Case classification | PHVS_CaseClassStatus_NND | TBD | |
| LabCriteria | Laboratory Criteria for Diagnosis | TBD | ||
| APNeonateAgeAtCollection | Neonatal age at time of laboratory specimen collection | TBD | ||
| ResultCulture | Result of culture-based test on specimen | PHVS_PosNegUnkNotDone_CDC | TBD | |
| ResultCIDT | Result of CIDT-based test on specimen | PHVS_PosNegUnkNotDone_CDC | TBD | |
| EpiLink | Indicates the case is epi-linked to a confirmed or probable case | PHVS_YesNoUnknown_CDC | TBD | |
| PrInfantOutcomeDeathDate | Pregnant: If infant died, when was the date of death (Date) | TBD | ||
| LocalRecordIDMother | Pregnant: If mother and infant are counted as separate cases provide the State Epi Case ID of the mother | TBD | ||
| LocalRecordIDNeonate | Pregnant: If mother and infant are counted as separate cases provide the State Epi Case ID of the neonate | TBD |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | CDC Priority |
| TB State Case Number | State case number for the case specific to TB investigations (4 digit report year + 2 letter state + 9 digit alphanumeric number) | N/A | P |
| City or County Case Number | City or county case number assigned to this case | N/A | P |
| Birth Sex | What was the patient's sex at birth? | PHVS_Sex_MFU | P |
| Previously Counted Case | Has this case already been counted by another reporting area? | PHVS_CaseCountStatus_TB | P |
| Previously Reported State Case Number | If case previously counted, provide the state case number from the other reporting area. | N/A | P |
| Country of Verified Case | If the case was previously reported by another country, specify the country. | PHVS_BirthCountry_CDC | P |
| Patient Address City | Patient address city | N/A | P |
| Inside City Limits | Is the patient's residence within city limits? | PHVS_YesNoUnknown_CDC | P |
| Census Tract of Case-Patient Residence | Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area. | N/A | P |
| Detailed Race | Provide the detailed race information for the patient. | PHVS_Race_CDC | P |
| Date Arrived in US | If country of birth is NOT United States, regardless of citizenship, indicate the date when the patient first arrived in the US. | N/A | P |
| US Born | Was the patient eligible for US citizenship at birth? | PHVS_YesNoUnknown_CDC | P |
| Primary Guardian(s) Country of Birth | Indicates the birth country of the primary guardian(s) of patient (pediatric [<15 years old] cases only) | PHVS_BirthCountry_CDC | P |
| Remain in US After Report | If not US reporting area, did patient remain in the United States for >= 90 days after report date? | PHVS_YesNoUnknown_CDC | P |
| Initial Reason for Evaluation | What was the initial reason the patient was evaluated for TB? | PHVS_PrimaryReasonForEvaluation_TB | P |
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case. Please provide a response for each of the main test types (culture, smear, pathology/cytology, NAA, TST, IGRA, HIV, diabetes) If test was not done please indicate so. | PHVS_LabTestType_TB | P |
| Test Result | Epidemiologic interpretation of the results of the test(s) performed for this case - This is a qualitative test result. (e.g., positive, detected, negative) | PHVS_LabTestInterpretation_TB | P |
| Date/Time of Lab Result | Date result sent from reporting laboratory. Time of result is an optional addition to date. | N/A | P |
| Specimen Source Site | This indicates the anatomical source of the specimen tested. | PHVS_MicroscopicExamCultureSite_TB | P |
| Specimen Collection Date/Time | Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection is an optional addition to date. | N/A | P |
| Test Result Quantitative | Quantitative test result value | N/A | P |
| Result Units | Units of measure for the Quantitative Test Result Value | PHVS_UnitofMeasure_TB | P |
| Type of Chest Study | Indicate the type of chest study performed. Please provide a response for each of the main test types (plain chest radiograph, chest CT Scan) and if test was not done please indicate so. | PHVS_TypeofRadiologyStudy_CDC | P |
| Result of Chest Study | Result of chest diagnostic testing | PHVS_ResultofRadiologyStudy_TB | P |
| Evidence of Cavity | Did test show evidence of cavity? | PHVS_YesNoUnknown_CDC | P |
| Evidence of Miliary TB | Did test show evidence of miliary TB? | PHVS_YesNoUnknown_CDC | P |
| Date of Chest Study | Date of the chest diagnostic study | N/A | P |
| Current Occupation | This data element is used to capture the narrative text of a subject's current occupation. | N/A | P |
| Current Occupation Standardized | This data element is used to capture the CDC NIOSH standard occupation code based upon the narrative text of a subject's current occupation. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes. The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here: http://www.cdc.gov/niosh/topics/coding/overview.html |
PHVS_Occupation_CDC_Census2010 | P |
| Current Industry | This data element is used to capture the narrative text of subject's current industry. | N/A | P |
| Current Industry Standardized | This data element is used to capture the CDC NIOSH standard industry code based upon the narrative text of a subject's current industry. (The National Institute for Occupational Safety and Health (NIOSH) has developed a web-based software tool designed to translate industry and occupation text to standardized Industry and Occupation codes. The NIOSH Industry and Occupational Computerized Coding System (NIOCCS) is available here: http://www.cdc.gov/niosh/topics/coding/overview.html |
PHVS_Industry_CDC_Census2010 | P |
| 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 | PHVS_EpidemiologicalRiskFactors_TB | P |
| Patient Epidemiological Risk Factors Indicator | Provide a response for each value in the patient epidemiological risk factors value set | PHVS_YesNoUnknown_CDC | P |
| Type of Correctional Facility | If patient was a Resident of Correctional Facility at Diagnostic Evaluation, indicate the type of correctional facility. | PHVS_CorrectionalFacilityType_NND | P |
| Type of Long-Term Care Facility | If patient was a Resident of Long Term Care Facility at Diagnostic Evaluation, indicate the type of long term care facility. | PHVS_LongTermCareFacilityType_NND | P |
| Smoking Status | What is the patient's current tobacco smoking status? | PHVS_SmokingStatus_CDC | P |
| Patient lived outside of US for more than 2 months | Residence or Travel in countries other than the United States, Canada, Australia, New Zealand, or countries in northern or western Europe for >60 consecutive days at any point in the patient's lifetime. | PHVS_YesNoUnknown_CDC | P |
| Identified During Contact Investigation | Was the patient identified during the contact investigation around the likely source case? | PHVS_YesNoUnknown_CDC | P |
| Evaluation During Contact Investigation | If patient was identified during contact investigation, was the patient evaluated for TB during the contact investigation? | PHVS_YesNoUnknown_CDC | P |
| Linked Case Number | State case numbers for epidemiologically linked cases | N/A | P |
| Date Treatment or Therapy Started | Date the initial treatment regimen was started | N/A | P |
| Treatment Administration Type | Choose all treatment administration types that apply to the case, such as DOT, eDOT, or SAT. | PHVS_TreatmentAdministrationType_TB | P |
| Date Treatment or Therapy Stopped | Date treatment stopped | N/A | P |
| Treatment Started | Was treatment started for LTBI? | PHVS_YesNoUnknown_CDC | P |
| Initial LTBI Drug Regimen | If treatment was started indicate the initial LTBI drug regimen. | PHVS_LTBIDrugRegimen_TB | P |
| Primary Reason LTBI Treatment Not Started | If treatment was not started, what was the primary reason LTBI treatment was not started? | PHVS_ReasonLTBINotStarted_TB | P |
| Reason LTBI Treatment Stopped | Reason LTBI treatment stopped | PHVS_ReasonLTBITreatmentStopped_TB | P |
| NTSS State Case Number | If patient developed TB from LTBI, list the NTSS state case number | N/A | P |
| Adverse Event Severity | If treatment was stopped due to adverse event from LTBI treatment indicate the severity. | PHVS_AdverseEventSeverity_TB | P |
| Usual Occupation and Industry | Usual occupation and industry | TBD | P |
| Meets Binational Reporting Criteria | Does case meet binational reporting criteria? | 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 |
| Erythema Migrans | Indicates whether the patient had erythema migrans (physician diagnosed EM at least 5 cm in diameter). | PHVS_YesNoUnknown_CDC | |
| Swelling | Indicates whether the patient had arthritis characterized by brief attacks of joint swelling. | PHVS_YesNoUnknown_CDC | |
| Bell’s Palsy or other cranial neuritis | Indicates whether the patient had Bell's palsy or other cranial neuritis. | PHVS_YesNoUnknown_CDC | |
| Radiculoneuropathy | Indicates whether the patient had radiculoneuropathy. | PHVS_YesNoUnknown_CDC | |
| Lymphocytic meningitis | Indicates whether the patient had lymphocytic meningitis. | PHVS_YesNoUnknown_CDC | |
| Encephalitis/Encephalomyelitis | Indicates whether the patient had encephalitis/encephalomyelitis. | PHVS_YesNoUnknown_CDC | |
| 2nd or 3rd degree atrioventricular block | Indicates whether the patient had 2nd or 3rd degree atrioventricular block. | PHVS_YesNoUnknown_CDC | |
| OtherSpeci | Name of another laboratory test performed | TEXT | |
| Results | Result of other specific laboratory tests performed | P/N/E/ND/U | |
| EIA_IFA test type | Type of EIA performed | Whole cell antigen EIA/ELISA/ELFA; Defined antigen EIA/ELISA/ELFA;Antigen capture EIA/ELISA/ELFA; IFA; Unknown; Other; not done | |
| EIA_IFA test result | Result of EIA | IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done | |
| Immunoblot result | Result of immunblot | IgM positive only; IgG positive only; IgM and IgG positive; negative; unknown; not done | |
| IgM_21kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgM_39kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgM_41kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_18kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_21kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_28kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_30kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_39kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_41kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_45kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_58kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_66kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| IgG_93kDa | Immunoblot specific test result; linked to laboratory criteria | positive; negative; unknown; not done | |
| Exposure in high incidence state | Did patient live in or visit a state defined as high incidence within 30 days prior to onset of symptoms? | PHVS_YesNoUnknown_CDC | P |
| Symptom onset greater than 30 days | Did onset of symptoms occur more than 30 days prior to diagnosis? | PHVS_YesNoUnknown_CDC | P |
| Clinical Manifestation | Clinical manifestation of Lyme disease | PHVS_ClinicalManifestations_Lyme | P |
| Clinical Manifestation Indicator | For each clinical manifestation reported, indicate whether the subject developed the specified manifestation as a result of the illness. | PHVS_YesNoUnknown_CDC | P |
| Medication Administered | What antibiotic did the patient receive for this episode? | PHVS_MedicationReceived_Lyme | P |
| Date Treatment or Therapy Started | Date the treatment or therapy was initiated | N/A | P |
| Treatment Duration | Number of days the patient actually took the antibiotic referenced | 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) |
| Height | Subject's height | |||
| Height Units | Subject's height units | PHVS_HeightUnit_UCUM | ||
| Weight | Subject's weight | |||
| Weight Units | Subject's weight units | PHVS_WeightUnit_UCUM | ||
| Hospital Name | Name of hospital where case was admitted | free text | ||
| Hospital Record Number | Hospital Record Number, if subject was hospitalized | |||
| Patient last name | Patient's last name | free text | ||
| Patient first name | Patient's first name | free text | ||
| Physician last name | Last name of physician seen for this case | free text | ||
| Physician first name | First name of physician seen for this case | free text | ||
| Physician phone number | Phone number of the physician seen for this case | |||
| Laboratory Name | Reporting Laboratory Name | |||
| Laboratory Phone Number | Reporting Laboratory Phone Number | |||
| Specimen(s) sent to CDC? | Was specimen sent to CDC for Malaria confirmation? | PHVS_YesNoUnknown_CDC | ||
| Specimen Type(s) sent to CDC | Type(s) of specimen sent to CDC. | PHVS_SpecimenType_Malaria | ||
| Description of other specimen type | Description of the other type of specimen sent to CDC | free text | ||
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case. | PHVS_LabTestProcedure_Malaria |
||
| Organism Name | Species identified through testing. | PHVS_Species_Malaria | ||
| Description of other organism | Description of the other organism tested positive for | free text | ||
| Parasitemia Level Percentage | The estimated number of infected erythrocytes expressed as a percentage of the total erythrocytes. | |||
| Subject Traveled or Lived Outside U.S. | Has the subject traveled or lived outside the U.S. during the past two years? | PHVS_YesNoUnknown_CDC | ||
| Subject Reside in U.S. prior to most recent travel | Did the subject reside in the U.S. prior to most recent travel? | PHVS_YesNoUnknown_CDC | ||
| Subject's Country of Residence prior to most recent travel | If the subject did not reside in the U.S. prior to most recent travel, what was the country of residence? | PHVS_Country_ISO_3166-1 | ||
| Principal reason for Travel | If the subject did not reside in the U.S. prior to most recent travel, what was the country of residence? | PHVS_TravelReason_Malaria | ||
| Description of other reason for travel | Description of the other reason for travel from/to the US | free text | ||
| International Destination(s) or residence(s) #1 | Destination(s) or residence(s) outside the U.S. during the past 2 years | PHVS_Country_ISO_3166-1 | ||
| Date of return from travel #1 | Date the subject returned/arrived to the U.S. from an international destination or residence. | |||
| Duration of Stay #1 | Duration of stay in country outside the U.S. | |||
| Duration of Stay Units #1 | Duration of stay units in country outside the U.S. | PHVS_AgeUnit_UCUM | ||
| International Destination(s) or residence(s) #2 | Destination(s) or residence(s) outside the U.S. during the past 2 years | PHVS_Country_ISO_3166-1 | ||
| Date of return from travel #2 | Date the subject returned/arrived to the U.S. from an international destination or residence. | |||
| Duration of Stay #2 | Duration of stay in country outside the U.S. | |||
| Duration of Stay Units #2 | Duration of stay units in country outside the U.S. | PHVS_AgeUnit_UCUM | ||
| International Destination(s) or residence(s) #3 | Destination(s) or residence(s) outside the U.S. during the past 2 years | PHVS_Country_ISO_3166-1 | ||
| Date of return from travel #3 | Date the subject returned/arrived to the U.S. from an international destination or residence. | |||
| Duration of Stay #3 | Duration of stay in country outside the U.S. | |||
| Duration of Stay Units #3 | Duration of stay units in country outside the U.S. | PHVS_AgeUnit_UCUM | ||
| Was malaria chemoprophylaxis taken? | Was malaria chemoprophylaxis taken for prevention of malaria? | PHVS_YesNoUnknown_CDC | ||
| Preventative Medication(s) | Listing of preventative medication(s) taken by the subject | PHVS_MedicationProphylaxis_Malaria | ||
| Description of other malaria chemophophylaxis taken | Description of the other type of malaria chemoprophylaxis taken | free text | ||
| Preventative Medication taken as prescribed? | Was all preventative medication taken as prescribed? | PHVS_YesNoUnknown_CDC | ||
| If doses were missed, what was the reason? | If doses of preventative medicine were missed, what was the primary reason? | PHVS_MedicationMissedReason_Malaria | ||
| Specific side effect that caused missed doses | Desciption of the side effect that was the reason for missing doses of malaria chemoprophylaxis | free text | ||
| Description of the Other reason for missing chemophophylaxis doses | Description of the other reason that resulted in missing doses of malaria chemoprophylaxis | free text | ||
| History of malaria past 12 months | Does the subject have a previous history of malaria in the last 12 months (prior to this report)? | PHVS_YesNoUnknown_CDC | ||
| Date of previous malaria attack | Date of previous malaria attack | |||
| Malaria species associated with previous attack | Malaria species associated with previous attack | PHVS_Species_Malaria | ||
| Description of other malaria species associated with previous attack | Description of the other malaria species associated with the malaria attack in the past 12 months | free text | ||
| Received blood transfusion/organ transplant | Has the subject received a blood transfusion or organ transplant within the last 12 months? | PHVS_YesNoUnknown_CDC | ||
| Blood transfusion/organ transplant date | If subject has received a blood transfusion/organ transplant within the last 12 months, what was the date? | |||
| Complication(s) | Listing of complications as related to this attack. | PHVS_Complications_Malaria | ||
| Other complication(s) | Description of the other clinical complications experienced during this episode/attack of malaria | free text | ||
| Treatment Medication(s) | Listing of treatment medication the subject received for this attack. | PHVS_MedicationTreatment_Malaria | ||
| Other treatment medication(s) | Description of the other treatment medications received for this attack | free text | ||
| Medications pre-treatment | List of all medications taken during the 2 weeks before starting treatment for malaria | free text | ||
| Medications post-treatment | List of all medications taken during the 4 weeks after starting treatment for malaria | free text | ||
| Malaria treatment taken as prescribed | Was the medicine for malaria treatment taken as prescribed? | PHVS_YesNoUnknown_CDC | ||
| Symptoms resolved within 7 days after treatment | Did all signs or symptoms of malaria resolve without any additional malaria treatment within 7 days after starting treatment? | PHVS_YesNoUnknown_CDC | ||
| Recurrence of symptoms during 4 weeks after treatment | If signs and symptoms resolved within 7 days after starting treatment, did the patient experience a recurrence of signs or symptoms of malaria during 4 weeks after starting treatment? | PHVS_YesNoUnknown_CDC | ||
| Adverse events within 4 weeks after starting treatment | Did the patient experience any adverse events within 4 weeks after receiving the malaria treatment | PHVS_YesNoUnknown_CDC | ||
| Adverse Event #1 description | Adverse Event description | free text | ||
| Adverse Event #1 relationship to treatment | Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility? | checkbox | ||
| Adverse Event #1 time to onset | Time to onset since starting treatment | free text | ||
| Adverse Event #1 fatal | Was the adverse event fatal? | checkbox | ||
| Adverse Event #1 life-threatening | Was the adverse event life-threatening? | checkbox | ||
| Adverse Event #1 other seriousness | Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)? | checkbox | ||
| Adverse Event #2 description | Adverse Event description | free text | ||
| Adverse Event #2 relationship to treatment | Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility? | checkbox | ||
| Adverse Event #2 time to onset | Time to onset since starting treatment | free text | ||
| Adverse Event #2 fatal | Was the adverse event fatal? | checkbox | ||
| Adverse Event #2 life-threatening | Was the adverse event life-threatening? | checkbox | ||
| Adverse Event #2 other seriousness | Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)? | checkbox | ||
| Adverse Event #3 description | Adverse Event description | free text | ||
| Adverse Event #3 relationship to treatment | Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility? | checkbox | ||
| Adverse Event #3 time to onset | Time to onset since starting treatment | free text | ||
| Adverse Event #3 fatal | Was the adverse event fatal? | checkbox | ||
| Adverse Event #3 life-threatening | Was the adverse event life-threatening? | checkbox | ||
| Adverse Event #3 other seriousness | Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)? | checkbox | ||
| Adverse Event #4 description | Adverse Event description | free text | ||
| Adverse Event #4 relationship to treatment | Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility? | checkbox | ||
| Adverse Event #4 time to onset | Time to onset since starting treatment | free text | ||
| Adverse Event #4 fatal | Was the adverse event fatal? | checkbox | ||
| Adverse Event #4 life-threatening | Was the adverse event life-threatening? | checkbox | ||
| Adverse Event #4 other seriousness | Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)? | checkbox | ||
| Adverse Event #5 description | Adverse Event description | free text | ||
| Adverse Event #5 relationship to treatment | Is it suspected a causal relationship between the treatment and the adverse event is at least a reasonable possibility? | checkbox | ||
| Adverse Event #5 time to onset | Time to onset since starting treatment | free text | ||
| Adverse Event #5 fatal | Was the adverse event fatal? | checkbox | ||
| Adverse Event #5 life-threatening | Was the adverse event life-threatening? | checkbox | ||
| Adverse Event #5 other seriousness | Was the adverse event serious in another way (i.e., significant disability/incapacity, medically significant, requiring hospitalization or prolonging of existing hospitalization)? | checkbox | ||
| CSID | 10-digit, de-identified specimen number generated after submission of the 50.34 form for CDC diagnostic assistance (Example data: 3000123456) | |||
| Admitted as Inpatient | Was subject admitted to the hospital for greater than 24 hours as an inpatient? | PHVS_YesNoUnknown_CDC | P | |
| Date Treatment or Therapy Started | Date the treatment was initiated | N/A | P | |
| Date Treatment or Therapy Stopped | Date treatment stopped | N/A | P | |
| Treatment Duration | Number of days the patient was prescribed antimalarial treatment | N/A | P | |
| Medication Administered Relative to Treatment | Indicate if the patient took the medication 2 weeks before treatment or within the 4 weeks after starting treatment. | PHVS_MedicationAdministeredRelativeTreatment_Malaria | P | |
| Medication Administered | Please list all prescription and over the counter medicines the patient had taken during the 2 weeks before and during the 4 weeks after starting treatment for malaria. If information for both pre- and post-treatment are available, please complete below questions for each time frame. | N/A | P | |
| Medication Start Date | Medication Start Date | N/A | P | |
| Medication Stop Date | Medication Stop Date | N/A | P | |
| Medication Duration | Number of days that patient took the medication referenced | N/A | P | |
| 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) |
| Did the subject have a rash? | Did the subject being reported in this investigation have a rash? | PHVS_YesNoUnknown_CDC |
| Rash onset date | What was the onset date of the subject's rash? | |
| Rash Duration | How many days did the rash reported in this investigation last? | |
| Was the rash generalized? | Was the rash generalized? (Occurring on more than one or two parts of the body?) | PHVS_YesNoUnknown_CDC |
| Rash onset occur within 21 days of entering USA | Did rash onset occur within 21 days of entering the USA, following any travel or living outside the USA? | PHVS_YesNoUnknown_CDC |
| Did the subject have a fever? | Did the subject have a fever? I.E., a measured temperature >2 degrees above normal | PHVS_YesNoUnknown_CDC |
| Highest Measured Temperature | What was the subject's highest measured temperature during this illness? | |
| Temperature units | The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius. | PHVS_TemperatureUnit_UCUM |
| Date of fever onset | Date of fever onset | |
| Cough | Did the subject develop a cough during this illness? | PHVS_YesNoUnknown_CDC |
| Coryza (runny nose) | Did the subject develop coryza (runny nose) during this illness? | PHVS_YesNoUnknown_CDC |
| Conjunctivitis | Did the subject develop conjunctivitis during this illness? | PHVS_YesNoUnknown_CDC |
| Otitis Media (Complication) | Did the subject develop otitis media as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Diarrhea (Complication) | Did the subject develop diarrhea as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Pneumonia (Complication) | Did the subject develop pneumonia as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Encephalitis (Complication) | Did the subject develop encephalitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Thrombocytopenia (Complication) | Did the subject develop thrombocytopenia as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Croup (Complication) | Did the subject develop croup as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Hepatitis (Complication) | Did the subject develop hepatitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Other Complication | Did the subject develop other conditions as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Specify Other Complication | Please specify the other complication the subject developed, during or as a result of this illness. | |
| Was laboratory testing done for measles? | Was laboratory testing done to confirm a diagnosis of measles? | PHVS_YesNoUnknown_CDC |
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case | PHVS_LabTestProcedure_Measles |
| Test Result | Epidemiologic interpretation of the results of the tests performed for this case. | PHVS_LabTestInterpretation_VPD |
| Sample Analyzed Date | The date the specimen/isolate was tested. | |
| Test Method | The technique or method used to perform the test and obtain the test results. | PHVS_LabTestMethod_CDC |
| Date Collected | Date of specimen collection | |
| Specimen Source | The medium from which the specimen originated. | PHVS_SpecimenSource_Measles |
| Were the specimens sent to CDC for genotyping (molecular typing)? | Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)? | PHVS_YesNoUnknown_CDC |
| Specimen type sent to CDC for genotyping | Specimen type sent to CDC for genotyping | PHVS_SpecimenSource_Measles |
| Date sent for genotyping | The date the specimens were sent to the CDC laboratories for genotyping. | |
| Was Measles virus genotype sequenced? | Identifies whether the Measles virus was genotype sequenced. | PHVS_YesNoUnknown_CDC |
| Type of Genotype Sequence | Identifies the genotype sequence of the Measles virus | PHVS_Genotype_Measles |
| Transmission Setting | What was the transmission setting where the measles was acquired? | PHVS_TransmissionSetting_NND |
| Source of Infection | What was the source of the measles infection? | |
| Were age and setting verified? | Does the age of the case match or make sense for the transmission setting listed (i.e. A subject aged 80 probably would not have a transmission setting of child day care center.)? | PHVS_YesNoUnknown_CDC |
| Is this case Epi-linked to another confirmed or probable case? | Specify if this case is Epidemiologically-linked to another confirmed or probable case of measles? | PHVS_YesNoUnknown_CDC |
| Is this case linked to an international imported case either directly or within same chain of transmission? | A "Yes" answer to this question denotes this case was infected by another subject who acquired infection while outside of the U.S. | PHVS_YesNoUnknown_CDC |
| International Destination(s) of recent travel | List any international destinations of recent travel | PHVS_Country_ISO_3166-1 |
| Date of return from travel. | Date the subject returned from all travel | |
| Did the subject ever receive a disease-containing vaccine? | Did the subject ever receive a measles-containing vaccine? | PHVS_YesNoUnknown_CDC |
| If no, reason subject did not receive a disease-containing vaccine | If the subject did not receive a measles-containing vaccine, what was the reason? | PHVS_VaccineNotGivenReasons_CDC |
| Number of doses received BEFORE first birthday | The number of doses of measles-containing vaccine the subject received before their first birthday. | |
| Number of doses received ON or AFTER first birthday | The number of measles-containing vaccine doses the subject received on or after their first birthday. | |
| Reason for vaccinating before first (1st) birthday but not after | If the subject was vaccinated with measles-containing vaccine BEFORE the first birthday, but did not receive a vaccine dose after their first birthday, state the reason. | PHVS_VaccineNotGivenReasons_CDC |
| Reason subject received one dose ON or AFTER first birthday, but never received a second dose after the first (1st) birthday | If the subject received one dose of measles-containing vaccine ON or AFTER their first birthday, but did not receive a second dose after the first birthday, what was the reason? | PHVS_VaccineNotGivenReasons_CDC |
| Total doses disease-containing vaccine | Total doses measles-containing vaccine | |
| Vaccine Administered | The type of vaccine administered | PHVS_VaccinesAdministeredCVX_CDC_NIP |
| Vaccine Manufacturer | Manufacturer of the vaccine | PHVS_ManufacturersOfVaccinesMVX_CDC_NIP |
| Vaccine Lot Number | The vaccine lot number of the vaccine administered | |
| Vaccine Administered Date | The date that the vaccine was administered | |
| US Acquired | Sub-classification of disease or condition acquired in the US |
PHVS_CaseClassificationExposureSource_NND |
| Age at Rash Onset | Age of patient at rash onset | |
| Age Type at rash Onset | Age units of patient at rash onset | |
| Chest x-ray for pneumonia | Was a chest x-ray for pneumonia done? | |
| Case Patient a Healthcare Worker | Was the case patient a healthcare provider (HCP) at illness onset? | |
| Import Status | Was this case imported? | |
| Vaccination Doses Prior to Illness Onset | Number of vaccine doses against this disease prior to illness onset | |
| Date of Last Dose Prior to Illness Onset | Date of last vaccine dose against this disease prior to illness onset | |
| Vaccine History Comments | Comments about the subject's vaccination history |
| 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 First Report to CDC | Date the case was first reported to the CDC | |||
| Notification Result Status | Status of the notification. | PHVS_ResultStatus_NETSS | ||
| Condition Code | Condition or event that constitutes the reason the notification is being sent | PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS | ||
| Case Class Status Code | Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. | PHVS_CaseClassStatus_NND | ||
| MMWR Week | MMWR Week for which case information is to be counted for MMWR publication. | |||
| MMWR Year | MMWR Year (YYYY) for which case information is to be counted for MMWR publication. | |||
| Reporting State | State reporting the notification. | PHVS_State_FIPS_5-2 | ||
| Reporting County | County reporting the notification. | PHVS_County_FIPS_6-4 | ||
| National Reporting Jurisdiction | National jurisdiction reporting the notification to CDC. | PHVS_NationalReportingJurisdiction_NND | ||
| Reporting Source Type Code | Type of facility or provider associated with the source of information sent to Public Health. | PHVS_ReportingSourceType_NND | ||
| Reporting Source ZIP Code | ZIP Code of the reporting source for this case. | |||
| Date First Reported PHD | Earliest date the case was reported to the public health department whether at the local, county, or state public health level. | |||
| Person Reporting to CDC - Name | Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Person Reporting to CDC - Phone Number | Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Person Reporting to CDC - Title | Job title / description of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Person Reporting to CDC - Affiliation | Affiliated Facility of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification. | |||
| Subject Address County | County of residence of the subject | PHVS_County_FIPS_6-4 | ||
| Subject Address State | State of residence of the subject | PHVS_State_FIPS_5-2 | ||
| Age units at case investigation | Subject age units at time of case investigation | PHVS_AgeUnit_UCUM_NETSS | ||
| Country of Birth | Country of Birth | PHVS_CountryofBirth_CDC | ||
| Time in U.S. | Length of time this subject has been living in the U.S. (if born out of the U.S. | |||
| Date entered U.S. | Date entered U.S. in YYYYMM format (if born out of the U.S.) | |||
| Travel or Live Outside U.S. | Did the subject travel or live outside the U.S.A.? | PHVS_YesNoUnknown_CDC | ||
| Country of Exposure or Country Where Disease was Acquired Note: use exposure or acquired consistently across variables |
Indicates the country in which the disease was potentially acquired. | PHVS_Country_ISO_3166-1 | ||
| Subject’s Sex | Subject’s current sex | PHVS_Sex_MFU | ||
| Race Category | Field containing one or more codes that broadly refer to the subject’s race(s). | PHVS_RaceCategory_CDC | ||
| Ethnic Group Code | Based on the self-identity of the subject as Hispanic or Latino | PHVS_EthnicityGroup_CDC_Unk | ||
| Country of Usual Residence | Where does the person usually* live (defined as their residence) *For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf . |
PHVS_CountryofBirth_CDC | ||
| Earliest Date Reported to County | Earliest date reported to county public health system | |||
| Earliest Date Reported to State | Earliest date reported to state public health system | |||
| Diagnosis Date | Earliest date of diagnosis (clinical or laboratory) of condition being reported to public health system | |||
| Date of Onset of symptoms | Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system | |||
| Date sample collected | Provide date test was performed in YYYYMM format | |||
| Date test performed | Provide date test was performed in YYYYMM format | |||
| Type of test utilized to identify case | Indicate the type of test performed to confirm case | |||
| Test Result | Epidemiologic interpretation of the results of the tests performed for this case | PHVS_LabTestInterpretation_melioidosis | ||
| Hospitalized | Indicate whether subject was or is currently hospitalized due to this illness | PHVS_YesNoUnknown_CDC | ||
| Did patient expire? | Indicate whether subject died of this illness | PHVS_YesNoUnknown_CDC | ||
| Current antimicrobial Treatment | Indicate all antimicrobial drugs used to treat subject |
PHVS_MedicationTreatment_Melioidosis | ||
| Date current antimicrobial Treatment | Indicate the date antimicrobial treatment started |
PHVS_MedicationTreatment_Date_Melioidosis | ||
| Diabetes | Does subject have diabetes? | PHVS_YesNoUnknown_CDC | ||
| Chronic renal disease | Does subject have chronic renal disease? | PHVS_YesNoUnknown_CDC | ||
| Chronic lung disease | Does subject have chronic lung disease? | PHVS_YesNoUnknown_CDC | ||
| Liver disease or chronic alcohol abuse | Does subject have liver disease or chronic alcohol abuse? | PHVS_YesNoUnknown_CDC | ||
| Thalassemia | Does subject have thalassemia? | PHVS_YesNoUnknown_CDC | ||
| Non HIV-related immune suppression | Does subject have non HIV-related immune suppression? | PHVS_YesNoUnknown_CDC | ||
| Military service | Has subject ever served overseas in in the military? | PHVS_YesNoUnknown_CDC | ||
| Military service Date | If yes, date of service in YYYYMM format. | |||
| Laboratory exposure | Was subject ever exposed to burkolderia through lab work? | PHVS_YesNoUnknown_CDC | ||
| Laboratory exposure Date | If yes, date of exposure in YYYYMM format. | |||
| Contact with soil or water in melioidosis-endemic areas | Has subject ever been in contact with soil or water in melioidosis-endemic areas? | PHVS_YesNoUnknown_CDC | ||
| Contact with soil or water in melioidosis-endemic areas service Date | If yes, date of contact in YYYYMM format. | |||
| Contact with someone with the same disease | Did subject have contact with someone diagnosed with melioidosis? | PHVS_YesNoUnknown_CDC | ||
| Were you at any recent mass gathering? | Was subject present at any recent mass gathering? | PHVS_YesNoUnknown_CDC | ||
| State or Local Public Health Laboratory/LRN POC- Name | Name of the laboratory person who is the lab POC for this investigation | N/A | 1 | |
| State or Local Public Health Laboratory/LRN POC- Phone number | Phone number of the laboratory person who is the lab POC for this investigation | N/A | 1 | |
| State or Local Public Health Lab/LRN POC Email Address | Email address of person who is reporting cases to CDC | N/A | 1 | |
| State or Local Public Health Lab/LRN POC- Affiliation | Affiliated Facility of the state LRN/lab POC | N/A | 1 | |
| Case origin/type | Is this a human or animal case? | TBD | 1 | |
| Country of travel destination | Choose a country for each destination | PHVS_Country_ISO_3166-1 | 2 | |
| International Region | Enter region (list multiple if applicable) | N/A | 3 | |
| Dates of International Travel | Enter dates of travel (multiple if applicable) | N/A | 2 | |
| Contact with soil or water in International travel destination | Was the subject contact with soil or water during this visit? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific location of exposure for International Travel | If yes to Question above, indicate specific location of exposure | N/A | 3 | |
| Other close contacts with same soil/water exposures (International Travel) | If yes to Question above, indicate whether other close contacts also had the same soil/water exposure | PHVS_YesNoUnknown_CDC | 3 | |
| Number of close contacts (International Travel) | If yes to Question above, list the total number of close contacts | N/A | 3 | |
| Relationship (International Travel) | If yes to Question above, select relationship to subject (select all that apply) | TBD | 3 | |
| Significant weather or environmental events during this visit (International Travel) | Were there any significant weather or environmental events during this visit? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific weather or environmental events (International Travel) | If yes to Question above, select all weather/environmental events | TBD | 3 | |
| Contact with soil or water in melioidosis-endemic areas | Has subject ever been in contact with soil or water in melioidosis-endemic areas? | PHVS_YesNoUnknown_CDC | 2 | |
| Contact with soil or water in melioidosis-endemic areas service Date | If yes, date of contact in YYYYMM format. | N/A | 2 | |
| Travel within U.S. but >50 miles from residence | Did the subject travel 50 miles or more outside his or her normal residence but within the U.S. 30 days prior to onset? | PHVS_YesNoUnknown_CDC | 2 | |
| State | Choose a state each destination | PHVS_State_FIPS_5-2 | 2 | |
| City/town | Please indicate city/town (list multiple if applicable) | N/A | 3 | |
| Dates of Travel | Enter dates of travel | N/A | 2 | |
| Contact with soil or water in travel destination | Was the subject contact with soil or water during this visits? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific location of exposure | If yes to Question above, indicate specific location of exposure | N/A | 3 | |
| Other close contacts with same soil/water exposures | If yes to Question above, were there other close contacts also had the same soil/water exposure | PHVS_YesNoUnknown_CDC | 3 | |
| Number of close contacts | If yes to Question above, list the total number of close contacts | N/A | 3 | |
| Relationship | If yes to Question above, select relationship to subject (select all that apply) | TBD | 3 | |
| Significant weather or environmental events during this visit | Were there any significant weather or environmental events during this visit? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific weather or environmental events | If yes to Question above, select all weather/environmental events | TBD | 3 | |
| Travel (in the last 10 years) | In the 10 years before symptoms onset, did the patient travel outside of the continental U.S. or to an area in the U.S. where the endemicity is possible | PHVS_YesNoUnknown_CDC | 2 | |
| Country of travel destination (in the last 10 years) | Choose a country for each destination | N/A | 2 | |
| Region of travel in last 10 years | Enter region (list multiple if applicable) | N/A | 2 | |
| Dates of Travel (in the last 10 years) | Enter dates of travel | N/A | 2 | |
| Contact with soil or water in travel destination (in the last 10 years) | Was the subject contact with soil or water during this visit? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific location of exposure (in the last 10 years) | If yes to Question above, indicate specific location of exposure | N/A | 3 | |
| Other close contacts with same soil/water exposures (International Travel) | If yes to Question above, indicate whether other close contacts also had the same soil/water exposure | PHVS_YesNoUnknown_CDC | 3 | |
| Number of close contacts (International Travel) | If yes to Question above list the total number of close contacts | N/A | 3 | |
| Relationship (International Travel) | If yes to Question above, select relationship to subject (select all that apply) | TBD | 3 | |
| Significant weather or environmental events during this visit (International Travel) | Were there any significant weather or environmental events during this visit? | PHVS_YesNoUnknown_CDC | 2 | |
| Specific weather or environmental events (International Travel) | If yes to Question above, select all weather/environmental events | TBD | 2 | |
| Specify other or abscess for "specimen source" | If abscess or other specimen selected, please specify | N/A | 2 | |
| Date of LRN confirmation, if applicable | Enter Date of Confirmation by LRN | N/A | 3 | |
| AST Request | Is the jurisdiction requesting AST on the isolate | TBD | 3 | |
| Dates of Hospitalization | Give reporting jurisdiction ability to enter multiple hospitalizations if needed | N/A | 2 | |
| Pneumonia/pleural effusion | Did the subject have pneumonia/pleural effusion | PHVS_YesNoUnknown_CDC | 2 | |
| Skin/soft tissue infections | Did the subject have skin/soft tissue infection | PHVS_YesNoUnknown_CDC | 2 | |
| Genitourinary infection | Did the subject have genitourinary infection | PHVS_YesNoUnknown_CDC | 2 | |
| Neurologic infection | Did the subject have neurologic infection | PHVS_YesNoUnknown_CDC | 2 | |
| Pericardial effusion | Did the subject have pericardial effusion | PHVS_YesNoUnknown_CDC | 2 | |
| Bone or joint infection | Did the subject have bone/joint infection | PHVS_YesNoUnknown_CDC | 2 | |
| Internal abscesses | Did the patient have internal abscesses | PHVS_YesNoUnknown_CDC | 2 | |
| Select or specify location of abscesses | If yes, for internal abscesses, please select all that apply | TBD | 2 | |
| Additional notes describing abscesses | If yes for internal abscesses, additional notes (number, location of abscesses) | N/A | 2 | |
| Septic Shock | Did the subject have septic shock | PHVS_YesNoUnknown_CDC | 2 | |
| Bacteremia | Did the subject have bacteremia | PHVS_YesNoUnknown_CDC | 2 | |
| Date antimicrobial Treatment ended | Indicate the date antimicrobial treatment ended |
N/A | 2 | |
| Liver disease | Does subject have liver disease | PHVS_YesNoUnknown_CDC | 2 | |
| Excess alcohol abuse | Does subject have history chronic alcohol abuse? | PHVS_YesNoUnknown_CDC | 2 | |
| Chronic granulomatous disease | Does the subject have chronic granulomatous disease? | PHVS_YesNoUnknown_CDC | 2 | |
| Malignancy | Does the subject have malignancy? | PHVS_YesNoUnknown_CDC | 2 | |
| Systemic lupus erythematous | Does the subject have systemic lupus erythematous? | PHVS_YesNoUnknown_CDC | 2 | |
| Prior splenectomy | Does the subject have a history of prior splenectomy | PHVS_YesNoUnknown_CDC | 2 | |
| Immunosuppressing drugs | Is the subject on any immunosuppressing medication | PHVS_YesNoUnknown_CDC | 2 | |
| Other immunocompromising condition | Does the patient have any other immunocompromising conditions | PHVS_YesNoUnknown_CDC | 2 | |
| Patient's Occupation | What is the patient's occupation | N/A | 2 | |
| Recreational Gardener | Is the patient a recreational gardener? | PHVS_YesNoUnknown_CDC | 2 | |
| Is this case part of a cluster? | Is this case part of a cluster? | PHVS_YesNoUnknown_CDC | 3 | |
| Exposure to Iguanas | In the 30 days prior to symptoms onset did the patient own or have direct contact with an iguana? | PHVS_YesNoUnknown_CDC | 2 | |
| Type of Iguana | Indicate type of iguana if yes to previous question | N/A | 2 | |
| Type of exposure | Indicate type of exposure if yes to exposure to iguana | TBD | 2 | |
| If owned, how acquired | If owned an iguana, indicate how case patient acquired | TBD | 2 | |
| Location of purchase or where acquired | Location of purchase/where acquired (name of river, lake, park, or location of pet store, for example) | N/A | 2 | |
| Exposure to Pet Fish | In the 30 days prior to symptoms onset did the patient own or have direct contact with pet fish? | PHVS_YesNoUnknown_CDC | 2 | |
| Type of pet fish | Indicate type of pet fish if yes to previous question | N/A | 2 | |
| Type of exposure | Indicate type of exposure if yes to exposure to pet fish | TBD | 2 | |
| If owned, how acquired | If owned a pet fish, indicate how case patient acquired | TBD | 2 | |
| Location of purchase or where acquired | Location of purchase/where acquired (name of river, lake, park, or location of pet store, for example) | N/A | 2 | |
| Exposure to Aquatic Plants | In the 30 days prior to symptoms onset did the patient own or have direct contact with aquatic plants? | PHVS_YesNoUnknown_CDC | 2 | |
| Type of aquatic plant | Indicate type of aquatic plant if yes to previous question | N/A | 2 | |
| Type of exposure | Indicate type of exposure if yes to exposure to aquatic plants | TBD | 2 | |
| If owned, how acquired | If owned aquatic plant, indicate how case patient acquired | TBD | 2 | |
| Location of purchase or where acquired | Location of purchase/where acquired (name of river, lake, park, or location of pet store, for example) | N/A | 2 | |
| Exposure to Other Animals | In the 30 days prior to symptoms onset did the patient own or have direct contact with other animals | PHVS_YesNoUnknown_CDC | 2 | |
| Type of "Other Animal" | Indicate type of other animal if yes to previous question | N/A | 2 | |
| Type of exposure | Indicate type of exposure if yes to exposure to "other animal" | TBD | 2 | |
| If owned, how acquired | If owned "other animal", indicate how case patient acquired | TBD | 2 | |
| Location of purchase or where acquired | Location of purchase/where acquired (name of river, lake, park, or location of pet store, for example) | N/A | 2 | |
| Laboratory exposures identified | Were potential laboratory exposures identified in this investigation | PHVS_YesNoUnknown_CDC | 1 | |
| Name of Facility (Exposures) | Name of facility/hospital where exposures were identified | N/A | 2 | |
| City/town (Exposures) | City of facility where exposures were identified | N/A | 2 | |
| State (Exposures) | State where the facility where the exposures were identified | PHVS_State_FIPS_5-2 | 2 | |
| Number of laboratorians exposed | Total number of laboratory personnel exposures | N/A | 1 | |
| High Risk | Number of laboratory personnel with high-risk exposures | N/A | 2 | |
| Low Risk | Number of laboratory personnel with low-risk exposures | N/A | 2 | |
| Minimal Risk | Number of laboratory personnel with minimal exposures | N/A | 2 | |
| Date of Exposure | For each laboratory personnel, date of exposures | N/A | 2 | |
| Risk Factors | Does the laboratory personnel have risk factors for melioidosis | TBD | 2 | |
| Laboratory Activity | Select activity that resulted in exposure | TBD | 2 | |
| Risk Category | For each laboratory personnel and each activity, select risk category | TBD | 2 | |
| Serologic Monitoring | Did the laboratory personnel undergo serologic monitoring | TBD | 2 | |
| Received post-exposure prophylaxis | Did the laboratory personnel receive post-exposure prophylaxis | TBD | 2 | |
| Reported Symptoms (lab exposures) | Did the laboratory personnel report symptoms within 21 days of exposure | TBD | 2 | |
| Onset Date (lab exposure) | If the laboratory personnel reported symptoms, please provide onset date | N/A | 2 | |
| Describe Symptoms | If the laboratory personnel reported symptoms, describe | N/A | 2 | |
| Physician Name | Name of the physician or clinician who diagnosed and/or treated the patient | N/A | 3 | |
| Physician Phone | Phone number of the patient's clinician/provider of care | N/A | 3 | |
| Patient Case Status | Indicate the patient's case status | TBD | 2 | |
| Microorganism Identified in Isolate | Pathogen/Organism Identified in Isolate | TBD | 1 | |
| Underlying Condition(s) | Listing of underlying causes or prior illnesses | TBD | 2 | |
| Immunocompromised Associated Condition or Treatment | If the subject was immunocompromised, what was the associated immunocompromising condition or treatment? | TBD | 3 | |
| Continents Visited | Select all continents where patient has visited or lived in their lifetime | TBD | 2 | |
| Most recent year visited | Most recent year visited (continents) | N/A | 3 | |
| Visited or Lived in States | Has the patient EVER visited or lived in any of the following US states in their lifetime? | TBD | 2 | |
| Travel | In the 30 days prior to illness onset, did the patient travel 50 miles or more from their normal residence? | PHVS_YesNoUnknown_CDC | 1 | |
| Travel Outside USA Prior to Illness Onset within Program Specific Timeframe | Did the subject travel internationally in the 30 days prior to illness onset? | PHVS_YesNoUnknown_CDC | 1 | |
| Activity Type | What activities led to the indicated environmental or animal exposure(s)? | TBD | 2 | |
| Severe Weather Location | Specify the location where severe weather occurred (e.g., home, work) | TBD | 3 | |
| Event Notes | Notes related to event exposure | N/A | 3 | |
| Signs and Symptoms Indicator | Indicator for associated signs and symptoms | PHVS_YesNoUnknown_CDC | 1 | |
| Treatment Drug Indicator | Did the subject receive antimicrobials for this illness or following an exposure? | PHVS_YesNoUnknown_CDC | 2 | |
| Reason Medication Not Completed | Reason full course of antimicrobials was not completed | PHVS_ReasonMedicationNotCompleted_BSP | 3 | |
| Antimicrobials Not Taken or Discontinued | Did the patient complete the course of antimicrobials received? | TBD | 3 | |
| Disease Outcome Type | Patient's status or outcome for this condition | TBD | 1 | |
| Specimen Source Site | If specimen type is tissue, indicate the anatomical source (e.g., lung, kidney) | TBD | 2 | |
| Specimen Sent to CDC | Was specimen(s) sent to CDC for testing? | 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) |
| MIS ID | Multisystem inflammatory syndrome identifier. | N/A | 1 | |
| Health Department ID | Health Department identifier. | N/A | 1 | |
| NCOV ID | COVID-19 identifier (if available) | N/A | 1 | |
| Abstractor name | Name of person compiling medical records and/or interviews. | N/A | 1 | |
| Date of abstraction | Date of abstraction | N/A | 1 | |
| Temperature if fever | Fever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours | N/A | 1 | |
| Inflammation laboratory markers | Laboratory markers of inflammation (including, but not limited to one or more; an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin), | TBD | 1 | |
| Signs and symptoms | Evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement. | TBD | 1 | |
| Signs and symptoms indicator | Indicator for associated sign and symptom | PHVS_YesNoUnknown_CDC | 1 | |
| No alternative plausible diagnosis | Is there no alternative plausible diagnosis? | PHVS_YesNoUnknown_CDC | 1 | |
| SARS-COV-2 test | Positive for current or recent SARS-COV-2 infection (select all applicable tests) | TBD | 1 | |
| Symptom onset within 4 weeks of exposure | COVID-19 exposure within the 4 weeks prior to the onset of symptoms | PHVS_YesNoUnknown_CDC | 1 | |
| Date of symptom onset | If yes, date of first exposure within the 4 weeks prior | N/A | 1 | |
| Height | Height specified in inches | N/A | 1 | |
| Weight | Weight in pounds | N/A | 1 | |
| Body Mass Index | Body Mass Index | N/A | 1 | |
| Patient Epidemiological Risk Factors | Underlying medical conditions or risk behaviors for the case patient. | TBD | 1 | |
| Patient Epidemiological Risk Factors Indicator | Provide a response for each value in the risk factors value set. | PHVS_YesNoUnknown_CDC | 1 | |
| Type of complication | Complications associated with the illness being reported | TBD | 1 | |
| Type of complication indicator | Provide a response for each complication. | PHVS_YesNoUnknown_CDC | 1 | |
| ICU Admission Date | If admitted to the ICU, ICU admission date | N/A | 1 | |
| Days in ICU | Number of days in ICU | N/A | 1 | |
| Patient outcome | Patient outcome | TBD | 1 | |
| Preceding COVID-like illness | Did the patient have preceding COVID-like illness? | PHVS_YesNoUnknown_CDC | 1 | |
| Date of onset of preceding COVID-like illness | If yes, date of onset of preceding illness | N/A | 1 | |
| Fever | Fever ≥ 38.0°C | PHVS_YesNoUnknown_CDC | 1 | |
| Date of fever onset | Date of fever onset | N/A | 1 | |
| Highest temperature | Highest temperature © | N/A | 1 | |
| Number of days febrile | Number of days febrile | N/A | 1 | |
| Clinical finding | Clinical finding | TBD | 1 | |
| Clinical finding indicator | Provide a response for each clinical finding. | PHVS_YesNoUnknown_CDC | 1 | |
| Treatment Type | Listing of treatment or medical intervention the subject received for this illness | TBD | 1 | |
| Treatment type indicator | Provide a response for each treatment type. | PHVS_YesNoUnknown_CDC | 1 | |
| Vasoactive medications | Specify vasoactive medications | TBD | 1 | |
| Immune modulators | Specify immune modulators treatment | TBD | 1 | |
| Antiplatelets | Specify antiplatelets treatment | TBD | 1 | |
| Anticoagulation | Specify anticoagulation treatment | TBD | 1 | |
| Echocardiogram | Select any echocardiogram that apply. | TBD | 1 | |
| Max coronary artery Z-score | If coronary artery aneurysms, state max coronary artery Z-score. | N/A | 1 | |
| Cardiac dysfunction | If cardiac ventricular dysfunction, specify type. | TBD | 1 | |
| Mitral regurgitation | Specify type of mitral regurgitation. | TBD | 1 | |
| Date of coronary artery aneurysm | Date of first test showing coronary artery aneurysm or dilatation. | N/A | 1 | |
| Abdominal imaging type | Type of abdominal imaging (ultrasound, CT) | TBD | 1 | |
| Chest imaging type | Type of chest imaging (chest x-ray, CT) | TBD | 1 | |
| MIS Inclusion | Did the patient meet all inclusion criteria associated with MIS illness case definition | PHVS_YesNoUnknown_CDC | 1 | |
| MIS Inclusion Criteria | Inclusion criteria associated with the illness being reported | MIS Inclusion (MIS) | 1 | |
| MIS Inclusion Criteria indicator | Indicator for associated inclusion criteria | PHVS_YesNoUnknown_CDC | 1 | |
| Patient outcome date | Date of hospital discharge or death | N/A | 1 | |
| Medical history | Does the patient have a history of the following illnesses prior to developing MIS-C symptoms? | Patient history (MIS) | 1 | |
| Medical history indicator | Indicator for associated medical history diagnosis | Patient history (MIS) | 1 | |
| Date of medical history | Date of past medical history diagnosis | N/A | 1 | |
| Imaging Study | Listing of imaging studies the subject received for this illness | Imaging Studies | 1 | |
| Imaging Study indicator | Provide a response for normal or abnormal results for each imaging study received | Normal, Abnormal, Not Done | 1 | |
| Left ventricular ejection fraction (LVEF) level | Specify left ventricular ejection fraction (LVEF) | 1:≥55%, 2: 50-54% 3: <50% | 1 |
| 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) |
| Tribal Residence | If you reside in a Tribal Area, please specify | TBD | 2 | |
| Tribal Name | If the selected race is American Indian or Alaska Native, what is the tribal affiliation? | PHVS_TribeName_NND | 3 | |
| Gender Identity | Do you currently describe yourself as male, female, or transgender? | PHVS_GenderIdentity_USCDI | 1 | |
| Sexual Orientation | Patient identified sexual orientation (i.e., an individual's physical and/or emotional attraction to another individual of the same gender, opposite gender, or both genders). | PHVS_SexualOrientation_USCDI | 2 | |
| Birth Sex | What sex were you assigned at birth, on your original birth certificate? | PHVS_Sex_MFU | 1 | |
| Reason Vaccine Administered | Reason individual received a vaccine against this condition | TBD | 2 | |
| Sexual Contact | Did you engage in any sex and/or close intimate contact before your first symptom appeared? | PHVS_YesNoUnknown_CDC | 2 | |
| Sex with Male Partners | Sex with male partners? | PHVS_YesNoUnknown_CDC | 2 | |
| Number of Male Sexual Partners | Number of male partners or description if no number is provided | N/A | 2 | |
| Numerical Range of Male Partners | If individual is unable to specify, provide a range of options for the number of male partners | TBD | 2 | |
| Sex with Female Partners | Sex with female partners? | PHVS_YesNoUnknown_CDC | 2 | |
| Number of Female Sexual Partners | Number of female partners or description if no number is provided | N/A | 2 | |
| Numerical Range of Female Partners | If individual is unable to specify, provide a range of options for the number of female partners | TBD | 2 | |
| Sex with Transgender Female Partners | Sex with transgender female partners? | PHVS_YesNoUnknown_CDC | 2 | |
| Number of Transgender Female Partners | Number of transgender female partners or description if no number is provided | N/A | 2 | |
| Numerical Range of Female Transgender Partners | If individual is unable to specify, provide a range of options for the number of transgender female partners | TBD | 2 | |
| Sex with Transgender Male Partners | Sex with transgender male partners? | PHVS_YesNoUnknown_CDC | 2 | |
| Number of Transgender Male Partners | Number of transgender male partners or description if no number is provided | N/A | 2 | |
| Numerical Range of Transgender Male Partners | If individual is unable to specify, provide a range of options for the number of transgender male partners | TBD | 2 | |
| Sex with Other Gender Identity Partners | Sex with other gender identity partners? | PHVS_YesNoUnknown_CDC | 2 | |
| Number of Other Gender Identity Partners | Number of other gender identity partners or description if no number is provided | N/A | 2 | |
| Numerical Range of Other Identity Gender Partners | If individual is unable to specify, provide a range of options for the number of other gender identity partners | TBD | 2 | |
| Epi Linked | Specify if this case is epidemiologically linked to another confirmed or probable case | PHVS_YesNoUnknown_CDC | 1 | |
| CDC Event Case ID | This ID is used to track information about the case-patient in CDC data systems and must be provided on all forms or specimens related to this individual | N/A | 3 | |
| Linked Case Number | Provide State assigned Case ID | N/A | 3 | |
| Contact Type | Type of contact | TBD | 1 | |
| Specify Other Contact Type | Other contact type | N/A | 1 | |
| Did The Case Travel Domestically Prior To Illness Onset? | Did you spend time (within the US) outside your home state or territory during the [time period] before your first symptom appeared (also called symptom onset)? | PHVS_YesNoUnknown_CDC | 3 | |
| Travel State | State traveled to | PHVS_State_FIPS_5-2 | 3 | |
| Date Of Departure From Travel Destination | Date of departure (MM/DD/YYYY) | N/A | 3 | |
| Date Of Arrival To Travel Destination | Date of return (MM/DD/YYYY) | N/A | 3 | |
| Sexual Contact During Domestic Travel | Did you have intimate or sexual contact with new partners on domestic trip? | PHVS_YesNoUnknown_CDC | 3 | |
| Domestic Travel Comment | Any additional comments on travel within the US that may be important | N/A | 3 | |
| Travel Outside USA Prior To Illness Onset Within Program Specific Timeframe | Did you spend time in a country outside the US during the [time period] before your first symptom appeared (also called symptom onset)? | PHVS_YesNoUnknown_CDC | 3 | |
| International Destination(s) of Recent Travel | Country traveled to | PHVS_Country_ISO_3166-1 | 3 | |
| Sexual Contact During International Travel | Did you have any intimate or sexual contact with new partners on international trip? | PHVS_YesNoUnknown_CDC | 3 | |
| International Travel Comment | Any additional comments on travel outside the US that may be important? | N/A | 3 | |
| Case Patient a Healthcare Worker | Is this individual a health care worker who was exposed at work? | PHVS_YesNoUnknown_CDC | 1 | |
| Location of Exposure | Please provide the suspect location of exposure | TBD | 1 | |
| Exposure Comment | Please provide any additional details on the location of exposure (e.g., health care setting, large gathering, private party) | N/A | 1 | |
| Number of Household Contacts | Please provide the number of identified contacts this case may have exposed (either named or anonymous) | N/A | 2 | |
| Signs and Symptoms | Signs and symptoms associated with the illness being reported | TBD | 3 | |
| Signs and Symptoms Indicator | Indicator for associated sign and symptom | PHVS_YesNoUnknown_CDC | 3 | |
| Skin Lesion(s) (disorder) | Did you have a rash during the course of your illness? | PHVS_YesNoUnknown_CDC | 3 | |
| Rash Onset Date | If yes, what was the date of rash onset (i.e., the date the rash first appeared)? | N/A | 3 | |
| Body Region(s) of Rash | If yes, where on your body is the rash? (choose all that apply) | TBD | 3 | |
| Ocular Manifestations | Any evidence of ocular involvement (ocular lesions, keratitis, conjunctivitis, eyelid lesions)? | TBD | 3 | |
| Co-infection | Has this individual been diagnosed with any acute infections other than [condition] during this current illness/or within [time period]? | PHVS_YesNoUnknown_CDC | 3 | |
| Co-infection Type | Specify other co-infections | TBD | 3 | |
| HIV Status | What is the individual's HIV status? | PHVS_HIVStatus_STD | 1 | |
| HIV Viral Load Undetectable | If HIV positive, was the individual's viral load undetectable when it was last checked? | PHVS_YesNoUnknown_CDC | 2 | |
| Patient Immunocompromised | Does the individual have any known immunocompromising conditions (excluding HIV) or take immunosuppressive medications? | PHVS_YesNoUnknown_CDC | 1 | |
| Immunocompromised Condition or Treatment | Describe the associated immunocompromising condition or treatment | TBD | 1 | |
| Reason for Hospitalization | Reason for the hospitalization? (choose all that apply) | TBD | 2 | |
| Receiving HIV Pre-exposure Prophylaxis | Is the individual currently receiving HIV pre-exposure prophylaxis? | PHVS_YesNoUnknown_CDC | 2 | |
| Currently Breastfeeding | Are you currently breastfeeding? | PHVS_YesNoUnknown_CDC | 2 | |
| Household pets | Do any pets live in your household? | PHVS_YesNoUnknown_CDC | 2 | |
| Type of animal(s) | Which type of animal(s) in household? (select all that apply) | TBD | 2 | |
| Other pet(s) | Please specify other pet(s) | N/A | 2 | |
| Vaccine Route of Administration | The route of administration of the vaccine | PHVS_RouteOfAdministration_IIS | 2 |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Did the subject have a fever? | Did the subject have a measured temperature greater than two degrees above normal? | PHVS_YesNoUnknown_CDC |
| Date of Fever Onset | Date of fever onset | |
| Highest Measured Temperature | What was the subject's highest measured temperature during this illness? | |
| Temperature Units | The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius. | PHVS_TemperatureUnit_UCUM |
| Parotitis (opposite second (2nd) molars)? (Symptom) | Did the subject have parotitis as a symptom of this illness? | PHVS_YesNoUnknown_CDC |
| Unilateral or Bilateral Parotitis (Symptom) |
Indicates if the parotitis is unilateral or bilateral | PHVS_ParotitisLaterality_Mumps |
| Jaw Pain (Symptom) | Did the subject have jaw pain as a symptom of this illness? | PHVS_YesNoUnknown_CDC |
| Salivary Gland Swelling Onset Date | Date of subject's salivary gland swelling (including parotitis) onset. | |
| Salivary Gland Swelling Duration | The length of time that the subject exhibited swelling of the salivary gland. | |
| Salivary Gland Swelling Duration Units | The length of time units that the subject exhibited swelling of the salivary gland | PHVS_AgeUnit_UCUM |
| Submandibular Swelling (Symptom) | Did the subject have submandibular swelling as a symptom of this illness? | PHVS_YesNoUnknown_CDC |
| Sublingual Swelling (Symptom) | Did the subject have sublingual swelling as a symptom of this illness? | PHVS_YesNoUnknown_CDC |
| Import Status | Did symptom onset occur within 12-25 days of entering the U.S., following any travel or living outside the U.S.? | PHVS_YesNoUnknown_CDC |
| International Destination(s) of recent travel | List any international destinations of recent travel | PHVS_Country_ISO_3166-1 |
| Date of return from travel | Date the subject returned from all travel | |
| Encephalitis (Complication) | Did the subject develop encephalitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Meningitis (Complication) | Did the subject develop meningitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Deafness (Complication) | Did the subject become deaf as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Type of Deafness | Was the type of deafness permanent or temporary? | PHVS_DeafnessType_Mumps |
| Orchitis (Complication) | Did the subject develop orchitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Other Complication | Did the subject develop an other condition as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Specify Other Complication | Please specify the other complication the subject developed, during or as a result of this illness. | |
| Was laboratory testing done for mumps? | Was laboratory testing done to confirm a diagnosis of mumps? | PHVS_YesNoUnknown_CDC |
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case. | PHVS_LabTestProcedure_Mumps |
| Test Result | Epidemiologic interpretation of the results of the tests performed for this case | PHVS_LabTestInterpretation_VPD |
| Numeric Test Result | Numeric quantitative result of the test(s) performed for this case | |
| Numeric Test Result Units | Numeric quantitative result unit of the test(s) performed for this case | PHVS_UnitsOfMeasure_CDC |
| Sample Analyzed Date | The date the specimen/isolate was tested. | |
| Test Method | The technique or method used to perform the test and obtain the test results. | PHVS_LabTestMethods_CDC |
| Date Collected | Date of specimen collection | |
| Specimen Source | The medium from which the specimen originated | PHVS_SpecimenSource_Mumps |
| Were the specimens sent to CDC for genotyping (molecular typing)? | Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)? | PHVS_YesNoUnknown_CDC |
| Date sent for genotyping | The date the specimens were sent to the CDC laboratories for genotyping | |
| Transmission Setting | What was the transmission setting where the mumps was acquired? | PHVS_TransmissionSetting_NND |
| Were Age and Setting Verified? | Does the age of the case match or make sense for the transmission setting listed (e.g., a subject aged 80 probably would not have a transmission setting of child day care center)? | PHVS_YesNoUnknown_CDC |
| Source of Infection | What was the source of the mumps infection? | |
| Case Class by Source | If this is a case aquired in the U.S., how should the case be classified by source? | PHVS_CaseClassificationExposureSource_NND |
| Is this Case Epi-Linked to Another Confirmed or Probable Case? | Specify if this case is Epidemiologically-linked to another confirmed or probable case of mumps? | PHVS_YesNoUnknown_CDC |
| Did the subject ever receive a disease-containing vaccine? | Did the subject ever receive a mumps-containing vaccine? | PHVS_YesNoUnknown_CDC |
| If no, reason subject did not receive a disease-containing vaccine | Specifies reason the subject did not receive a mumps-containing vaccine | PHVS_VaccineNotGivenReasons_CDC |
| Number of doses received ON or AFTER first birthday | The number of measles-containing vaccine doses the subject received on or after their first birthday | |
| Vaccine History Comments | Comments about the subject's vaccination history. | |
| Vaccine Administered | The type of vaccine administered. | PHVS_VaccinesAdministeredCVX_CDC_NIP |
| Vaccine Manufacturer | Manufacturer of the vaccine. | PHVS_ManufacturersOfVaccinesMVX_CDC_NIP |
| Vaccine Lot Number | The vaccine lot number of the vaccine administered. | |
| Vaccine Administered Date | The date that the vaccine was administered. | |
| US Acquired | Sub-classification of disease or condition acquired in the US |
PHVS_CaseClassificationExposureSource_NND |
| Length of time in the US | Length of time in the US, from NBS MM | |
| Length of Time in the U.S. units | Length of time in the US Units | |
| Patient Address City | Patient address city, from NBS MM | |
| Case Investigation Status Code | Case Investigation Status Code, from NBS MM | |
| Detection Method | Detection Method, from NBS MM | |
| Transmission Setting, Other | If Other, Specify Transmission Setting | |
| Laboratory Confirmed | Was the case laboratory confirmed? | |
| Specimen sent to CDC | Was a specimen sent to CDC for testing? | |
| Type of testing at CDC | What type of testing was done at CDC for this subject? | |
| Type of testing at CDC, other | If other, specify testing done at CDC | |
| Date specimen sent to CDC | Date specimen sent to CDC | |
| VPD Lab Message Patient Identifier | VPD Lab Message Patient Identifier | |
| VPD Lab Message Observation Identifier | VPD Lab Message Observation Identifier | |
| VPD Lab Message Observation Value | VPD Lab Message Observation Value | |
| Other Lab Test | If other, specify lab test | |
| Performing Laboratory Type | Performing laboratory type | |
| Other (Performing Laboratory Type) | If other, specify performing laboratory type | |
| Date of last dose prior to illness onset | Date of last disease-containing vaccination dose prior to illness onset | |
| Vaccination doses prior to onset | Number of disease-containing vaccination doses prior to illness onset | |
| Vaccinated per ACIP recommendations | Was subject vaccinated as recommended by ACIP? | |
| Reason not vaccinated per ACIP recommendations | Reason subject not vaccinated as recommended by ACIP | |
| Reason not vaccinated per ACIP, Other | If other, specify reason not vaccinated per ACIP | |
| Vaccine Administered Product Type, Other | If other, specify type of vaccine administered | |
| Vaccine Product Manufacturer, Other | If other, specify vaccine manufacturer | |
| NDC Brand Name/Bar Code information | NDC from the vaccine's bar code. With the NDC code, vaccine brand name and manufacturer can be obtained. | |
| Vaccination Record ID | Vaccination Record ID, from NBS MM | |
| Reason immunizaton not given, regardless of the schedule used | Reason subject was not vaccinated, regardless of the immunization schedule used |
| 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) |
| DAYCARE | If <6 years of age, is the patient in daycare? | PHVS_YesNoUnknown_CDC | ||
| FACNAME | Name of the daycare facility. | PHVS_YesNoUnknown_CDC | ||
| NURSHOME | Does the patient reside in a nursing home or other chronic care facility? | PHVS_YesNoUnknown_CDC | ||
| NHNAME | Name of the nursing home or chronic care facility. | |||
| SYNDRM | Types of infection that are caused by the organism. This is a multi-select field. | TBD | ||
| SPECSYN | Other infection that is caused by the organism. | |||
| SPECIES | Bacterial species that was isolated from any normally sterile site. | TBD | ||
| OTHBUG1 | Other bacterial species that was isolated from any normally sterile site. | TBD | ||
| STERSITE | Sterile sites from which the organism was isolated. This is a multi-select field. | TBD | ||
| OTHSTER | Other sterile site from which the organism was isolated. | |||
| DATE | Date the first positive culture was obtained. (This is considered diagnosis date.) | |||
| NONSTER | Nonsterile sites from which the organism was isolated. This is a multi-select field. | TBD | ||
| UNDERCOND | Did the patient have any underlying conditions? | PHVS_YesNoUnknown_CDC | ||
| COND | Underlying conditions that the subject has. This is a multi-select field. | TBD | ||
| OTHMALIG | Other malignancy that the subject had as an underlying condition. | |||
| OTHORGAN | Detail of the organ transplant that the subject had as an underlying condition. | |||
| OTHILL | Other prior illness that the subject had as an underlying condition. | |||
| OTHOTHSPC | Another Bacterial Species not listed in the Other Bacterial Species drop-down list. | |||
| Specify Internal Body Site | Internal Body Site where the organism was located. | TBD | ||
| Other Prior Illness 2 | Other prior illness that the subject had as an underlying condition. | |||
| Other Prior Illness 3 | Other prior illness that the subject had as an underlying condition. | |||
| Other Nonsterile Site | Other nonsterile site from which the organism was isolated. | |||
| INSURANCE | Patient's type of insurance (multi-selection). | TBD | ||
| INSURANCEOTH | Patient's other type of insurance. | |||
| WEIGHTLB | Weight of the patient in pounds. | |||
| WEIGHTOZ | Weight of the patient in ounces. | |||
| WEIGHTKG | Weight of the patient in kilograms. | |||
| HEIGHTFT | Height of the patient in feet. | |||
| HEIGHTIN | Height of the patient in inches. | |||
| HEIGHTCM | Height of the patient in centimeters. | |||
| WEIGHTUNK | Indicator that the weight of the patient is unknown. | PHVS_TrueFalse_CDC | ||
| HEIGHTUNK | Indicator that the height of the patient is unknown. | PHVS_TrueFalse_CDC | ||
| SEROGROUP | Serogroup of the culture. | TBD | ||
| OTHSERO | Other serogroup of the culture. | |||
| COLLEGE | Is patient currently attending college? This question is only applicable if the patient is 15-24 years of age. | PHVS_YesNoUnknown_CDC | ||
| CASEID | How was the case identified? | TBD | ||
| OTHSTRST | Other sterile site from which species was isolated. | |||
| OTHID | Other case identification method. | |||
| SCHOOLYR | Patient's year in college. (freshman, sophomore, etc.) | TBD | ||
| STUDTYPE | Patient's status in college as defined by the university. | TBD | ||
| HOUSE | Patient's current living situation. | TBD | ||
| OTHHOUSE | Other housing option. | |||
| SCHOOLNM | Full name of the college or university the patient is currently attending. | |||
| POLYVAC | Has patient received the polysaccharide meningococcal vaccine? | PHVS_YesNoUnknown_CDC | ||
| SECCASE | Is this case of Neiserria meningitidis a secondary case? | PHVS_YesNoUnknown_CDC | ||
| SECCASETY | Type of secondary contact for a case of Neisseria meningitidis. | TBD | ||
| OTHSECCASE | Other field available if the secondary case type selected is other. | |||
| NMSULFRES | Neisseria meningitidis resistance to Sulfa. | PHVS_YesNoUnknown_CDC | ||
| NMRIFARES | Neisseria meningitidis resistance to Rifampin. | PHVS_YesNoUnknown_CDC | ||
| DIAGDATE | Date the sample was collected for diagnostic testing if a culture was not done. | |||
| PCRSOURCE | Specifies the PCR source for how the case was identified. | TBD | ||
| IHCSPEC1 | Specifies the first IHC specimen. | |||
| IHCSPEC2 | Specifies the second IHC specimen. | |||
| IHCSPEC3 | Specifies the third IHC specimen. | |||
| MENGVAC | Specifies whether the patient has received a meningococcal vaccine. | |||
| Bacterial Infection Syndrome | Types of infection caused by organism | PHVS_InfectionType_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 (grams) | N/A | P | |
| Birth Weight Units | Birth Weight Units | PHVS_WeightUnit_UCUM | P | |
| Secondary Case | Is this a secondary case? | PHVS_YesNoUnknown_CDC | 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 | |
| Case Report Form Status | Case Report Form Status | PHVS_FormStatus_RIBD | P | |
| Had Sex with a Male within the Past 12 Months | Had sex with a male within the past 12 months? | PHVS_YNRD_CDC | P | |
| Had Sex with a Female within the Past 12 Months | Had sex with a female within the past 12 months? | PHVS_YNRD_CDC | P | |
| Number of Male Sexual Partners | In the 3 months prior to the onset of symptoms, number of male sex partners the person had? | N/A | P | |
| HIV Status | Documented or self-reported HIV status at the time of event | PHVS_HIVStatus_STD | P | |
| Homeless | Was the patient homeless at time of symptom onset? | PHVS_YesNoUnknown_CDC | P | |
| Signs and Symptoms | Indicate what symptoms of interest the patient had during the course of the illness | PHVS_SignsSymptoms_RIBD | P | |
| Signs and Symptoms Indicator | Indicator for associated sign and symptom | PHVS_YesNoUnknown_CDC | P | |
| Eculizumab | Was the patient taking eculizumab/Soliris at the time of disease onset? | 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 | |
| Residence | Where was the patient a resident at time of initial culture? | PHVS_ResidenceLocation_RIBD | 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 | |
| Serogroup Method | Serogroup method | PHVS_SerogroupMethod_RIBD | P | |
| Test Manufacturer | Test Manufacturer | N/A | P | |
| Lab Accession Number | Lab Accession Number (including CDC Lab ID) | N/A | P | |
| Susceptibility Test | Was any susceptibility data available? | PHVS_YesNoUnknown_CDC | 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 | |
| Vaccine Name | Vaccine Name | 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 | |
| Ravulizumab | Was the patient taking Ravulizumab (Ultomiris) at the time of disease onset? | https://phinvads.cdc.gov/vads/ViewValueSet.action?oid=2.16.840.1.114222.4.11.888 | 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) |
| COVID-19 ID | ID to link all case information on patient | N/A | 1 | |
| Interviewer Last Name | Last name of interviewer | N/A | 1 | |
| Interviewer First Name | First name of interviewer | N/A | 1 | |
| Interviewer Organization | The affiliation or organization of the interviewer. | N/A | 1 | |
| Interviewer Telephone | Telephone number of interviewer | N/A | 1 | |
| Interviewer Email | Email of interviewer | N/A | 1 | |
| Probable Classification Reason | If probable case classification status, provide reason for classification. | TBD | 1 | |
| Process for Case Identification | Under what process was the case first identified? | TBD | 1 | |
| DGMQID | If EpiX notification of traveler, provide the DGMQID. | N/A | 1 | |
| Positive Collection Date | Date of first positive specimen collection. | N/A | 1 | |
| Hospital Translator | If hospitalized, was a translator required? | PHVS_YesNoUnknown_CDC | 1 | |
| Translator Language | If translator required in the hospital, specify which language? | TBD | 1 | |
| Intensive Care Unit Admittance | Was patient admitted to an intensive care unit (ICU)? | PHVS_YesNoUnknown_CDC | 1 | |
| ICU Admission Date | If patient was admitted to an ICU, provide the admission date. | N/A | 1 | |
| ICU Discharge Date | If patient was admitted to an ICU, provide the discharge date. | N/A | 1 | |
| Housing Type | Select the best description of where the patient lived at the time of illness onset. | TBD | 1 | |
| Health Care Worker | Is the patient a health care worker in the U.S.? | PHVS_YesNoUnknown_CDC | 1 | |
| Health Care Worker Job Type | If patient is a health care worker, select their occupation. If other, specify in text. | TBD | 1 | |
| Health Care Worker Job Setting | If patient is a health care worker, select their job setting. If other, specify in text. | TBD | 1 | |
| Exposure of Interest | In the 14 days prior to illness onset, did the patient have any of the following exposures? Select all that apply. | TBD | 1 | |
| State of Travel Exposure | If domestic travel outside of state of normal residence, specify the state. | N/A | 1 | |
| Country of Travel Exposure | If patient traveled internationally, specify country. | N/A | 1 | |
| Cruise Ship or Vessel | If exposed on a cruise ship or vessel, specify the name of the cruise ship. | N/A | 1 | |
| Workplace Critical Infrastructure | If the patient was exposed at their workplace, is the workplace critical infrastructure? | PHVS_YesNoUnknown_CDC | 1 | |
| Workplace Exposure | If workplace exposure, specify the workplace setting (e.g., long term healthcare setting, hospital, grocery store) | TBD | 1 | |
| Animal Case | If an animal with confirmed or suspected COVID-19, specify the animal. | N/A | 1 | |
| Type of Contact with COVID-19 Case | If the patient had contact with a known COVID-19 case, specify the type of contact. | TBD | 1 | |
| Contact with U.S. COVID-19 Case | Was this person a U.S. case? | TBD | 1 | |
| COVID-19 Case Identifier | If patient had contact with a known COVID-19 case, specify the COVID-19 ID(s). | N/A | 1 | |
| Clinical History Collection Mechanism | Select which mechanisms were used for the collection of the clinical course, symptoms, past medical history and social history. | TBD | 1 | |
| Symptomatic | Symptoms present during course of illness. | TBD | 1 | |
| Symptoms Resolved | Did the patient’s symptoms resolve? | TBD | 1 | |
| Clinical Symptoms | Indicate the symptoms associated with this illness. | TBD | 1 | |
| Clinical Symptoms Indicator | Indicator for each symptom. | PHVS_YesNoUnknown_CDC | 1 | |
| Diagnostic | Select the diagnostic tests that were performed. | TBD | 1 | |
| Diagnostic Result | Indicator for each diagnostic test result. | TBD | 1 | |
| Treatment | Indicate the treatment received. | TBD | 1 | |
| Treatment Indicator | Indicator for each treatment. | N/A | 1 | |
| Days of Mechanical Ventilation | If patient received mechanical ventilation intubation, specify the total days of treatment. | N/A | 1 | |
| Underlying Risk Factors | Specify any of the underlying medical conditions and/or risk behaviors. | TBD | 1 | |
| Underlying Risk Factors Indicator | Indicator for each medical condition and risk behaviors. | PHVS_YesNoUnknown_CDC | 1 | |
| Chronic Disease | If other chronic diseases, please specify. | N/A | 1 | |
| Underlying Condition | If other underlying condition, please specify. | N/A | 1 | |
| Risk Behavior | If other underlying risk behavior, please specify | N/A | 1 | |
| Disability | If disability (neurologic, neurodevelopmental, intellectual, physical, vision or hearing impairment, please specify. | N/A | 1 | |
| Psychological or Psychiatric Condition | If psychological or psychiatric condition, please specify. | N/A | 1 | |
| Tribe Affiliation | Does this case have any tribal affiliation? | PHVS_YesNoUnknown_CDC | 1 | |
| Tribe Name | If case has tribal affiliation, provide tribe name. | N/A | 1 | |
| Tribe Enrolled Member | If case has tribal affiliation, indicate if case is an enrolled member. | PHVS_YesNoUnknown_CDC | 1 | |
| Trimester at Onset of Illness | If the case-patient was pregnant at time of illness onset, indicate trimester of gestation at time of disease. | PHVS_PregnancyTrimester_CDC | 2 | |
| Number of Weeks Gestation at Onset of Illness | If the case-patient was pregnant at time of illness onset, specify the number of weeks gestation at onset of illness (1-45 weeks). | N/A | 2 | |
| Exposure Indicator | Exposure indicator | PHVS_YesNoUnknown_CDC | 1 | |
| Reason for Testing | Listing of the reason(s) the subject was tested for COVID-19 | TBD | 3 | |
| Secondary Diagnosis | Did the patient have another diagnosis/etiology for their illness? | PHVS_YesNoUnknown_CDC | 3 | |
| Secondary Diagnosis Description | If patient had another diagnosis/etiology for their illness, specify the diagnosis or etiology | N/A | 3 | |
| Clinical Finding | Clinical findings associated with the illness being reported | PHVS_ClinicalFinding_COVID-19 | 1 | |
| Clinical Finding Indicator | Indicator for associated clinical findings | PHVS_YesNoUnknown_CDC | 1 | |
| Did the Subject Ever Receive a Vaccine Against This Disease | Did the subject ever receive a vaccine against this disease? | PHVS_YesNoUnknown_CDC | 1 | |
| Vaccination Doses Prior to Onset | Number of vaccine doses against this disease prior to illness onset | N/A | 1 | |
| Date of Last Dose Prior to Illness Onset | Date of last vaccine dose against this disease prior to illness onset | N/A | 3 | |
| Vaccine History Comments | Comments about the subject's vaccination history | N/A | 3 | |
| Date Left For Travel | Date left for travel | N/A | 1 | |
| Date of Return from Travel | Date of return from travel | N/A | 1 | |
| Primary Language | What's case's primary language? Please indicate for both hospitalized and not hospitalized cases. | PHVS_Language_ISO_639-2_Alpha3 | 2 | |
| Information Source for Data | Clinical information collected from which source(s)? Check all that apply | PHVS_DataReportingSource_COVID-19 | 3 | |
| Did Underlying Condition(s) Exist | Did they have any underlying medical conditions and/or risk behaviors? | PHVS_YesNoUnknown_CDC | 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) | 1 | |
| Previously Reported Jurisdiction 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 | 1 | |
| WGS_ID | Genomic sequencing ID number. | N/A | 2 | |
| Lineage | Lineage designation or sub-lineage, 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) |
| Fever >38°C (100.4°F) | Did/does the patient have a fever (specify max temp)? | |
| Feverish but temp not taken | Did/does the patient have a fever but temperature not taken? | |
| Cough | Was cough a symptom? | |
| Headache | Did/does the patient have a headache? | |
| Seizures | Did/does the patient have seizures? | |
| Sore throat | Did/does the patient have a sore throat? | |
| Conjunctivitis | Did/does the patient have conjunctivitis? | |
| Shortness of breath | Did/does the patient have shortness of breath? | |
| Diarrhea | Did/does the patient have shortness of breath? | |
| Other | Did/does the patient have any other symptoms (specify)? | |
| Vaccinated | Was the patient vaccinated against human influenza in the past year? | |
| Vaccination date | If yes, date of vaccination | |
| Vaccine type | If yes, type of vaccine received? | |
| Antiviral medications | Did the patient receive antiviral medications? | |
| Date initiated oseltamivir | What was the date that oseltamivir was intiated? | |
| Date discontinued oseltamivir | What was the date that oseltamivir was discontinued? | |
| Oseltamivir dosage | What was the dosage of oseltamivir? | |
| Zanamivir | What was the date that zanamivir was intiated? | |
| Date initiated zanamivir | What was the date that zanamivir was discontinued? | |
| Date discontinued zanamivir | What was the dosage of zanamivir? | |
| Rimantidine | What was the date that rimantidine was intiated? | |
| Date initiated rimantidine | What was the date that rimantidine was discontinued? | |
| Date discontinued rimantidine | What was the dosage of rimantidine? | |
| Amantidine | What was the date that amantidine was intiated? | |
| Date initiated amantidine | What was the date that amantidine was discontinued? | |
| Date discontinued amantidine | What was the dosage of amantidine? | |
| Other antivial (specify) | What was the date that an other antiviral was intiated? | |
| Dateintiated other | What was the date that an other antiviral was discontinued? | |
| Date discontinued other | What was the dosage of an other antiviral? | |
| Leukopenia | Was leukopenia a lab finding? | |
| Lymphopenia | Was lymphopenia a lab finding? | |
| Thrombocytopenia | Was thrombocytopenia a lab finding? | |
| Underlying medical conditions | Does the patient have any underlying medical conditions? | |
| Compromised immune function | Does the patient have compromised immune function such as HIV infection, cancer, chronic corticosteroid therapy, diabetes, or organ transplant recipient? | |
| Compromised immune function specified | If yes, specify function. | |
| Mechanical ventilation | Did the patient require mechanical ventilation? | |
| Chest x-ray/CAT | Did the patient have a chest x-ray or CAT scan performed? | |
| Pneumonia | If abnormal, was there evidence of pneumonia? | |
| ARDS | If abnormal, did the patient have acute respiratory distress syndrome?? | |
| Death | Did the patient die a s a result of this illness? | |
| Test 1 Specimen Type | What was the specimen type for diagnostic test 1? | |
| Test 1 Date collected | Date of collection of specimen for test 1? | |
| Test 1 type | What is the test type for diagnostic test 1? | |
| Test 2 Specimen Type | What was the specimen type for diagnostic test 2? | |
| Test 2 Date collected | Date of collection of specimen for test 2? | |
| Test 2 type | What is the test type for diagnostic test 2? | |
| Specimens to CDC | Indicate when and what type of specimens (including sera) were sent to CDC | |
| Epi Risk - Travel | In the 10 days prior to illness onset, did the patient travel? | |
| Country/Arrival/Departure | If yes, fill in the arrival and departure dates for all countries visited. | |
| Case close contact | Did the patient have close contact with a person who is a suspected, probable,, or confirmed novel human influenza A case? | |
| Animal touch | Did the patient touch animals or their remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month? | |
| Animal exposure | Was the patient exposed to animal remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month? | |
| Environmental exposure | Was the patient exposed to environments contaminated by animal feces in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month? | |
| Raw/Undercooked animals | Did the patient consume raw or undercooked animals in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month? | |
| Animal contact | Did the patient have any animal contact (specify)? | |
| Laboratory sample handling | Did the patient handle samples suspected of containing influenza virus in a laboratory or other setting? | |
| HC setting | Does the patient work in a healthcare facility or setting? | |
| Household illness contact | Did the patient visit or stay in the same household with anyone with pneumonia or severe influenza-like illness? | |
| Household death contact | Did the patient visit or stay in the same household with anyone who died following thevisit? | |
| Porcine exposure | Did the patient visit an agricultural event, farm, petting zoo, or place where pigs live or were exhibited in the last month? | |
| Porcine contact | Did the patient have direct contact with pigs at an agricultural event, farm, petting zoo, or place where pigs were exhibited in the last month? | |
| Epidemiological link with lab-confirmed or probable case | If this patient has a diagnosis of novel influenza A virus infection that has not been serologically confirmed, is there an epidemiologic link between this patient and a lab-confirmed or probable novel influenza A case? |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Autopsy | Was an autopsy performed on the patient? | |
| Cardiac/respiratory arrest | Did the patient experience cardiac/respiratory arrest outside the hospital? | |
| Location of death | What was the location of the patient's death? | |
| Hospital Admission Date | If patient's death occurrred in a hospital, what was the date of admission? | |
| Pathology specimens to CDC | Were pathology specimens sent to CDC's Infectious Diseases Pathology Branch? | |
| Lab ID for pathology specimen | Provide the lab ID number(if known) for pathology specimen(s) sent to CDC. | |
| Isolates/original clinical material | Were influenza isolates or original clinical material sent to CDC Influenza Division? | |
| Lab ID for isolates/clinical specimen | Provide the lab ID number(if known) for isolates/clinical specimen(s) sent to CDC. | |
| Staph aureus isolates | Were staph aureus isolates sent to CDC's Healthcare Quality Promotion? | |
| Lab ID for isolates | Provide the lab ID number(if known) for isolate(s) sent to CDC. | |
| Commercial Rapid Diagnostic Test | Indicate if commercial rapid test used. | |
| Rapid test result | What is the result of the rapid test? | |
| Rapid test specimen collection date | What is the specimen collection date for the rapid test? | |
| Viral Culture | Indicate if viral culture used. | |
| Viral culture result | What is the result of the viral culture? | |
| Viral culture specimen collection date | What is the specimen collection date for the viral culture? | |
| Fluorescent Antibody (IFA or DFA) | Indicate if fluorescent antibody test used. | |
| IFA/DFA result | What is the result of the IFA/DFA? | |
| IFA/DFA specimen collection date | What is the specimen collection date for the IFA/DFA? | |
| Enzyme Immunoassay | Indicate if enzyme immunoassay used. | |
| EIA result | What is the result of the EIA? | |
| EIA collection date | What is the specimen collection date for the EIA? | |
| RT-PCR test | Indicate if an RT-PCR test was used. | |
| RT-PCR result | What is the result of the RT-PCR? | |
| RT-PCR specimen collection date | What is the specimen collection date for the RT-PCR? | |
| IHC test | Indicate if an immunohistochemistry test was used. | |
| IHC result | What is the result of the IHC? | |
| IHC specimen collection date | What is the specimen collection date for the IHC? | |
| Bacterial Culture | Was a specimen collected for bacterial culture from a normally sterile site? | |
| Specimen Type | What was the specimen type obtained for the bacterial culture? This is a multi-select field. | |
| Collection Date | What was the collection date for the bacterial culture? | |
| Bacterial Culture Results | What was the result of the bacterial culture? | |
| Bacterial culture species isolated | If bacterial culture positive, check the organism cultured. This is a multi-select field. | |
| Other Respiratory Specimen/ Non-sterile site | Were other respiratory specimens from non-sterile site(s) collected for bacterial culture (e.g., sputum, ET tube aspirate)? | |
| Other respiratory specimen site | If yes, indicate the site from which the specimen was obtained. This is a multi-select field. | |
| Other respiratory specimen site | If yes, indicate the date collected of the specimen. | |
| Other respiratory specimen collection date | If yes, indicate the date collected of the specimen. | |
| Other respiratory specimen result | If yes, indicate the result for the specimen culture. | |
| Bacterial species cultured | If positve, what was the organism cultured? | |
| Autopsy Specimen | Was a specimen (e.g., fixed lung tissue) collected from an autopsy for bacterial pathogen testing? | |
| Autopsy Specimen Results | If autopsy specimen was taken, what were the results (indicate in the comments section)? | |
| Mechanical Ventilation | Was the patient placed on mechanical ventilation? | |
| Complications | Did complications occur during the acute illness? | |
| Type complications | If yes, check all complications that occurred during the acute illness. This is a multi-select field. | |
| Existing Medical Conditions | Did the child have any medical conditions that existed before the start of the acute illness? | |
| Medical conditions before acute illness | If yes,check all medical conditions that exised before the start of the acute illness. This is a multi-select field | |
| Medications and/or Therapies | Was the patient receiving any of the listed therapies prior to illness onset? | |
| Medications received before illness | Check all medications/therapies patient was receiving before the acute illness. This is a multi-select field. | |
| Medications received after illness | Did the patient receive any of the following after illness onset? This is a multi-select field. | |
| Influenza Vaccine | Did the patient receive any seasonal influenza vaccine during the current season (before illness)? | |
| Vaccine before illness | If yes, specify the seasonal vaccine received before illness onset. | |
| 1 Dose <14 days | If yes, did patient receive 1 dose of vaccine <14 days prior to illness onset (date given)? | |
| 1 Dose >14 days | If yes, did patient receive1 dose of vaccine ≥14 days prior to illness onset (date given)? | |
| 2 Dose <14 days | If yes, did patient receive vaccines <14 days prior to illness onset (dates given)? | |
| 2 Dose >14 days | If yes, did patient receive 2 doses of vaccines ≥14 days prior to illness onset (dates given)? | |
| Previous Seasonal Vaccine | Did the patient receive any seasonal influenza vaccine in previous seasons? | |
| 1 Dose Seasonal | If yes, and patient was between 6 months and ≤8 years of age at the time of death, was the 2009-2010 influenza season the first time the patient received seasonal influenza vaccine? | |
| 2 Dose Seasonal | If yes, did patient receive 2 doses of seasonal influenza vaccine during the 2009-2010 influenza season? | |
| 1 Dose AT Least | If the patient was between 6 months and ≤8 years of age at the time of death, did they receive at least 1 dose of 2009 influenza A (H1N1) vaccine during the previous season? |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Did the patient have a cough? | Did the patient's illness include the symptom of cough? | PHVS_YesNoUnknown_CDC |
| Cough Onset Date | Cough onset date | |
| Paroxysmal Cough | Did the patient's illness include the symptom of paroxysmal cough? | PHVS_YesNoUnknown_CDC |
| Whoop | Did the patient's illness include the symptom of whoop? | PHVS_YesNoUnknown_CDC |
| Post-tussive Vomiting | Did the patient's illness include the symptom of post-tussive vomiting? | PHVS_YesNoUnknown_CDC |
| Apnea | Did the patient's illness include the symptom of apnea? | PHVS_YesNoUnknown_CDC |
| Date of Final Interview | Date of the patient's final interview | |
| Did the patient have a cough at final interview? | Was there a cough at the patient's final interview? | PHVS_YesNoUnknown_CDC |
| Total Cough Duration | What was the duration (in days) of the patient's cough? | |
| Result of chest X-ray for pneumonia | Result of chest x-ray for pneumonia | PHVS_ChestXrayResult_CDC |
| Did the patient have generalized or focal seizures due to pertussis? | Did the patient have generalized or focal seizures due to pertussis? | PHVS_YesNoUnknown_CDC |
| Did the patient have acute encephalopathy due to pertussis? | Did the patient have acute encephalopathy due to pertussis? | PHVS_YesNoUnknown_CDC |
| Were antibiotics given? | Were antibiotics given to the patient? | PHVS_YesNoUnknown_CDC |
| Antibiotic Name | What antibiotic did the patient receive? | PHVS_AntibioticReceived_Pertussis |
| Antibiotic Start Date | Date the patient first started taking the antibiotic | |
| Number of days antibiotic actually taken. | Number of days the patient actually took the antibiotic referenced | |
| Second antibiotic patient received? | If Other, please specify antibiotic | PHVS_AntibioticReceived_Pertussis |
| Date second antibiotic started | Date second antibiotic started | |
| Number of days second antibiotic actually taken | Number of days second antibiotic actually taken | |
| Was laboratory testing done for pertussis? | Was laboratory testing done for pertussis? | PHVS_YesNoUnknown_CDC |
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case | PHVS_LabTestProcedure_Pertussis |
| Test Result | Epidemiologic interpretation of the results of the tests performed for this case. | PHVS_LabTestInterpretation_Pertussis |
| Date Collected | Date of specimen collection | |
| Did the subject ever receive a disease-containing vaccine? | Did the patient ever receive a pertussis-containing vaccine? | PHVS_YesNoUnknown_CDC |
| Vaccine Administered | The type of vaccine administered. | PHVS_VaccinesAdministeredCVX_CDC_NIP |
| Vaccine Manufacturer | Manufacturer of the vaccine. | PHVS_ManufacturersOfVaccinesMVX_CDC_NIP |
| Vaccine Lot Number | The vaccine lot number of the vaccine administered. | |
| Vaccine Administered Date | The date that the vaccine was administered. | |
| Is this case epi-linked to a laboratory-confirmed case? | Is this case epi-linked to a laboratory-confirmed case? | PHVS_YesNoUnknown_CDC |
| Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? | Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? | PHVS_YesNoUnknown_CDC |
| Transmission Setting | Transmission setting (Where did this case acquire pertussis?) | PHVS_TransmissionSetting_NND |
| Was there documented transmission from this case of pertussis to a new setting? (not in household) | Was there documented transmission (outside of the household) for transmission from this case? | PHVS_YesNoUnknown_CDC |
| Number of contacts of this case recommended to receive antibiotic prophylaxis | Number of contacts of this case recommended to receive antibiotic prophylaxis | |
| Age of person contracted patient contracted pertussis from | Age of the person from whom this patient contracted pertussis | |
| Age Type | Age Type | Age_Type |
| Setting where patient contracted pertussis | Transmission setting (Where did this patient acquire pertussis?) | PHVS_TransmissionSetting_NND |
| Specify In which setting was pertussis acquired. | setting in which pertussis was acquired | |
| Specify In which setting was there secondary spread | In which setting was there secondary spread | |
| Name Of Contacts | Name Of Contacts | |
| Birth Date of contacts | Birth Date of contacts | |
| Contact Relationship to Subject | Relationship of contact | PHVS_Relationship_Flu |
| Case? | Case | |
| Contact Case ID | Unique case identifier of the contact. This would be the same as INV168 (Case Local ID) | |
| Cough Onset Date(If Present | Cough Onset Date(If Present | |
| Number of PCVs* | Number of PCVs* | |
| Date of Last PCV | Date of Last PCV | |
| Parent’s Name (If Applicable) | Parent’s Name (If Applicable) | |
| Parent’s Phone # (If Applicable) | Parent’s Phone # (If Applicable) | |
| Cyanosis | Did patient have cyanosis during his/her illness? | |
| Treatment Drug, Other | If other, specify antibiotic used | |
| Case patient a healthcare worker | Was case patient healthcare personnel (HCP) (at illness onset)? | |
| Mother’s age at infant’s birth | Mother’s age at infant’s birth (used only if patient under 12 months old) | |
| Gestational age in weeks | Gestational age (if case-patient < 1 year of age at illness onset) | |
| Birth Weight | Infant’s birth weight (used only if patient under 12 months old) | |
| Birth Weight Units | Infant’s birth weight units | |
| Did mother receive Tdap? | Did mother receive Tdap (if case-patient < 1 year of age at illness onset)? | |
| Timing of mother's Tdap administration | If mother received Tdap, when was it administered? | |
| Date of mother's Tdap administration | If mother received Tdap, what date was it administered? *(if available) | |
| One or more suspected sources? | Was there one or more suspected sources of infection? (from NBS MM) | |
| Number of suspected sources? | Number of suspected sources? (from NBS MM) | |
| Suspected source sex | Suspected source sex (from NBS MM) | |
| Suspected source relationship to case (other) | Suspected source relationship to case (other) | |
| Patient Address City | Patient Address City, from NBS MM | |
| Case Investigation Status Code | Case Investigation Status Code, from NBS MM | |
| Detection Method | Detection Method, from NBS MM | |
| Age at cough onset | Age of patient at cough onset | |
| Age type at cough onset | Age units at cough onset | |
| Laboratory Confirmed | Was the case laboratory confirmed? | |
| Specimen sent to CDC | Was a specimen sent to CDC for testing? | |
| Type of testing at CDC | What type of testing was done at CDC for this subject? | |
| Type of testing at CDC, Other | If other, specify testing done at CDC | |
| Date specimen sent to CDC | Date specimen sent to CDC | |
| VPD Lab Message Patient Identifier | VPD Lab Message Patient Identifier | |
| VPD Lab Message Observation Identifier | VPD Lab Message Observation Identifier | |
| VPD Lab Message Observation Value | VPD Lab Message Observation Value | |
| Test Type, Other | If other, specify lab test | |
| Specimen ID Placer Assigned Identifier | Specimen ID Placer Assigned Identifier | |
| Specimen ID Filler Assigned Identifier | Specimen ID Filler Assigned Identifier | |
| Performing Laboratory Type | Performing Laboratory Type | |
| Performing Laboratory Type, Other | If other, specify performing laboratory type | |
| Numeric Test Result | Numeric Result Value | |
| Numeric Test Result Units | The unit of measure for numeric result value. | |
| Vaccinated per ACIP recommendations | Was subject vaccinated as recommended by ACIP? | |
| Reason not vaccinated per ACIP recommendations | Reason subject not vaccinated as recommended by ACIP | |
| Reason not vaccinated per ACIP, Other | If other, specify reason not vaccinated per ACIP | |
| Vaccine Administered Product Type, Other | If other, specify type of vaccine administered | |
| NDC Brand Name/Bar Code information | NDC from the vaccine’s bar code. With the NDC code, vaccine brand name and manufacturer can be obtained. | |
| Vaccine Product Manufacturer, Other | If other, specify vaccine manufacturer | |
| Vaccine Lot Expiration Date | Vaccine expiration date | |
| Vaccination Record ID | Vaccination Record ID, from NBS MM | |
| Reason immunizaton not given, regardless of the schedule used | Reason subject was not vaccinated, regardless of the immunization schedule used | |
| Other transmission setting | If other, specify the other transmission setting | |
| Setting of further spread | If other, specify transmission setting of further spread | |
| Suspected source relation to case | Suspexcted source of infection relationship to case | |
| Estimated cough onset date of suspected source | Estimated cough onset date of suspected source of infection |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | CDC Priority |
| Primary plague type | Classification of primary clinical manifestation of infection | TBD | P |
| Animal Contact | Contact with sick or dead animals | TBD | P |
| Flea bite | Flea bite | TBD | P |
| Immuncompromised | If patient has any immunocompromising conditions, specify | N/A | P |
| Date first medical | Date that the patient was first seen by medical person. | N/A | P |
| Fever/sweats/chills | Did the patient's illness include the symptom of fever/sweats/chills? | PHVS_YesNoUnknown_CDC | P |
| Confusion/delirium | Did the patient's illness include the symptom of confusion/delirium? | PHVS_YesNoUnknown_CDC | P |
| Vomiting/diarrhea/abdominal pain | Did the patient's illness include the symptom of vomiting/diarrhea/abdominal pain? | PHVS_YesNoUnknown_CDC | P |
| Sore throat | Did the patient's illness include the symptom of sore throat? | PHVS_YesNoUnknown_CDC | P |
| Cough | Did the patient's illness include the symptom of cough? | PHVS_YesNoUnknown_CDC | P |
| Chest Pain | Did the patient's illness include the symptom of chest pain? | PHVS_YesNoUnknown_CDC | P |
| Shortness of breath | Did the patient's illness include the symptom of shortness of breath? | PHVS_YesNoUnknown_CDC | P |
| Other_symptoms | Did the patient's illness include other symptoms of not listed? | PHVS_YesNoUnknown_CDC | P |
| Other_symptoms_specify | Which other symptoms did the patient's illness include? | N/A | P |
| Bubo | Did patient have bubo? | PHVS_YesNoUnknown_CDC | P |
| Type of Bubo | Specify type of bubo | TBD | P |
| Location/description Bubo | Describe location and appearance of bubo | N/A | P |
| Insect bites/skin ulcer | Did patient have any insect bites/skin ulcer | PHVS_YesNoUnknown_CDC | P |
| Location/description insect bites/skin ulcer | Describe location and appearance of insect bites/skin ulcer | N/A | P |
| Chest X-ray | Results of chest x-ray | TBD | P |
| Antibiotic | Did patient receive an effective antibiotic for illness? | TBD | P |
| Antibiotic start date | Date each antibiotic started | N/A | P |
| Illness outcome | Outcome of illness | TBD | P |
| Primary plague type | Classification of primary clinical manifestation of infection | TBD | P |
| Secondary pneumonic plague | Did patient have secondary pneumonic plague? | PHVS_YesNoUnknown_CDC | P |
| Y. pestis cultured | Was Y. pestis cultured? | PHVS_YesNoUnknown_CDC | P |
| Specimen source | Source of culture | N/A | P |
| Date specimen collected | Date specimen was collected | N/A | P |
| Y. pestis detected | Was Y. pestis detected by other tests? | PHVS_YesNoUnknown_CDC | P |
| Test performed | Test used to detect Y. pestis | N/A | P |
| Specimen source | Specimen source in which Y. pestis was detected | N/A | P |
| Date specimen collected | Date of specimen collection | N/A | P |
| Serology | Serology results | TBD | P |
| First Serum titer | Titer of first serum specimen | N/A | P |
| Second Serum titer | Titer of second serum specimen | N/A | P |
| Date first serum drawn | Date first serum drawn | N/A | P |
| Date second serum drawn | Date second serum drawn | N/A | P |
| Epi-linked to any other plague cases | Was this illness epi-linked to any other plague cases? | PHVS_YesNoUnknown_CDC | P |
| Likely location of exposure | Most likely location of exposure | TBD | P |
| Animal contact | Did patient have any animal contact in the 2 weeks preceding illness? | PHVS_YesNoUnknown_CDC | P |
| Nature of contact | Nature of animal contact in the 2 weeks preceding illness | TBD | P |
| Type of animal contact | Was animal domestic or wild | TBD | P |
| Flea bite or insect bites | Did patient have flea or insect bites in the 2 weeks preceding illness? | PHVS_YesNoUnknown_CDC | P |
| Wild animal | Specify wild animal that patient had contact with in the 2 weeks preceding illness | N/A | P |
| Domestic animal | Specify domestic animal that patient had contact with in the 2 weeks preceding illness | N/A | P |
| Evidence of infected animals or fleas | Evidence of infected animals or fleas in the likely exposure location | PHVS_YesNoUnknown_CDC | P |
| Specify infected animals or fleas | Describe evidnece of Y. pestis infected animals or fleas in likely exposure location | N/A | P |
| Other exposure | Specify any other exposures in the two weeks preceding illness | N/A | P |
| Comments | Additional comments | N/A | P |
| Person to person transmission | Evidence of person to person transmission from a known plague patient | 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) |
| Paralysis onset date | Date of onset of paralysis | |
| Clinical course | Clinical course | |
| CSF date | Date of CSF results | |
| WBCs | White blood cell test results for cerebral spinal fluid | |
| RBCs | Red blood cell test results for cerebral spinal fluid | |
| %Lymph | %lymphs test results for CSF | |
| %polys | %polys test results for CSF | |
| Protein | Protein test results for CSF | |
| Glucose | Glucose test results for CSF | |
| 60-day follow up date | Date of 60-day follow up | |
| Paralysis site | Sites of paralysis | |
| Specific sites | Specific sites of paralysis | |
| 60-day residual | 60-day paralysis residual | |
| TOPV immunization history | TOPV within 30 days prior to onset of symptoms? | |
| Date of TOPV | TOPV immunization date | |
| Lot number | TOPV vaccine lot number | |
| IPV-containing vaccine | Total doses ever received of IPV-containing vaccine | |
| Date 1 IPV | First IPV vaccine date | |
| Date 2 IPV | Second IPV vaccine date | |
| Date 3 IPV | Third IPV vaccine date | |
| TOPV vaccine | Total doses ever received of TOPV vaccine | |
| Date 1 TOPV | First TOPV vaccine date | |
| Date 2 TOPV | Second TOPV vaccine date | |
| Date 3 TOPV | Third TOPV vaccine date | |
| BOPV vaccine | Total doses ever received of BOPV vaccine | |
| Date 1 BOPV | First BOPV vaccine date | |
| Date 2 BOPV | Second BOPV vaccine date | |
| Date 3 BOPV | Third BOPV vaccine date | |
| MOPV vaccine | Total doses ever received of MOPV vaccine | |
| Date 1 MOPV | First MOPV vaccine date | |
| Date 2 MOPV | Second MOPV vaccine date | |
| Date 3 MOPV | Third MOPV vaccine date | |
| First injection date | Date of first injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of first injection | |
| Describe | Description of first injection substance | |
| First injection site | Site of first injection | |
| Second injection date | Date of second injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of second injection | |
| Describe | Description of second injection substance | |
| Second injection site | Site of second injection | |
| Third injection date | Date of third injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of third injection | |
| Describe | Description of third injection substance | |
| Third injection site | Site of third injection | |
| Fourth injection date | Date of fourth injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of fourth injection | |
| Describe | Description of fourth injection substance | |
| Fourth injection site | Site of fourth injection | |
| Travel to endemic/epidemic area(s) | Did case/household member travel to endemic/epidemic area(s)? | |
| Exposure location(s) 1 | Locations of exposure of case/household member | |
| Departure date 1 | Date of travel departure | |
| Return date 1 | Date of travel return | |
| Exposure to person(s) from or returning to endemic areas | Was case/household members exposed to persons from or returning to endemic areas? | |
| Exposure location(s) 2 | Locations of exposure to case/household member who traveled/is from endemic area | |
| Departure date 2 | Date of travel departure of person to whom exposed | |
| Return date 2 | Date of travel return of person to whom exposed | |
| Contact with known case | Did case/household member have contact with known case? | |
| Contact name | Name of case contact (last, first) | |
| Exposure to case location | Location of exposure to case? | |
| Contact date | Date of contact with known case | |
| OVP recipient contact | Did case have contact with OPV vaccine recipient | |
| OVP recipient contact | If yes, date of contact with household OVP vaccine | |
| OVP recipient relation | Relationship of household OVP vaccine recipient to case | |
| OVP recipient age | Age of the OVP vaccine recipient | |
| OPV recipient agetype | Agetype of the OVP vaccine recipient | |
| Date received OVP | Date contact received OVP vaccine | |
| OVP dose number | Number of doses of OVP vaccine received by contact | |
| OVP lot number | Lot number of OVP vaccine received by contact | |
| State or local laboratory name | Name of state or local laboratory which received serum specimens | |
| Serum 1 | Indicate whether P1, P2, or P3 | |
| Serum 1 test type | Test type (neut/CSF) | |
| Serum 1 result | Test result for serum 1 | |
| Serum 1 date | Date drawn/obtained for serum1 | |
| Serum 2 | Indicate whether P1, P2, or P3 | |
| Serum 2 test type | Test type (neut/CSF) | |
| Serum 2 result | Test result for serum 2 | |
| Serum 2 date | Date drawn/obtained for serum 2 | |
| Specimen 1 results | Results of specimen 1 sent for viral isolation | |
| Specimen 1 laboratory | Name of laboratory which received specimens for viral isolation | |
| Specimen 1 type | Type specimen 1 submitted for viral isolation | |
| Specimen 1 date | Date drawn/obtained for specimen 1 | |
| Specimen 2 results | Results of specimen 2 sent for viral isolation | |
| Specimen 2 laboratory | Name of laboratory which received specimens for viral isolation | |
| Specimen 2 type | Type specimen 2 submitted for viral isolation | |
| Specimen 2 date | Date drawn/obtained for specimen 2 | |
| CDC serum 1 | Indicate whether P1, P2, or P3 (serum sent to CDC lab) | |
| CDC serum 1 test type | Test type (neut/CSF for serum sent to CDC lab) | |
| CDC serum 1 result | Test result for serum 1 (sent to CDC lab) | |
| CDC serum 1 date | Date drawn/obtained for serum 1 (sent to CDC) | |
| CDC serum 2 | Indicate whether P1, P2, or P3 | |
| CDC serum 2 test type | Test type (neut/CSF for serum sent to CDC lab)) | |
| CDC serum 2 result | Test result for serum 2 (sent to CDC lab) | |
| CDC serum 2 date | Date drawn/obtained for serum 2 (sent to CDC lab) | |
| CDC specimen 1 type | Type specimen 1 submitted for viral isolation (to CDC lab) | |
| CDC specimen 1 results | Results of specimen 1 sent for viral isolation (to CDC lab) | |
| CDC specimen 1 strain results | Strain characterization results for specimen 1 | |
| CDC specimen 1 date received | Date specimen 1 received by CDC lab | |
| CDC specimen 1 obtained | Date specimen 1 obtained for CDC testing | |
| CDC specimen 2 type | Type specimen 2 submitted for viral isolation (to CDC lab) | |
| CDC specimen 2 results | Results of specimen 2 sent for viral isolation (to CDC lab) | |
| CDC specimen 2 strain results | Strain characterization results for specimen 2 | |
| CDC specimen 2 date received | Date specimen 2 received by CDC lab | |
| CDC specimen 2 obtained | Date specimen 2 obtained for CDC testing | |
| EMG | Was an EMG performed? | |
| EMG results | What were the results of the EMG? | |
| EMG date | Indicate date of EMG. | |
| Nerve conduction | Was a nerve conduction performed? | |
| Nerve results | What were the results of the nerve conduction? | |
| Nerve conduction date | Indicate date of the nerve conduction. | |
| Immune deficiency | Was an immune deficiency diagnosed prior to OPV exposure? | |
| Immune deficiency diagnosis | What was thespecific diagnosi?s | |
| Immune studies | Indicate any immune studies performed | |
| HIV status | Wehat is the HIV status of the patient? |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Clinical course | Clinical course | |
| CSF date | Date of CSF results | |
| WBCs | White blood cell test results for cerebral spinal fluid | |
| RBCs | Red blood cell test results for cerebral spinal fluid | |
| %Lymph | %lymphs test results for CSF | |
| %polys | %polys test results for CSF | |
| Protein | Protein test results for CSF | |
| Glucose | Glucose test results for CSF | |
| 60-day follow up date | Date of 60-day follow up | |
| TOPV immunization history | TOPV within 30 days prior to onset of symptoms? | |
| Date of TOPV | TOPV immunization date | |
| Lot number | TOPV vaccine lot number | |
| IPV-containing vaccine | Total doses ever received of IPV-containing vaccine | |
| Date 1 IPV | First IPV vaccine date | |
| Date 2 IPV | Second IPV vaccine date | |
| Date 3 IPV | Third IPV vaccine date | |
| TOPV vaccine | Total doses ever received of TOPV vaccine | |
| Date 1 TOPV | First TOPV vaccine date | |
| Date 2 TOPV | Second TOPV vaccine date | |
| Date 3 TOPV | Third TOPV vaccine date | |
| BOPV vaccine | Total doses ever received of BOPV vaccine | |
| Date 1 BOPV | First BOPV vaccine date | |
| Date 2 BOPV | Second BOPV vaccine date | |
| Date 3 BOPV | Third BOPV vaccine date | |
| MOPV vaccine | Total doses ever received of MOPV vaccine | |
| Date 1 MOPV | First MOPV vaccine date | |
| Date 2 MOPV | Second MOPV vaccine date | |
| Date 3 MOPV | Third MOPV vaccine date | |
| First injection date | Date of first injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of first injection | |
| Describe | Description of first injection substance | |
| First injection site | Site of first injection | |
| Second injection date | Date of second injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of second injection | |
| Describe | Description of second injection substance | |
| Second injection site | Site of second injection | |
| Third injection date | Date of third injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of third injection | |
| Describe | Description of third injection substance | |
| Third injection site | Site of third injection | |
| Fourth injection date | Date of fourth injection received within 30 days prior to onset of illness | |
| Substance | Substance (vaccine, antibiotic, other) of fourth injection | |
| Describe | Description of fourth injection substance | |
| Fourth injection site | Site of fourth injection | |
| Travel to endemic/epidemic area(s) | Did case/household member travel to endemic/epidemic area(s)? | |
| Exposure location(s) 1 | Locations of exposure of case/household member | |
| Departure date 1 | Date of travel departure | |
| Return date 1 | Date of travel return | |
| Exposure to person(s) from or returning to endemic areas | Was case/household members exposed to persons from or returning to endemic areas? | |
| Exposure location(s) 2 | Locations of exposure to case/household member who traveled/is from endemic area | |
| Departure date 2 | Date of travel departure of person to whom exposed | |
| Return date 2 | Date of travel return of person to whom exposed | |
| Contact with known case | Did case/household member have contact with known case? | |
| Contact name | Name of case contact (last, first) | |
| Exposure to case location | Location of exposure to case? | |
| Contact date | Date of contact with known case | |
| OVP recipient contact | Did case have contact with OPV vaccine recipient | |
| OVP recipient contact | If yes, date of contact with household OVP vaccine | |
| OVP recipient relation | Relationship of household OVP vaccine recipient to case | |
| OVP recipient age | Age of the OVP vaccine recipient | |
| OPV recipient agetype | Agetype of the OVP vaccine recipient | |
| Date received OVP | Date contact received OVP vaccine | |
| OVP dose number | Number of doses of OVP vaccine received by contact | |
| OVP lot number | Lot number of OVP vaccine received by contact | |
| State or local laboratory name | Name of state or local laboratory which received serum specimens | |
| Serum 1 | Indicate whether P1, P2, or P3 | |
| Serum 1 test type | Test type (neut/CSF) | |
| Serum 1 result | Test result for serum 1 | |
| Serum 1 date | Date drawn/obtained for serum1 | |
| Serum 2 | Indicate whether P1, P2, or P3 | |
| Serum 2 test type | Test type (neut/CSF) | |
| Serum 2 result | Test result for serum 2 | |
| Serum 2 date | Date drawn/obtained for serum 2 | |
| Viral Isolation Specimen 1 results | Results of specimen 1 sent for viral isolation | |
| Specimen 1 laboratory | Name of laboratory which received specimens for viral isolation | |
| Specimen 1 type | Type specimen 1 submitted for viral isolation | |
| Specimen 1 date | Date drawn/obtained for specimen 1 | |
| Specimen 2 results | Results of specimen 2 sent for viral isolation | |
| Specimen 2 laboratory | Name of laboratory which received specimens for viral isolation | |
| Specimen 2 type | Type specimen 2 submitted for viral isolation | |
| Specimen 2 date | Date drawn/obtained for specimen 2 | |
| CDC serum 1 | Indicate whether P1, P2, or P3 (serum sent to CDC lab) | |
| CDC serum 1 test type | Test type (neut/CSF for serum sent to CDC lab) | |
| CDC serum 1 result | Test result for serum 1 (sent to CDC lab) | |
| CDC serum 1 date | Date drawn/obtained for serum 1 (sent to CDC) | |
| CDC serum 2 | Indicate whether P1, P2, or P3 | |
| CDC serum 2 test type | Test type (neut/CSF for serum sent to CDC lab)) | |
| CDC serum 2 result | Test result for serum 2 (sent to CDC lab) | |
| CDC serum 2 date | Date drawn/obtained for serum 2 (sent to CDC lab) | |
| CDC specimen 1 type | Type specimen 1 submitted for viral isolation (to CDC lab) | |
| CDC specimen 1 results | Results of specimen 1 sent for viral isolation (to CDC lab) | |
| CDC specimen 1 strain results | Strain characterization results for specimen 1 | |
| CDC specimen 1 date received | Date specimen 1 received by CDC lab | |
| CDC specimen 1 obtained | Date specimen 1 obtained for CDC testing | |
| CDC specimen 2 type | Type specimen 2 submitted for viral isolation (to CDC lab) | |
| CDC specimen 2 results | Results of specimen 2 sent for viral isolation (to CDC lab) | |
| CDC specimen 2 strain results | Strain characterization results for specimen 2 | |
| CDC specimen 2 date received | Date specimen 2 received by CDC lab | |
| CDC specimen 2 obtained | Date specimen 2 obtained for CDC testing | |
| EMG | Was an EMG performed? | |
| EMG results | What were the results of the EMG? | |
| EMG date | Indicate date of EMG. | |
| Nerve conduction | Was a nerve conduction performed? | |
| Nerve results | What were the results of the nerve conduction? | |
| Nerve conduction date | Indicate date of the nerve conduction. | |
| Immune deficiency | Was an immune deficiency diagnosed prior to OPV exposure? | |
| Immune deficiency diagnosis | What was thespecific diagnosi?s | |
| Immune studies | Indicate any immune studies performed | |
| HIV status | Wehat is the HIV status of the patient? |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | CDC Priority |
| Clinical description | Check all signs and symptoms listed below (note maximum temperature). Thi is a multi-select field. | ||
| Specific therapy | Specify products, dosage, and duration. | ||
| Outcome | What was the outcome of this illness? | ||
| Death date | If patient died, date of death. | ||
| Acute-phase serum | What was the acute-phase serum test method? | ||
| Acute-phase serum collected | What was the acute-phase serum collection date? | ||
| Acute-phase serum IgM test result | What was the acute-phase serum IgM result? | ||
| Acute-phase serum IgG test result | What was the acute-phase serum IgG result? | ||
| Acute-phase serum lab | What was the laboratory name? | ||
| Convalescent-phase serum | What was the convalescent-phase serum test method? | ||
| Convalescent-phase serum collected | What was the convalescent-phase serum collection date? | ||
| Convalescent-phase serum IgM test result | What was the convalescent-phase serum IgM result? | ||
| Convalescent-phase serum IgG test result | What was the convalescent-phase serum IgG result? | ||
| Convalescent-phase serum lab | What was the laboratory name? | ||
| PCR | What was the PCR test specimen type? | ||
| PCR collected | What was the PCR specimen collection date? | ||
| PCR test result | What was the PCR test result? | ||
| PCR specimen lab | What was the laboratory name? | ||
| Sputum culture collected | What was the sputum specimen collection date? | ||
| Sputum culture test result | What was the sputum specimen test result? | ||
| Sputum culture lab | What was the laboratory name? | ||
| Chest x-ray | Was a chest x-ray done? | ||
| Chest x-ray date | When was the chest x-ray done? | ||
| Chest x-ray results | What was the chest x-ray result? | ||
| Onset Date Occupation | What was the patient's occupation at date of onset? | ||
| Specific duties | What are/were the patient's specific duties? | ||
| Contact types prior to onset | Indicate which of the following contacts the patient had during the 5 weeks prior to onset. | ||
| Psittacine contact | If exposure to birds, did the patient have contact with psittacines (species, approx number and were birds healthy)? | ||
| Pigeons | If exposure to birds, did the patient have contact with pigeons (species, approx number and were birds healthy)? | ||
| Domestic fowl | If exposure to birds, did the patient have contact with domestic fowl (species, approx number and were birds healthy)? | ||
| Other birds | If exposure to birds, did the patient have contact with any other birds (species, approx number and were birds healthy)? | ||
| Healthy birds | If birds were not healthy, please elaborate. | ||
| Private home - owner | Indicate the owner of the private home | ||
| Private home - adress | Indicate the address of the private home | ||
| Private home - species | Indicate the species to which exposed | ||
| Private home - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Private home - date | Indicate the date of exposure | ||
| Private aviary - owner | Indicate the owner of the aviary | ||
| Private aviary - adress | Indicate the address of the aviary | ||
| Private aviary - species | Indicate the species to which exposed | ||
| Private aviary -setting | Indicate the exposure setting (indoor, outdoor) | ||
| Private aviary - date | Indicate the date of exposure | ||
| Coomercial aviary - owner | Indicate the owner of the aviary | ||
| Coomercial aviary - address | Indicate the address of the aviary | ||
| Coomercial aviary - species | Indicate the species to which exposed | ||
| Coomercial aviary - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Coomercial aviary - date | Indicate the date of exposure | ||
| Pet shop - owner | Indicate the owner of the pet shop | ||
| Pet shop - address | Indicate the address of the pet shop | ||
| Pet shop - species | Indicate the species to which exposed | ||
| Pet shop - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Pet shop - date | Indicate the date of exposure | ||
| Bird loft - owner | Indicate the owner of the bird loft | ||
| Bird loft - address | Indicate the address of the bird loft | ||
| Bird loft - species | Indicate the species to which exposed | ||
| Bird loft - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Bird loft - date | Indicate the date of exposure | ||
| Poultry establishment - owner | Indicate the owner of the establishment | ||
| Poultry establishment - address | Indicate the address of the establishment | ||
| Poultry establishment - species | Indicate the species to which exposed | ||
| Poultry establishment - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Poultry establishment - date | Indicate the date of exposure | ||
| Other - owner | Indicate the owner of the 'other' | ||
| Other - address | Indicate the address of the 'other' | ||
| Other - species | Indicate the species to which exposed | ||
| Other - setting | Indicate the exposure setting (indoor, outdoor) | ||
| Other - date | Indicate the date of exposure | ||
| Unknown - owner | Indicate the owner unknown | ||
| Unknown - address | Indicate the address unknown | ||
| Unknown - species | Indicate if species to which exposed unknown | ||
| Unknown - setting | Indicate if exposure setting (indoor, outdoor) is unknown | ||
| Unknown - date | Indicate if the date of exposure is unknown | ||
| Other epi link | Indicate if any other epi linkage (specify) | ||
| Implicated birds | If pet birds, domestic pigeons, or fowl are implicated as the source of the human psittacosis, list address of every known place where the birds were harbored and approx dates. | ||
| Additional revelant information | Indicate any additional revelant information | ||
| Signs and Symptoms | Indicate what symptoms of interest the patient had during the course of the illness | PHVS_SignsSymptoms_RIBD | P |
| Signs and Symptoms Indicator | Indicator for associated sign and symptom | PHVS_YesNoUnknown_CDC | P |
| Highest Measured Temperature | What was the subject's highest measured temperature during this illness? | N/A | P |
| Temperature Units | Units for highest measured temperature | PHVS_TemperatureUnit_UCUM | P |
| Antibiotics given | Did the subject take antibiotics as treatment for this illness? | PHVS_YesNoUnknown_CDC | P |
| Treatment Start Date | Start date of antibiotic | N/A | P |
| Treatment End Date | Stop date of antibiotic | N/A | P |
| Treatment Duration | Number of days the patient actually took the antibiotic | N/A | 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 |
| 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 |
| Autopsy Specimen Type | Type of autopsy specimen | PHVS_SpecimenSite_RIBD | P |
| Autopsy Result | Autopsy result | N/A | P |
| Date of Autopsy | Date of autopsy (date autopsy specimen collected) | N/A | P |
| Autopsy Laboratory Name | Autopsy Laboratory Name | N/A | P |
| Industry at Date of Onset | Industry at date of onset | PHVS_Industry_CDC_Census2010 | P |
| Personal Protective Equipment | At the time of exposure, which of the following personal protective equipment was used by the patient? | PHVS_PersonalProtectiveEquipment_RIBD | P |
| Respiratory Protective Equipment | If respiratory protective equipment was used at the time of exposure, specify what kind | PHVS_RespiratoryProtectiveEquipment_RIBD | P |
| Annual Respirator Fit Testing and Training | Does the patient get annual respirator fit testing and training? | PHVS_YesNoUnknown_CDC | P |
| Glove Material | If gloves were used, specify glove material | PHVS_GloveMaterial_RIBD | P |
| Contact Type | Indicate which of the following contacts patient had during 5 weeks prior to onset | PHVS_ContactType_RIBD | P |
| Bird Type | What type of bird did the patient have contact with during the 5 weeks prior to onset? | PHVS_BirdType_RIBD | P |
| Bird Species | Bird species | N/A | P |
| Number of Birds | Approximate number of birds | N/A | P |
| Illness Onset Age | Illness onset age | N/A | P |
| Illness Onset Age Units | Illness onset age units | PHVS_AgeUnit_UCUM | P |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Wool or Felt Plant | Did the case work in a wool or felt plant | PHVS_YesNoUnknown_CDC |
| Tannery or Rendering | Did the case work in a tannery or rendering plant | PHVS_YesNoUnknown_CDC |
| Dairy | Did the case work in a dairy | PHVS_YesNoUnknown_CDC |
| Veterinarian | Did the case work as a veterinarian | PHVS_YesNoUnknown_CDC |
| Medical Researcher | Did the case work as a medical researcher | PHVS_YesNoUnknown_CDC |
| Animal Researcher | Did the case work as an animal researcher | PHVS_YesNoUnknown_CDC |
| Slaughterhouse | Did the case work in a slaughterhouse | PHVS_YesNoUnknown_CDC |
| Laboratory | Did the case work in a laboratory | PHVS_YesNoUnknown_CDC |
| Rancher | Did the case work as a rancher | PHVS_YesNoUnknown_CDC |
| Lives in Household | Did the case live in a household with someone who may have one of the above occupational exposures | PHVS_YesNoUnknown_CDC |
| Military | Did the case work in the military | PHVS_YesNoUnknown_CDC |
| Other Occupation | Indicate the case's occupation if none of the above | |
| Cattle Contact | Did the case have contact with cattle within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Sheep Contact | Did the case have contact with sheep within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Goat Contact | Did the case have contact with goats within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Pigeon Contact | Did the case have contact with pigeons within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Cat Contact | Did the case have contact with cats within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Rabbit Contact | Did the case have contact with rabbits within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Other Animal Contact | Indicate any other animals the case had contact within within two months of illness onset | |
| Exposure to Birthing Animals | Was the case exposed to birthing animals within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Exposure to Unpasteurized Milk | Was the case exposed to unpasteurized milk within two months of illness onset | PHVS_YesNoUnknown_CDC |
| Milk Animal | If the case was exposed to unpasteurized milk, what animal was the milk from | PHVS_YesNoUnknown_CDC |
| Other Family Ill | Was another family member ill with a similar illness within the last year | PHVS_YesNoUnknown_CDC |
| Fever | Did the case report a fever of at least 100.5 during this illness | PHVS_YesNoUnknown_CDC |
| Myalgia | Did the case report myalgia during this illness | PHVS_YesNoUnknown_CDC |
| Retro Orbital Pain | Did the case report retro orbital pain during this illness | PHVS_YesNoUnknown_CDC |
| Malaise | Did the case report malaise during this illness | PHVS_YesNoUnknown_CDC |
| Rash | Did the case report a rash during this illness | PHVS_YesNoUnknown_CDC |
| Cough | Did the case report a coughduring this illness | PHVS_YesNoUnknown_CDC |
| Headache | Did the case report a headache during this illness | PHVS_YesNoUnknown_CDC |
| Splenomegaly | Did the case report splenomegaly during this illness | PHVS_YesNoUnknown_CDC |
| Hepatomegaly | Did the case report hepatomegaly during this illness | PHVS_YesNoUnknown_CDC |
| Pneumonia | Did the case report pneumonia during this illness | PHVS_YesNoUnknown_CDC |
| Hepatitis | Did the case report hepatitis during this illness | PHVS_YesNoUnknown_CDC |
| Endocarditis | Did the case report endocarditis during this illness | PHVS_YesNoUnknown_CDC |
| Other Signs or Symptoms | If there were other signs or symptoms reported, the indicate them here | |
| Immunocompromised | Did the case report a pre-existing immunocompromised system | PHVS_YesNoUnknown_CDC |
| Pregnant | Was the case pregnant during this illness | PHVS_YesNoUnknown_CDC |
| Valvular Disease | Did the case have a pre-existing valvular heart disease or graft | PHVS_YesNoUnknown_CDC |
| Other Pre-existing Medical Condition | If the case had nother pre-existing medical conditions, then list them here | |
| Laboratory Name | Indicate the name of the laboratory which supplied results supporting the current CSTE case definitions. | |
| Laboratory State | Indicate the state where the laboratory is located | PHVS_State_FIPS_5-2 |
| Acute Phase I Serology Collection Date | If acute phase I serology was performed, then list the date of collection | |
| Acute Phase I IFA IgG Result | If performed, was the acute phase I IFA IgG positive | PHVS_YesNoUnknown_CDC |
| Acute Phase I IFA IgG Titer | If performed, what was the reciprocal titer of the acute phase I IFA IgG | |
| Acute Phase I IFA IgM Result | If performed, was the acute phase I IFA IgM positive | PHVS_YesNoUnknown_CDC |
| Acute Phase I IFA IgM Titer | If performed, what was the reciprocal titer of the acute phase I IFA IgM | |
| Acute Phase I Compliment Fixation Result | If performed, was the acute phase I compliment fixation positive | PHVS_YesNoUnknown_CDC |
| Acute Phase I Compliment Fixation Titer | If performed, what was the reciprocal titer of the acute phase I compliment fixation | |
| Acute Phase I, Other Test Name | If performed, what was the name of another phase I acute serologic test | |
| Acute Phase I, Other Test Result | If performed, was the other phase I acute serologic test positive | PHVS_YesNoUnknown_CDC |
| Acute Phase I, Other Test Numeric Result | If performed, what was the numeric result of the other phase I acute serologic test | |
| Acute Phase II Serology Collection Date | If acute phase II serology was performed, then list the date of collection | |
| Acute Phase II IFA IgG Result | If performed, was the acute phase II IFA IgG positive | PHVS_YesNoUnknown_CDC |
| Acute Phase II IFA IgG Titer | If performed, what was the reciprocal titer of the acute phase II IFA IgG | |
| Acute Phase II IFA IgM Result | If performed, was the acute phase II IFA IgM positive | PHVS_YesNoUnknown_CDC |
| Acute Phase II IFA IgM Titer | If performed, what was the reciprocal titer of the acute phase II IFA IgM | |
| Acute Phase II Compliment Fixation Result | If performed, was the acute phase II compliment fixation positive | PHVS_YesNoUnknown_CDC |
| Acute Phase II Compliment Fixation Titer | If performed, what was the reciprocal titer of the acute phase II compliment fixation | |
| Acute Phase II, Other Test Name | If performed, what was the name of another phase II acute serologic test | |
| Acute Phase II, Other Test Result | If performed, was the other phase II acute serologic test positive | PHVS_YesNoUnknown_CDC |
| Acute Phase II, Other Test Numeric Result | If performed, what was the numeric result of the other phase II acute serologic test | |
| Convalescent Phase I Serology Collection Date | If convalescent phase I serology was performed, then list the date of collection | |
| Convalescent Phase I IFA IgG Result | If performed, was the convalescent phase I IFA IgG positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase I IFA IgG Titer | If performed, what was the reciprocal titer of the convalescent phase I IFA IgG | |
| Convalescent Phase I IFA IgM Result | If performed, was the convalescent phase I IFA IgM positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase I IFA IgM Titer | If performed, what was the reciprocal titer of the convalescent phase I IFA IgM | |
| Convalescent Phase I Compliment Fixation Result | If performed, was the convalescent phase I compliment fixation positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase I Compliment Fixation Titer | If performed, what was the reciprocal titer of the convalescent phase I compliment fixation | |
| Convalescent Phase I, Other Test Name | If performed, what was the name of another phase I convalescent serologic test | |
| Convalescent Phase I, Other Test Result | If performed, was the other phase I convalescent serologic test positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase I, Other Test Numeric Result | If performed, what was the numeric result of the other phase I convalescent serologic test | |
| Convalescent Phase II Serology Collection Date | If convalescent phase II serology was performed, then list the date of collection | |
| Convalescent Phase II IFA IgG Result | If performed, was the convalescent phase II IFA IgG positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase II IFA IgG Titer | If performed, what was the reciprocal titer of the convalescent phase II IFA IgG | |
| Convalescent Phase II IFA IgM Result | If performed, was the convalescent phase II IFA IgM positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase II IFA IgM Titer | If performed, what was the reciprocal titer of the convalescent phase II IFA IgM | |
| Convalescent Phase II Compliment Fixation Result | If performed, was the convalescent phase II compliment fixation positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase II Compliment Fixation Titer | If performed, what was the reciprocal titer of the convalescent phase II compliment fixation | |
| Convalescent Phase II, Other Test Name | If performed, what was the name of another phase II convalescent serologic test | |
| Convalescent Phase II, Other Test Result | If performed, was the other phase II convalescent serologic test positive | PHVS_YesNoUnknown_CDC |
| Convalescent Phase II, Other Test Numeric Result | If performed, what was the numeric result of the other phase II convalescent serologic test | |
| Fourfold | If paired sera were collected, was there a fourfold change in titer between acute and convalescent of the same phase | PHVS_YesNoUnknown_CDC |
| PCR | If performed, was the polymerase chain reaction assay positive | PHVS_YesNoUnknown_CDC |
| Immunostain | If performed, were antibodies detected using immunohistochemistry during microscopy | PHVS_YesNoUnknown_CDC |
| Culture | If performed, was the etiologic agent isolated from culture | PHVS_YesNoUnknown_CDC |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| 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 |
| SURGERY | Did the patient have surgery? | PHVS_YesNoUnknown_CDC |
| SURGDATE | Date of the surgery | |
| DELIVERY | Did the patient have a baby (vaginal or C-section)? | PHVS_YesNoUnknown_CDC |
| BABYDATE | Date of the baby's delivery | |
| GASCOND | Did the patient have other prior conditions? This is a multi-select field. | TBD |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Did the subject have a rash? | Did the subject being reported in this investigation have a rash? | PHVS_YesNoUnknown_CDC |
| Rash onset date | What was the rash onset date? | |
| Duration of rash | How many days did the rash last? | |
| Rash Onset occur within 14-23 days of entering USA | Did rash onset occur 14-23 days after entering USA, following any travel or living outside the USA? | PHVS_YesNoUnknown_CDC |
| Did the Subject have a fever? | Did the subject have a fever? i.e., a measured temperature >2 degrees above normal | PHVS_YesNoUnknown_CDC |
| Highest Measured Temperature | What was the person's highest measured temperature during this illness? | |
| Temperature Units | The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius. | PHVS_TemperatureUnit_UCUM |
| Date of Fever Onset | Date of fever onset | |
| Arthralgia/arthritis (symptom) | Did the Subject have arthralgia/arthritis (symptom)? | PHVS_YesNoUnknown_CDC |
| Lymphadenopathy (symptom) | Did the Subject have lymphadenopathy (symptom)? | PHVS_YesNoUnknown_CDC |
| Conjunctivitis (symptom) | Did the Subject have conjunctivitis (symptom)? | PHVS_YesNoUnknown_CDC |
| Encephalitis (complication) |
Did the person develop encephalitis as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Thrombocytopenia (complication) |
Did the person develop thrombocytopenia as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Arthralgia/arthritis (complication) | Did Subject have arthralgia/arthritis (complication)? | PHVS_YesNoUnknown_CDC |
| Other Complication | Did the person develop an other condition(s) as a complication of this illness? | PHVS_YesNoUnknown_CDC |
| Specify Other Complication | Please specify the other complication(s) the person developed, during or as a result of this illness. | |
| Cause of Death | Cause of subject's death | |
| Was laboratory testing done for rubella? | Was laboratory testing done for rubella? | 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 specimen/isolate was tested | |
| Test Method | The technique or method used to perform the test and obtain the test results | PHVS_LabTestMethod_CDC |
| Date Collected | Date of specimen collection | |
| Specimen Source | The medium from which the specimen originated | PHVS_SpecimenSource_VPD |
| 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 | |
| Was Rubella genotype sequenced? | Identifies whether the Rubella virus was genotype sequenced. | PHVS_YesNoUnknown_CDC |
| Type of Genotype Sequence | Identifies the genotype sequence of the Rubella virus | PHVS_Genotype_Rubella |
| Transmission Setting | What was the transmission setting where the Rubella was acquired? | PHVS_TransmissionSetting_NND |
| Were age and setting verified? | Does the age of the case match or make sense for the transmission setting listed (i.e.) a person aged 80 probably would not have a transmission setting of child day care center? | PHVS_YesNoUnknown_CDC |
| Source of Infection | What was the source of the Rubella infection? | |
| 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 Rubella? | PHVS_YesNoUnknown_CDC |
| Traceable to international import? | Identifies whether the Rubella case was traceable (linked) to an international import. | PHVS_YesNoUnknown_CDC |
| Expected Delivery Date | What is the expected delivery date of this pregnancy? | |
| Expected Place of Delivery | Expected place of delivery | |
| Number of weeks gestation at time of disease | Number of weeks gestation at time of rubella disease | |
| Trimester of gestation at time of disease | Trimester of gestation at time of rubella disease | PHVS_PregnancyTrimester_CDC |
| Documentation of previous disease immunity testing | Is there documentation of previous rubella immunity testing? | PHVS_YesNoUnknown_CDC |
| Result of previous immunity testing | Result of previous immunity testing | PHVS_LabTestInterpretation_VPD |
| Year of previous immunity testing | Year of previous immunity testing | |
| Age of Subject at time of immunity testing (in years) | Age of Subject at time of immunity testing | |
| Did the Subject ever have this disease prior to this pregnancy? | Did the Subject ever have rubella disease prior to this pregnancy? | PHVS_YesNoUnknown_CDC |
| Was previous disease serologically confirmed? | Was previous rubella disease serologically confirmed? | PHVS_YesNoUnknown_CDC |
| Year of previous disease | If previous rubella was serologically confirmed, what was the year of previous disease? | |
| Age of the Subject at time of previous disease (in years) | If previous rubella was serologically confirmed, what was the age of the Subject at time of previous disease? | |
| Current Pregnancy Outcome | What was the outcome of the current pregnancy? | PHVS_BirthOutcome_Rubella |
| 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)? | |
| 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 | |
| Did the Subject ever receive disease-containing vaccine? | Did the Subject ever receive rubella-containing vaccine? | PHVS_YesNoUnknown_CDC |
| If no, reason subject did not receive a disease-containing vaccine | If the subject did not receive a rubella-containing vaccine, what was the reason? | PHVS_VaccineNotGivenReasons_CDC |
| Number of doses received ON or AFTER first birthday | Number of rubella-containing vaccine doses Subject received ON or AFTER first birthday | |
| 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 |
| Part of Outbreak | Is this case part of an outbreak of 3 or more | |
| Date of Return from Travel | Date of return from most recent travel | |
| Case Patient a Healthcare Worker | Was the case patient a healthcare provider (HCP) at illness onset? | |
| Previous case diagnosed by | Who diagnosed previous case? | |
| Vaccination Doses Prior to Onset | Number of vaccine doses against this disease prior to illness onset | |
| Date of Last Dose Prior to Illness Onset | Date of last vaccine dose against this disease prior to illness onset | |
| Vaccine History Comments | Comments about the subject's vaccination history | |
| Age at rash onset | Age at rash onset | |
| Age units at rash onset | Age units at rash onset | |
| Age units at previous diagnosis | Age units at previous diagnosis | |
| Length of time in U.S. | Length of time in U.S. | |
| Length of time in U.S. Units | Length of time in U.S. Units | |
| International Destination(s) of Recent Travel | List any international destinations of recent travel. |
| 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) |
| Formtype | Type of form reported on (9=carrier form or known carrier) | N/A | P | |
| CDCNUM | CDC Number | N/A | P | |
| StateEpiNumber | State Epi Number | N/A | P | |
| SLABSID | State Lab Isolate ID Number | N/A | P | |
| SLABSID2 | State Lab Isolate ID Number 2, maybe if another entry is associated in NARMS data | N/A | P | |
| SpecNumber | NARMS Isolate Identification Number | N/A | P | |
| SpecNumber2 | NARMS Isolate Identification Number- for dulplicate sample from a single patient | N/A | P | |
| SpecNumber3 | NARMS Isolate Identification Number- for dulplicate sample from a single patient | N/A | P | |
| Year | Year of report (based on date onset) | N/A | P | |
| Date Entered | Date Form was entered into database | N/A | P | |
| Date Rec CDC | Date Form was received to CDC | N/A | P | |
| Name | First three letters of patient's last name | N/A | P | |
| Foodhand | Work as foodhandler? (1=Yes, 2=No, 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| Citizen | Citizen (1=US 2=other 9=unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9=didn't answer) WAIT to change in SAS | P | ||
| Othcitzn | Other citizenship | N/A | P | |
| Ill | Ill with typhoid fever (1=Yes 2=No 9=Unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9 didn't answer) Changed in SAS! | PHVS_YesNoUnknown_CDC | P | |
| Dtonset | Date of onset of Symptoms | N/A | P | |
| Outcome | Outcome of case (1=Recovered 2=Died 3=didn't answer 9=unknown) | PHVS_ConditionStatus_FDD | P | |
| Dtisol | Date Salmonella first isolated | N/A | P | |
| Site | Sites of isolation (1=Blood 2=Stool 3=didn't answer 9=unknown 4=gallbalder 5=other) CAREFUL with this variable - LOTS of dif. codes! | PHVS_SpecimenCollectionSource_FDD | P | |
| Othsite | Other site of isolation | N/A | P | |
| Serotype | N/A | P | ||
| Sensi | Was sensitivity testing done? (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| Ampr | Resistant to ampicillin on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | PHVS_YesNoUnknown_CDC | P | |
| Chlorr | Resistant to chloramphenicol on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | PHVS_YesNoUnknown_CDC | P | |
| Tmpsmxr | Resistant to trimethoprim-sulfamethoxazole on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | PHVS_YesNoUnknown_CDC | P | |
| quinol | Resistant to fluoroquinolone on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | PHVS_YesNoUnknown_CDC | P | |
| Ceft | Resistant to ceftriaxone (1=Yes 2=No 9=unknown) | PHVS_YesNoUnknown_CDC | P | |
| outbreak | Case occur as part of outbreak? (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| vac5yr | Vaccinated within 5 yrs? (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| stanvax | Standard Killed typhoid shot (1=Yes 2=No, 9=unknown, 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| yrstanvx | Year standard vaccine received | N/A | P | |
| ty21vax | Oral Ty 21a or Vivotof four pill series (1=Yes 2=No, 9=unknown, 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| yrty21 | Year of Oral Ty 21a or Vivotof four pill series received | N/A | P | |
| vicps | VICPS or Typhium VI shot (1=Yes 2=No, 9=unknown, 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| yrvicps | Year VICPS or Typhium VI shot received | N/A | P | |
| outus | Travel outside of US? (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| country1 | Country 1 visited | PHVS_Country_ISO_3166-1 | P | |
| country2 | Country 2 visited | PHVS_Country_ISO_3166-1 | P | |
| country3 | Country 3 visited | PHVS_Country_ISO_3166-1 | P | |
| country4 | Country 4 visited | PHVS_Country_ISO_3166-1 | P | |
| country1oth | country 1 other | PHVS_Country_ISO_3166-1 | P | |
| country2oth | country 2 other | PHVS_Country_ISO_3166-1 | P | |
| country3oth | country 3 other | PHVS_Country_ISO_3166-1 | P | |
| country4oth | country 4 other | PHVS_Country_ISO_3166-1 | P | |
| dtentus | Date of most return or entry in the US | N/A | P | |
| business | Business is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_TravelPurpose_FDD | P | |
| tourism | Tourism is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_TravelPurpose_FDD | P | |
| visitfam | Visiting relatives or friends is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_TravelPurpose_FDD | P | |
| immigrat | Immigration to the US is purpose of international travel (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_TravelPurpose_FDD | P | |
| othtrav | Other travel is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)Reason for other travel | PHVS_TravelPurpose_FDD | P | |
| travreas | Reason for other travel | N/A | P | |
| anycarr | Case traced to typhoid carrier? (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| prevcarr | Carrier previously known to health dept (1=Yes 2=No 9=unknown 3=didn't answer) | PHVS_YesNoUnknown_CDC | P | |
| comment | Comments | N/A | P | |
| dtform | Date PH Dept completed form | N/A | P | |
| Specify Different Travel Exposure Window | If the travel exposure window used by the jurisdiction is not 30 days. Specify the time interval in days here. Otherwise, leave blank. | N/A | P | |
| health care worker | Was the patient a health care provider? | PHVS_YesNoUnknown_CDC | P | |
| day care attendee | Was the patient a health care attendee? | PHVS_YesNoUnknown_CDC | P | |
| day care worker | Was the patient a day care provider? | PHVS_YesNoUnknown_CDC | P | |
| PulseNet ID | State lab ID submitted to PulseNet | N/A | 1 | |
| WGS ID Number | Whole Genome Sequencing (WGS) ID Number | N/A | 1 | |
| Date Of Arrival To Travel Destination | Date of arrival to travel destination | N/A | 3 | |
| Travel State | Domestic destination, state(s) traveled to | PHVS_State_FIPS_5-2 | 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) |
| Formtype | Type of form reported on (9=carrier form or known carrier) | |||
| CDCNUM | CDC Number | |||
| StateEpiNumber | State Epi Number | |||
| SLABSID | State Lab Isolate ID Number | |||
| SLABSID2 | State Lab Isolate ID Number 2, maybe if another entry is associated in NARMS data | |||
| SpecNumber | NARMS Isolate Identification Number | |||
| SpecNumber2 | NARMS Isolate Identification Number- for dulplicate sample from a single patient | |||
| SpecNumber3 | NARMS Isolate Identification Number- for dulplicate sample from a single patient | |||
| Year | Year of report (based on date onset) | |||
| Date Entered | Date Form was entered into database | |||
| Date Rec CDC | Date Form was received to CDC | |||
| State | Reporting State | |||
| Name | First three letters of patient's last name | |||
| DOB | Date of Birth | |||
| Age | Age | |||
| Sex | Sex (1=Male 2=Female) | |||
| Foodhand | Work as foodhandler? (1=Yes, 2=No, 9=unknown 3=didn't answer) | |||
| Citizen | Citizen (1=US 2=other 9=unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9=didn't answer) WAIT to change in SAS | |||
| Othcitzn | Other citizenship | |||
| Ill | Ill with typhoid fever (1=Yes 2=No 9=Unknown 3=didn't answer) CSP CHANGED CODE (before, 3=unknown, 9 didn't answer) Changed in SAS! | |||
| Dtonset | Date of onset of Symptoms | |||
| Hosp | Hospitalized? (1=Yes 2=No, 9=unknown, 3=didn't answer) | |||
| Hospdays | Days hospitalized NOTE -- 999= didn't answer in a field like this! | |||
| Outcome | Outcome of case (1=Recovered 2=Died 3=didn't answer 9=unknown) | |||
| Dtisol | Date Salmonella first isolated | |||
| Site | Sites of isolation (1=Blood 2=Stool 3=didn't answer 9=unknown 4=gallbalder 5=other) CAREFUL with this variable - LOTS of dif. codes! | |||
| Othsite | Other site of isolation | |||
| Serotype | ||||
| Sensi | Was sensitivity testing done? (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| Ampr | Resistant to ampicillin on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | |||
| Chlorr | Resistant to chloramphenicol on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | |||
| Tmpsmxr | Resistant to trimethoprim-sulfamethoxazole on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | |||
| quinol | Resistant to fluoroquinolone on form 3? (1=Yes 2=No 7=not tested 3=didn't answer 9=unknown) | |||
| Ceft | Resistant to ceftriaxone (1=Yes 2=No 9=unknown) | |||
| outbreak | Case occur as part of outbreak? (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| vac5yr | Vaccinated within 5 yrs? (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| stanvax | Standard Killed typhoid shot (1=Yes 2=No, 9=unknown, 3=didn't answer) | |||
| yrstanvx | Year standard vaccine received | |||
| ty21vax | Oral Ty 21a or Vivotof four pill series (1=Yes 2=No, 9=unknown, 3=didn't answer) | |||
| yrty21 | Year of Oral Ty 21a or Vivotof four pill series received | |||
| vicps | VICPS or Typhium VI shot (1=Yes 2=No, 9=unknown, 3=didn't answer) | |||
| yrvicps | Year VICPS or Typhium VI shot received | |||
| outus | Travel outside of US? (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| country1 | Country 1 visited | |||
| country2 | Country 2 visited | |||
| country3 | Country 3 visited | |||
| country4 | Country 4 visited | |||
| country1oth | country 1 other | |||
| country2oth | country 2 other | |||
| country3oth | country 3 other | |||
| country4oth | country 4 other | |||
| dtentus | Date of most return or entry in the US | |||
| business | Business is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | |||
| tourism | Tourism is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | |||
| visitfam | Visiting relatives or friends is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer) | |||
| immigrat | Immigration to the US is purpose of international travel (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| othtrav | Other travel is purpose of international travel(1=Yes 2=No 9=unknown 3=didn't answer)Reason for other travel | |||
| travreas | Reason for other travel | |||
| anycarr | Case traced to typhoid carrier? (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| prevcarr | Carrier previously known to health dept (1=Yes 2=No 9=unknown 3=didn't answer) | |||
| comment | Comments | |||
| dtform | Date PH Dept completed form | |||
| Specify Different Travel Exposure Window | If the travel exposure window used by the jurisdiction is not 30 days. Specify the time interval in days here. Otherwise, leave blank. | N/A | P | |
| health care worker | Was the patient a health care provider? | PHVS_YesNoUnknown_CDC | P | |
| day care attendee | Was the patient a health care attendee? | PHVS_YesNoUnknown_CDC | P | |
| day care worker | Was the patient a day care provider? | PHVS_YesNoUnknown_CDC | P | |
| PulseNet ID | State lab ID submitted to PulseNet | N/A | 1 | |
| WGS ID Number | Whole Genome Sequencing (WGS) ID Number | N/A | 1 | |
| Date Of Arrival To Travel Destination | Date of arrival to travel destination | N/A | 3 | |
| Travel State | Domestic destination, state(s) traveled to | PHVS_State_FIPS_5-2 | 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) |
| 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 | |||
| BioId | Was the pathogen identified by culture? | |||
| 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 7 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 | 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? | |||
| SalGroup | Salmonella serogroup | |||
| SentCDC | Was specimen or isolate forwarded to CDC for testing or confirmation? | |||
| SeroSite | Serotype/species of pathogen | |||
| 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 7 days of onset) | |||
| Dom_travel | In the 7 days before illness, would you/your child have traveled within the US but outside of the area where you live or work? | |||
| Out_freq | How many times would you/your child have eaten out (deli, fast food, or other restaurant)? | |||
| Chx_handle | Would you/your child, or anyone in your household, have handled raw chicken in the home? | |||
| Chicken | How many times would you/your child have eaten chicken or any foods containing chicken? | |||
| Chx_uncook | In the 7 days before illness, would you/your child have eaten any chicken that was raw or undercooked? | |||
| chx_ground | In the 7 days before illness, would you/your child have eaten any ground chicken? | |||
| Chx_whole | In the 7 days before illness, would you/your child have eaten any whole or cut chicken parts (e.g., rotisserie, chicken breasts, wings, etc.)? | |||
| chx_processed | In the 7 days before illness, would you/your child have eaten any processed chicken (e.g., deli meat, chicken nuggets, pre-made dinners, etc.)? | |||
| Chx_outside | In the 7 days before illness, would you/your child have eaten any chicken made outside of home (deli, fast food, take-out, or restaurant)?** | |||
| Chx_home | In the 7 days before illness, would you/your child have eaten any chicken made at home? | |||
| Chx_fresh | Was the chicken bought fresh (refrigerated)? (Answer if Yes to Q56) | |||
| Chx_frozen | Was the chicken bought frozen? (Answer if Yes to Q56) | |||
| Turkey_handle | Would you/your child, or anyone in your household, have handled raw turkey in the home? | |||
| Turkey | In the 7 days before illness, would you/your child have eaten any turkey or any foods containing turkey? | |||
| Turkey_uncook | In the 7 days before illness, would you/your child have eaten any turkey that was undercooked or raw? | |||
| Turkey_ground | In the 7 days before illness, would you/your child have eaten any ground turkey? | |||
| Turkey_whole | In the 7 days before illness, would you/your child have eaten any whole or cut turkey parts? | |||
| Turkey_processed | In the 7 days before illness, would you/your child have eaten any processed turkey (e.g., deli meat, bacon, sausage, pre-made dinners, etc.)?** | |||
| Turkey_outside | In the 7 days before illness, would you/your child have eaten any turkey made outside of home (deli, fast food, take-out, or restaurant)? | |||
| Turkey_home | In the 7 days before illness, would you/your child have eaten any turkey made at home? | |||
| Other_poultry | In the 7 days before illness, would you/your child have eaten any poultry other than chicken or turkey (e.g., duck, cornish hens, quail, etc.)? | |||
| Beef_handle | Would you/your child, or anyone in household, have handled raw beef in the home? | |||
| Beef | In the 7 days before illness, would you/your child have eaten beef or any foods containing beef? | |||
| Beef_uncook | In the 7 days before illness, would you/your child have eaten any beef that was undercooked or raw? | |||
| Beef_ground | In the 7 days before illness, would you/your child have eaten any ground beef? | |||
| Beef_whole | In the 7 days before illness, would you/your child have eaten any whole or cut beef parts (e.g., steaks, roasts, etc.)? | |||
| Beef_processed | In the 7 days before illness, would you/your child have eaten any processed beef (e.g., deli meat, sausage, jerky, pre-made dinners, etc.)? | |||
| Beef_outside | In the 7 days before illness, would you/your child have eaten any beef made outside of home (deli, fast food, take-out, or restaurant)? | |||
| Beef_home | In the 7 days before illness, would you/your child have eaten any beef made at home? | |||
| Beef_fresh | Was the beef bought fresh (refrigerated)? (Answer if Yes to Q75) | |||
| Beef_frozen | Was the beef bought frozen? (Answer if Yes to Q75) | |||
| Pork_handle | Would you/your child, or anyone in your household, have handled raw pork in the home? | |||
| Pork | In the 7 days before illness, would you/your child have eaten pork or any foods containing pork? | |||
| Pork_uncook | In the 7 days before illness, would you/your child have eaten any undercooked or raw pork? | |||
| Pork_whole | In the 7 days before illness, would you/your child have eaten any whole or cut pork parts (e.g., ham shank, pork chops, chitlins, etc.)? | |||
| Pork_processed | In the 7 days before illness, would you/your child have eaten any processed pork (e.g., deli meat [like ham slices], bacon, sausage, etc.)?** | |||
| Lamb | In the 7 days before illness, would you/your child have eaten any lamb? | |||
| Seafood | In the 7 days before illness, would you/your child have eaten any non-fish seafood (e.g., crab, shrimp, oysters, clams, etc.) that was not from a can? | |||
| seafood_uncook | In the 7 days before illness, would you/your child have eaten any non-fish seafood that was undercooked or raw (e.g., raw oysters, clams, etc.)? | |||
| Fish | In the 7 days before illness, would you/your child have eaten any fish or fish products (processed or unprocessed) that was not from a can? | |||
| Fish_uncook | In the 7 days before illness, would you/your child have eaten any fish that was undercooked or raw (e.g., sushi, etc.)? | |||
| Fish_whole | In the 7 days before illness, would you/your child have eaten any whole fish or fish filets (unprocessed fish)? | |||
| Eggs | In the 7 days before illness, would you/your child have eaten eggs or any foods containing eggs? | |||
| Eggs_outside | In the 7 days before illness, would you/your child have eaten any eggs made away outside of home (deli, fast food, take-out, or restaurant)?** | |||
| Eggs_home | In the 7 days before illness, would you/your child have eaten any eggs made at home? | |||
| Eggs_uncook | In the 7 days before illness, would you/your child have eaten any eggs that were runny or raw, or uncooked foods made with raw eggs? | |||
| Dairy | In the 7 days before illness, would you/your child have eaten or drank any dairy products (e.g., milk, yogurt, cheese, ice cream, etc.)? | |||
| Queso_fresco | In the 7 days before illness, would you/your child have eaten any queso fresco, queso blanco, or other type of Mexican-style soft cheese? | |||
| Dairy_uncook | …eaten or drank any dairy products that were raw or unpasteurized (e.g., raw milk, or cheeses, yogurts, and ice cream made from raw milk)? | |||
| Cantaloupe | In the 7 days before illness, would you/your child have eaten any fresh cantaloupe? | |||
| Strawberries | In the 7 days before illness, would you/your child have eaten any fresh (unfrozen) strawberries? | |||
| Other_berries | In the 7 days before illness, would you/your child have eaten any other fresh (unfrozen) berries? | |||
| Watermelon | In the 7 days before illness, would you/your child have eaten any fresh watermelon? | |||
| Apples | In the 7 days before illness, would you/your child have eaten any fresh apples? | |||
| Honeydew | In the 7 days before illness, would you/your child have eaten any fresh honeydew melon? | |||
| Pineapple | In the 7 days before illness, would you/your child have eaten any fresh pineapple? | |||
| Raw_cider | In the 7 days before illness, would you/your child have drank any unpasteurized juice or cider? | |||
| Other_fruit | In the 7 days before illness, would you/your child have eaten any other fruit (fresh or frozen) or drank other fruit juices? | |||
| Nuts_uncook | In the 7 days before illness, would you/your child have eaten any raw or uncooked nuts? | |||
| Lettuce | In the 7 days before illness, would you/your child have eaten any fresh, raw lettuce? | |||
| Cabbage | In the 7 days before illness, would you/your child have eaten any fresh, raw cabbage? | |||
| Spinach | In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw spinach? | |||
| Broccoli | In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw broccoli? | |||
| Tomatoes | In the 7 days before illness, would you/your child have eaten any fresh, raw tomatoes? | |||
| Onions | In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw onions? | |||
| Carrots | In the 7 days before illness, would you/your child have eaten any fresh (unfrozen), raw carrots? | |||
| Sprouts | In the 7 days before illness, would you/your child have eaten any fresh, raw sprouts? | |||
| Herbs | In the 7 days before illness, would you/your child have eaten any fresh (not dried) herbs? | |||
| Other_veggies | In the 7 days before illness, would you/your child have eaten any other vegetables (fresh or frozen) or drank any vegetable juices? | |||
| Infant_formula | If you are answering for an ill infant aged 1 year or younger, are they drinking infant formula? | |||
| Infant_bmilk | If you are answering for an ill infant aged 1 year or younger, are they drinking breast milk? | |||
| Infant_omilk | If you are answering for an ill infant aged 1 year or younger, are they drinking any other milk? | |||
| Well_water | In the 7 days before illness, would you/your child have drank any water from a well? | |||
| Other_untreated | In the 7 days before illness, would you/your child have swallowed or drank any water directly from a natural spring, lake, pond, stream, or river? | |||
| Swim_unchlor | In the 7 days before illness, would you/your child have swam in, waded in, or entered an ocean, lake, pond, river, stream, or natural spring? | |||
| Sick_contacts | Was there a household member or a close contact with diarrhea? | |||
| Diaper_contact | In the 7 days before illness, would you/your child have had contact with dirty diapers? | |||
| Shared_facility | In the 7 days before illness, would you/your child have lived, worked, or volunteered in a shared living facility (e.g., dorm, nursing home, etc.)? | |||
| Daycare | Would you/your child, or anyone in your house, have attended, worked, or volunteered at a day care? | |||
| Sick_pet | In the 7 days before illness, would you/your child have had any contact with a pet that had diarrhea? | |||
| Reptile_amphib | In the 7 days before illness, would you/your child have had any contact with a reptile or amphibian (e.g., frog, snake, turtle, etc.)? | |||
| Outdoors | In the 7 days before illness, would you/your child have done any hiking, camping, gardening, or yard work? | |||
| Manure_compost | In the 7 days before illness, would you/your child have had any contact with animal manure, pet feces, or compost? | |||
| Farm_ranch | In the 7 days before illness, would you/your child have visited, worked, or lived on farm, ranch, petting zoo, or other setting that has farm animals? | |||
| Live_poultry | Were there any live poultry (e.g., chickens, turkeys, hens, etc.)? (Answer if Yes to Q130) | |||
| Cattle_others | Were there any cattle, goats, or sheep? (Answer if Yes to Q130) | |||
| Other_animals | Were there any other farm animals (e.g., pigs, horses, etc.)? (Answer if Yes to Q130) | |||
| Site ID | Site ID assigned by CDC. | |||
| Disease | Foodborne Disease. | |||
| State Lab ID | Identification of Isolate | |||
| Collection Date | Date isolate taken from patient | |||
| Last Updated | Date of Last Modification | |||
| Confirmed | Is isolate confirmed | |||
| Specimen Source | Source of isolate | |||
| Test Result | Serotype/Species/Test Result | |||
| Occupation/Industry/Place of Business | Is patient employed in a high risk occupation (e.g., food handler, healthcare worker, daycare worker)? | |||
| Child care attendee | Did patient have a high risk exposure related to child care facility? | |||
| Long term care facility resident | Did patient have a high risk exposure related to residence in a long term care facility? | |||
| Contact of a Salmonellosis case | Did patient have a high risk exposure related to contact with a Salmonellosis case? | |||
| Method(s) of laboratory testing | Type of laboratory testing performed | |||
| Name of test | Name of laboratory test performed | |||
| Name of test manufacturer | Name of test manufacturer | |||
| Probable case from CIDT testing | Probable case status confirmed by CIDT testing | |||
| Probable case from Epi-linkage | Probable case confirmed by Epi-linkage | |||
| Reported symptoms and signs of illness | Symptoms and signs associated with illness | |||
| WGS (Whole-Genome Sequencing) ID | The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case | |||
| 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 | |
| PulseNet ID | State lab ID submitted to PulseNet | N/A | 1 | |
| 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) |
| Fever | Did the patient have a fever (subjective or objective)? | |
| Fever date | If yas, date of fever onest | |
| Temperature >38°C(100.4°F) | Was the measured temperature >38°C? | |
| Lower respiratory symptoms | Did the patient have any lower respiratory symptoms (e.g., a cough, shortness of breath, difficulty breathing?)? | |
| Chest x-ray/CAT scan | Was a chest x-ray or CAT scan performed? | |
| Pneumonia/RDS evidence | If yes, did the patient have radiographic evidence of pneumonia or respiratory distress syndrome? | |
| Evaluation first date | Indicate date of the first evaluation for this illness. | |
| Hospitalization | Was patient hospitalized for >24 hours during the course? | |
| Hospital name | If yes, indicate the name of the hospital | |
| Hospital city | If yes, indicate the city of the hospital | |
| Hospital state | If yes, indicate the state of the hospital | |
| Hospitalization date | Indicate date of hospitalization | |
| Discharge date | Indicate date of hospital discharge | |
| ICU admission | Was trhe patient ever admitted to the intensive care unit (ICU)? | |
| Mechanical ventilation | Was the patient ever placed on mechanical ventilation? | |
| Death | Did the patient die as a result of his /her illness? | |
| Death date | Indicate date of death | |
| Autopsy | Was an autopsy performed? | |
| Pathology results | Was pathology consistent with pneumonia or RDS? | |
| HCW | Is the patient a healthcare worker? | |
| HCW type | If so, indicate type of HCW (physician, nurse/PA, lab, other [specify]) | |
| Direct patient care | Does patient have DIRECT patient care responsibilities? | |
| Occupation | If not a HCW, list occupation. | |
| Case contact | In the 10 days prior to symptom onset did the patient have close contact with a confirmed or probable SARS-CoV case? | |
| RUI-2 or RUI-3 contact | In the 10 days prior to symptom onset did the patient have close contact with a person considered an RUI-2 or RUI-3? | |
| Travel to SARS area | In the 10 days prior to symptom onset did the patient have travel to foreign or domestic area with documented or suspected recent local transmissionof SARS cases? | |
| Travel destination | If yes, list travel destinations (departure and arrival dates). | |
| Contact classification | Classification of contact (RUI-2w, RUI-3, probable SARS-CoV, confirmed SARS-CoV). | |
| Nature of contact | Nature of contact (same household, coworker, HC environment, other). | |
| Contact start | Date contact started | |
| Contact end | Date contact ended | |
| Contact travel to SARS area | Did the ill contact recently travel to an area with SARS transmission (specify where)? | |
| Contact CDC ID | Contact CDC ID | |
| Contact State ID | Contact State ID | |
| Contact name | If CDC ID or State ID unavailable ((first, middle initial, last) | |
| Foreign travel Health Alert | If recent foreign travel, did the patient recive a health Alert or other SARS educational information on arrival in the U.S? | |
| Symptomatic during travel for a SARS area | Was the patient symptomatic during the travel from a SARS affected area within 24 hours of return to the U.S or local area? | |
| SARS suspect name | If yes, provide to the CDC the name of the SARS suspect who has traveled (enter name) | |
| Public conveyance travel departure | If yes, indicate public conveyance departure date | |
| Public conveyance travel departure city | If yes, indicate public conveyance departure city | |
| Public conveyance travel arrival city | If yes, indicate public conveyance arrival city | |
| Public conveyance transport type | Public conveyance transport type (airline, train, cruise, bus, auto, tour grp, other) | |
| Transport company | Name of transport company | |
| Transport number | Indicate transport number | |
| Comment | ||
| Initial patient classification | Patient's intial classification by state of municipality (RUI-1, RUI-2, RUI-3, RUI-4, or probable SARS-CoV, confirmed SARS-CoV) | |
| Updated patient classification | Patient's updated classification( RUI-1, RUI-2, RUI-3, RUI-4, probable SARS-CoV, confirmed SARS-CoV, not a case: negative serology, not a case: alternative diagnosis accounts for illness) | |
| Date updated | Most recent updated classification | |
| Laboratory Specimen 1 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 1 collection date | Collection date for specimen 1 | |
| Lab specimen 1 test | Test requested for specimen 1 | |
| Lab specimen 1 source of local testing | Source of local testing for specimen 1 | |
| Lab specimen 1 result | Result of lab testing for specimen 2 | |
| Laboratory Specimen 2 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 2 collection date | Collection date for specimen 2 | |
| Lab specimen 2 test | Test requested for specimen 2 | |
| Lab specimen 2 source of local testing | Source of local testing for specimen 2 | |
| Lab specimen 2 result | Result of lab testing for specimen 2 | |
| Laboratory Specimen 3 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 3 collection date | Collection date for specimen 3 | |
| Lab specimen 3 test | Test requested for specimen 3 | |
| Lab specimen 3 source of local testing | Source of local testing for specimen 3 | |
| Lab specimen 3 result | Result of lab testing for specimen 3 | |
| Laboratory Specimen 4 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 4 collection date | Collection date for specimen 4 | |
| Lab specimen 4 test | Test requested for specimen 4 | |
| Lab specimen 4 source of local testing | Source of local testing for specimen 4 | |
| Lab specimen 4 result | Result of lab testing for specimen 4 | |
| Laboratory Specimen 5 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 5 collection date | Collection date for specimen 5 | |
| Lab specimen 5 test | Test requested for specimen 5 | |
| Lab specimen 5 source of local testing | Source of local testing for specimen 5 | |
| Lab specimen 5 result | Result of lab testing for specimen 5 | |
| Laboratory Specimen 6 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 6 collection date | Collection date for specimen 6 | |
| Lab 6 test | Test requested for specimen 6 | |
| Lab specimen 6 source of local testing | Source of local testing for specimen 6 | |
| Lab specimen 6 result | Result of lab testing for specimen 6 | |
| Laboratory Specimen 7 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 7 collection date | Collection date for specimen 7 | |
| Lab 7 test | Test requested for specimen 7 | |
| Lab specimen 7 source of local testing | Source of local testing for specimen 7 | |
| Lab specimen 7 result | Result of lab testing for specimen 7 | |
| Laboratory Specimen 8 | Enter specimen for each test (whole blood, serum [acute and/or convalescent],NP swab, NP aspirate, broncheoalveolar lavage, OP swab, urine, stool, tissue [specify tissue type]) | |
| Lab specimen 8 collection date | Collection date for specimen 8 | |
| Lab 8 test | Test requested for specimen 8 | |
| Lab specimen 8 source of local testing | Source of local testing for specimen 8 | |
| Lab specimen 8 result | Result of lab testing for specimen 8 | |
| Alternative Diagnosis | Was an alternative respiratory pathogen detected? | |
| Alternative pathogen | If yes, indicate the pathogen isolated. | |
| CDC Specimen 1 | List specimen(s) sent to CDC | |
| Tissue specimen 1 | If 'tissue', specify. | |
| CDC specimen 1 date | Date specimen 1 sent to CDC | |
| CDC Specimen 2 | List specimen(s) sent to CDC | |
| Tissue specimen 2 | If 'tissue', specify. | |
| CDC specimen 2 date | Date specimen 2 sent to CDC | |
| CDC Specimen 3 | List specimen(s) sent to CDC | |
| Tissue specimen 3 | If 'tissue', specify. | |
| CDC specimen 3 date | Date specimen 3 sent to CDC | |
| CDC Specimen 4 | List specimen(s) sent to CDC | |
| Tissue specimen 4 | If 'tissue', specify. | |
| CDC specimen 4 date | Date specimen 4 sent to CDC | |
| CDC Specimen 5 | List specimen(s) sent to CDC | |
| Tissue specimen 5 | If 'tissue', specify. | |
| CDC specimen 5 date | Date specimen 5 sent to CDC | |
| CDC Specimen 6 | List specimen(s) sent to CDC | |
| Tissue specimen 6 | If 'tissue', specify. | |
| CDC specimen 6 date | Date specimen 6 sent to CDC | |
| CDC Specimen 7 | List specimen(s) sent to CDC | |
| Tissue specimen 7 | If 'tissue', specify. | |
| CDC specimen 7 date | Date specimen 7 sent to CDC | |
| CDC Specimen 8 | List specimen(s) sent to CDC | |
| Tissue specimen 8 | If 'tissue', specify. | |
| CDC specimen 8 date | Date specimen 8 sent to CDC | |
| Notes | Any notes needed |
| 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) |
| Site ID | Site ID assigned by CDC. | |||
| Disease | Foodborne Disease. | |||
| State Lab ID | Identification of Isolate | |||
| Collection Date | Date isolate taken from patient | |||
| Last Updated | Date of Last Modification | |||
| Confirmed | Is isolate confirmed | |||
| Specimen Source | Source of isolate | |||
| Test Result | Serotype/Species/Test Result | |||
| International travel in the 7 days prior to onset | Did patient travel internationally within 7 days of illness onset? | |||
| Occupation/Industry/Place of Business | Is patient employed in a high risk occupation (e.g., food handler, healthcare worker, daycare worker)? | |||
| Child care attendee | Did patient have a high risk exposure related to attendance at a child care facility? | |||
| Long term care facility resident | Did patient have a high risk exposure related to residence in a long term care facility? | |||
| Contact of a Shigellosis case | Did patient have a high risk exposure related to contact with a Shigellosis case? | |||
| Method(s) of laboratory testing | Type of laboratory testing performed | |||
| Name of test | Name of laboratory test performed | |||
| Name of test manufacturer | Name of test manufacturer | |||
| Probable case from CIDT | Probable case status confirmed by CIDT (Culture Independent Diagnostic Testing) | |||
| Probable case from Epi-linkage | Probable case confirmed by Epi-linkage | |||
| Reported symptoms and signs of illness | Symptoms and signs associated with illness | |||
| WGS (Whole-Genome Sequencing) ID | The identifier used in PulseNet for the whole genome sequenced isolate that corresponds to the reported case | |||
| 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 | |
| Travel State | Domestic destination, state(s) traveled to | PHVS_State_FIPS_5-2 | P | |
| International Destination(S) Of Recent Travel | International destination or countries the patient traveled to | PHVS_Country_ISO_3166-1 | P | |
| PulseNet ID | State lab ID submitted to PulseNet | N/A | 1 | |
| Date Of Arrival To Travel Destination | Date of arrival to travel destination | N/A | 2 | |
| Date Of Departure From Travel Destination | Date of departure from travel destination | N/A | 2 | |
| 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 (Legacy) | CDC Priority (New) |
| Notification ID | The unique identifier for the notification record | |||
| Receiving Application | CDC's PHIN Common Data Store (CDS) is the Receiving Application for this message. | |||
| Message Profile ID | First instance is the reference to the structural specification used to validate the message. Second instance is the reference to the PHIN Message Mapping Guide from which the content is derived. |
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| Local Subject ID | The local ID of the subject/entity. | |||
| Subject Name Type | Name is not requested by the program, but the Patient Name field is required to be populated for the HL7 message to be valid. Have adopted the HL7 convention for processing a field where the name has been removed for de-identification purposes. | PHVS_NameType_HL7_2x | ||
| Local Record ID | Sending system-assigned local ID of the case investigation with which the subject is associated. Note: The local record ID should be the unique identifier for the case being reported. |
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| Subject Type | Type of subject for the notification. "Person," "Place/Location," or "Non-Person Living Subject" are the appropriate subject types for Notifications to CDC. | PHVS_NotificationSectionHeader_CDC | ||
| Notification Type | Type of notification. Notification types are "Individual Case," "Environmental," "Summary," and "Laboratory Report". | PHVS_NotificationSectionHeader_CDC | ||
| Date First Submitted | Date/time the notification was first sent to CDC. This value does not change after the original notification. | |||
| Date of Report | Date/time this version of the notification was sent. It will be the same value as NOT103 for the original notification. For updates, this is the update/send date/time. | |||
| Notification Result Status | Status of the notification. | PHVS_ResultStatus_NND | ||
| Immediate National Notifiable Condition | Does this case meet the criteria for immediate (extremely urgent or urgent) notification to CDC? | PHVS_NationalReportingJurisdiction_NND | ||
| 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 | ||
| Condition Code | Condition or event that constitutes the reason the notification is being sent | PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS | ||
| Birth Date | Date of birth in YYYYMMDD format | |||
| Subject’s Sex | Subject’s current sex | |||
| Race Category | Field containing one or more codes that broadly refer to the subject’s race(s). | PHVS_RaceCategory_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 | ||
| Subject Address ZIP Code | ZIP Code of residence of the subject | |||
| Ethnic Group Code | Based on the self-identity of the subject as Hispanic or Latino | PHVS_EthnicityGroup_CDC_Unk | ||
| Country of Birth | Country of Birth | PHVS_CountryofBirth_CDC | ||
| Census tract of case-patient residence | Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area. A single community may be composed of several census tracts. | |||
| 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 | ||
| Jurisdiction Code | Identifier for the physical site from which the notification is being submitted. | |||
| Case Investigation Status Code | Status of the investigation | PHVS_CaseInvestigationStatus_NND | ||
| Investigation Date Assigned | Date the investigator was assigned to this investigation. | |||
| Date of Report/Referral | Date the event or illness was first reported by the reporting source (physician or lab reported to the local/county/state health department). | |||
| 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. | |||
| 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 | |||
| Hospitalized | Was subject hospitalized because of this event? | PHVS_YesNoUnknown_CDC | ||
| Admission Date | Subject’s admission date to the hospital for the condition covered by the investigation. | |||
| Discharge Date | Subject's discharge date from the hospital for the condition covered by the investigation. | |||
| Duration of hospital stay in days | Subject's duration of stay at the hospital for the condition covered by the investigation. | |||
| Diagnosis Date | Date of diagnosis of condition being reported to public health system | |||
| 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 | |||
| Illness End Date | Time at which the disease or condition ends. | |||
| Illness Duration | Length of time this subject had this disease or condition. | |||
| Illness Duration Units | Unit of time used to describe the length of the illness or condition. | PHVS_AgeUnit_UCUM | ||
| Did the subject die from this condition? | 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 | |||
| Case Investigation Start Date | The date the case investigation was initiated. | |||
| Case Outbreak indicator | Denotes whether the reported case was associated with an identified outbreak. | PHVS_YesNoUnknown_CDC | ||
| Case Outbreak Name | A state-assigned name for an indentified outbreak. | |||
| 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 | ||
| Imported State | If the disease or condition was imported, indicates the state in which the disease was likely acquired. | PHVS_State_FIPS_5-2 | ||
| Imported City | If the disease or condition was imported, indicates the city in which the disease was likely acquired. | PHVS_City_USGS_GNIS | ||
| Imported County | If the disease or condition was imported, contains the county of origin of the disease or condition. | PHVS_County_FIPS_6-4 | ||
| Transmission Mode | Code for the mechanism by which disease or condition was acquired by the subject of the investigation. | PHVS_CaseTransmissionMode_NND | ||
| 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. | |||
| State Case ID | States use this field to link NEDSS investigations back to their own state investigations. Note: This may be any state-assigned ID number for the case; may be different than INV168, which is the system-assigned unique identified for the 'case' of disease being reported. |
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| Date of First Report to CDC | Date the case was first reported to the CDC | |||
| 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. | |||
| Pregnancy status | Indicates whether the subject was pregnant at the time of the event. | PHVS_YesNoUnknown_CDC | ||
| Person Reporting to CDC - Name | Name of the person who is reporting the case to the CDC | |||
| Person Reporting to CDC - Phone Number | Phone Number of the person who is reporting the case to the CDC | |||
| Person Reporting to CDC - Title | Job title / description of the person reporting the case to the CDC | |||
| Person Reporting to CDC - Affiliation | Affiliated Facility of the person reporting the case to the CDC | |||
| Legacy Case ID | CDC uses this field to link current case notifications to case notifications submitted by a previous system (NETSS, STD-MIS, etc.) | |||
| 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 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 | ||
| State or Province of Exposure | Indicates the state in which the disease was potentially acquired. Business Rule: If Country of exposure was US, populate with US State. If Country of exposure was Mexico, populate with Mexican State. If country of exposure was Canada, populated with Canadian Province. For all other countries, leave null. |
PHVS_State_FIPS_5-2 | ||
| City of Exposure | Indicates the city in which the disease was potentially acquired. Business Rule: If country of exposure is US, populate with US city. For all other cities, can be populated but not required. Note: Since value set only includes US cities, would allow states to populate the CWE 9th component with another city. |
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| County of Exposure | Indicates the county in which the disease was potentially acquired. Business Rule: If country of exposure is US, populate with US county. Otherwise, leave null. |
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| Binational Reporting Criteria | For cases meeting the binational criteria, select all the criteria which are met | PHVS_BinationalReportingCriteria_CDC | ||
| Date of initial health exam associated with case report "health event" | Date of earliest healthcare encounter/visit /exam associated with this event/case report. May equate with date of exam or date of diagnosis. | |||
| Neurological involvement? | If event = some stage of syphilis, does the patient have neurologic involvement based on current case definition? | New Value Set PHVS_Neurological_involvement_CDC |
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| Treatment Date | Date treatment initiated for the condition that is the subject of this case report. | |||
| HIV Status | Documented or self-reported HIV status at the time of event. | New Value Set PHVS_HIVStatus_CDC |
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| Had sex with a male within past 12 months? | Had sex with a male within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Had sex with a female within past 12 months? | Had sex with a female within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Had sex with an anonymous partner within past 12 months? | Had sex with an anonymous partner within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Had sex with a person know to him/her to be an IDU within past 12 months? | Had sex with a person known to him/her to be an IDU within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Had sex while intoxicated and/or high on drugs within past 12 months? | Had sex while intoxicated and/or high on drugs within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Exchanged drugs/money for sex within past 12 months? | Exchanged drugs/money for sex within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Had sex with a person who is know to her to be an MSM within past 12 months? | Had sex with a person who is known to her to be an MSM within past 12 months? NOTE: For women only. | New Value Set PHVS_YNRD_CDC |
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| Engaged in injection drug use within past 12 months? | Engaged in injection drug use within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| During the past 12 months, which of the following injection or non-injection drugs have been used? | During the past 12 months, which of the following injection or non-injection drugs have been used? | New Value Set PHVS_DrugsUsed_CDC |
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| Previous STD history? | Does the patient have a history of ever having had an STD prior to the condition reported in this case report? | New Value Set PHVS_PreviousSTDhistory_CDC |
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| Been incarcerated with past 12 months? | Been incarcerated within past 12 months? | New Value Set PHVS_YNRD_CDC |
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| Have you met sex partners through the Internet in the last 12 months? | Did the patient use an online computer site to exchange messages by typing them onscreen to engage in conversation with other visitors to the site for the purpose of having sex? | New Value Set PHVS_YNRD_CDC |
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| Total number of sex partners last 12 months? | Total number of sex partners that the case patient has had in the last 12 months. Total partners equal the sum of all male, female, and transgender partners during the period. | |||
| Clinician-observed lesion(s) indicative of syphilis | If condition = any stage of syphilis, report anatomic site(s) of clinician-observed lesion(s) (e.g., chancre, rash, condyloma lata) at time of initial exam or specimen collection. Mark all that apply. | New Value Set PHVS_Clinician-observed lesions_CDC |
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| Type of nontreponemal serologic test for syphilis | What type of non-treponemal serologic test for syphilis was performed on specimen collected to support case patient's diagnosis of syphilis? | New Value Set PHVS_nontreponemalserologictest_CDC |
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| Quantitative syphilis test result | If the test performed provides a quantifiable result, provide quantitative result (e.g. if RPR is positive, provide titer, e.g. 1:64) Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024. |
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| Patient refused to answer questions regarding number of sex partners | Patient refused to answer questions regarding number of sex partners | PHVS_YesNoUnknown_CDC | ||
| Unknown number of sex partners in last 12 months | Unknown number of sex partners in last 12 months | PHVS_YesNoUnknown_CDC | ||
| Date of laboratory specimen collection | Date of collection of initial laboratory specimen used for diagnosis of health event reported in this case report. PREFERRED date for assignment of MMWR week. First date in hierarchy of date types associated with case report/event. | |||
| Specimen source | Anatomic site or specimen type from which positive lab specimen was collected. | New Value Set PHVS_SpecimenSource_CDC |
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| Date of lab result | Date result sent from Reporting Laboratory. | |||
| HIV status documented through eHARS Record Search? | Was the HIV status of this case investigated through search of eHARS? | PHVS_YesNoUnknown_CDC | ||
| eHARS Stateno | Stateno from eHARS registry for HIV+ cases. | |||
| Trans_Categ (eHARS, person dataset) | Mode of exposure from eHARS for HIV+ cases. | New Value Set PHVS_TransCateg_CDC |
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| Case sampled for enhanced investigation? | Was this case selected by reporting jurisdiction for enhanced investigarion? | PHVS_YesNoUnknown_CDC | ||
| Method of case detection | How case patient first came to the attention of the health department for this condition | New Value Set PHVS_DetectionMethod_CDC |
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| Type of treponemal serologic test for syphilis | What type of treponemal serologic test for syphilis was performed on specimen collected to support case patient's diagnosis of syphilis? | New Value Set PHVS_treponemalserologic_CDC |
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| Count | represents # of cases reported in this ‘record’; supports aggregate-(when >1) or case-specific (when=1) reporting. | ##### Default=00001 for case-specific records where a single case is represented by data record. | ||
| Event date | date of disease in YYMMDD format. This date depends upon how case dates are assigned in the STD program. i.e., date could be the onset of symptoms date, diagnosis date, laboratory result date, date case first recognized and/or reported to STD program, or date case reported to CDC. | YYMMDD Unknown=999999 | ||
| Datetype | describes the type of date provided in Event date | 1=Onset Date 2=Date of diagnosis 3=Date of laboratory result 4=Date of first report to coummunity health system 5=State/MMWR report date 9=Unknown | ||
| NETSS version | What version of the NETSS record layout are you providing? | i.e. Version 3 (January 2011) 03=Version 3 | ||
| STD-Associated Lab Tests | STD-Associated Lab Tests | STD-Associated RCMT Lab Tests (OBX-3) | ||
| STD-Associated Lab Results | STD-Associated Lab Results | STD-Associated RCMT Lab Results (OBX-5) | ||
| Injection or non-injection drugs use indicator | Injection or non-injection drug use indicator | New Value Set PHVS_YNRD_CDC |
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| Nontreponemal serologic syphilis test (quantitative) | If the test performed provides a quantifiable result, provide quantitative result (e.g. if RPR is positive, provide titer, e.g. 1:64) Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024. |
New Value Set PHVS_QuantitativeSyphilisTestResult_STD |
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| Nontreponemal serologic syphilis test (qualitative) | Qualitative test result of STD123 Nontreponemal serologic syphilis test result (quantitative) | New Value Set PHVS_LabTestReactivity_NND |
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| Qualitative treponemal serologic syphilis test result | If the test performed provides a qualitative result, provide qualitative result, e.g. weakly reactive. | New Value Set PHVS_LabTestResultQualitative_NND |
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| Neurological manifestations | Neurological manifestations of disease | |||
| Ocular Manifestations | Infection of any eye structure with T. pallidum, as evidenced by manifestations including posterior uveitis, panuveitis, anterior uveitis, optic neuropathy, and retinal vasculitis. | |||
| Otic Manifestations | Infection of the cochleovestibular system with T. pallidum, as evidenced by manifestations including sensorineural hearing loss, tinnitus, and vertigo. | |||
| Late Clinical Manifestations (tertiary syphilis) | Late clinical manifestations of syphilis (tertiary syphilis) may include inflammatory lesions of the cardiovascular system, skin, bone, or other tissue. Certain neurologic manifestations (e.g., general paresis and tabes dorsalis) are late clinical manifestations of syphilis. | |||
| Transgender | Patient identified as transgender (i.e., an individual’s personal sense of being male, female, or transgender). | |||
| Sexual Orientation | Patient identified sexual orientation (i.e., an individual's physical and/or emotional attraction to another individual of the same gender, opposite gender, or both genders). | |||
| Date Treatment was Prescribed | Date treatment associated with the condition was prescribed | TBD | O | |
| Date Treatment was Administered | Date treatment associated with the condition was administered | TBD | O | |
| Medication Administered | Name of the antibiotic administered | TBD | O | |
| Medication Administered Dose | Dose of the antibiotic administered | TBD | O | |
| Treatment Duration | Prescribed duration of antibiotic | TBD | O | |
| Type of Complication | Complications associated with the illness being reported | TBD | O | |
| Type of Complication Indicator | Indicator for associated complication | TBD | O | |
| Treatment Dosage | Dose of the treatment associated with the condition | TBD | O | |
| Treatment Dosage Unit | Unit of measure for the treatment associated with the condition | TBD | O | |
| Treatment Route of Delivery | Route of delivery of treatment | TBD | O | |
| Treatment Drug Frequency | Frequency of treatment drug | TBD | O | |
| Treatment Drug Frequency Unit | Unit of measure for the frequency of treatment associated with the condition | TBD | O | |
| Treatment Duration Units | Unit of measure for the duration of treatment associated with the condition | TBD | O | |
| Drug Use Route of Delivery | Route of delivery of drug(s) used | TBD | O | |
| 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 |
| 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) |
| AgClinic | For possible E. coli cases: What was the result of specimen testing for Shiga toxin 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 | For possible E. coli cases: What was the result of specimen testing for Shiga toxin 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 | |||
| BioId | Was the pathogen identified by culture? | |||
| 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? | |||
| HUS | Did case patient have a diagnosis of HUS? | |||
| Immigrate | Did case-patient immigrate to the U.S.? (within 7 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 | What was the result of specimen testing for Shiga toxin using another test at the CDC? | |||
| OtherClinicTest | What was the result of specimen testing for Shiga toxin 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 for Shiga toxin 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 Shiga toxin using PCR at CDC? | |||
| PcrClinic | What was the result of specimen testing for Shiga toxin using PCR at a clincal laboratory? | |||
| PcrClinicTestType | Name of PCR assay used | |||
| PcrSphl | What was the result of specimen testing for Shiga toxin using PCR at a state public health laboratory? | |||
| 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 | |||
| StecH7 | Was it H7 antigen positive? | |||
| StecHAg | What was the H-antigen number? | |||
| StecNM | Was the isolate non-motile? | |||
| StecO157 | Was it O157 positive? | |||
| StecOAg | What was the O-antigen number? | |||
| StecStx | Was E. coli Shiga toxin-producing? | |||
| 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 7 days of onset) | |||
| PulseNet Key | Identification tag in PulseNet database | |||
| Date of interview | Date questionnaire administered to case | |||
| Respondent | Individual who was interviewed | Self; Parent; Spouse; Other | ||
| Other Respondent | If case, parent, or spouse not interviewed, then who was? | |||
| City of residence | City where patient resides | |||
| Month of birth | Month when patient was born | 12-Jan | ||
| Year of birth | Year when patient was born | |||
| Hispanic or Latino | Is the patient of Hispanic or Latino origin | Hispanic; Non-Hispanic; Unknown | ||
| Total days ill | Length of patient's illness in days | |||
| Still ill | Is the patient still ill | Yes; No | ||
| Diarrhea | Patient experienced 3 or more loose stools in 24-hour period | Yes; No; Maybe; Unknown | ||
| Diarrhea onset | Date patient first expierenced 3 or more loose stools | |||
| Bloody stool | Patient experienced blood in stool | Yes; No; Maybe; Unknown | ||
| Still hospitalized | Is the patient still hospitalizaed | Yes; No | ||
| HUS | Patient diagnosed by doctor with HUS or kidney failure | Yes; No; Maybe; Unknown | ||
| Food handler | Patient works as a food handler at dining establishment | Yes; No; Maybe; Unknown | ||
| Daycare worker | Patient works in a daycare facility | Yes; No; Maybe; Unknown | ||
| Foods at home | List of locations where foods eaten at home were purchased | |||
| Foods away from home | List of locations where foods were eaten outside of the home | |||
| Handled raw ground beef | Patient handled raw ground beed (even if not consumed) in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Ground beef | Patient consumed ground beef in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Ground beef at home | Patient consumed ground beef at home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Pink ground beef at home | Patient consumed red or pink ground beef at home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Ground beef at home purchase location | Location(s) where ground beef consumed at home in 7 days prior to illness onset was purchased | |||
| Ground beef at home purchase date | Date(s) when ground beef consumed at home in 7 days prior to illness onset was purchased | |||
| Ground beef brand | Brand(s) of ground beef eaten at home in 7 days prior to illness onset | |||
| Ground beef bulk | Ground beef eaten at home was purchased in bulk | Yes; No | ||
| Ground beef patties | Ground beef eaten at home was purchased in pre-formed patties | Yes; No | ||
| Ground beef other | Ground beef eaten at home was purchased in other form | Yes; No | ||
| Ground beef unknown purchase form | Patient unable to recall form in which ground beef eaten at home was purchased | Yes; No | ||
| Home ground beef size | Size in which ground beef consumed at home was purchased | Number of pounds; Unknown | ||
| Percent lean | Percentage lean of ground beef eaten at home | Percentage; Unknown | ||
| Fresh ground beef | Ground beef eaten at home was purchased fresh | Yes; No | ||
| Frozen ground beef | Ground beef eaten at home was purchased frozen | Yes; No | ||
| Unknown fresh/frozen ground beef | Patient unable to recall if ground beef consumed at home was purchased fresh or frozen | Yes; No | ||
| Ground beef away from home | Patient consumed ground beef away from home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Gound beef away from home location | Location(s) where ground beef consumed away from home | |||
| Pink ground beef away | Patient consumed red or pink ground beef away from home | Yes; No; Maybe; Unknown | ||
| Hamburger | Ground beef eaten outside the home as hamburger | Yes; No | ||
| Meatball | Ground beef eaten outside the home as meatball | Yes; No | ||
| Meatloaf | Ground beef eaten outside the home as meatloaf | Yes; No | ||
| Taco | Ground beef eaten outside the home in a taco | Yes; No | ||
| Ground beef in a dish | Ground beef eaten in a dish (ex. casserole) outside the home | Yes; No | ||
| Other form of ground beef outside home | Ground beef eaten outside the home in form other than hamburger, meatball, meatloaf, taco, or in a dish | Yes; No | ||
| Specify other form of ground beef | Other type of ground beef eaten outside the home | |||
| Steak | Patient consumed steak in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Steak at home | Patient consumed steak at home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Pink steak at home | Steak consumed at home was pink or read | Yes; No; Maybe; Unknown | ||
| Steak at home purchase location | Location(s) where steak consumed at home was purchased | |||
| Steak at home purchase date | Date(s) when steak consumed at home was purchased | |||
| Steak brand | Brand(s) of steak eaten at home | |||
| Steak consumed as steak | Steak was consumed as steak | Yes; No | ||
| Steak consumed as stew | Steak was consumed in a stew | Yes; No | ||
| Steak consumed as roast | Steak was consumed as a roast | Yes; No | ||
| Unknown steak type | Patient unable to recall how steak was consumed | Yes; No | ||
| Steak consumed as other | Steak was consumed in form other than steak, stew, roast | Yes; No | ||
| Specify how steak was consumed | If steak was consumed in other form, then specify | |||
| Steak away from home | Patient consumed steak away from home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Steak away from home location | Location(s) where steak was consumed away from home | |||
| Steak away from home dates | Date(s) when steak was consumed away from home | |||
| Pink steak away | Patient consumed red or pink steak away from home | Yes; No; Maybe; Unknown | ||
| Pink steak away as steak | Patient consumed red or pink steak away from home as steak | Yes; No | ||
| Pink steak away as stew | Patient consumed red or pink steak away from home as stew | Yes; No | ||
| Pink steak away as roast | Patient consumed red or pink steak away from home as a roast | Yes; No | ||
| Pink steak away as other product | Patient consumed red or pink steak away from home in form other than steak, stew, or roast | Yes; No | ||
| Specify how other pink steak was consumed | Specify if 'Other' red or pink steak was reported | |||
| Bison | Patient consumed bison in the 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Bison at home | Patient consumed bison at home in the 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Pink bison at home | Patient consumed red or pink bison at home | Yes; No; Maybe; Unknown | ||
| Bison purchase location | Location(s) where ground beef consumed at home was purchased | |||
| Bison purchase date | Date(s) when bison consumed at home was purchased | |||
| Bison at home brand | Brand of bison purchased for home consumption | |||
| Bison away from home | Patient consumed bison away from home in 7 days prior to illness onset | Yes; No; Maybe; Unknown | ||
| Bison away location | Location(s) where bison was consumed outside the home | |||
| Bison away date | Date(s) when bison was consumed outside the home | |||
| Pink bison away from home | Bison eaten outside the home was red or pink | Yes; No; Maybe; Unknown | ||
| Wild game | Patient consumed wild game in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Dried meat | Patient consumed dried meat in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Pepperoni | Patient consumed dried meat that was pepperoni | Yes; No | ||
| Salami | Patient consumed dried meat that was salami | Yes; No | ||
| Sausage | Patient consumed dried meat that was sausage | Yes; No | ||
| Other dried meat | Patient consumed dried meat that was not pepperoni, salami, or sausage | Yes; No | ||
| Typle of other dried meat | Specify other type of dried meat consumed | |||
| Jerky | Patient consumed jerkey of any type in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Raw milk | Patient consumed raw milk in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Raw cheese | Patient consumed cheese made with raw milk in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Raw cheese type | Type of raw milk cheese consumed | |||
| Raw cheese location | Location(s) where raw milk cheese was purchased | |||
| Raw cheese date | Date(s) when raw milk cheese was purchased | |||
| Raw ice cream | Patient consumed ice cream made with raw milk in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Raw juice | Patient consumed raw or unpasteurized juice or cide in the 7 dayse before illness onset | Yes; No; Maybe; Unknown | ||
| Lettuce | Patient consumed lettuce of any kind in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Lettuce at home | Patient consumed lettuce of any kind at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Lettuce at home purchase location | Location(s) where lettuce consumed at home was purchased | |||
| Lettuce at home purchase date | Date(s) when lettuce consumed at home was purchased | |||
| Lettuce at home brand | Brand(s) of lettuce purchased for home consumption | |||
| Loose lettuce at home | Patient consumed loose lettuce of any kind in the 7 days before illness onset | Yes; No | ||
| Prepackaged lettuce at home | Patient consumed prepackaged lettuce of any kind in the 7 days before illness onset | Yes; No | ||
| Unknown packaging of lettuce at home | Patient unable to recall how lettuce consumed at home was packaged | Yes; No | ||
| Lettuce away from home | Patient consumed lettuce of any kind away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Lettuce away from home location | Location(s) where the lettuce was consumed away from home | |||
| Mesclun lettuce | Patient consumed mesclun lettuce in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Mesclun lettuce at home | Patient consumed mesclun lettuce at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Mesclun lettuce at home purchase location | Location(s) where mesclun lettuce consumed at home was purchased | |||
| Mesclun lettuce at home purchase date | Date(s) when mesclun lettuce consumed at home was purchased | |||
| Mesclun lettuce at home brand | Brand(s) of mesclun lettuce consumed at home | |||
| Loose mesclun lettuce at home | Patient consumed loose mesclun lettuce at home | Yes; No | ||
| Prepackaged mesclun lettuce at home | Patient consumed prepackaged mesclun lettuce at home | Yes; No | ||
| Unknown packaging of mesclun lettuce at home | Patient unable to recall how mesclun lettuce consumed at home was purchased | Yes; No | ||
| Mesclun lettuce away from home | Patient consumed mesclun lettuce away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Mesclun lettuce away from home location | Location(s) where the mesclun lettuce was consumed away from home | |||
| Iceberg lettuce | Patient consumed iceberg lettuce in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Iceberg lettuce at home | Patient consumed iceberg lettuce at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Iceberg lettuce at home purchase location | Location(s) where iceberg lettuce consumed at home was purchased | |||
| Iceberg lettuce at home purchase date | Date(s) when iceberg lettuce consumed at home was purchased | |||
| Iceberg lettuce at home brand | Brand(s) of iceberg lettuce consumed at home | |||
| Loose iceberg lettuce at home | Patient consumed iceberg mesclun lettuce at home | Yes; No | ||
| Prepackaged iceberg lettuce at home | Patient consumed prepackaged iceberg lettuce at home | Yes; No | ||
| Unknown packaging of iceberg lettuce at home | Patient unable to recall how iceberg lettuce consumed at home was purchased | Yes; No | ||
| Iceberg lettuce away from home | Patient consumed iceberg lettuce away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Iceberg lettuce away from home location | Location(s) where the iceberg lettuce was consumed away from home | |||
| Romaine lettuce | Patient consumed romaine lettuce in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Romaine lettuce at home | Patient consumed romaine lettuce at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Romaine lettuce at home purchase location | Location(s) where romaine lettuce consumed at home was purchased | |||
| Romaine lettuce at home purchase date | Date(s) when romaine lettuce consumed at home was purchased | |||
| Romaine lettuce at home brand | Brand(s) of romaine lettuce consumed at home | |||
| Loose romaine lettuce at home | Patient consumed loose romaine lettuce at home | Yes; No | ||
| Prepackaged romaine lettuce at home | Patient consumed prepackaged romaine lettuce at home | Yes; No | ||
| Unknown packaging of romaine lettuce at home | Patient unable to recall how romaine lettuce consumed at home was purchased | Yes; No | ||
| Romaine lettuce away from home | Patient consumed romaine lettuce away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Romaine lettuce away from home location | Location(s) where the romaine lettuce was consumed away from home | |||
| Red leaf lettuce | Patient consumed red leaf lettuce in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Red leaf lettuce at home | Patient consumed red leaf lettuce at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Red leaf lettuce at home purchase location | Location(s) where red leaf lettuce consumed at home was purchased | |||
| Red leaf lettuce at home purchase date | Date(s) when red leaf lettuce consumed at home was purchased | |||
| Red leaf lettuce at home brand | Brand(s) of red leaf lettuce consumed at home | |||
| Loose red leaf lettuce at home | Patient consumed loose red leaf lettuce at home | Yes; No | ||
| Prepackaged red leaf lettuce at home | Patient consumed prepackaged red leaf lettuce at home | Yes; No | ||
| Unknown packaging of red leaf lettuce at home | Patient unable to recall how red leaf lettuce consumed at home was purchased | Yes; No | ||
| Red leaf lettuce away from home | Patient consumed red leaf lettuce away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Red leaf lettuce away from home location | Location(s) where the red leaf lettuce was consumed away from home | |||
| Spinach | Patient consumed spinach in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Spinach at home | Patient consumed spinach at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Spinach at home purchase location | Location(s) where spinach consumed at home was purchased | |||
| Spinach at home purchase date | Date(s) when spinach consumed at home was purchased | |||
| Spinach at home brand | Brand(s) of spinach consumed at home | |||
| Loose spinach at home | Patient consumed spinach at home | Yes; No | ||
| Prepackaged spinach at home | Patient consumed prepackaged spinach at home | Yes; No | ||
| Unknown packaging of spinach at home | Patient unable to recall how spinach consumed at home was purchased | Yes; No | ||
| Spinach away from home | Patient consumed spinach away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Spinach away from home location | Location(s) where the spinach was consumed away from home | |||
| Other leafy greens | Patient consumed other leafy greens in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Other leafy greens at home | Patient consumed other leafy greens at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Other leafy greens at home purchase location | Location(s) where other leafy greens consumed at home was purchased | |||
| Other leafy greens at home purchase date | Date(s) when other leafy greens consumed at home was purchased | |||
| Other leafy greens at home brand | Brand(s) of other leafy greens consumed at home | |||
| Loose other leafy greens at home | Patient consumed other leafy greens at home | Yes; No | ||
| Prepackaged other leafy greens at home | Patient consumed prepackaged other leafy greens at home | Yes; No | ||
| Unknown packaging of other leafy greens at home | Patient unable to recall how other leafy greens consumed at home was purchased | Yes; No | ||
| Other leafy greens away from home | Patient consumed other leafy greens away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Other leafy greens away from home location | Location(s) where the other leafy greens was consumed away from home | |||
| Sprouts | Patient consumed sprouts of any kind in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Sprouts at home | Patient consumed sprouts of any kind at home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Sprouts at home purchase locations | Location(s) where sprouts consumed at home were purchased | |||
| Sprouts at home purchase date | Date(s) when sprouts consumed at home were purchased | |||
| Sprouts at home brand | Brand(s) of sprouts consumed at home | |||
| Sprouts away from home | Patient consumed sprouts of any kind away from home in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Sprouts away from home location | Location(s) where sprouts were consumed away from home | |||
| Sprouts way from home type | Type of sprouts consumed outside the home | |||
| Petting zoo | Patient visited a petting zoo in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Farm with livestock | Patient visited, worked, or lived on a farm with livestock in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Farm and Feed store | Patient visited an agricultural 'Farm and Feed' store in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Pet store | Patient visited a pet store, swap meets, or other places where animals/birds are sold or shown in the 7 dayse before illness onset | Yes; No; Maybe; Unknown | ||
| Fair | Patient visited a county or state fair, 4-H event, or similar even with animals in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Pet treats | Patient had contact with pet treats or chews in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Animal droppings | Patient had contact with dried animal droppings or pellets in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Daycare | Patient attended or had contact with a daycare facility in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Any travel | Patient spent all or some of the 7 days before illness onset outside of their state of residence | Yes; No; Maybe; Unknown | ||
| Domestic travel | Postal code abbreviation of state(s) where patient traveled | |||
| Domestic travel start date | Domestic travel start date | |||
| Domestic travel end date | Domestic travel end date | |||
| International travel | Countries visited in the 7 days before illness onset | |||
| International travel start date | International travel start date | |||
| International travel end date | International travel end date | |||
| Group meals | Patient attended a group meal in the 7 days before illness onset | Yes; No; Maybe; Unknown | ||
| Institution | Patient visited, lives, or works in an institutional home (jail, nursing home, etc.) | Yes; No; Maybe; Unknown | ||
| Institution location | Location of institution where patient visits, lives, or works | |||
| Source of drinking water | Main source of drinking water for patient during the 7 days before illness onset | City/municipal; Well; Bottled; Unknown | ||
| Site ID | Site ID assigned by CDC. | |||
| Disease | Foodborne Disease. | |||
| State Lab ID | Identification of Isolate | |||
| Collection Date | Date isolate taken from patient | |||
| Last Updated | Date of Last Modification | |||
| Confirmed | Is isolate confirmed | |||
| Specimen Source | Source of isolate | |||
| Test Result | Serotype/Species/Test Result | |||
| Probable – laboratory-diagnosed | Probable case is laboratory-diagnosed | |||
| Probable – epi-linked | Probable case is epidemiologically linked | |||
| TTP | Patient had a diagnosis of TTP (Thrombotic thrombocytopenic purpura) | |||
| Ill contact | Patient had close contact with anyone with diarrhea or vomiting in the 7 days prior to illness onset | |||
| Gourmet cheese | Patient consumed artisanal or gourmet cheese in the 7 days before illness onset | |||
| Specify other leafy greens | Specify other leafy greens | |||
| Sprouts location | Purchase location of sprouts | |||
| Sprouts brand | Brand and variety of sprouts | |||
| Treated recreational water | Visit or swim in any treated recreational water facilities in 7 days prior to illness onset | |||
| Untreated recreational water | Visit or swim in any untreated recreational water facilities in 7 days prior to illness onset | |||
| Treated recreational water location | Location of treated recreational water facilities | |||
| Untreated recreational water location | Location of untreated recreational water facilities | |||
| Other related diagnosis | Other related diagnosis | |||
| Specify other related diagnosis | Specify other related diagnosis | |||
| Shopper card consent | Consent to retrieve purchases based on shopper card information | |||
| Ground beef at home brand | Brand and variety of ground beef consumed at home | |||
| Steak at home brand | Brand and variety of steak consumed at home | |||
| Steak at home frozen | Steak consumed at home was purchased frozen | |||
| Steak at home fresh | Steak consumed at home was purchased fresh | |||
| Bison brand | Brand and variety of bison | |||
| Wild game brand | Brand and variety of wild game | |||
| Dried meat brand | Brand and variety of dried or fermented meat | |||
| Other dried meat brand | Brand and variety of other dried or fermented meat | |||
| Pork | Patient consumed pork in 7 days prior to illness onset | |||
| Pork at home | Patient consumed pork at home in 7 days prior to illness onset | |||
| Pork at home purchase location | Purchase location of pork consumed at home | |||
| Pork at home brand | Brand and variety of pork consumed at home | |||
| Pork at home ground | Pork consumed at home was ground | |||
| Pork at home whole | Pork consumed at home was whole pig | |||
| Pork at home other form | Pork consumed at home was other form | |||
| Specify other form of pork at home | Specify other type of pork consumed at home | |||
| Pork away from home | Patient consumed pork away from home in 7 days prior to illness onset | |||
| Pork away from home location | Purchase location of pork consumed away from home | |||
| Pork away from home dish | Dish in which pork was consumed away from home | |||
| Raw milk location | Purchase location of raw milk | |||
| Raw milk brand | Brand and variety of raw milk | |||
| Raw cheese | Purchase location of cheese made from raw milk | |||
| Raw cheese brand | Brand and variety of cheese made from raw milk | |||
| Raw cheese aged | Cheese made from raw milk was aged for 60 days | |||
| Gourmet cheese location | Purchase location of artisanal or gourmet cheese | |||
| Gourmet cheese brand | Brand and variety of artisanal or gourmet cheese | |||
| Raw juice location | Purchase location of unpasteurized juice or cider | |||
| Raw juice brand | Brand and variety of unpasteurized juice or cider | |||
| Other raw dairy product | Patient consumed any other unpasteurized dairy product in 7 days prior to illness onset | |||
| Specify other raw dairy product | Specify other unpasteurized dairy product | |||
| Other raw dairy product location | Purchase location of other unpasteurized dairy product | |||
| Other raw dairy product brand | Brand and variety of other unpasteurized dairy product | |||
| Raw dough | Patient ate, tasted, or licked uncooked or unbaked dough or batter | |||
| Leafy greens | Patient consumed fresh, uncooked leafy greens in 7 days prior to illness onset | |||
| Leafy greens location | Purchase location of fresh, uncooked leafy greens | |||
| Leafy greens brand | Brand and variety of fresh, uncooked leafy greens | |||
| Loose leafy greens | Patient consumed loose fresh, uncooked leafy greens | |||
| Prepackaged leafy greens | Patient consumed prepackaged fresh, uncooked leafy greens | |||
| Cabbage | Patient consumed cabbage in 7 days prior to illness onset | |||
| Cabbage location | Purchase location of cabbage | |||
| Cabbage brand | Brand and variety of cabbage | |||
| Arugula | Patient consumed arugula in 7 days prior to illness onset | |||
| Arugula location | Purchase location of arugula | |||
| Arugula brand | Brand and variety of arugula | |||
| Kale | Patient consumed kale in 7 days prior to illness onset | |||
| Kale location | Purchase location of kale | |||
| Kale brand | Brand and variety of kale | |||
| Premade salad | Patient consumed pre-made, single-serving salads in 7 days prior to illness onset | |||
| Premade salad location | Purchase location of pre-made, single-serving salads | |||
| Premade salad brand | Brand and variety of pre-made, single-serving salads | |||
| Other prepackaged leafy greens | Patient consumed other pre-packaged leafy greens or salad kits | |||
| Other prepackaged leafy greens location | Purchase location of other pre-packaged leafy greens or salad kits | |||
| Other prepackaged leafy greens brand | Brand and variety of other pre-packaged leafy greens or salad kits | |||
| Other leafy greens location | Purchase location of other leafy greens | |||
| Other leafy greens brand | Brand and variety of other leafy greens | |||
| Herbs | Patient consumed fresh herbs in 7 days prior to illness onset | |||
| Specify herbs | Specify fresh herbs | |||
| Herbs location | Purchase location of fresh herbs | |||
| Herbs brand | Brand and variety of fresh herbs | |||
| Specify petting zoo | Specify petting zoo | |||
| Specify type of livestock | Specify type of livestock | |||
| Specify fair | Specify fair or event with animals | |||
| Pet | Patient has a pet of their own | |||
| Specify pet | Specify pet | |||
| Specify institution | Specify institution | |||
| Treated recreational water type | Types of treated recreational water facilities | |||
| Untreated recreational water type | Types of untreated recreational water facilities | |||
| Occupation | Patient's occupation | |||
| Food allergy | Does the patient have a food allergy? | |||
| Special diet | Is the patient on a special diet? | |||
| 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 | |
| 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 | |
| WGS ID Number | Whole Genome Sequencing (WGS) ID Number | N/A | 1 | |
| 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 |
| Clinically Compatible Illness | Did this case have a clinically compatible illness as defined by the latest CSTE case definitions? | PHVS_YesNoUnknown_CDC | |
| History of Tick Bite | Was there a history of a tick bite within 14 days of onset? | PHVS_YesNoUnknown_CDC | |
| Eschar | Was there an eschar, or tache noire, present? | PHVS_YesNoUnknown_CDC | |
| Immunosuppressive Condition | If the case reports an immunosuppressive condition, then indicate condition here | ||
| Adult respiratory distress syndrome | Did the case report adult respiratory distress syndrome during the course of this illness? | PHVS_YesNoUnknown_CDC | |
| Disseminated Intravascular Coagulation | Did the case report disseminated intravascular coagulation during the course of this illness? | PHVS_YesNoUnknown_CDC | |
| Meningitis | Did the case report meningitis during the course of this illness? | PHVS_YesNoUnknown_CDC | |
| Encephalitis | Did the case report encephalitis during the course of this illness? | PHVS_YesNoUnknown_CDC | |
| Renal Failure | Did the case report renal failure during the course of this illness? | PHVS_YesNoUnknown_CDC | |
| Othere life threatening complication | If the case reported another life threatening complication during the course of this illness, then list it here | ||
| Laboratory Name | Indicate the name of the laboratory which supplied results supporting the current CSTE case definitions. | ||
| Laboratory State | Indicate the state where the laboratory is located | PHVS_State_FIPS_5-2 | |
| Acute Serology Collection Date | If an acute serology was collected, then list the date of collection | ||
| Acute IFA IgG Result | If performed, was the acute IFA IgG positive | PHVS_YesNoUnknown_CDC | |
| Acute IFA IgG Titer | If performed, what was the reciprocal titer of the acute IFA IgG | ||
| Acute IFA IgM Result | If performed, was the acute IFA IgM positive | PHVS_YesNoUnknown_CDC | |
| Acute IFA IgM Titer | If performed, what was the reciprocal titer of the acute IFA IgM | ||
| Acute Serology, Other Test | If performed, what was the name of another acute serology test | ||
| Acute Serology Result, Other Test | If performed, was this other acute serology test positive | PHVS_YesNoUnknown_CDC | |
| Acute Serology Numeric Result, Other Test | If performed, what was the numeric result of the other serology test | ||
| Convalescent Serology Collection Date | If an convalescent serology was collected, then list the date of collection | ||
| Convalescent IFA IgG Result | If performed, was the convalescent IFA IgG positive | PHVS_YesNoUnknown_CDC | |
| Convalescent IFA IgG Titer | If performed, what was the reciprocal titer of the convalescent IFA IgG | ||
| Convalescent IFA IgM Result | If performed, was the convalescent IFA IgM positive | PHVS_YesNoUnknown_CDC | |
| Convalescent IFA IgM Titer | If performed, what was the reciprocal titer of the convalescent IFA IgM | ||
| Convalescent Serology, Other Test | If performed, what was the name of another convalescent serology test | ||
| Convalescent Serology Result, Other Test | If performed, was this other convalescent serology test positive | PHVS_YesNoUnknown_CDC | |
| Convalescent Serology Numeric Result, Other Test | If performed, what was the numeric result of the other serology test | ||
| PCR | If performed, was the polymerase chain reaction assay positive | PHVS_YesNoUnknown_CDC | |
| Morulae | If performed, were morulae visualized during microscopy | PHVS_YesNoUnknown_CDC | |
| Immunostain | If performed, were antibodies detected using immunohistochemistry during microscopy | PHVS_YesNoUnknown_CDC | |
| Culture | If performed, was the etiologic agent isolated from culture | PHVS_YesNoUnknown_CDC | |
| Fourfold | If paired sera were collected, was there a fourfold change in titer between acute and convalescent | PHVS_YesNoUnknown_CDC | |
| Other Etiologic Agent | If etiologic agent was unusual, then indicate the species here (for example, R. africae) | ||
| Physician Name | Name of subject's clinician/provider of care,Provide the name in the following format:,<last name>, <first name> | N/A | P |
| Physician Phone | Phone number of subject's clinician/provider of care | N/A | P |
| Clinical Manifestation | Clinical manifestation of TBRD | PHVS_ClinicalManifestation_TBRD | P |
| Clinical Manifestation Indicator | For each clinical manifestation reported, indicate (YNU) whether the subject developed the specified manifestation as a result of the illness. | PHVS_YesNoUnknown_CDC | P |
| Experienced Complication | Did the subject experience any complications due to this episode? | PHVS_YesNoUnknown_CDC | P |
| Type of Complication | If the subject experienced complications due to this episode, what was the complication? | PHVS_Complication_TBRD | P |
| Patient Immunocompromised | At the time of diagnosis, was the subject immunocompromised? | PHVS_YesNoUnknown_CDC | P |
| Treatment Drug Indicator | Did the subject receive antimicrobial treatment for this infection? | PHVS_YesNoUnknown_CDC | P |
| Medication Administered | What antibiotic did the patient receive for this episode? | PHVS_MedicationReceived_TBRD | P |
| Date Treatment or Therapy Started | Date the treatment was initiated | P | |
| Treatment Duration | Number of days the patient actually took the antibiotic referenced | P | |
| Occupation related to exposure | Is the subject's current occupation related to the exposure? | PHVS_YesNoUnknown_CDC | P |
| Travel | In the two weeks before symptom onset or diagnosis (use earlier date), did the subject travel out of their county, state, or country of residence? | PHVS_YesNoUnknown_CDC | P |
| International Destination(s) of Recent Travel | International destination, countries traveled to | PHVS_YesNoUnknown_CDC | P |
| Travel State | Domestic destination, state(s) traveled to | PHVS_State_FIPS_5-2 | P |
| Travel County | Intrastate destination, counties traveled to | PHVS_County_FIPS_6-4 | P |
| Date of Arrival to Travel Destination | If the subject traveled, when did they arrive to their travel destination? | P | |
| Date of Departure from Travel Destination | If the subject traveled, when did they depart from their travel destination? | P | |
| Tick Bite Location | If subject noticed tick bite, where did the bite occur (geographic location)? | P | |
| Tick Bite Date | If subject noticed tick bite, when did the bite occur? | P | |
| Blood Transfusion | In the year before symptom onset or diagnosis (use earlier date), did the subject receive a blood transfusion? | PHVS_YesNoUnknown_CDC | P |
| Blood Transfusion Date | Date(s) of blood transfusion(s) | P | |
| Transfusion Associated | Was the subject’s infection transfusion associated? | PHVS_YesNoUnknown_CDC | P |
| Transfused Product | If a transfused blood product was implicated in an investigation, specify which type(s) of product. | PHVS_BloodProduct_CDC | P |
| Organ Transplant | In the year before symptom onset or diagnosis (use earlier date), did the subject receive an organ transplant(s)? | PHVS_YesNoUnknown_CDC | P |
| Transplant type | If the subject received an organ transplant, what was the organ? | P | |
| Transplant date | Date(s) of organ transplant(s) | P | |
| Transplant associated infection | Was the subject's infection transplant-related? | PHVS_YesNoUnknown_CDC | P |
| Blood Donor | Did the subject donate blood in the 30 days prior to symptom onset? | PHVS_YesNoUnknown_CDC | P |
| Blood Donation Date | Date(s) of blood donation(s) | P | |
| Blood Donor Implicated During Investigation | Was the subject a blood donor identified during a transfusion investigation (i.e., had positive test results and was linked to an infected recipient)? | PHVS_YesNoUnknown_CDC | P |
| Donated Product | If a donated blood product was implicated in an investigation, specify which type(s) of product. | PHVS_BloodProduct_CDC | P |
| Blood bank notified | Was the blood bank/hospital/transplant service notified? | PHVS_YesNoUnknown_CDC | O |
| Co-infection | Was the subject diagnosed with a co-infection? | PHVS_YesNoUnknown_CDC | P |
| Co-infection type | Specify coinfection | P |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| 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 | |
| Primary occupation | Specifies patient's primary occupation. | |
| Military Service | History of Military (Active or Reserve)? | PHVS_YesNoUnknown_CDC |
| Military Service Year | Year of Entry into Militart Service | |
| Tetanus Toxoid Vaccination | Tetanus Toxoid (TT) History Prior to Tetanus Disease (Exclude Doses Received Since Acute Injury) |
0 = Never 1 = 1 dose 2 = 2 doses 3 = 3 doses 4 = 4 + doses 9 = Unknown |
| Year of last tetanus dose | Specifies the year of patients' last tetanus dose. | |
| Acute wound | Did the patient have an acute wound or injury? | PHVS_YesNoUnknown_CDC |
| Acute wound date | This field indicates the date an acute wound or injury occurred. | |
| Acute wound anatomic site | Specifies the anatomic site of acute wound or injury. | Body Region (Tetanus) |
| Acute wound work related | If there was an acute wound or injury, was it work related? | PHVS_YesNoUnknown_CDC |
| Acute wound environment | Specifies the environment where the acute wound or injury was work related. | Injury Occurred Environment (VPD) |
| Acute wound circumstances | Specifies the circumstances under which the acute wound or injury occurred. | |
| Acute wound type | Specifies the principle acute wound or injury type. | Injury Type (VPD) |
| Wound Contaminated | Wound Contaminated | PHVS_YesNoUnknown_CDC |
| Depth of Wound | Depth of Wound | 1 = 1 cm or les 2 = more than 1 cm 9 = Unknown |
| Acute wound signs of infection | Were there signs of infection at the time of care for the acute wound or injury? | PHVS_YesNoUnknown_CDC |
| Denervated Tissue Present | Devitalized, Ischemic, or Denervated Tissue Present? | PHVS_YesNoUnknown_CDC |
| Acute wound medical care | Did the patient obtain medical care for the acute wound or injury before tetanus symptom onset? | PHVS_YesNoUnknown_CDC |
| Acute wound tetanus toxiod administered | Was patient administered tetanus toxiod (Td, TT, DT, DTaP) for the acute wound or injury before tetanus symptom onset? | PHVS_YesNoUnknown_CDC |
| If Yes, tetanus toxiod administered, How Soon after Injury? | If Yes, How Soon after Injury? | PHVS_AftterInjury_Time |
| Wound Debrided | Wound Debrided before Tetanus Onset | PHVS_YesNoUnknown_CDC |
| If Yes, Debrided How Soon after Injury? | If Yes, Debrided How Soon after Injury? | PHVS_AftterInjury_Time |
| TIG given before symptom onset | Indicates whether tetanus immune globulin (TIG) prophylaxis was given as a part of the wound care before tetanus symptom onset. | PHVS_YesNoUnknown_CDC |
| If Yes, TIG Given How Soon after Injury? | If Yes, TIG Given How Soon after Injury? | PHVS_AftterInjury_Time |
| TIG given before symptom onset dosage | Specifies the date the tetanus immune globulin (TIG) prophylaxis units given. | |
| Tetanus Associated Condition | Tetanus Associated Conditions Prior to Onset(If no Acute Injury) | PHVS_TET_Associated_Conditions |
| Diabetes | Indicates whether patient have diabetes. | PHVS_YesNoUnknown_CDC |
| Insulin dependents | Indicates whether the patient is insulin dependent. | PHVS_YesNoUnknown_CDC |
| Parenteral Drug Abuse? | Pranteral Drug Abuse? | PHVS_YesNoUnknown_CDC |
| Tetanus type | Type of tetanus. | Tetanus Type (VPD) |
| TIG given after symptom onset | Indicates whether the tetanus immune globulin (TIG) therapy was given after symptom onset. | PHVS_YesNoUnknown_CDC |
| If Yes, How Soon after Injury? | If Yes, How Soon after Injury? | PHVS_AftterInjury_Time |
| TIG given after symptom onset dosage | Specifies the total therapeutic TIG dosage. | |
| Intensive Care Unit | Was the patient in the Intensive Care Unit (ICU)? | PHVS_YesNoUnknown_CDC |
| Mechanical Ventilation Days | Number of days the patient received mechanically ventilation. | |
| Final outcome | Final outcome (e.g. Recovered, Died, Unknown) | Treatment Outcome Tetanus (VPD) |
| Mother's Age | Specifies mothers age. | |
| Mother's DOB | Specifies mothers DOB. | |
| Date mother first resided in the U.S. | Date mother first resided in the U.S. | |
| Mother tetanus vacc number of known doses | Specifies number of known tetanus vaccination doses mother received prior to the infant's (case's) birth. | PHVS_VaccineDosesReceived_Tetanus |
| Last time mother received tetanus vacc | Specifies number of years or months since mother received last tetanus vaccination. | |
| Infant's birth place location | Specifies infant's (case) birth place location (e.g. Hospital, Home, Other, Unknown). | PHVS_BirthLocation_VPD |
| Birth attendees | Specifies birth attendees (e.g. Physician, Nurse, Licensed midwife, Unlicensed midwife, Family, EMS technician(s)). | PHVS_BirthAttendees_VPD |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) |
| Eosinophilia | Did patient have Eosinophilia? | PHVS_YesNoUnknown_CDC |
| Eosin Absolute | If "Yes," please specify absolute number or percentage: | |
| Eosin Units | Specify percent or numeric | Eosin Units_FDD |
| Fever | Did patient have a fever? | PHVS_YesNoUnknown_CDC |
| Temperature | If "Yes," please specify temperature: | |
| Temperature Units | Specify fahrenheit or celsius | PHVS_TemperatureUnit_UCUM |
| Trichinellosis Signs and Symptoms Code(s) | Did patient have any of the following signs or symptoms of Trichinellosis? | PHVS_TrichinellosisSignsSymptoms _FDD |
| Trichinellosis Signs and Symptoms Other | If "Other," please specify other signs or symptoms of Trichinellosis: | |
| Suspected Foods | What suspect foods did the patient eat? | PHVS_SuspectedFoodConsumed_FDD |
| Pork Type Code | Please specify type of pork: | PHVS_PorkType_FDD |
| Pork Type Other | If “Other,” please specify other type of pork: | |
| Pork Consumed Date | Date suspect food was consumed: | |
| Pork Larvae Found | Was larvae found in suspect food? | PHVS_PresentAbsentUnkNotExamined_CDC |
| Pork Source Obtained Code | Where was the suspect meat obtained? | PHVS_MeatPurchaseInfo_FDD |
| Pork Source Other | If “Other,” please specify where suspect meat was obtained: | |
| Pork Prep Code | How was suspect food prepared or further processed after purchase? | PHVS_FoodProcessingMethod_FDD |
| Pork Prep Other | If “Other,” please specify other type of processing: | |
| Pork Cook Method Code | What was the method of cooking the suspect food? | PHVS_FoodCookingMethod_FDD |
| Pork Cook Method Other | If “Other,” please specify other type of cooking method: | |
| Non-Pork Type Code | Please specify type of non-pork: | PHVS_NonPorkType_FDD |
| Non-Pork Type Other | If “Other,” please specify other type of non-pork: | |
| Non-Pork Consumed Date | Date suspect food was consumed: | |
| Non-Pork Larvae Found Code | Was larvae found in suspect food? | PHVS_PresentAbsentUnkNotExamined_CDC |
| Non-Pork Source Code | Where was the suspect meat obtained? | PHVS_MeatPurchaseInfo_FDD |
| Non-Pork Source Other | If “Other,” please specify where suspect meat was obtained: | |
| Non-Pork Prep Code | How was suspect food prepared or further processed after purchase? | PHVS_FoodProcessingMethod_FDD |
| Non-Pork Prep Other | If “Other,” please specify other type of processing: | |
| Non-Pork Method Code | What was the method of cooking the suspect food? | PHVS_FoodCookingMethod_FDD |
| Non-Pork Method Other | If “Other,” please specify other type of cooking method: | |
| 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 |
| Travel History | In the 8 weeks before onset of illness, did the subject travel out of their state or country of residence? | |
| International Destination(s) of Recent Travel | International destination or countries the case-patient traveled to in the 8 weeks before onset of illness | |
| Travel State | Domestic destination or state(s) the case-patient traveled to in the 8 weeks before onset of illness | |
| Date of Arrival to Travel Destination | Date of arrival to travel destination | |
| Date of Departure from Travel Destination | Date of departure from travel destination | |
| Epi-Linked | Is this case epi-linked to another confirmed or probable case? | |
| Where Meat Tested | Where was the suspected meat tested? | |
| Meat Comments | Use this field, if needed, to communicate anything unusual about the suspect meat, which is not already covered with the other data elements (e.g., additional details about where eaten, if consumed while traveling outside of the U.S., where wild game was hunted, etc.). |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | CDC Priority |
| TB State Case Number | State case number for the case specific to TB investigations (4 digit report year + 2 letter state + 9 digit alphanumeric number) | N/A | P |
| City or County Case Number | City or county case number assigned to this case | N/A | P |
| Birth Sex | What was the patient's sex at birth? | PHVS_Sex_MFU | P |
| Previously Counted Case | Has this case already been counted by another reporting area? | PHVS_CaseCountStatus_TB | P |
| Previously Reported State Case Number | If case previously counted, provide the state case number from the other reporting area. | N/A | P |
| Country of Verified Case | If the case was previously reported by another country, specify the country. | PHVS_BirthCountry_CDC | P |
| Patient Address City | Patient address city | N/A | P |
| Inside City Limits | Is the patient's residence within city limits? | PHVS_YesNoUnknown_CDC | P |
| Census Tract of Case-Patient Residence | Census tract where the address is located is a unique identifier associated with a small statistical subdivision of a county. Census tract data allows a user to find population and housing statistics about a specific part of an urban area. | N/A | P |
| Detailed Race | Provide the detailed race information for the patient. | PHVS_Race_CDC | P |
| Date Arrived in US | If country of birth is NOT United States, regardless of citizenship, indicate the date when the patient first arrived in the US. | N/A | P |
| US Born | Was the patient eligible for US citizenship at birth? | PHVS_YesNoUnknown_CDC | P |
| Primary Guardian(s) Country of Birth | Indicates the birth country of the primary guardian(s) of patient (pediatric [<15 years old] cases only) | PHVS_BirthCountry_CDC | P |
| Remain in US After Report | If not US reporting area, did patient remain in the United States for >= 90 days after report date? | PHVS_YesNoUnknown_CDC | P |
| Initial Reason for Evaluation | What was the initial reason the patient was evaluated for TB? | PHVS_PrimaryReasonForEvaluation_TB | P |
| Test Type | Epidemiologic interpretation of the type of test(s) performed for this case. Please provide a response for each of the main test types (culture, smear, pathology/cytology, NAA, TST, IGRA, HIV, diabetes) If test was not done please indicate so. | PHVS_LabTestType_TB | P |
| Test Result | Epidemiologic interpretation of the results of the test(s) performed for this case - This is a qualitative test result. (e.g., positive, detected, negative) | PHVS_LabTestInterpretation_TB | P |
| Date/Time of Lab Result | Date result sent from reporting laboratory. Time of result is an optional addition to date. | N/A | P |
| Specimen Source Site | This indicates the anatomical source of the specimen tested. | PHVS_MicroscopicExamCultureSite_TB | P |
| Specimen Collection Date/Time | Date of collection of laboratory specimen used for diagnosis of health event reported in this case report. Time of collection is an optional addition to date. | N/A | P |
| Test Result Quantitative | Quantitative test result value | N/A | P |
| Result Units | Units of measure for the Quantitative Test Result Value | PHVS_UnitofMeasure_TB | P |
| Type of Chest Study | Indicate the type of chest study performed. Please provide a response for each of the main test types (plain chest radiograph, chest CT Scan) and if test was not done please indicate so. | PHVS_TypeofRadiologyStudy_CDC | P |
| Result of Chest Study | Result of chest diagnostic testing | PHVS_ResultofRadiologyStudy_TB | P |
| Evidence of Cavity | Did test show evidence of cavity? | PHVS_YesNoUnknown_CDC | P |
| Evidence of Miliary TB | Did test show evidence of miliary TB? | PHVS_YesNoUnknown_CDC | P |
| Date of Chest Study | Date of the chest diagnostic study | N/A | P |
| 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 | PHVS_EpidemiologicalRiskFactors_TB | P |
| Patient Epidemiological Risk Factors Indicator | Provide a response for each value in the patient epidemiological risk factors value set | PHVS_YesNoUnknown_CDC | P |
| Type of Correctional Facility | If patient was a Resident of Correctional Facility at Diagnostic Evaluation, indicate the type of correctional facility. | PHVS_CorrectionalFacilityType_NND | P |
| Type of Long-Term Care Facility | If patient was a Resident of Long Term Care Facility at Diagnostic Evaluation, indicate the type of long term care facility. | PHVS_LongTermCareFacilityType_NND | P |
| Smoking Status | What is the patient's current tobacco smoking status? | PHVS_SmokingStatus_CDC | P |
| Patient lived outside of US for more than 2 months | Residence or Travel in countries other than the United States, Canada, Australia, New Zealand, or countries in northern or western Europe for >60 consecutive days at any point in the patient's lifetime. | PHVS_YesNoUnknown_CDC | P |
| Identified During Contact Investigation | Was the patient identified during the contact investigation around the likely source case? | PHVS_YesNoUnknown_CDC | P |
| Evaluation During Contact Investigation | If patient was identified during contact investigation, was the patient evaluated for TB during the contact investigation? | PHVS_YesNoUnknown_CDC | P |
| Linked Case Number | State case numbers for epidemiologically linked cases | N/A | P |
| Date Treatment or Therapy Started | Date the initial treatment regimen was started | N/A | P |
| Treatment Administration Type | Choose all treatment administration types that apply to the case, such as DOT, eDOT, or SAT. | PHVS_TreatmentAdministrationType_TB | P |
| Date Treatment or Therapy Stopped | Date treatment stopped | N/A | P |
| Case Verification Category | Indicates case verification criteria result based on factors such as culture results, smear results, major and additional sites of the disease, x-ray results, TST, IDR, reason therapy was stopped. | PHVS_CaseVerification_TB | P |
| Status at Diagnosis of TB | Was the patient alive or dead at the time of diagnostic evaluation? | PHVS_GeneralConditionStatus_TB | P |
| Site of Disease | What was the site of the patient's TB disease? | PHVS_AdditionalDiseaseSite_TB | P |
| Contact Investigation | Was a contact investigation conducted around this case? | PHVS_YesNoUnknown_CDC | P |
| Diagnosis Type | Previous TB or LTBI Diagnosis - Provide only 1 response for LTBI, multiple responses for TB are allowed | PHVS_DiagnosisType_TB | P |
| History of Previous Illness | Did the subject have a history of TB or LTBI? | PHVS_YesNoUnknown_CDC | P |
| Date of Previous Illness | Date of previous diagnosis | N/A | P |
| Previous State Case Number | Previous TB or LTBI State Case Number | N/A | P |
| Completed Treatment for Previous Diagnosis | Completed Treatment for Previous Diagnosis | PHVS_YesNoUnknown_CDC | P |
| Initially Treated with RIPE | Was the patient initially treated with the recommended four-drug therapy (RIPE)? | PHVS_YesNoUnknown_CDC | P |
| Reason Not Treated with RIPE | If not initially treated with RIPE, why not? | PHVS_ReasonNotTreatedwithRIPE_TB | P |
| Reason Therapy Stopped | Indicate the primary reason that therapy was stopped or never started; specify this data when the case is closed. | PHVS_ReasonTherapyStopped_TB | P |
| Reason Therapy Extended | Select the reason the therapy extended beyond 12 months. | PHVS_TherapyExtendedReason_TB | P |
| Final Disease Outcome | Final TB disease case outcome | PHVS_FinalTreatmentOutcome_TB | P |
| Initial Drug Regimen | Initial drug regimen for the patient: Please provide a response for each of the values in the value set using the associated indicator. | PHVS_Medications_TB | P |
| Initial Drug Regimen Indicator | Indicator response for the initial drug regimen question | PHVS_YesNoUnknown_CDC | P |
| Isolate Submitted for Genotyping | Was an isolate submitted for genotyping? | PHVS_YesNoUnknown_CDC | P |
| Accession Number for Genotyping | If an isolate was submitted for genotyping to a CDC laboratory only, list the accession number for genotyping. | N/A | P |
| Phenotypic Drug Susceptibility Completed | Was phenotypic/growth-based drug susceptibility testing done? | PHVS_YesNoUnknown_CDC | P |
| Molecular Drug Susceptibility Completed | Was genotypic/molecular drug susceptibility testing done? | PHVS_YesNoUnknown_CDC | P |
| Antimicrobial Susceptibility Test Type | Antimicrobial Susceptibility Test Type of TB drugs. For the initial susceptibility testing please send a response for each values in the value set. Changes in susceptibility should be reported for each individual drug when change is identified. | PHVS_SusceptibilityTestType_TB | P |
| Antimicrobial Susceptibility Specimen Collection Date | Antimicrobial Susceptibility Specimen Collection Date | N/A | P |
| Antimicrobial Susceptibility Result Reported Date | Antimicrobial susceptibility result reported date | N/A | P |
| Antimicrobial Susceptibility Specimen Type | Antimicrobial Susceptibility Specimen Type (e.g. Exudate, Blood, Serum, Urine) | PHVS_MicroscopicExamCultureSite_TB | P |
| Antimicrobial Susceptibility Test Interpretation | Antimicrobial Susceptibility Test Interpretation (e.g. Susceptible, Resistant, Intermediate, Not tested) | PHVS_SusceptibilityTestResultQuantitative_TB | P |
| Antimicrobial Susceptibility Test Method | Antimicrobial Susceptibility Test Method (e.g. E-Test, MIC, Disk Diffusion) | PHVS_SusceptibilityTestMethod_TB | P |
| Gene Identifier | Gene identifier - Please report the full test results for the samples that have unique features, such as specimen type (sputum or another anatomic site), test type (sequencing or non-sequencing) or mutation (detected or not detected). There is no need to report test results that differ only by date or laboratory and where all other aspects are identical in regards to specimen type, test type, and/or the results of mutation. | PHVS_GeneName_TB | P |
| Molecular Susceptibility Specimen Collection Date | Molecular Susceptibility Specimen Collection Date | N/A | P |
| Molecular Susceptibility Date Reported | Molecular Susceptibility Date Reported | N/A | P |
| Molecular Susceptibility Specimen Type | Molecular Susceptibility Specimen Type | PHVS_MicroscopicExamCultureSite_TB | P |
| Molecular Susceptibility Test Result | Molecular Susceptibility Test Result | PHVS_MolecularTestResults_TB | P |
| Molecular Susceptibility Nucleic Acid Change | Molecular Susceptibility Nucleic Acid Change | N/A | P |
| Molecular Susceptibility Amino Acid Change | Molecular Susceptibility Amino Acid Change | N/A | P |
| Molecular Susceptibility Indel | Molecular Susceptibility Indel | PHVS_MolecularIndel_TB | P |
| Molecular Susceptibility Test Method | Molecular Susceptibility Test Method | PHVS_MolecularTestMethods_TB | P |
| Culture Conversion Documented | Did the patient's sputum become culture negative? | PHVS_YesNoUnknown_CDC | P |
| Date of First Consistently Negative Culture | Date the first consistently negative sputum culture was collected. | N/A | P |
| Reason for Not Documenting Sputum Culture Conversion | Indicate the one reason for not documenting the sputum culture conversion. | PHVS_SputumCultureConversionNotDocumentedReason_TB | P |
| Patient Move During TB Therapy | Did the patient move during therapy? | PHVS_YesNoUnknown_CDC | P |
| Moved to Where | If the patient moved to a different reporting area during TB therapy, select all that apply to where the patient moved. | PHVS_MovedWhereDuringTherapy_TB | P |
| Out of State Move | If moved out of state, then specify the new state jurisdiction. | PHVS_State_FIPS_5-2 | P |
| Out of Country Move | If moved out of country, then specify the new country jurisdiction. | PHVS_Country_ISO_3166-1 | P |
| Transnational Referral | If moved out of the US, indicate whether a transnational referral was made. | PHVS_YesNoUnknown_CDC | P |
| History of Treatment | History of treatment before current episode with second-line TB drugs for the treatment of TB disease (not LTBI) | PHVS_YesNoUnknown_CDC | P |
| Date MDR Treatment Started | Date MDR TB therapy started for current episode | N/A | P |
| Drug Used to Treat MDR TB | Drugs ever used for MDR TB treatment, from MDR start date: Please provide a response for each medication in the value set with an associated indicator. Medications should be recorded as part of the regimen beginning with the MDR TB therapy start date. | PHVS_Medications_TB | P |
| Length of Time Drug Was Administered | Indicate length of time drug was taken or if it was not taken | PHVS_LengthofTimeDrugTaken_TB | P |
| Date Injectable Medication Stopped | Date injectable medication stopped. If no injectable drugs were used leave blank. | N/A | P |
| Surgery to Treat MDR TB | Surgery to Treat MDR TB | PHVS_YesNoUnknown_CDC | P |
| Surgery to Treat MDR TB Date | Surgery to Treat MDR TB Date | N/A | P |
| Adverse Event Description | Did patient experience any of the following side effects during treatment that resulted in a permanent discontinuation of medication or at the end of treatment were there any of the following side effects related to MDR-TB treatment present? Please provide a response for all side effects in the value set with an associated indicator. | PHVS_SideEffectofTreatment_TB | P |
| Adverse Event Indicator | Side Effects of Treatment Indicator | PHVS_YesNoUnknown_CDC | P |
| Adverse Event Manifestation Time | Did the side effect manifest during treatment or at the end of treatment? | PHVS_SideEffectTimetoOnset_TB | P |
| Usual Occupation and Industry | Usual occupation and industry | TBD | P |
| Meets Binational Reporting Criteria | Does case meet binational reporting criteria? | PHVS_YesNoUnknown_CDC | P |
| Patient Treated as MDR Case | Was the Patient Treated as an MDR TB Case (Regardless of DST Results? | 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 |
| Immuncompromised | If patient has any immunocompromising conditions, specify | N/A | P |
| Date first medical | Date that the patient was first seen by medical person. | N/A | P |
| Fever/sweats/chills | Did the patient's illness include the symptom of fever/sweats/chills? | PHVS_YesNoUnknown_CDC | P |
| Confusion/delirium | Did the patient's illness include the symptom of confusion/delirium? | PHVS_YesNoUnknown_CDC | P |
| Vomiting/diarrhea/abdominal pain | Did the patient's illness include the symptom of vomiting/diarrhea/abdominal pain? | PHVS_YesNoUnknown_CDC | P |
| Sore throat | Did the patient's illness include the symptom of sore throat? | PHVS_YesNoUnknown_CDC | P |
| Cough | Did the patient's illness include the symptom of cough? | PHVS_YesNoUnknown_CDC | P |
| Chest Pain | Did the patient's illness include the symptom of chest pain? | PHVS_YesNoUnknown_CDC | P |
| Shortness of breath | Did the patient's illness include the symptom of shortness of breath? | PHVS_YesNoUnknown_CDC | P |
| Other_symptoms | Did the patient's illness include other symptoms of not listed? | PHVS_YesNoUnknown_CDC | P |
| Other_symptoms_specify | Which other symptoms did the patient's illness include? | N/A | P |
| Lymphadenopathy | Did the patient have lymphadenopathy? | PHVS_YesNoUnknown_CDC | P |
| Describe lympadenopathy | If lymphadenopathy present, provide location and description. | N/A | P |
| Skin lesions | Did the patient have skin lesion? | PHVS_YesNoUnknown_CDC | P |
| Describe skin lesions | If skin lesion present, provide location and description. | N/A | P |
| Conjunctivitis | Did the patient have conjunctivitis? | PHVS_YesNoUnknown_CDC | P |
| Pharyngitis/tonsilitis | Did the patient have pharyngitis/tonsilitis? | PHVS_YesNoUnknown_CDC | P |
| Chest X-ray | Results of chest x-ray | TBD | P |
| Antibiotic | Did patient receive an effective antibiotic for illness? | TBD | P |
| Antibiotic start date | Date each antibiotic started | N/A | P |
| Illness outcome | Outcome of illness | TBD | P |
| Primary clinical syndrome | Classification of primary clinical manifestation of infection | TBD | P |
| F. tularensis cultured | Was F. tularensis cultured? | PHVS_YesNoUnknown_CDC | P |
| Specimen source | Source of culture | N/A | P |
| Date specimen collected | Date specimen was collected | N/A | P |
| F. tularensis detected | Was F. tularensis detected by other tests? | PHVS_YesNoUnknown_CDC | P |
| Test performed | Test used to detect F. tularensis | N/A | P |
| Specimen source | Specimen source in which F. tularenisis was detected | N/A | P |
| Date specimen collected | Date of specimen collection | N/A | P |
| F. tularensis subspecies | Subspecies of F. tularensis detected | TBD | P |
| Serology | Serology results | TBD | P |
| First Serum titer | Titer results | N/A | P |
| Second Serum titer | Titer results | N/A | P |
| Date first serum drawn | Date first serum drawn | N/A | P |
| Date second serum drawn | Date second serum drawn | N/A | P |
| Epi-linked to other cases | Was this illness epi-linked to any other tularemia cases? | PHVS_YesNoUnknown_CDC | P |
| Epi-link specify | Describe epi-linked case | N/A | P |
| Travel associated | Was this illness associated with travel? | PHVS_YesNoUnknown_CDC | P |
| Travel specify | Describe travel | N/A | P |
| Animal contact | Did patient have any animal contact in the 2 weeks preceding illness? | PHVS_YesNoUnknown_CDC | P |
| Domestic animal | Indicate if domestic animal contact occurred and specify domestic animals that patient had contact with in the 2 weeks preceding illness | N/A | P |
| Type of animal contact | Was animal domestic or wild | TBD | P |
| Wild animal | Indicate if wild animal contact occurred and specify wild animals that patient had contact with in the 2 weeks preceding illness | N/A | P |
| Nature of contact | Nature of animal contact | TBD | P |
| Tick or deerfly bite | Did patient have tick or deerfly bite in the two weeks preceding illness? | TBD | P |
| Contact with or ingestion of untreated water | Did patient have contact with or ingestion of untreated water in the two weeks preceding illness? | PHVS_YesNoUnknown_CDC | P |
| Environmental aerosol generating activities | Did patient participate in any environmental aerosol generating activities in the two weeks preceding illness | PHVS_YesNoUnknown_CDC | P |
| Specify environmental aerosol generating activities | Specify environmental aerosol generating activities | N/A | P |
| Other exposure | Specify any other exposures in the two weeks preceding illness | N/A | P |
| Comments | Additional comments | 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) | ||||||
| Number of lesions in total | Choose the numeric range within which a count of the patient's lesions falls. Note that if "Unknown" is sent, the HL7 Flavor of Null UNK value is sent. | PHVS_NumberOfLesions_VZ | ||||||
| Number of lesions if less than 50 | Number of lesions if less than 50 | |||||||
| Did the patient receive Varicella-containing vaccine | Indicate whether the patient received varicella-containing vaccine; a value of Yes or No enables other fields in this section, allowing for answers to their questions. | PHVS_YesNoUnknown_CDC | ||||||
| Reason why patient did not receive Varicella-containing vaccine | If the value in Did the patient receive varicella-containing vaccine? is No, choose the reason why the patient did not receive the vaccine; if none of the specific choices in the list apply, choose Other. | PHVS_VaccineNotGivenReasons_CDC | ||||||
| Other reason why patient did not receive Varicella-containing vaccine | If the value specified in Reason why patient did not receive varicella-containing vaccine is Other, indicate the reason (a reason other than those provided in the list). | |||||||
| Number of doses received on or after first birthday | If the value in Did the patient receive varicella-containing vaccine? is Yes, indicate the number of doses received on or after the patient's first birthday. | |||||||
| Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose | Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose. Choose from the list the reason the patient never received the second dose; if none of the specific choices in the list apply, choose Other.” | PHVS_VaccineNotGivenReasons_CDC | ||||||
| Other reason patient did not receive second dose | If the value specified in Reason patient is >= 6 years old and received one dose on or after 6th birthday but never received second dose is Other, indicate the reason (a reason other than those provided in the list). | |||||||
| Rash Onset Date | Date on which the physical manifestations of the illness—the rash—appeared | |||||||
| Rash Location | The distribution of the rash on the body | PHVS_RashDistribution_VZ | ||||||
| Dermatome | If a value of Focal is specified in the Rash Location field, enter the nerve where the rash occurred (lumbar or thoracic, with a number) | |||||||
| Location First Noted | If a value of Generalized is specified for the Rash Location field, choose location where rash was first noted (if any); if none of the specific choices in the list apply, choose Other. | PHVS_RashLocationFirstNoted_VZ | ||||||
| Other Generalized rash location | If a value of Other is specified in the Location First Noted, enter the location (i.e., the location where the rash was first noted is other than one of the values provided in the Location First Noted list) | |||||||
| Macules Present | If the value specified in Total Number of Lesions is < 50, indicate whether macules were present. | PHVS_YesNoUnknown_CDC | ||||||
| Number of Macules | If the value specified in Macules Present is Yes, indicate how many macules were present. | |||||||
| Papules Present | If the value specified in Total Number of Lesions is < 50, indicate whether papules were present. | PHVS_YesNoUnknown_CDC | ||||||
| Number of Papules | If the value specified in Papules Present is Yes, indicate how many papules were present. | |||||||
| Vesicles Present | If the value specified in Total Number of Lesions is < 50, indicate whether vesicles were present. | PHVS_YesNoUnknown_CDC | ||||||
| Number of Vesicles | If the value specified in Vesicles Present is Yes, indicate how many vesicles were present. | |||||||
| Mostly macular/papular | Indicate whether the lesions were mostly macular/papular. | PHVS_YesNoUnknown_CDC | ||||||
| Mostly vesicular | Indicate whether the lesions were mostly vesicular. | PHVS_YesNoUnknown_CDC | ||||||
| Hemorrhagic | Indicate whether the rash was hemorrhagic. | PHVS_YesNoUnknown_CDC | ||||||
| Itchy | Indicate whether the patient complained of itchiness. | PHVS_YesNoUnknown_CDC | ||||||
| Scabs | Indicate whether there were scabs. | PHVS_YesNoUnknown_CDC | ||||||
| Crops/Waves | Indicate whether the lesions appeared in crops or waves. | PHVS_YesNoUnknown_CDC | ||||||
| Did rash crust | Indicate whether the rash crusted. | PHVS_YesNoUnknown_CDC | ||||||
| Number of Days until lesions crusted over | If the value specified in Did the rash crust? is Yes, enter the number of days that transpired for all of the lesions to crust over. | |||||||
| Number of Days rash lasted | If the value specified in Did the rash crust? is No, enter the number of days that the rash was present. | |||||||
| Fever | Indicate whether the patient had a fever during the course of the illness. | PHVS_YesNoUnknown_CDC | ||||||
| Fever Onset Date | If the value specified in Did patient have fever? is Yes, indicate the date when the fever began. | |||||||
| Highest measured temperature | If the value specified in Did patient have fever? is Yes, indicate the highest temperature that was measured. | |||||||
| Temperature Units | Temperature Units (Fahrenheit or Celsius). | PHVS_TemperatureUnit_UCUM | ||||||
| Fever Duration in Days | If the value specified in Did patient have fever? is Yes, indicate the number of days for which the patient had a fever. | |||||||
| Is patient immunocompromised due to medical condition or treatment | Indicate whether the patient was immunocompromised (anergic). | PHVS_YesNoUnknown_CDC | ||||||
| Medical Condition or Treatment | If Yes, indicate the medical condition or treatment associated with the patient being immunocompromised | |||||||
| Did patient visit a healthcare provider during this illness | Indicate whether the patient visited a healthcare provider during the course of this illness. | PHVS_YesNoUnknown_CDC | ||||||
| Did patient develop any complications that were diagnosed by a healthcare provider? | If the value specified in Did patient visit a healthcare provider during this illness? is Yes, indicate whether the patient developed complications (as described). | PHVS_YesNoUnknown_CDC | ||||||
| Skin/soft tissue infection | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was skin or soft tissue infection. | PHVS_YesNoUnknown_CDC | ||||||
| Cerebellitis/ ataxia | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was cerebellitis/ataxia. | PHVS_YesNoUnknown_CDC | ||||||
| Encephalitis | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was encephalitis. | PHVS_YesNoUnknown_CDC | ||||||
| Dehydration | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether the patient was diagnosed as being dehydrated. | PHVS_YesNoUnknown_CDC | ||||||
| Hemorrhagic condition | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there was hemorrhagic condition. | PHVS_YesNoUnknown_CDC | ||||||
| Pneumonia | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether pneumonia was a complication. | PHVS_YesNoUnknown_CDC | ||||||
| How was pneumonia diagnosed | If the value in Pneumonia? is Yes, indicate how the pneumonia was diagnosed. | PHVS_DiagnosedPneumoniaBy_VZ | ||||||
| Other complications | If the value specified in Did patient develop any complications that were diagnosed by a healthcare provider? is Yes, indicate whether there were other complications not cited here. | PHVS_YesNoUnknown_CDC | ||||||
| Other complication details | If the value specified in Other Complications? Is Yes, list the other complication(s) | |||||||
| Antiviral treatment | Indicate whether the patient was treated with acyclovir, famvir, or any licensed antiviral. | PHVS_YesNoUnknown_CDC | ||||||
| Name of medication | If the value specified in Antiviral? is yes, list the name of the medication. | PHVS_MedicationReceived _VZ | ||||||
| Name of the Medication if ‘Other’ | If Name of Medication is ‘other’, indicate name of medication | |||||||
| Start Date of Medication | Start date of medication. | |||||||
| Stop Date of medication | Stop date of medication. | |||||||
| Autopsy performed | If a value of Yes is specified in Did the patient die from this illness or complications associated with this illness?, indicate whether an autopsy was performed for the death. | PHVS_YesNoUnknown_CDC | ||||||
| Cause of death | If a value of Yes is specified in Did the patient die from this illness or complications associated with this illness?, indicate the official cause of death. | |||||||
| Diagnosed with Varicella before | Indicate whether the patient has a prior diagnosis of varicella. | PHVS_YesNoUnknown_CDC | ||||||
| Age at diagnosis | Age at diagnosis | |||||||
| Age at diagnosis units | Age at diagnosis units | PHVS_AgeUnit_UCUM | ||||||
| Previous Case Diagnosed by | Indicate who diagnosed the illness; if none of the choices apply choose Other. | PHVS_Diagnosed_By_VZ | ||||||
| Previous Case Diagnosed by Other | If the value specified in Previous Case Diagnosed by is Other, indicate who diagnosed the case | |||||||
| Is this case epi-linked to another confirmed or probable case | Indicate whether this case is epi-linked to another case (confirmed or probable). | PHVS_YesNoUnknown_CDC | ||||||
| Type of case this case is epi-linked to | If the value specified in Is this case epi-linked to another confirmed or probable case? is Yes, indicate the kind of case with which the current case is epi-linked. | PHVS_EpilinkedCaseType_VZ | ||||||
| Transmission setting (setting of exposure) | Location where the patient was exposed to the illness; if none of the specific choices in the list apply, choose Other. | PHVS_TransmissionSetting_NND | ||||||
| Other transmission setting | If the value specified in Transmission Setting? is Other, describe the other transmission setting. | |||||||
| Is this case a healthcare worker | Indicate whether the patient who is the subject of the current case is a healthcare worker. | PHVS_YesNoUnknown_CDC | ||||||
| Number of weeks gestation | If the patient was pregnant during the illness, indicate the number of weeks of gestation at the onset of the illness. | |||||||
| Trimester | If the patient was pregnant during the illness, indicate the trimester at the onset of the illness. | PHVS_PregnancyTrimester_CDC | ||||||
| Was laboratory testing done for varicella? | Was laboratory testing done for varicella? | PHVS_YesNoUnknown_CDC | ||||||
| Direct fluorescent antibody (DFA)? | Was direct fluorescent antibody (DFA) testing performed? | PHVS_YesNoUnknown_CDC | ||||||
| Date of DFA | Date of DFA | |||||||
| DFA Result | DFA Result | PHVS_LabTestInterpretation_CDC | ||||||
| PCR specimen? | PCR specimen? | PHVS_YesNoUnknown_CDC | ||||||
| Date of PCR specimen | Date of PCR specimen | |||||||
| Source of PCR specimen | Source of PCR specimen | PHVS_PCRSpecimenSource_VZ | ||||||
| Specify other PCR source | Specify other PCR source | |||||||
| PCR Result | PCR Result | PHVS_LabTestInterpretation_CDC | ||||||
| Specify other PCR result | Specify other PCR result | |||||||
| Culture performed? | Culture performed? | PHVS_YesNoUnknown_CDC | ||||||
| Date of Culture Specimen | Date of Culture Specimen | |||||||
| Culture Result | Culture Result | PHVS_LabTestInterpretation_CDC | ||||||
| Was other laboratory testing done? | Was other laboratory testing done? | PHVS_YesNoUnknown_CDC | ||||||
| Specify Other Test | Specify Other Test | PHVS_LabTestMethod_VZ | ||||||
| Date of Other test | Date of Other test | |||||||
| Other Lab Test Result | Other Lab Test Result | PHVS_LabTestInterpretation_CDC | ||||||
| Other Test Result Value | Other Test Result Value | |||||||
| Serology performed? | Serology performed? | PHVS_YesNoUnknown_CDC | ||||||
| IgM performed? | IgM performed? | PHVS_YesNoUnknown_CDC | ||||||
| Type of IgM Test | Type of IgM Test | PHVS_IgMTestType_VZ | ||||||
| Specify Other IgM Test | Specify Other IgM Test | |||||||
| Date IgM Specimen Taken | Date IgM Specimen Taken | |||||||
| IgM Test Result | IgM Test Result | PHVS_LabTestInterpretation_CDC | ||||||
| IgM Test Result Value | IgM Test Result Value | |||||||
| IgG performed? | IgG performed? | PHVS_YesNoUnknown_CDC | ||||||
| Type of IgG Test | Type of IgG Test | PHVS_IgGTestType_VZ | ||||||
| If "Whole Cell ELISA," specify manufacturer | If "Whole Cell ELISA," specify manufacturer | PHVS_WholeCellELISAManufacturer_VZ | ||||||
| If "gp ELISA" specify manufacturer | If "gp ELISA" specify manufacturer | PHVS_gpELISAManufacturer_VZ | ||||||
| Specify Other IgG Test | Specify Other IgG Test | |||||||
| Date of IgG - Acute | Date of IgG - Acute | |||||||
| IgG - Acute Result | IgG - Acute Result | PHVS_LabTestInterpretation_CDC | ||||||
| IgG - Acute Test Result Value | IgG - Acute Test Result Value | |||||||
| Date of IgG - Convalescent | Date of IgG - Convalescent | |||||||
| IgG - Convalescent Result | IgG - Convalescent Result | PHVS_LabTestInterpretation_CDC | ||||||
| IgG - Convalescent Test Result Value | IgG - Convalescent Test Result Value | |||||||
| Were the specimens sent to the CDC for genotyping (molecular typing)? | Were the specimens sent to the CDC for genotyping (molecular typing)? | PHVS_YesNoUnknown_CDC | ||||||
| Date sent for genotyping | Date sent for genotyping | |||||||
| Was specimen sent for strain (wild- or vaccine-type) identification? | Was specimen sent for strain (wild- or vaccine-type) identification? | PHVS_YesNoUnknown_CDC | ||||||
| Strain Type | Strain Type | PHVS_StrainType_VZ | ||||||
| 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. | |||||||
| Case Investigation Status Code | Case Investigation Status Code, from NBS MM | |||||||
| Vaccinated per ACIP recommendations | Was subject vaccinated as recommended by ACIP? | |||||||
| Reason not vaccinated per ACIP recommendations | Reason subject not vaccinated as recommended by ACIP | |||||||
| Reason not vaccinated per ACIP, Other | If other, specify reason not vaccinated per ACIP | |||||||
| Treatment duration | Number of days antiviral taken | |||||||
| Specimen Description | Text description of the specimen | |||||||
| Test Type, other | If other, specify lab test | |||||||
| Specimen sent to CDC | Was a specimen sent to CDC for testing? | |||||||
| Type of testing at CDC | What type of testing was done at CDC for this subject? | |||||||
| Type of testing at CDC, other | If other, specify testing done at CDC | |||||||
| Date specimen sent to CDC | Date specimen sent to CDC | |||||||
| Patient Address City | Patient address city, from NBS MM | |||||||
| Vaccine Administered Product Type, Other | If other, specify type of vaccine administered | |||||||
| Vaccine Product Manufacturer, Other | If other, specify vaccine manufacturer | |||||||
| Date of last dose prior to illness onset | Date of last disease-containing vaccination dose prior to illness onset | |||||||
| Vaccination doses prior to onset | Number of disease-containing vaccination doses prior to illness onset | |||||||
| Vaccination Record ID | Vaccination Record ID, from NBS MM | |||||||
| Vaccine Expiration Date | Vaccine expiration date | |||||||
| NDC Brand Name/Bar Code information | NDC from the vaccine's bar code. With the NDC code, vaccine brand name and manufacturer can be obtained. | |||||||
| Vaccine dose number | Indicates the dose number in a series_x000D_ |
|||||||
| Vaccine Event information source | Indicates whether the vaccine was administered by the provider organization recording the immunization or obtained from a historical record | |||||||
| Immunization Schedule used | Identifies the schedule used for immunization evaluation and forecast. | |||||||
| Exemption/refusal reason | Indicates the reason the patient is either exempt from the immunization or refuses the immunization | |||||||
| Laboratory Confirmed | Was the case laboratory confirmed? | |||||||
| Performing Laboratory Type | Performing laboratory type | |||||||
| Performing Laboratory Type, Other | If other, specify performing laboratory type | |||||||
| VPD Lab Message Patient Identifier | VPD Lab Message Patient Identifier | |||||||
| VPD Lab Message Observation Identifier | VPD Lab Message Observation Identifier | |||||||
| VPD Lab Message Observation Value | VPD Lab Message Observation Value | Drag | ||||||
| Specimen Collection Date | Date of specimen collection | |||||||
| Specimen Source | The medium from which the specimen originated | |||||||
| Numeric Test Result | Numeric quantitative result of the test(s) performed for this case | |||||||
| Numeric Test Result Units | Numeric quantitative result unit of the test(s) performed for this case | |||||||
| Chest X-ray result | Chest X-ray result | |||||||
| Was the rash generalized | Was the rash generalized | |||||||
| Reason for Hospitalization | If the subject was hospitalized because of this event, indicate the reason(s). |
| Label/Short Name | Description | Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) | CDC Priority (Legacy) | CDC Priority (New) |
| 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 | |||
| 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 | |||
| Culture Confirmation | Was Vibrio confirmed by culture? | |||
| CIDT Results | Was there a positive CIDT result? | |||
| CIDT Species Results | Name of species identified by CIDT | |||
| CIDT Test Name | Name of CIDT test used if applicable | |||
| Dining Partner Seafood Consumption | Did dining partners consume same seafood? | |||
| Ill Dining Partners | Did dining partners who consumed the same seafood become ill? | |||
| Exposure related to occupation | Was your exposure related to your occupation? | |||
| 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) | CDC Priority (Legacy) | CDC Priority (New) |
| VSPB Epi-Number | VSPB Epi-Number | N/A | 1 | |
| DGMQ ID | DGMQ ID | N/A | 2 | |
| Physician Name | Physician name | N/A | 3 | |
| Physician Email | Physician email | N/A | 3 | |
| Physician Phone | Physician phone | N/A | 3 | |
| How was the case identified | How was the case identified? | TBD | 3 | |
| How was the case identified, other | How was the case identified, other? | TBD | 3 | |
| Detailed Ethnic Group | Other ethnicity | TBD | 3 | |
| Resident of the United States | Is the patient a resident of the United States? | PHVS_YesNoUnknown_CDC | 2 | |
| Non-US city of residence | Non-US city of residence | N/A | 2 | |
| Non-US district of residence | Non-US district of residence | N/A | 2 | |
| Signs and Symptoms | Signs and symptoms associated with the illness being reported | TBD | 3 | |
| Signs and Symptoms Indicator | Indicator for associated sign and symptom | PHVS_YesNoUnknown_CDC | 2 | |
| Temperature Units | Celsius or Fahrenheit? | TBD | 2 | |
| Signs and Symptoms Onset Date | Signs and Symptoms Onset date | N/A | 2 | |
| Signs and Symptoms Onset Date Unknown | Signs and Symptoms Onset Date, Unknown | N/A | 2 | |
| Other Signs and Symptoms, Specify | Other symptom specify | N/A | 2 | |
| Other Signs and Symptoms Onset Date | Other symptom onset date | N/A | 2 | |
| Other Signs and Symptoms Onset Date Unknown | Other symptom onset date, unknown | N/A | 2 | |
| Additional Sign or Symptom | Do you have another symptom to enter? | PHVS_YesNoUnknown_CDC | 2 | |
| Pregnancy Length | Pregnancy length | N/A | 2 | |
| Pregnancy Length Indicator | Pregnancy length - weeks or months | TBD | 2 | |
| Breastfeeding | Breastfeeding | PHVS_YesNoUnknown_CDC | 2 | |
| Malaria Test Performed | Has malaria testing been performed? | PHVS_YesNoUnknown_CDC | 2 | |
| Malaria Test Type | Type of malaria test | TBD | 2 | |
| Other Malaria Test Type | Other type of malaria test | N/A | 2 | |
| Malaria Test Result | Malaria test result | TBD | 2 | |
| Malaria species associated with previous illness | Malaria species | TBD | 2 | |
| Location of Death, City | Location of death, city | N/A | 1 | |
| Location of Death, State | Location of death, state | PHVS_State_FIPS_5-2 | 1 | |
| Was An Autopsy Performed | Was an autopsy or other medical examination performed on the body? | PHVS_YesNoUnknown_CDC | 2 | |
| Date of Autopsy | Autopsy date | N/A | 2 | |
| Disposition of Body | Final disposition of the body | TBD | 2 | |
| Cremation Date | Cremation date | N/A | 2 | |
| Cremation Date Unknown | Cremation date unknown | N/A | 2 | |
| Burial Date | Burial date | N/A | 2 | |
| Burial Date Unknown | Burial date unknown | N/A | 2 | |
| Hospital Name | Hospitalization facility name | N/A | 2 | |
| City of Treatment Hospital | Hospitalization facility city | N/A | 2 | |
| State of Treatment Hospital | Hospitalization facility state | PHVS_State_FIPS_5-2 | 2 | |
| Patient Transport | How was the patient transported? | TBD | 2 | |
| Patient Transport Other | How was the patient transported, other? | N/A | 2 | |
| Isolation Precautions | Was the patient managed under isolation precautions? | PHVS_YesNoUnknown_CDC | 1 | |
| Isolation Date | Isolation date | N/A | 1 | |
| Isolation Type | Isolation precaution types | TBD | 1 | |
| Isolation Type Other | Other isolation precaution | N/A | 1 | |
| Travel to Ebola-affected Country/Region | Did the patient travel to an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Travel Country | Travel country | PHVS_Country_ISO_3166-1 | 1 | |
| Travel City | Travel city | N/A | 1 | |
| Travel District/County | Travel district/county | N/A | 1 | |
| Date of Arrival to Travel Destination | Travel start date | N/A | 1 | |
| Date of Departure from Travel Destination | Travel end date | N/A | 1 | |
| Reason(s) for Travel | Nature of travel | N/A | 2 | |
| Travel for Medical/Relief Organization | Medical/relief organization | TBD | 2 | |
| Reason for Travel Other | Other nature of travel reason | N/A | 2 | |
| Contact with Ebola Case | Has the patient had contact with a symptomatic Ebola case (suspect or confirmed), or Ebola survivor in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Contact with Ebola Case Start Date | Contact with EVD case start date | N/A | 1 | |
| Contact with Ebola Case End Date | Contact with EVD end date | N/A | 1 | |
| Ebola Contact Type | Nature of contact with EVD case | N/A | 2 | |
| Other Ebola Contact Type | Other type of contact with EVD case | N/A | 2 | |
| Provide Care for Ebola Patient | Did the patient care for someone who was sick or died while in an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Provide Care for Ebola Patient Start Date | Care for sick person start date | N/A | 1 | |
| Provide Care for Ebola Patient End Date | Care for sick person end date | N/A | 1 | |
| Contact Type | Nature of contact with ill person | TBD | 2 | |
| Other Contact Type | Other type of contact with ill person | N/A | 2 | |
| Visit Healthcare Facility | Did the patient visit a healthcare facility or traditional healer (witch doctor) while in an Ebola-affected country/region in the three weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Healthcare Facility Name | Healthcare facility name | N/A | 2 | |
| Country of Healthcare Facility Outside the US | Healthcare facility country | PHVS_Country_ISO_3166-1 | 1 | |
| City of Healthcare Facility | Healthcare facility city | N/A | 2 | |
| District/County of Healthcare Facility | Healthcare facility district/county | N/A | 2 | |
| Date Arrived at Healthcare Facility | Healthcare facility admission date | N/A | 2 | |
| Date Departed Healthcare Facility | Healthcare facility discharge date | N/A | 2 | |
| Healthcare Facility Reason Visited | Healthcare facility reason for visit | TBD | 2 | |
| Healthcare Facility Reason Visited Other | Healthcare facility other reason for visit | N/A | 2 | |
| Enter Another Healthcare Facility | Do you want to enter another facility? | PHVS_YesNoUnknown_CDC | 2 | |
| Attend Funeral in Ebola-affect Country/Region | Did the patient attend a funeral in an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Funeral Location Country | Funeral location country | PHVS_Country_ISO_3166-1 | 1 | |
| Funeral Location City | Funeral location city | N/A | 2 | |
| Funeral Location District | Funeral location district | N/A | 2 | |
| Funeral Start Date | Start date of funeral | N/A | 2 | |
| Funeral End Date | End date of funeral | N/A | 2 | |
| Participate in Funeral Practices | Did the patient participate in burial practices (touch the body, wash the body, wash clothes of the deceased)? | PHVS_YesNoUnknown_CDC | 1 | |
| Animal Contact Indicator | Did the patient have any animal contact in an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Animal Contact Type | Species of animal contact | TBD | 1 | |
| Animal Contact Type Other | Other species of animal contact | N/A | 3 | |
| Animal Contact Start Date | Start date of animal contact | N/A | 2 | |
| Animal Contact End Date | End date of animal contact | N/A | 2 | |
| Activity Type | Nature of animal contact | N/A | 2 | |
| Sick Animal | Did the animal display any symptoms of illness or was the animal dead? | PHVS_YesNoUnknown_CDC | 1 | |
| Consumed Meat from Ebola-affected Country/Region | Did the patient consume any meat harvested from wild animals in an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Last Date of Wild Animal Meat Contact | Last date of patient contacting meat harvested from wild animals | N/A | 2 | |
| Type of Wild Animal Meat | Type of meat harvested from wild animals | TBD | 1 | |
| Other Type of Wild Animal Meat | Other type of meat harvested from wild animals | N/A | 3 | |
| Time Spent in Mine/Cave | Did the patient work or spend time in a mine/cave in an Ebola-affected country/region in the 3 weeks before becoming ill? | PHVS_YesNoUnknown_CDC | 1 | |
| Mine Location Country | Mine country | PHVS_Country_ISO_3166-1 | 2 | |
| Mine Location District/City | Mine district/city | N/A | 2 | |
| Last Date in Mine | Last date in mine | N/A | 2 | |
| Performing Laboratory City | Performing Laboratory City | N/A | 2 | |
| State of Facility | State of Facility | PHVS_State_FIPS_5-2 | 2 | |
| Performing Person Phone | Performing Person Phone | N/A | 2 | |
| Laboratory Email | Laboratory Email | N/A | 2 | |
| Non-CDC Laboratory Type | Non-CDC Laboratory Type | TBD | 1 | |
| Other Non-CDC Laboratory Type | Other Non-CDC Laboratory Type | N/A | 1 | |
| Performing Laboratory Location | Performing Laboratory Location | N/A | 1 |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |