States - One time addition of diseases and data elements

[CSELS] National Notifiable Diseases Surveillance System (NNDSS)

Att 10 - Disease-Specific Data_2023.xlsx

States - One time addition of diseases and data elements

OMB: 0920-0728

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Overview

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


Sheet 1: General

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







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


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


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


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



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


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


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


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


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



1/20/2023


Sheet 2: Alpha-gal Syndrome

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

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

Sheet 3: Animal Rabies

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

Sheet 4: Anthrax

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Case Class Status Code Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. PHVS_CaseClassStatus_NND

Case Status Determined How was the case status determined, from "Laboratory Results", "Clinical Presentation", "Epi Link"


State State reporting case PHVS_State_FIPS_5-2

State Case ID States use this field to link NEDSS investigations back to their own state investigations.


Date State Notified Date State Notified


County reporting the case County reporting the case PHVS_County_FIPS_6-4

Date local health department notified Date local health department notified


Person Reporting to CDC - Name Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Person Reporting to CDC - Phone Number Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Treating HCP Name of the treating health care provider of the subject


HCP Phone Telephone number of the treating health care provider of the subject


MMWR year MMWR year of report


Event date Event Date ( earliest date associated with case)


Event Type Event Type from "Date Onset", "Date Diagnosis", "Date State Notified", "Date LHD notified", "Date Laboratory diagnosis"


Subject’s Sex Subject’s current sex PHVS_Sex_MFU

Pregnancy status Indicates whether the subject was pregnant at the time of the event. PHVS_YesNoUnknown_CDC

Date of Birth Birth Date (mm/yyyy)


Age at case investigation Subject age at time of case investigation


Age units at case investigation Subject age units at time of case investigation PHVS_AgeUnit_UCUM_NETSS

Country of usual residence Country of usual residence PHVS_CountryofBirth_CDC

Occupation Provide the subject's occupation


Date Onset Date Onset


Subject Address County County of residence of the subject PHVS_County_FIPS_6-4

Date Diagnosis Date Diagnosis


Clinical presentation Clinical Presentation (Cutaneus, Inhalation, Meningitis, GI/Oroph, Injection)


Hospitalized Was subject hospitalized because of this event? PHVS_YesNoUnknown_CDC

Final treatment place List the place of final treatment (only to be sent during a bioterrorism event)


Admission Date Subject’s first admission date to the hospital for the condition covered by the investigation.


ICU Was the subject admitted to Intensive Care Unit for any length of time? PHVS_YesNoUnknown_CDC

Mechanical ventilation Was the subject on mechanical ventilation for any length of time? PHVS_YesNoUnknown_CDC

AIG Did the subject receive Anthrax anti-toxin? PHVS_YesNoUnknown_CDC

Raxibacumab Did the subject receive raxibacumab? PHVS_YesNoUnknown_CDC

Outcome Clinical outcome of the patient ("Still hospitalized"; "Discharged"; "Died";"Other")


Discharge Date Subject's first discharge date from the hospital for the condition covered by the investigation.


Deceased Date If the subject died from this illness or complications associated with this illness, indicate the date of death


Autopsy If the subject died, was an autopsy performed? PHVS_YesNoUnknown_CDC

Reporting Lab Name Name of Laboratory that reported test result.


Date Laboratory diagnosis Date Laboratory diagnosis


Date Sample Received at Lab Date Sample Received at Lab (accession date).


Date of Acute Specimen Collection The date the acute specimen was collected.


Date of Convalscent Specimen Collection The date the convalscent specimen was collected.


Resulted Test Name The lab test that was run on the specimen PHVS_LabTestName_CDC

Numeric Result Results expressed as numeric value/quantitative result.


Result Units The unit of measure for numeric result value. PHVS_UnitsOfMeasure_CDC

Coded Result Value Coded qualitative result value (e.g., Positive, Negative). PHVS_PosNegUnk_CDC

Organism Name The organism name as a test result. This element is used when the result was reported as an organism. PHVS_Microorganism_CDC

Lab Result Text Value Textual result value, used if result is neither numeric nor coded.


Result Status The Result Status is the degree of completion of the lab test. PHVS_ObservationResultStatus_HL7_2x

Specimens to CDC Were specimens or isolates sent to CDC for testing? PHVS_YesNoUnknown_CDC

Interpretation Flag The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low. PHVS_AbnormalFlag_HL7_2x

Exposure event If participated in a documented exposure event, give the name or location


Exposure response Participated in exposure response? PHVS_YesNoUnknown_CDC

Exposure to animals Exposure to livestock/ wild mammals/ their body fluids? PHVS_YesNoUnknown_CDC

Exposure to animals products Exposure to animal products? PHVS_YesNoUnknown_CDC

Contact with undercooked meat Consumed or contact with undercooked or raw meat? PHVS_YesNoUnknown_CDC

Gardened Gardened or other work with soil? PHVS_YesNoUnknown_CDC

Bone meal If yes, was bone meal fertilizer or similar used? PHVS_YesNoUnknown_CDC

Laboratory work Worked in a clinical or microbiological laboratory? PHVS_YesNoUnknown_CDC

Unknown powder Exposed to unknown powder? PHVS_YesNoUnknown_CDC

Suspicious mail Handled suspicious mail? PHVS_YesNoUnknown_CDC

Similar illness Undiagnosed similar illness in friends, family, coworkers, or other contacts? PHVS_YesNoUnknown_CDC

Similar food contact Consumed same food/drink as lab-confirmed anthrax case? PHVS_YesNoUnknown_CDC

Similar exposures Exposed to the same environment, animal, or objects as a lab-confirmed anthrax case? PHVS_YesNoUnknown_CDC

Illicit drugs Contact with illicit drugs? PHVS_YesNoUnknown_CDC

Received injection Received an injection? PHVS_YesNoUnknown_CDC

Took public transportation Took public transportation? PHVS_YesNoUnknown_CDC

Transportation type If Took public transportation is "Yes", what form of transportation did the subject take ("Bus"; "Train";"Light rail"; "Subway"; "Ferry"; "Other")


Other transportation If the patient took Other form of public transportation, describe


Attended gathering Attended a large gathering (e.g., concert, sporting event)? PHVS_YesNoUnknown_CDC

Congregate Attended a place where people congregate (e.g., shopping mall, relgious services)? PHVS_YesNoUnknown_CDC

Travel Traveled out of county, state, or country? PHVS_YesNoUnknown_CDC

Latitude Latitude of suspected exposure location (only to be sent during a bioterrorism event)


Longitude Longitude of suspected exposure location (only to be sent during a bioterrorism event)


Vaccine Was anthrax vaccine received? PHVS_YesNoUnknown_CDC

Vaccine received If anthrax vaccine received is "Yes", specify what was received from "Post-exposure vaccine (1,2,or 3 doses)", "Partial series of pre-exposure vaccine", "Full series of pre-exposure vaccine"


Vaccine dose If anthrax vaccine received is "Yes" specify the number of doses received or vaccination status, from "1", "2", "3", "<5", "Outdated on annual boosters", "Fully updated on annual boosters", "Unknown"


Post exposure antibiotics Received Post-Exposure Antibiotics PHVS_YesNoUnknown_CDC

Antibiotics not taken Antibiotics not taken or discontinued? PHVS_YesNoUnknown_CDC

Antibiotics not taken specify If Antibiotics were not taken or were discontinued is "Yes", select the primary reason why they were not taken "Low perceived risk", "Adverse events", "Fear of side effects", "Other", "Unknown"


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

Sheet 5: Arboviral

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


Year Current year (new)


State State of residence


County County of residence


Week Week of report (new)


OnsetDate Date of onset of symptoms consistent with arboviral infection


ImportedFrom Likely location of acquisition of arboviral infection


CountryOfOrigin Country in which infection was likely acquired


StateOfOrigin State in which infection was likely acquired


ForeignResident (New)


Arbovirus Type of arboviral infection


CaseStatus Case classification according to CDC/CSTE surveillance case definitions


Age Age at time of case investigation


AgeUnit Age units


BirthDate Date of Birth


Sex Current sex


Race Race


Ethnicity Ethnicity


ClinicalSyndrome General clinical presentation


Fever Clinical Sign/Symptom


Headache Clinical Sign/Symptom


Rash Clinical Sign/Symptom


NauseaVomiting Clinical Sign/Symptom


Diarrhea Clinical Sign/Symptom


Myalgia Clinical Sign/Symptom


ArthralgiaArthritis Clinical Sign/Symptom


ParesisParalysis Clinical Sign/Symptom


StiffNeck Clinical Sign/Symptom


AlteredMentalStatus Clinical Sign/Symptom


Seizures Clinical Sign/Symptom


StateLocalPublicHealthLab Testing performed at:


CDCLab Testing performed at:


CommercialLab Testing performed at:


Serum1Collected Was Serum1 collected?


Serum1CollectedDate When was Serum1 collected?


Serum2Collected Was Serum2 collected?


Serum2CollectedDate When was Serum2collected?


CSFCollected Was CSF collected?


CSFCollectedDate When was CSF collected?


CSFPLeocytosis



SerumIgM



SerumPRNT



SerumPCRorNAT



SerumPairedAntibody



CSFIgM



CSFPRNT



CSFPCRorNAT



Hospitalized Patient was hospitalized as a result of arboviral illness


Fatality Patient died as a result of arboviral infection


DateOfDeath Date of death


LabAcquired Patient likely acquired infection due to occupational exposure in a laboratory setting


NonLabAcquired Patient likely acquired infection due to occupational exposure in a non-laboratory setting


BloodDonor Patient donated blood within 30 days prior to illness onset


BloodTransfusion Patient received a blood transfusion within 30 days prior to illness onet


OrganDonor Patient donated a solid organ within 30 days prior to illness onset


OrganTransplant Patient received a solid organ transplant within 30 days prior to illness onset


BreastFedInfant Patient was a breastfed infant at time of illness onset


InfectedInUteroOrPerinatal Patient likely acquired infection in utero or perinatal


Pregnant Patient acquired infection during pregnancy


AFP Patient suffered acute flaccid paralysis


IdentifiedByBloodDonorScreening Infection identified through blood donor screening


DateOfDonation Date of blood donation


LabTestingBy Source of diagnostic testing


TransmissionOrigin



TransmissionMode



BloodTissueBorneTransmission



DomesticTravelDestinationLast



DomesticTravelDestination2ndLast



DomesticTravelDestination3rdLast



ForeignTravelDestinationLast



ForeignTravelDestination2ndLast



ForeignTravelDestination3rdLast



DateUSReturn



DurationDaysTravelOutsideUS



ReasonTravel



PreTravelHealthConsultation



CountryBirth



ResidenceStatus



DurationMonthsVisitOrLiveUS



MilitaryStatus



ClinicalSyndrome2



DurationDaysHospitalized



ICUAdmission



SevereEncephalitis



SevereSeizure



SevereMeningitis



SevereAcuteFlaccidParalysis



SevereGuillainBarreSyndrome



SevereHemorrhageShock



SeverePlasmaLeakage



SevereAcuteLiverFailure



SevereAcuteMyocarditis



SevereMultiSystemOrganFailure



SevereOtherSevereSigns



SevereUnknown



PreExistingAsthma



PreExistingChronicHeart



PreExistingChronicLiver



PreExistingChronicRenal



PreExistingDiabetesMellitus



PreExistingSickleCell



PreExistingHyperlipidemia



PreExistingHypertension



PreExistingObesity



PreExistingPregnancy



PreExistingThyroidDisease



PreExistingOther



PreExistingUnknown



S1DENVCollected



S1DENVCollectedDate



S1IgMAntiDENV



S1MolecularDENV



S1OtherDENVMethod



S1OtherDENVResult



S2DENVCollected



S2DENVCollectedDate



S2IgMAntiDENV



S2MolecularDENV



S2OtherDENVMethod



S2OtherDENVResult



OtherSpecCollected



OtherSpecType



OtherSpecCollectedDate



OtherSpecDENVMethod



OtherSpecDENVResult



DENVSeroType



Published



FeverMedication Did patient receive medication for fever?


ImmuneSuppressTreatment Is patient on immunosuppressive therapy?


ImmuneSuppressCondition Does patient have an immunosuppressive condition?


ImmuneSuppressDesc Description of immunosuppressive condition


OtherAfebrileCause Other afebrile causes


ChillsRigors Did patient have chills or rigors?


FatigueMalaise Did patient exhibit fatigue or malaise?


Ataxia Did patient have ataxia?


ParkinsonismCogwheel Was Parkinsonism cogwheel rigidity present?


SevereShock Did patient exhibit severe shock?


SevereHemorrhage Did patient have severe hemorrhaging?


OtherSymptoms Other symptoms of interest


Arthralgia Did patient exhibit arthralgia?


Arthritis Did patient exhibit arthritis?


Conjunctivitis Did the patient have conjunctivitis?


RetroOrbitalPain Did the patient have retro orbital pain?


TourniquetTestPositive Did the patient have a tourniquet test positive?


Leukopenia Did the patient have leukopenia?


AbdominalPainTenderness Did the patient have abdominal pain tenderness?


PersistingVomiting Did the patient have persisting vomiting?


ExtravascularFluidAccumulation Did the patient have extravascular fluid accumulation?


MucosalBleeding Did the patient have mucosal bleeding?


LiverEnlargement Did the patient have liver enlargement?


IncreasingHematocritDecPLT Did the patient have increasing hematocrit dec PLT?


SevereBleeding Did the patient have severe bleeding?


SevereOrganInvolvement Did the patient have severe organ involvement?


Mother-Infant Case ID Linkage Mother and infant case IDs


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


Pregnancy Complications Complications of pregnancy


Pregnancy Outcome Pregnancy outcomes


Newborn Complications Compliations for newborn


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


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

Sheet 6: Babesiosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Date Submitted Date the case report form (extended variables) was submitted to CDC


Clinician Name Name of treating clinician


Clinician Phone Phone number for treating clinician


Symptomatic Was the case-patient symptomatic? PHVS_YesNoUnknown_CDC

ClinicalManifestation Did the case-patient have any clinical manifestations of babesiosis? PHVS_YesNoUnknown_CDC

Asplenic Is the case-patient asplenic? PHVS_YesNoUnknown_CDC

Reason for Splenectomy Why was the case-patient's spleen removed?


Date of Splenectomy Date of splenectomy


Symptoms Indicate case-patient's signs and symptoms


Symptom Fever Did the case-patient have a fever? PHVS_YesNoUnknown_CDC

Temperature If fever was indicated, specify temperature (observation includes units)


Temperature Units If fever was indicated, specify Fahrenheit or Celsius PHVS_TemperatureUnit_UCUM

Symptom Headache Did the case-patient have a headache? PHVS_YesNoUnknown_CDC

Symptom Myalgia Did the case-patient have myalgia? PHVS_YesNoUnknown_CDC

Symptom Anemia Did the case-patient have anemia? PHVS_YesNoUnknown_CDC

Symptom Chills Did the case-patient have chills? PHVS_YesNoUnknown_CDC

Symptom Arthralgia Did the case-patient have arthralgia? PHVS_YesNoUnknown_CDC

Symptom Thrombocytopenia Did the case-patient have thrombocytopenia? PHVS_YesNoUnknown_CDC

Symptom Sweats Did the case-patient have sweats? PHVS_YesNoUnknown_CDC

Symptom Nausea Did the case-patient have nausea? PHVS_YesNoUnknown_CDC

Symptom Hepatomegaly Did the case-patient have hepatomegaly? PHVS_YesNoUnknown_CDC

Symptom Splenomegaly Did the case-patient have splenomegaly? PHVS_YesNoUnknown_CDC

Symptom Cough Did the case-patient have a cough? PHVS_YesNoUnknown_CDC

Symptoms Other Indicate any additional symptoms or clinical manifestations


Complications Select all complications


Risk Factor Immunosuppressed At the time of diagnosis, was the case-patient immunosuppressed? PHVS_YesNoUnknown_CDC

Risk Factor Immune Condition If the case-patient reported being immunosuppressed, what was the cause?


Hospitalization If the case-patient was hospitalized, indicate the length in days of the hospitalization.


Death Related to Babesiosis Was the case-patient's death related to the Babesia infection? PHVS_YesNoUnknown_CDC

Treatment Did the case-patient receive antimicrobial treatment for Babesia infection? PHVS_YesNoUnknown_CDC

Treatment Medications If the case-patient was treated, specify which drugs were administered.


Transfusion Associated Recipient Was the case-patient’s infection transfusion associated? PHVS_YesNoUnknown_CDC

Transfusion Associated Donor Was the case-patient a blood donor identified during a transfusion investigation? PHVS_YesNoUnknown_CDC

Outdoor Activities In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient engage in outdoor activities? PHVS_YesNoUnknown_CDC

Outdoor Activities Type Specify outdoor activities


Occupation Indicate case-patient's occupation


Wooded Areas In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient spend time outdoors in or near wooded or brushy areas? PHVS_YesNoUnknown_CDC

History of Babesiosis Does the case-patient have a previous history of babesiosis in the last 12 months (prior to this report)? PHVS_YesNoUnknown_CDC

Date of Previous Babesiosis Date of previous babesiosis diagnosis


Tick Bite In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient notice any tick bites? PHVS_YesNoUnknown_CDC

Tick Bite Date When did the tick bite occur (approximate dates accepted)?


Tick Bite Place Where (geographic location) did the tick bite occur (city, state, country)?


Travel In the eight weeks before symptom onset or diagnosis (use earlier date), did the case-patient travel (check all that apply)?


Travel Date When did the travel occur?


Travel Place Where did the case-patient travel (city, state, country)?


Infected In Utero Was the case-patient an infant born to a mother who had babesiosis or Babesia infection during pregnancy? PHVS_YesNoUnknown_CDC

Mother Test Positive After Delivery Did the case-patient's mother test positive for babesiosis after delivery? PHVS_YesNoUnknown_CDC

Mother Test Positive Before Delivery Did the case-patient's mother test positive for babesiosis before or at the time of delivery? PHVS_YesNoUnknown_CDC

Mother Confirmed Positive Date Date of mother's earliest positive test result


Blood Donor Screening Donors who have been identified as having a Babesia infection through routine blood donor screening (e.g., IND) by the blood collection agency. May or may not be symptomatic. PHVS_YesNoUnknown_CDC

Blood Donor Did the case-patient donate blood in the 8 weeks prior to onset? PHVS_YesNoUnknown_CDC

Date of Donation Date of blood donation(s)


Linked Recipient Was a transfusion recipient(s) identified for the case-patient's donation? PHVS_YesNoUnknown_CDC

Blood Recipient Did the case-patient receive a blood transfusion in the 8 weeks prior to onset? PHVS_YesNoUnknown_CDC

Date of Transfusion Date of blood transfusion(s)


Implicated Product If a blood product was implicated, specify which type of product.


Linked Donor Was a blood donor identified for the case-patient's transfusion? PHVS_YesNoUnknown_CDC

Organ Donor Did the case-patient donate an organ in the 30 days prior to onset? PHVS_YesNoUnknown_CDC

Organ Transplant Did the case-patient receive an organ in the 30 days prior to onset? PHVS_YesNoUnknown_CDC

Lab Test Indicate each test performed (repeat variables as necessary). PHVS_LabTestName_Babesiosis

Date of Specimen Collection Provide the date the specimen was collected


Lab Information on whether the specimen was tested in public health labs or exclusively in commercial laboratories.


Coded Result Coded qualitative result value (e.g., positive, negative). PHVS_PosNegUnkNotDone_CDC

Numeric Result Results expressed as numeric value/quantitative result (e.g., titer).


Babesia Species Provide species identified by the laboratory test (if applicable). PHVS_LabResult_Babesiosis

Parasitemia Estimated number of infected erythrocytes expressed as a percentage of the total erythrocytes.


Confirmed SPHL Was the diagnosis confirmed at the state public health laboratory? PHVS_YesNoUnknown_CDC

Date of Onset Approx If exact date of illness onset is not known, provide approximate date (mm/yyyy).


Date of Death Approx If exact date of death is not known, provide approximate date (mm/yyyy).


Date Approx Is the date provided an approximation? PHVS_YesNoUnknown_CDC

Case Classification Indicate the case classification status (confirmed, probable, suspect, unknown)


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

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

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

Sheet 7: Botulism

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

Sheet 8: Brucellosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Specimen Number A laboratory generated number that identifies the specimen related to this test.


Date First Submitted Date/time the notification was first sent to CDC. This value does not change after the original notification.


Case Outbreak indicator Denotes whether the reported case was associated with an identified outbreak. PHVS_YesNoUnknown_CDC

Source of Infection What is the source of infection from list "naturally-acquired", "lab-aquired", "bioterrorism"


Outbreak source If case outbreak indicator is "Yes", what was the common exposure source, including "Food consumption", "Occupational exposure", "Recreational exposure", "Family", "Close contact", "Sexual contact"


State Case ID States use this field to link NEDSS investigations back to their own state investigations.


Health care provider Health care provider name


Local Subject ID The local ID of the subject/entity.


Health care provider Health care provider phone number


Person Reporting to CDC - Name Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Person Reporting to CDC - Phone Number Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Subject Address State State of residence of the subject PHVS_State_FIPS_5-2

Subject Address County County of residence of the subject PHVS_County_FIPS_6-4

Age at case investigation Subject age at time of case investigation


Age units at case investigation Subject age units at time of case investigation PHVS_AgeUnit_UCUM_NETSS

Subject’s Sex Subject’s current sex PHVS_Sex_MFU

Pregnancy status Indicates whether the subject was pregnant at the time of the event. PHVS_YesNoUnknown_CDC

Country of Birth Country of Birth PHVS_CountryofBirth_CDC

Ethnic Group Code Based on the self-identity of the subject as Hispanic or Latino PHVS_EthnicityGroup_CDC_Unk

Race Category Field containing one or more codes that broadly refer to the subject’s race(s). PHVS_RaceCategory_CDC

Occupation Occupation of the case patient, from list "Animal Research", "Medical Research", "Dairy", "Laboratory", "Wildlife", "Rancher", "Slaughterhouse", "Tannery/rendering", "Veterinarian/Vet Tech", "Lives w/person of with an occupation listed here", "Other"


Case Class Status Code Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. PHVS_CaseClassStatus_NND

Stage of disease Stage of disease, inlcuding "Acute", "Subacute", "Chronic", "Unknown"


Fever Did patient have a fever? PHVS_YesNoUnknown_CDC

Fever onset date Onset date of fatigue


Maximum temperature Maximum temperature reported


Temperature Units Specify fahrenheit or celsius PHVS_TemperatureUnit_UCUM

Sweats Experienced sweats PHVS_YesNoUnknown_CDC

Sweats onset date Onset date of sweats


arthralgia Experienced arthralgia? PHVS_YesNoUnknown_CDC

arthragia onset date Onset date of arthralgia


headache Experienced headache PHVS_YesNoUnknown_CDC

headache onset date Onset date of headache


Fatigue Experienced fatigue PHVS_YesNoUnknown_CDC

Fatigue date of onset Onset date of fatigue


Anorexia Experienced anorexia PHVS_YesNoUnknown_CDC

Anorexia Onset date Onset date of anorexia


Myalgia Experienced myalgia PHVS_YesNoUnknown_CDC

Myalgia onset date Onset date of myalgia


weight loss Experienced weight loss PHVS_YesNoUnknown_CDC

weight loss onset date Onset date of weight loss


endocarditis Experienced endocarditis? PHVS_YesNoUnknown_CDC

endocarditis onset date Onset date of endocarditis


Orchitis Experienced orchitis PHVS_YesNoUnknown_CDC

Orchitis onset date Onset date of orchitis


Epididymitis Experienced epididymitis? PHVS_YesNoUnknown_CDC

Epididymitis onset date Onset date of epididymitis


Hepatomegaly Experienced hepatomegaly PHVS_YesNoUnknown_CDC

Hepatomegaly onset date Onset date of hepatomegaly


splenomegaly Experienced splenomegaly PHVS_YesNoUnknown_CDC

splenomegaly onset date Onset date of splenomegaly


Arthritis Experienced athritis? PHVS_YesNoUnknown_CDC

Arthritis onset date Onset date of arthritis


Meningitis Experienced meningitis PHVS_YesNoUnknown_CDC

Meningitis onset date Onset date of meningitis


spondylitis Experienced spondylitis PHVS_YesNoUnknown_CDC

spondylitis onset date Onset date of spondylitis


Symptoms Other Were other symptoms or signs experienced PHVS_YesNoUnknown_CDC

Symptoms Other details Describe other symptoms or signs experienced


Symptoms Other onset date Details of other symptoms experienced


Hospitalized Was subject hospitalized because of this event? PHVS_YesNoUnknown_CDC

Admission Date Subject’s first admission date to the hospital for the condition covered by the investigation.


Discharge Date Subject's first discharge date from the hospital for the condition covered by the investigation.


Subject Died Did the subject die from this illness or complications of this illness? PHVS_YesNoUnknown_CDC

Deceased Date If the subject died from this illness or complications associated with this illness, indicate the date of death


Treatment status Status of treatment at time of case notification ("Currently under treatment", "Completed treatment", "Not treated", "No Response")


Treated doxycycline treated with doxycycline? PHVS_YesNoUnknown_CDC

Dose of doxycycline dosage of doxycycline prescribed


Days of doxycycline days of doxycycline prescribed


Treated with rifampin treated with rifampin? PHVS_YesNoUnknown_CDC

dosage of rifampin dosage of rifampin prescribed


days of rifampin days of rifampin prescribed


Treated with streptomycin treated with streptomycin? PHVS_YesNoUnknown_CDC

dosage of streptomycin dosage of streptomycin prescribed


days of streptomycin days of streptomycin prescribed


treated with other drug 1 treated with other drug 1? PHVS_YesNoUnknown_CDC

name of other drug 1 If Other drug 1 is "Yes", list name of the drug


dose of other drug 1 If Other drug 1 is "Yes", list the prescribed dosage of this drug


Days other drug 1 If Other drug 1 is "Yes", list the prescribed duration of this drug


treated with other drug 2 treated with other drug 2? PHVS_YesNoUnknown_CDC

name of other drug 2 If Other drug 2 is "Yes", list name of the drug


dose of other drug 2 If Other drug 2 is "Yes", list the prescribed dosage of this drug


Days other drug 2 If Other drug 2 is "Yes", list the prescribed duration of this drug


treated with other drug 3 treated with other drug 3? PHVS_YesNoUnknown_CDC

name of other drug 3 If Other drug 3 is "Yes", list name of the drug


dose of other drug 3 If Other drug 3 is "Yes", list the prescribed dosage of this drug


Days other drug 3 If Other drug 3 is "Yes", list the prescribed duration of this drug


Travel In the 6 months prior to illness onset did the subject travel outside of the state of residence? PHVS_YesNoUnknown_CDC

travel location 1 Location of travel 1


Travel departure date 1 If traveled, departure date to first destination


Travel return date 1 If traveled, return date from first destination


travel location 2 Location of travel 2


Travel departure date 2 If traveled, departure date to second destination


Travel return date 2 If traveled, return date from second destination


Animal Contact In the 6 months prior to illness onset, did the subject have animal contact? PHVS_YesNoUnknown_CDC

Birthing product animal Which animal(s) did case patient have contact with birthing products ("Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other")


Birthing product animal other Other animal with which case patient had contact with birthing products


Skinning contact with animal Which animal did case patient have contact with skinning/slaughtering ("Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other")?


Skinning contact with other animal If animal skinned/slaughtered is "Other", describe which animal(s) the case patient had contact with


Hunt animal contact Which animal(s) did case patient hunt, from list "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Hunt other animal If type of animal hunted is "Other", specify the type(s) of animal(s) hunted


Animal Other Contact Type If Type of animal contact is "Other" describe the contact


Other Animal Contact If Type of animal contact is "Other", which animal did case patient have this type of contact including "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Other animal contact If Type of animal contact is "Other" and animal is "Other" which animal did case patient have this type of contact


Birthing product own animal If case patient had contact with birthing products, who owned the animal ("Case", " Private", " Wild", " Commercial", " Unknown")


Skinning contact owned Who owned the animal which the case patient had contact with skinning/slaughter ("Case", " Private", " Wild", " Commercial", " Unknown")


Hunt own animal Who owned the animal which the case patient had contact with hunting from list "Case", " Private", " Wild", " Commercial", " Unknown"


Other animal owned If animal contact type was "Other", describe who owned the animal from this contact, from list "Case", " Private", " Wild", " Commercial", " Unknown"


Consumed meat or dairy In the 6 months prior to illness onset, did the subject consume unpasteurized dairy or undercooked meat? PHVS_YesNoUnknown_CDC

Milk animal source If the subject consumed unpasteurized milk from which animal(s) "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Milk Animal other If milk animal source is "Other", describe which animal this milk product was from


Cheese Consumed fresh or soft cheese from which animal(s), including "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Other animal source of cheese If animal source of cheese is "Other", which animal(s) was the source of cheese


Meat animal source Consumed undercooked meat from which animal(s) "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Meat animal other If animal source of meat is "Other", list the animal source(s) from which the case patient consumed meat


Food product other If food product is "Other", describe other food consumed


Food product animal source If food product is "Other", select the animal sources of this food from list "Cow", "Pig", "Goat", "Sheep", "Dog", "Deer", "Bison", "Elk", "Other"


Food Animal other If food product and animal are "Other", describe which animal this other food was from


Milk source country Country milk was from, "U.S.", "Other"


Milk source other 1 If milk source country is "Other", list country PHVS_CountryofBirth_CDC

Milk source other 2 If milk source country is "Other", list country PHVS_CountryofBirth_CDC

Cheese source country Country where the cheese product was from. Notification types include "U.S.", "Other"


Country cheese was from 1 If cheese source country is "Other", list country PHVS_CountryofBirth_CDC

Country cheese was from 2 If cheese source country is "Other", list country PHVS_CountryofBirth_CDC

Meat source country Country meat was from, "U.S.", "Other"


Meat source other 1 If meat source country is "Other", list country PHVS_CountryofBirth_CDC

Meat source other 2 If meat source country is "Other", list country PHVS_CountryofBirth_CDC

Food product source country Country where the food product was from. Notification types include "U.S.", "Other"


Food source other 1 If food source country is "Other", list country PHVS_CountryofBirth_CDC

Food source other 2 If food source country is "Other", list country PHVS_CountryofBirth_CDC

Is this case epi-linked to a laboratory-confirmed case? Is this case epi-linked to a laboratory-confirmed case? PHVS_YesNoUnknown_CDC

Similar illness Similar illness in contact of the subject? PHVS_YesNoUnknown_CDC

Close contact If epi-link to a laboratory-confirmed case or similar illness in a close contact are "Yes", then select the relationship of the contact ("Household", "Neighbor", "Co-worker", "Other")


Close contact Other If Close Contact is "Other", then describe the relationship of the contact


Exposure to Brucella Was the case patient exposed to Brucella, from the list "Clinical specimen", "Isolate", "Vaccine", "Unknown"


Location of Exposure If Brucella exposure is selected, where did exposure occur, from list "Clinical", "Laboratory", "Farm/ranch", "Surgery", "Unknown", "Other"


Location of Exposure, other If location of exposure to Brucella is "Other", specify exposure location


Risk of exposure Exposure risk classificaiton ("high", "low", "Unknown")


Exposure to Brucella vaccine If case patient was exposed to "Vaccine", choose which vaccine patient was exposed to, from list "S19", "RB51", "Rev1", "Other"


PEP received Did the subject receive post exposure prophylaxis? PHVS_YesNoUnknown_CDC

no PEP was taken If the case-patient had a known eposure to Brucella and PEP was not taken, why not, from list "Unaware of exposure", "Unavailable", "Allergic", "Pregnant", "Unknown", "Other"


no PEP was taken other If no PEP taken reason was "Other", desribe the reason PEP was not taken


Complete PEP Did the patient complete PEP regimen ("Yes","No", "Unknown", "Partial"?


Partial PEP If PEP completed is "Partial", Explain why partial pep was taken


Earliest Date Reported to State Earliest date reported to state public health system


Reporting Lab Name Name of Laboratory that reported test result.


Reporting Lab City City location of Laboratory that reported test result.


Reporting Lab State State Laboratory that reported test result. PHVS_State_FIPS_5-2

Reporting Lab Zip Zip code of Laboratory that reported test result.


Received from Received from (e.g., lab name, clinician, etc)


Received city Received from city


Received state Received from state PHVS_State_FIPS_5-2

Date Sample Received at Lab Date Sample Received at Lab (accession date).


Agglutination test name Name of agglutination test used


Acute total titer Acute Total antibody titer


Convalscent total titer Convalscent Total antibody titer


Positive Result Based on the acute and covalscent titers for the agglutination test used, what is the result of the paired total antibody titers (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Agglutination cut off Cut off value of a positive result for the Agglutination test used


Acute IgG titer Agglutination Acute IgG agglutination titer


Convalscent IgG titer Agglutination Convalscent IgG agglutination titer


Agglutination Positive Result Based on the acute and covalscent titers for the agglutination test used, what is the result of the paired IgG titers (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

ELISA test name Name of the ELISA test used


Acute IgG ELISA titer Acute IgG ELISA titer


Convalscent IgG ELISA titer Convalscent IgG ELISA titer


ELISA IgG Positive Result Based on the acute and covalscent titers for the IgG ELISA test used, what is the result of the paired IgG titers (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Acute IgM ELISA titer Acute IgM ELISA titer


Convalscent IgM ELISA titer Convalscent IgM ELISA titer


ELISA IgM Positive Result Based on the acute and covalscent titers for the IgM ELISA test used, what is the result of the paired IgM titers (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

ELISA test cut off ELISA test cut off


Date of Acute Serum Specimen Collection The date the acute serum specimen was collected.


Date of Convalscent Serum Specimen Collection The date the convalscent serum specimen was collected.


Rose Bengal titer Rose Bengal titer


Rose Bengal positive result Result of Rose Bengal test (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Rose Bengal test cut off Cut off value of a positive result for the Rose Bengal test


Coombs Titer Coombs Titer


Coombs Titer positive result Result of Coombs test (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Coombs test cut off Cut off value of a positive result for the Coombs test


Other serologic test name 1 Name of other serologic test used 1


Other serologic test titer or value 1 Titer or value of other serologic test 1


Other serologic test 1 positive Result of other serologic test 1 (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Other serologic test 1 cut off Cut off value of a positive result for the Other test used 1


Other serologic test name 2 Name of other serologic test used 2


Other serologic test value 2 Value of other serologic test 2


Other serologic test 2 positive Result of other serologic test 2 (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Other serologic test 2 cut off Cut off value of a positive result for the Other test used 2


PCR If PCR was done, select on which specimens it was used ("Blood", "Abscess/wound", "Bone marrow", "CSF", "Other")


PCR other specimen Describe the specimen if specimen tested by PCR was "Other"


Date specimen for PCR collected The date the specimen was collected for PCR


PCR positive Result of PCR (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

PCR Species identified What Brucella species were identified as a result of PCR ("abortus", "canis", "melitensis", "suis", "ceti", "inopinata", "microti", "neotomae", "pinnipedalis")


Culture If culture was done, which specimens were used ("Blood", "Abscess/wound", "Bone marrow", "CSF", "Other")


Culture other specimen Describe the specimen if specimen tested by culture was "Other"


Date specimen for culture was collected The date the specimen was collected for culture


Culture positive Result of culture (e.g., Positive, Negative, Unknown)? PHVS_YesNoUnknown_CDC

Culture Species identified What Brucella species were identified as a result of culture ("abortus", "canis", "melitensis", "suis", "ceti", "inopinata", "microti", "neotomae", "pinnipedalis")


Pre antimicrobials Were specimens collected before antimicrobials were taken PHVS_YesNoUnknown_CDC

Select Agent Reporting Was the select agent reported to CDC PHVS_YesNoUnknown_CDC

Lab exposure Did a laboratory exposure occur during manipulation of an isolate? PHVS_YesNoUnknown_CDC

Exposure reported If a laboratory exposure is "Yes", was it reported? PHVS_YesNoUnknown_CDC

Specimens to CDC Were specimens or isolates sent to CDC for testing? PHVS_YesNoUnknown_CDC

Specimens still available are clinical specimens or isolates still available for further testing? PHVS_YesNoUnknown_CDC

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

Sheet 9: Campylobacter

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


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


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


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


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


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


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


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


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


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


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


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

Sheet 10: Candida auris

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

Sheet 11: Carbon Monoxide Poisoning

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

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

Sheet 12: Cholera

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


AGEYY Age in years


CDCNUM CDC Number


CITY City


COUNTY County


DATECOMP Date completing form


DOB Date of birth


ETHNICITY Hispanic or Latino origin?


FDANUM FDA Number


FNAME First 3 letters of first name


LNAME First 3 letters of last name


OCCUPAT Occupation


RACE Race


SEX Sex


STATE State of exposure (usually reporting state)


STEPINUM State Number


STLABNUM State Lab Number


FEVER Fever


NAUSEA Nausea


VOMIT Vomiting


DIARRHEA Diarrhea


VISBLOOD Bloody stool


CRAMPS Abdominal cramps


HEADACHE Headache


MUSCPAIN Muscle Pain


CELLULIT Cellulitis


BULLAE Bullae


SHOCK Shock


OTHER Other


MAXTEMP Symptom: Maximum temp of fever


CENFAR Fever measured in units of C or F


NUMSTLS Symptom: # of stools/24 hours


CELLSITE Symptom: Site of cellulitis


BULLSITE Symtom: Site of Bullae


OTHSPEC2 Symptom: Specify other Symptoms


AMPMSYMP Seafood Investigation: Onset in am or pm


ANTIBYN Did patient receive antibiotics?


Descant1 Name of 1st Antibiotic


Descant2 Name of 2nd Antibiotic


Descant3 Name of 3rd Antibiotic


ANTNAM01 Name of 1st Antibiotic (old)


ANTNAM02 Name of 2nd Antibiotic (old)


ANTNAM03 Name of 3rd Antibiotic (old)


ANTNAM04 Name of 4th Antibiotic (old)


BEGANT1 Date began Antibiotic #1


BEGANT2 Date began Antibiotic #2


BEGANT3 Date began Antibiotic #3


BEGANT4 Date began Antibiotic #4


CDCISOL CDC Isolate No.


DATEADMN Date admitted to hospital


DATEDIED Date of death


DATEDISC Date of discharge from hospital


DATESYMP Date of symptom onset


DURILL # days ill


ENDANT1 Date ended Antibiotic #1


ENDANT2 Date ended Antibiotic #2


ENDANT3 Date ended Antibiotic #3


ENDANT4 Date ended Antibiotic #4


GSURGTYP Pre-existing: Type of gastric surgery


HEMOTYPE Pre-exisiting: Type of hemotological disease


HHSYMP Hour of symptom onset


HOSPYN Hospitalized?


IMMTYPE Pre-exisiting: Type of Immunodeficiency


LIVTYPE Pre-exisiting: type of liver disease


MALTYPE Pre-existing: Type of Malignancy


MISYMP Minute of symptom exposure


OTHCONSP Pre-existing: Type of Other condition


PATDIE Did patient die?


PEPULCER Pre-existing: Peptic ulcer


ALCOHOL Pre-existing: Alcoholism


DIABETES Pre-existing: Diabetes


INSULIN Pre-existing: on insulin?


GASSURG Pre-existing: Gastric surgery


HEART Pre-existing: Heart disease


HEARTFAL Pre-existing: Heart failure?


HEMOTOL Pre-existing: Hematologic disease


IMMUNOD Pre-existing: Immunodeficiency


LIVER Pre-existing: Liver disease


MALIGN Pre-existing: Malignancy


RENAL Pre-existing: Renal disease


RENTYPE Pre-existing: Type of renal disease


OTHCOND Pre-existing: Other


TRTANTI Type of treatment received: antibiotics


TRTCHEM Type of treatment received: chemotherapy


TRTRADIO Type of treatment received: radiotherapy


TRTSTER Type of treatment received: systemic steroids


TRTIMMUN Type of treatment received: immunosuppressants


TRTACID Type of treatment received: antacids


TRTULCER Type of treatment received: H2 Blocker or other ulcer medication


SEQDESC Describe Sequelae


SEQUELAE Sequelae?


TRTACISP If previously treated with Antacids, specifiy


TRTANTSP If previously treated with Antibiotics, specifiy


TRTCHESP If previously treated with chemotherapy, specifiy


TRTIMMSP If previously treated with immunosuppressants, specifiy


TRTRADSP If previously treated with radiotherapy, specifiy


TRTSTESP If previously treated with steroids, specifiy


TRTULCSP If treated with ulcer meds, specifiy


DATESPEC Date specimen collected


SPECIESNAME Species


SITE If other source, specify site from which Vibrio was isolated


STATECON Was Species confirmed at State PH Lab?


SOURCE Specimen source


OTHORGAN Other organism isolated from specimen?


SPECORGAN Specify other organism isolated


AMBTEMFC Seafood Investigation: Maximum ambient temp units - F or C


AMNTCONS Seafood Investigation: Amount of shellfish consumed


AMPMCONS Seafood Investigation: Shellfish consumed in am or pm


DATEAMBT Seafood investigation: Date ambient temp measured


DATEFECL Seafood Investigation: Date of fecal count


DATEH2O Seafood Investigation: Date water temp measured


DATEHAR1 Seafood Investigation: Date of harvest #1


DATEHAR2 Seafood Investigation: Date of harvest #2


DATERAIN Seafood Investigation: Date total rain fall recorded


DATESALN Seafood Investigation: Date salinity measured


DATESEAR Seafood Investigation: Date restaurant rec'd seafood


FECALCNT Seafood Investigation: Fecal Coliform Count


H2OSALIN Seafood Investigation: Results of Salinity test


HARVSIT1 Seafood Investigation: Harvest Site #1


HARVSIT2 Seafood Investigation: Harvest Site #2


HARVST01 Seafood Investigation: Status of Harvest Site #1


HARVST02 Seafood Investigation: Status of Harvest Site #2


HARVSTS1 Seafood Investigation: Specify if Status for Harvest Site #1 = other


HARVSTS2 Seafood Investigation: Specify if Status for Harvest Site #2 = other


HHCONSUM Seafood Investigation: Hour of seafood consumption


IMPROPER Seafood Investigtaion: Improper Storage?


MAMTEMP Seafood Investigation: Maximum ambient temp


MICONSUM Seafood Investigation: Minute of seafood consumption


RAINFALL Seafood Investigation: Total rainfall in Inches


RESTINV Seafood Investigation: Investigation of Restaurant?


SEADISSP Seafood Investigation: Specify how shellfish distributed


SEADIST Seafood Investigation: How is shellfish distributed?


SEAHARV Seafood Investigation: Was shellfish harvested by patient or friend?


SEAIMPOR Seafood Investigation: Was seafood imported?


SEAIMPSP Seafood Investigation: Specify country of Import


SEAOBT Seafood Investigation: where was seafood obtained?


SEAOBTSP Seafood Investigation: Specify from where seafood was obtained


SEAPREP Seafood Investigation: How was seafood prepared?


SEAPRSP Seafood Investigation: Specify how seafood was prepared (if other)


SH2OTEMP Seafood Investigation: Surface water temperature


SH2OTMFC Surface water temp units in F or C?


SOURCES Sources of seafood


SHIPPERS Shippers who handled suspected seafood (certification numbers)


TAGSAVA Seafood investigation: Are tags available from suspect lot?


TYPESEAF Seafood investigation: Type of shellfish consumed


HARVESTSTATE State in which seafood was harvested


HARVESTREGION Region in which seafood was harvested


BIOTYPE Cholera Only: biotype?


CHOLVACC Cholera Only: Patient ever received cholera vaccine


DATEVACC Cholera Only: Date cholera vaccine received


ORALVACC Cholera Only: Oral cholera vaccine received


PAREVACC Cholera Only: Parenteral cholera vaccine received


ELISA Cholera Only: Elisa test performed for Cholera toxin testing?


LATEX Cholera Only: Latex Agglut. performed for Cholera toxin testing?


RISKRAW Cholera Only: Raw seafood


RISKCOOK Cholera Only: Cooked seafood


RISKTRAV Cholera Only: Foreign travel


RISKPERS Cholera Only: Other person(s) with cholera or cholera-like illness


RISKVEND Cholera Only: Stree-vended food


RISKOTHER Cholera Only: Other


RISKSPEC Cholera Only: Other risk specified


SEROTYPE Cholera Only: Cholera Serotype


SPECTOXN Cholera Only: Specify other toxin test used for Cholera (if other)


TOXGENIC Cholera Only: is it toxigenic?


TRVOTHR Cholera prevention education: specify other source of education


TRVPREV Cholera prevention education prior to travel?


TRVPREV1 Cholera prevention: Pre-travel clinic


TRVPREV2 Cholera prevention: Airport


TRVPREV3 Cholera prevention: Newspaper


TRVPREV4 Cholera prevention: Friends


TRVPREV5 Cholera prevention: Private physician


TRVPREV6 Cholera prevention: Health department


TRVPREV7 Cholera prevention: Travel agency


TRVPREV8 Cholera prevention: CDC travelers' hotline


TRVPREV9 Cholera prevention: Other


TRVREAS1 Reason for travel: Visit friends/relatives


TRVREAS2 Reason for travel: Business


TRVREAS3 Reason for travel: Tourism


TRVREAS4 Reason for travel: Military


TRVREAS5 Reason for travel: Other


TRVREAS6 Reason for travel: Unknown


TRVROTHR Cholera, reason for travel: specify if other


AMPMEXP Seafood Investigation: Exposure to seawater in am or pm


HANDLING Exposure: handing/cleaning seafood


SWIMMING Exposure: Swimming/diving/wading


WALKING Exposure: Walking on beach/shore/fell on rocks/shells


BOATING Exposure: Boating/skiing/surfing


CONSTRN Exposure: Construction/repairs


BITTEN Exposure: Bitten/stung


ANYWLIFE Exposure: Contact with other marine/freshwater life


BODYH2O Exposure: Exposure to a body of water


CONSTRN Exposure to water via construction


DATEEXPO Exposure: Date of exposure to seawater


DATEWHI1 Date traveled/entered destination #1


DATEWHI2 Date traveled/entered destination #2


DATEWHI3 Date traveled/entered destination #3


DATEWHO1 Date left/returned home #1


DATEWHO2 Date left/returned home #2


DATEWHO3 Date left/returned home #3


FISHSP Type of fish


H2OCOMM Exposure: Comments on water exposure


H2OTYPE Exposure: Type of water exposure


HHEXPOS Exposure: Hour of seawater exposure


LOCEXPOS Exposure: location of water exposure


MIEXPOS Exposure: Minute of seawater exposure


OTHEREXP Exposure: Other exposure


OTHERH2O Exposure: Exposed to other water not listed?


OTHSHSP Specify other shellfish consumed


OUTBREAK Is case part of outbreak?


OUTBRKSP If part of an outbreak, Specify outbreak


CLAMS Consumption: clams


CRAB Consumption: crab


LOBSTER Consumption: lobster


MUSS Consumption: mussels


OYSTER Consumption: oysters


SHRIMP Consumption: shrimp


CRAY Consumption: crawfish


OTHSH Consumption: other shellfish


FISH Consumption: other fish


RCLAM Raw consumption: clams


RCRAB Raw consumption: crab


RLOBSTER Raw consumption: lobster


RMUSS Raw consumption: muss


ROYSTER Raw consumption: oyster


RSHRIMP Raw consumption: shrimp


RCRAY Raw consumption: crawfish


ROTHSH Raw consumption: other shellfish


RFISH Raw consumption: other fish


DATECLAM Date of seafood consumption: clams


DATECRAB Date of seafood consumption: crab


DATELOBS Date of seafood consumption: lobster


DATEMUSS Date of seafood consumption: mussels


DATEOYSTER Date of seafood consumption: oysters


DATESHRI Date of seafood consumption: shrimp


DATECRAY Date of seafood consumption: crawfish


DATEOTHSH Date of seafood consumption: other shellfish


DATEFISH Date of seafood consumption: other fish


SPECEXPO Specify other seawater/shellfish dripping exposure (if other)


STRESID State of residence


TRAVEL Exposure to travel outside home state in previous 7 days?


WHERE01 Travel destination #1


WHERE02 Travel destination #2


WHERE03 Travel destination #3


WOUNDEXP Did patient incur a wound before/during exposure?


WOUNDSP If patient incurred wound before/during exposure, describe wound


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

Sheet 13: Congenital Rubella Syndrome

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

Sheet 14: Congenital Syphilis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
RECTYPE Record type will determine how the record is handled when it arrives at CDC.
Value for case data: M=MMWR report

UPDATE Currently not implemented. (Pad with a 9)

STATE Reporting State FIPS code - (e.g., "06", "13").


YEAR MMWR Year (2-digits) for which case information reported to CDC.


CASEID Unique Case ID (numeric only) assigned by the state.


SITE Location code used by the state to indicate where report originated and who has responsibility for maintaining the record. (NOTE: STD*MIS software substitutes a '#' for the leading 'S' in codes listed). S01=State epidemiologist
S02=State STD Program
S03=State Chronic Disease Program
S04-S99=Other state offices
R01-R99=Regional or district offices
001-999=County health depts (FIPS codes)
L01-L99=Laboratories within state
CD1=Historical records (prior to new format)
CD2=Entered at CDC (based on phone reports)


WEEK MMWR Week on Surveillance Calendar, i.e., week for which case information reported to CDC.


EVENT Event (disease) code for the disease being reported. 10316=Syphilis (congenital)

COUNT For case records this field will always contain "00001".


COUNTY FIPS code for reporting county (999=Unknown)


BIRTHDATE Date of birth of infant in YYYYMMDD format (99999999=Unknown)


AGE Estimated Gestational Age in weeks - (e.g., "038", "042") (999= Unknown)


AGETYPE Indicates the units (weeks) for the AGE field. 2=0-52 Weeks
9=Gestational Age Unknown (AGE field should be 999)


RACE Race of Mother. 1=American Indian/Alaskan Native
2=Asian or Pacific Islander
3=Black
5=White
8=Other
9=Unknown
NOTE: Please use only one of the codes above if a single race was selected. If multiple races were selected, enter code 8=Other for Race and also select the appropriate race categories that apply in columns 238-244.


HISPANIC Indicator for Mother's Hispanic ethnicity. 1=Hispanic/Latino
2=Non-Hispanic/Latino
9=Unknown


EVENTDATE Date of Report to Health Department in YYMMDD format


DATETYPE A code describing the type of date provided in EVENTDATE. 4=Date of first report to community health system

CASE STATUS Recode of Case Classification. 1=Confirmed, Probable, or Syphilitic stillbirth
2=Not a case
9=Unknown


OUTBREAK Indicates whether the case was associated with an outbreak. 1=Yes
2=No
9=Unknown


INFOSRCE Information Source/Provider Codes (from Interview Record if available). 01=HIV Counseling and Testing Site
02=STD clinic
03=Drug Treatment
04=Family Planning
06=Tuberculosis clinic
07=Other Health Department clinic
08=Private Physician/HMO
10=Hospital-Emergency Room; Urgent Care Facility
11=Correctional Facility
12=Laboratory
13=Blood Bank
14=Labor and Delivery
15=Prenatal
16=National Job Training Program
17=School-based Clinic
18=Mental Health Provider
29=Hospital-Other
66=Indian Health Service
77=Military
88=Other
99=Unknown (if data not available)


DETECTED Method of Case Detection (from Interview Record if available). 20=Screening
21=Self-referred
22=Patient referred partner
23=Health Department referred partner
24= Cluster related
88=Other
99=Unknown


MZIP Zip Code for Mother's Residence 99999=Unknown (if data not available)

MSTATE FIPS Code for Mother's State of Residence. Code 98 for Mexico and 97 for any other non-USA residence. (999=Unknown)


MCOUNTY FIPS Code for Mother's County of Residence. Code 998 for Mexico and 997 for any other non-USA residence. (999=Unknown)


MBIRTH Mother's Date of Birth in YYYYMMDD format. (99999999=Unknown)


MARITAL Mother's Marital Status. 1=Single, never married
2=Married
3=Separated/Divorced
4=Widow
8=Other
9=Unknown


LMP Date of Mother's Last Menstrual Period before delivery in YYYYMMDD format. (99999999=Unknown)


PRENATAL Did mother have prenatal care? 0=No prenatal care
9=Unknown


PNCDATE1 Date of mother's first prenatal visit in YYYYMMDD format. (99999999=Unknown)


DATEA Date of mother’s most recent non-treponemal test in YYYYMMDD format. (99999999=Unknown)


RESULTA Result of mother’s most recent non-treponemal test. 1=Reactive
2=Nonreactive
9=Unknown


DATEB Date of mother’s first non-treponemal test in YYYYMMDD format. (99999999=Unknown)


RESULTB Result of mother’s first non-treponemal test. 1=Reactive
2=Nonreactive
9=Unknown


TITER Titer of mother’s most recent non-treponemal test. (The titer for date b is in columns 214-217). 0=weakly reactive
9999=Unknown


VITAL Vital status of infant/child. 1=Alive
2=Born alive, then died
3=Stillborn
9=Unknown


DEATHDAT Date of death of infant/child in YYYYMMDD format. (If alive, pad with 99999999)
(99999999=Unknown)


BIRTHWT Birthweight in grams (9999=Unknown)


REACSTS Did infant/child have reactive non-treponemal test for syphilis? 1=Yes
2=No
3=No test
9=Unknown


REACDATE Date of infant/child's first reactive non-treponemal test for syphilis in YYYYMMDD format. (99999999=Unknown)


DARKFLD Did the infant/child, placenta, or cord have darkfield exam, DFA, or special stains? 1=Yes, positive
2=Yes, negative
3=No test
4=No lesions and no tissue to test
9=Unknown


XRAYS Did infant/child have long bone x-rays? 1=Yes, changes consistent with CS
2=Yes, no signs of CS
3=No x-rays
9=Unknown


CSFVDRL Did infant/child have a CSF-VDRL? 1= Yes, reactive
2=Yes, nonreactive
3=No test
9=unknown


TREATED Was infant/child treated? 1=Yes, with Aqueous or Procaine Penicillin for 10 days
3=Yes, with Benzathine penicillin x 1
4=Yes, with other treatment
5=No treatment
9=Unknown


CLASS Case Classification. 1=Not a case
2=Confirmed Case (laboratory confirmed identification of T.pallidum, e.g., darkfield or direct fluorescent antibody positive lesions)
3=Syphilitic stillbirth
4=Probable case (a case identified by the algorithm, which is not a confirmed case or syphilitic stillbirth)


ID126 CDC 73.126 form Case ID number (9999999=Unknown)


VERSION CDC 73.126 Form Version. 41306

TITERB Titer of mother’s first non-treponemal test b. 0=weakly reactive
9999=Unknown
Note: All entries should be left justified (no preceding or trailing zeroes). Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.


INFTITER Titer of infant/child’s first reactive non-treponemal test for syphilis. 0=weakly reactive
9999=Unknown
Note: All entries should be left justified (no preceding or trailing zeroes). Example: If titer is 1:64, enter 64; if titer is 1:1024, enter 1024.


AMIND American Indian/Alaskan Native: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

ASIAN Asian: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

BLACK Black: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

WHITE White: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

NAHAW Native Hawaiian or Other Pacific Islander: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

RACEOTH Other Race: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

RACEUNK Unknown Race: If mother multi-racial: 1 = Yes; 2 = No; Otherwise pad with a 9.

MCOUNTRY Mother’s country of residence. (XX=Unknown)


REACTREP Did infant/child have reactive treponemal test? 1 = Yes
2 = No
3 = No test
9 = Unknown


RTDATE Date of infant/child’s reactive treponemal test in YYYYMMDD format. (99999999=Unknown)


STD IMPORT Was case imported? Was disease acquired elsewhere? Indicates probable location of disease acquisition relative to reporting state values. N = Not an imported case
C = Yes, imported from another country
S = Yes, imported from another state
J = Yes, imported from another county/jurisdiction in the state
D = Yes, imported but not able to determine source state and/or country
U = Unknown


GRAVIDA Number of pregnancies (e.g. 01) (99=Unknown)


PARA Number of live births (e.g. 03) (99=Unknown)


PNCTRI Trimester of mother’s first prenatal visit. 1 = 1st trimester
2 = 2nd trimester
3 = 3rd trimester
9 = Unknown


TESTVISA Did mother have non-treponemal or treponemal test at first prenatal visit? 1 = Yes
2 = No
9 = Unknown


TESTVISB Did mother have non-treponemal or treponemal test at 28-32 weeks gestation? 1 = Yes
2 = No
9 = Unknown


TESTVISC Did mother have non-treponemal or treponemal test at delivery? 1 = Yes
2 = No
9 = Unknown


TREPDTA Date of mother’s first treponemal test in YYYYMMDD format. (99999999=Unknown)


TESTTYPA Test type of mother’s first treponemal test. 1 = EIA or CLIA
2 = TP-PA
3 = Other
9 = Unknown


TREPRESA Result of mother’s first treponemal test. 1 = Reactive
2 = Nonreactive
9 = Unknown


TREPDTB Date of mother’s most recent treponemal test in YYYYMMDD format. (99999999=Unknown)


TESTTYPB Test type of mother’s most recent treponemal test. 1 = EIA or CLIA
2 = TP-PA
3 = Other
9 = Unknown


TREPRESB Result of mother’s most recent treponemal test. 1 = Reactive
2 = Nonreactive
9 = Unknown


HIVSTAT What was mother’s HIV status during pregnancy? P = Positive
E = Equivocal test
X = Patient not tested
N = Negative
U = Unknown


CLINSTAG What clinical stage of syphilis did mother have during pregnancy? 1 =Primary
2 = Secondary
3 = Early latent
4 = Late or late latent
5 = Previously treated/serofast
8 = Other
9 = Unknown


SURVSTAG What surveillance stage of syphilis did mother have during pregnancy? 1 = Primary
2 = Secondary
3 = Early latent
4 = Late or late latent
8 = Other
9 = Unknown


FIRSTDT Date of mother’s first dose of benzathine penicillin in YYYYMMDD format. (99999999=Unknown)


FIRSTDOS When did mother receive her first dose of benzathine penicillin? 1 = Before pregnancy
2 = 1st trimester
3 = 2nd trimester
4 = 3rd trimester
5 = No Treatment
9 = Unknown


MOMTX What was mother’s treatment? 1 = 2.4 M units benzathine penicillin
2 = 4.8 M units benzathine penicillin
3 = 7.2 M units benzathine penicillin
8 = Other
9 = Unknown


RESPAPP2 Did mother have an appropriate serologic response? 1 = Yes, appropriate response
2 = No, inappropriate response: evidence of treatment failure or reinfection
3 = Response could not be determined from available non-treponemal titer information
4 = Not enough time for titer to change


CLINNO No signs/asymptomatic? 1 = Yes; Otherwise pad with a 9.

CLINLATA Condyloma lata? 1 = Yes; Otherwise pad with a 9.

CLINSNUF Snuffles? 1 = Yes; Otherwise pad with a 9.

CLINRASH Syphilitic skin rash? 1 = Yes; Otherwise pad with a 9.

CLINHEPA Hepatosplenomegaly? 1 = Yes; Otherwise pad with a 9.

CLINJUAN Jaundice/Hepatitis? 1 = Yes; Otherwise pad with a 9.

CLINPARA Pseudo paralysis? 1 = Yes; Otherwise pad with a 9.

CLINEDEM Edema? 1 = Yes; Otherwise pad with a 9.

CLINOTH Other signs of CS? 1 = Yes; Otherwise pad with a 9.

CLINUNK Unknown signs of CS? 1 = Yes; Otherwise pad with a 9.

CSFWBC Did the infant/child have a CSF WBC count or CSF protein test? 1 = Yes, CSF WBC count elevated
2 = Yes, CSF protein elevated
3 = Both tests elevated
4 = Neither test elevated
5 = No test
9 = Unknown


Maternal Local Record ID



Maternal Notification Reporting Jurisdiction




Sheet 15: CP-CRE

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

Sheet 16: CPO

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

Sheet 17: Cryptosporidiosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Animal Contact Questions Indicator If contact with animal, then display the following questions Yes No Indicator (HL7)

Animal Contact Indicator Did patient come in contact with an animal? Yes No Unknown (YNU)

Animal Type Code(s) Type of animal: (MULTISELECT) Animal Type (FDD)

Animal Type Other If “Other,” please specify other type of animal:


Amphibian Other If “Other Amphibian,” please specify other type of amphibian:


Reptile Other If “Other Reptile,” please specify other type of reptile:


Mammal Other If "Other Mammal," please specify other type of mammal:


Animal Contact Location Name or Location of Animal Contact:


Acquired New Pet Did the patient acquire a pet prior to onset of illness? Yes No Unknown (YNU)

Applicable Incubation Period Applicable incubation period for this illness is


Associated with Daycare Indicator If Patient associated with a day care center: Yes No Indicator (HL7)

Day Care Attendee Attend a day care center? Yes No Unknown (YNU)

Day Care Worker Work at a day care center? Yes No Unknown (YNU)

Live with Day Care Attendee Live with a day care center attendee? Yes No Unknown (YNU)

Day Care Type What type of day care facility? Day CareType (FDD)

Day Care Facility Name What is the name of the day care facility?


Food Prepared at this Daycare Is food prepared at this facility? Yes No Unknown (YNU)

Diapered Infants at this Daycare Does this facility care for diapered persons? Yes No Unknown (YNU)

Drinking Water Exposure Indicator If patient has had Drinking Water exposure, then display the following questions Yes No Indicator (HL7)

Home Tap Water Source Code What is the source of tap water at home? Tap Water Source (FDD)

Home Well Treatment Code If “Private Well,” how was the well water treated at home? Well Water Treatment (FDD)

Home Tap Water Source Other If “Other,” specify other source of tap water at home:


School/Work Tap Water Source Code What is the source of tap water at school/work? Tap Water Source (FDD)

SchoolWork Well Treatment Code If “Private Well,” how was the well water treated at school/work? Well Water Treatment (FDD)

School/Work Tap Water Source Other If “Other,” specify other source of tap water at school/work:


Drink Untreated Water 14 days Prior to Onset Did patient drink untreated water 14 days prior to onset of illness? Yes No Unknown (YNU)

Food Handler If patient is a Food Handler, then display the following questions Yes No Indicator (HL7)

Food Handler after Illness Onset Did patient work as a food handler after onset of illness? Yes No Unknown (YNU)

Food HandlerLast Worked Date What was the last date worked as a food handler after onset of illness?


Food Handler Location Where was patient a food handler?


Recreational Water Exposure Questions Indicator If patient has had recreational water exposure, then display the following Yes No Indicator (HL7)

Recreational Water Exposure 14 Days Prior to Onset Was there recreational water exposure in the 14 days prior to illness? Yes No Unknown (YNU)

Recreational Water Exposure Type Code(s) What was the recreational water exposure type? (MULTISELECT) Recreational Water (FDD)

Recreational Water Exposure Type Other If "Other," please specify other recreational water exposure type:


Swimming Pool Type Code(s) If "Swimming Pool," please specify swimming pool type: (MULTISELECT) Swimming Pool Type (FDD)

Swimming Pool Type Other If "Other," please specify other swimming pool type:


Recreational Water Location Name Name or location of water exposure:


Related Case Indicator If related cases are associated to this case, then display the following questions Yes No Indicator (HL7)

Patient Knows of Similarly Ill Persons Does the patient know of any similarly ill persons? Yes No Unknown (YNU)

Health Department Investigated If "Yes," did the health department collect contact information about other similarly ill persons and investigate further? Yes No Unknown (YNU)

Other Related Cases Are there other cases related to this one? Other Related Cases

Travel Questions Indicator If patient has traveled, then display the following questions Yes No Indicator (HL7)

Travel Prior To Onset Did the patient travel prior to onset of illness? Yes No Unknown (YNU)

Incubation Period Applicable incubation period for this illness is 14 days


Travel Purpose Code(s) What was the purpose of the travel? (MULTISELECT) Travel Purpose

Travel Purpose Other If “Other,” please specify other purpose of travel:


Destination 1 Type: Destination 1 Type: Travel Destination Type

(Domestic) Destination 1: (Domestic) Destination 1: State

(International) Destination 1 (International) Destination 1 Country

Mode of Travel: (1) Mode of Travel: (1) Travel Mode

Date Of Arrival (1) Date of Arrival: (1)


Date of Departure (1) Date of Departure (1)


Destination 2 Type Destination 2 Type Travel Destination Type

(Domestic) Destination 2 (Domestic) Destination 2 State

(International) Destination 2 (International) Destination 2 Country

Mode of Travel: (2) Mode of Travel: (2) Travel Mode

Date of Arrival: (2) Date of Arrival: (2)


Date of Departure (2) Date of Departure (2)


Destination 3 Type: Destination 3 Type: Travel Destination Type

(Domestic) Destination 3: (Domestic) Destination 3: State

(International) Destination 3 (International) Destination 3 Country

Mode of Travel: (3) Mode of Travel: (3) Travel Mode

Date of Arrival: (3) Date of Arrival: (3)


Date of Departure (3) Date of Departure (3)


Other Destination Txt If more than 3 destinations, specify details here:


Reporting Lab Name Name of Laboratory that reported test result.


Reporting Lab CLIA Number CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.


Local record ID (case ID) Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it ap


Filler Order Number A laboratory generated number that identifies the test/order instance.


Ordered Test Name Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information. Ordered Test

Date of Specimen Collection The date the specimen was collected.


Specimen Site This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc. Specimen

Specimen Number A laboratory generated number that identifies the specimen related to this test.


Specimen Source The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc. Specimen

Specimen Details Specimen details if specimen information entered as text.


Date Sample Received at Lab Date Sample Received at Lab (accession date).


Sample Analyzed date The date and time the sample was analyzed by the laboratory.


Lab Report Date Date result sent from Reporting Laboratory.


Report Status The status of the lab report. Result Status (HL7)

Resulted Test Name The lab test that was run on the specimen. Lab Test Result Name (FDD)

Numeric Result Results expressed as numeric value/quantitative result.


Result Units The unit of measure for numeric result value. Units Of Measure

Coded Result Value Coded qualitative result value. Lab Test Result Qualitative

Organism Name The organism name as a test result. This element is used when the result was reported as an organism. Microorganism (FDD)

Lab Result Text Value Textual result value, used if result is neither numeric nor coded.


Result Status The Result Status is the degree of completion of the lab test. Observation Result Status (HL7)

Interpretation Flag The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low. Abnormal Flag (HL7)

Reference Range From The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.


Reference Range To The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.


Test Method The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture. Observation Method

Lab Result Comments Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.


Date received in state public health lab Date the isolate was received in state public health laboratory.


Lab Test Coded Comments Explanation for missing result (e.g., clotting, quantity not sufficient, etc.) Missing Lab Result Reason

Genotyping/ Subtyping Indicate whether the specimens were genotyped and/or subtyped Yes No Unknown (YNU)

Genotyping Sent Date If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.


Genotype/Subtype location Indicate where Genotype and/or subtype testing was performed


Genotype If the specimen was sent for genotype identification, indicate the genotype


Subtype If the specimen was sent for subtype idenfication, indicate the subtype


Track Isolate Track Isolate functionality indicator Yes No Indicator (HL7)

Patient status at specimen collection Patient status at specimen collection Patient Location Status at Specimen Collection

Isolate received in state public health lab Isolate received in state public health lab Yes No Unknown (YNU)

Reason isolate not received Reason isolate not received Isolate Not Received Reason

Reason isolate not received (Other) Reason isolate not received (Other)


Date received in state public health lab Date received in state public health lab


State public health lab isolate id number State public health lab isolate id number


Case confirmed at state public health lab Case confirmed at state public health lab Yes No Unknown (YNU)

AgClinic What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?


AgClinicTestType Name of antigen-based test used at clinical laboratory


AgeMnth Age of case-patient in months if patient is <1yr


AgeYr Age of case-patient in years


AgSphl What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory?


AgSphlTestType Name of antigen-based test used at state public health laboratory


BloodyDiarr Did the case-patient have bloody diarrhea (self reported) during this illness?


Diarrhea Did the case-patient have diarrhea (self-reported) during this illness?


DtAdmit2 Date of hospital admission for second hospitalization for this illness


DtDisch2 Date of hospital discharge for second hospitalization for this illness


DtEntered Date case was entered into site's database


DtRcvd Date case-pateint's specimen was received in laboratory for initial testing


DtRptComp Date case report form was completed


DtSpec Case-patient's specimen collection date


DtUSDepart If case-patient patient traveled internationally, date of departure from the U.S.


DtUSReturn If case-patient traveled internationally, date of return to the U.S.


EforsNum CDC FDOSS outbreak ID number


Fever Did the case-patient have fever (self-reported) during this illness?


HospTrans If case-patient was hospitalized, was s/he transferred to another hospital?


Immigrate Did case-patient immigrate to the U.S.? (within 15 days of illness onset)


Interview Was the case-patient interviewed by public health (i.e. state or local health department) ?


LabName Name of submitting laboratory


LocalID Case-patient's medical record number


OtherCdcTest What was the result of specimen testing using another test at CDC?


OtherClinicTest What was the result of specimen testing using another test at a clinical laboratory?


OtherClinicTestType Name of other test used at a clinical laboratory


OtherSphlTest What was the result of specimen testing using another test at a state public health laboratory?


OtherSphlTestType Name of other test used at a state public health laboratory


OutbrkType Type of outbreak that the case-patient was part of


PatID Case-patient identification number


PcrCdc What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).


PcrClinic What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)


PcrClinicTestType Name of PCR assay used


PcrSphl What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).


PersonID Unique identification number for person or patient


ResultID Unique identifier for laboratory result


RptComp Is all of the information for this case complete?


SentCDC Was specimen or isolate forwarded to CDC for testing or confirmation?


SLabsID State lab identification number


SpeciesClinic What was the species result at clinical lab?


SpeciesSphl What was the species result at SPHL?


SpecSite Case patient's specimen collection source


StLabRcvd Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)


TravelDest If case-patient traveled internationally, to where did they travel?


TravelInt Did the case patient travel internationally? (within 15 days of onset)


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

Sheet 18: Cyclosporiasis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Cabbage Was fresh cabbage consumed in the 14 days prior to onset of illness? PHVS_FreshProduce_FDD

Interview Status Interview Status PHVS_InterviewStatus_CDC

Travel Destination Type Travel Destination Type PHVS_TravelDestinationType_FDD

Travel Mode Travel Mode PHVS_TravelMode_CDC

Travel Purpose Purpose of Travel PHVS_TravelPurpose_FDD

Date of departure Departure Date


Date of arrival Arrival Date


Destination code FIPS code assigned to city/state/country


Destination description Name of city/state/country


Person Knows of Similarly Ill Persons Does the patient know of any similarly ill persons? FDD_Q_77 (PHIN_Questions_FDD)

Diarrhea Indicator Did the patient have diarrhea? PHVS_YesNoUnknown_CDC

Max Stools per 24 Hrs If "Yes,” please specify maximum number of stools per 24 hours:


Weight Loss Did patient experience weight loss? PHVS_YesNoUnknown_CDC

Baseline Weight If “Yes,” please specify baseline weight:


Baseline Weight Units specify baseline weight in lbs or kgs PHVS_WeightUnit_UCUM

Weight Lost Specify how much weight was lost:


Weight Lost Units Specify weight loss in lbs or kgs PHVS_WeightUnit_UCUM

Fever Did patient have a fever? PHVS_YesNoUnknown_CDC

Temperature If "Yes," please specify temperature (observation includes units)


Temperature Units Specify temperature in fahrenheit or centigrade PHVS_TemperatureUnit_UCUM

Cyclosporiasis Symptom Code(s) Did the patient have any of the following signs or symptoms of Cyclosporiasis? (MULTISELECT) PHVS_CyclosporiasisSignsSymptoms_FDD

Cyclosporiasis Symptoms Other If “Other,” please specify other signs or symptoms of Cyclosporiasis:


Cyclosporiasis Confirmed By CDC Was the case confirmed at the CDC lab? PHVS_YesNoUnknown_CDC

Treated For Cyclosporiasis Was the patient treated for Cyclosporiasis? PHVS_YesNoUnknown_CDC

Sulfa Allergy Does the patient have a sulfa allergy? PHVS_YesNoUnknown_CDC

Fresh Berries Code(s) What fresh berries were eaten in the 14 days prior to onset of illness? (MULTISELECT) PHVS_FreshBerries_FDD

Fresh Berries Other If “Other,” please specify other type of fresh berries:


Fresh Herbs Code(s) What fresh herbs were eaten in the 14 days prior to onset of illness? (MULTISELECT) PHVS_FreshHerbs_FDD

Fresh Herbs Other If “Other,” please specify other type of fresh herbs:


Lettuce Last 14 Days Code(s) What fresh lettuce was eaten in the 14 days prior to onset of illness? (MULTISELECT) PHVS_LettuceType_FDD

Lettuce Last 14 Days Other If “Other,” please specify other type of fresh lettuce:


Produce Last 14 Days Code(s) What other types of fresh produce were eaten in the 14 days prior to onset of illness? (MULTISELECT) PHVS_FreshProduce_FDD

Produce Last 14 Days Other If “Other,” please specify other type of fresh produce:


Fruit Other Than Berries Specify If "Fruit, other than berries," please specify type of fruit other than berries:


Attend Events 14 Days Prior to Onset Did patient attend any events in the 14 days prior to onset of illness? PHVS_YesNoUnknown_CDC

Event Specify If “Yes,” please specify the event:


Event Date Date of event:


Eat at Restaurant 14 Days Prior to Onset Did patient eat at restaurant(s) in the 14 days prior to onset of illness? PHVS_YesNoUnknown_CDC

Restaurant(s) Specify If “Yes,” please specify the name of the restaurant(s):


Reporting Lab Name Name of Laboratory that reported test result.


Reporting Lab CLIA Number CLIA (Clinical Laboratory Improvement Act) identifier for the laboratory that performed the test.


Local record ID (case ID) Sending system-assigned local ID of the case investigation with which the subject is associated. This field has been added to provide the mapping to the case/investigation to which this lab result is associated. This field should appear exactly as it appears in OBR-3 of the Case Notification.


Filler Order Number A laboratory generated number that identifies the test/order instance.


Ordered Test Name Ordered Test Name is the lab test ordered by the physician. It will always be included in an ELR, but there are many instances in which the user entering manual reports will not have access to this information.


Date of Specimen Collection The date the specimen was collected.


Specimen Site This indicates the physical location, of the subject, where the specimen originated. Examples include: Right Internal Jugular, Left Arm, Buttock, Right Eye, etc. PHVS_BodySite_CDC

Specimen Number A laboratory generated number that identifies the specimen related to this test.


Specimen Source The medium from which the specimen originated. Examples include whole blood, saliva, urine, etc. PHVS_Specimen_CDC

Specimen Details Specimen details if specimen information entered as text.


Date Sample Received at Lab Date Sample Received at Lab (accession date).


Sample Analyzed date The date and time the sample was analyzed by the laboratory.


Lab Report Date Date result sent from Reporting Laboratory.


Report Status The status of the lab report. PHVS_ResultStatus_HL7_2x

Resulted Test Name The lab test that was run on the specimen. PHVS_LabTestName_CDC

Numeric Result Results expressed as numeric value/quantitative result.


Result Units The unit of measure for numeric result value. PHVS_UnitsOfMeasure_CDC

Coded Result Value Coded qualitative result value (e.g., Positive, Negative). PHVS_LabTestResultQualitative_CDC

Organism Name The organism name as a test result. This element is used when the result was reported as an organism. PHVS_Microorganism_CDC

Lab Result Text Value Textual result value, used if result is neither numeric nor coded.


Result Status The Result Status is the degree of completion of the lab test. PHVS_ObservationResultStatus_HL7_2x

Interpretation Flag The interpretation flag identifies a result that is not typical as well as how it's not typical. Examples: Susceptible, Resistant, Normal, Above upper panic limits, below absolute low. PHVS_AbnormalFlag_HL7_2x

Reference Range From The reference range from value allows the user to enter the value on one end of a expected range of results for the test. This is used mostly for quantitative results.


Reference Range To The reference range to value allows the user to enter the value on the other end of a valid range of results for the test. This is used mostly for quantitative results.


Test Method The technique or method used to perform the test and obtain the test results. Examples: Serum Neutralization, Titration, dipstick, test strip, anaerobic culture. PHVS_LabTestMethods_CDC

Lab Result Comments Comments having to do specifically with the lab result test. These are the comments from the NTE segment if the result was originally an Electronic Laboratory Report.


Date received in state public health lab Date the isolate was received in state public health laboratory.


Lab Test Coded Comments Explanation for missing result (e.g., clotting, quantity not sufficient, etc.) PHVS_MissingLabResult_CDC

Sent to CDC for Genotyping Indicate whether the specimens were sent to CDC for genotyping. PHVS_YesNoUnknown_CDC

Genotyping Sent Date If the specimen was sent to the CDC for genotyping, date on which the specimens were sent.


Sent For Strain ID Indicate whether the specimen was sent for strain identification. PHVS_YesNoUnknown_CDC

Strain Type If the specimen was sent for strain identification, indicate the strain. PHVS_MicrobiologicalStrain_CDC

Track Isolate Track Isolate functionality indicator PHVS_TrueFalse_CDC

Patient status at specimen collection Patient status at specimen collection PHVS_PatientLocationStatusAtSpecimenCollection

Isolate received in state public health lab Isolate received in state public health lab PHVS_YesNoUnknown_CDC

Reason isolate not received Reason isolate not received PHVS_IsolateNotReceivedReason_NND

Reason isolate not received (Other) Reason isolate not received (Other)


Date received in state public health lab Date received in state public health lab


State public health lab isolate id number State public health lab isolate id number


Case confirmed at state public health lab Case confirmed at state public health lab PHVS_YesNoUnknown_CDC

AgClinic What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a clinical laboratory?


AgClinicTestType Name of antigen-based test used at clinical laboratory


AgeMnth Age of case-patient in months if patient is <1yr


AgeYr Age of case-patient in years


AgSphl What was the result of specimen testing using an antigen-based test (e.g. EIA or lateral flow) at a state public health laboratory? Results from rapid card testing or EIA would be entered here.


AgSphlTestType Name of antigen-based test used at state public health laboratory


BloodyDiarr Did the case-patient have bloody diarrhea (self reported) during this illness?


Diarrhea Did the case-patient have diarrhea (self-reported) during this illness?


DtAdmit2 Date of hospital admission for second hospitalization for this illness


DtDisch2 Date of hospital discharge for second hospitalization for this illness


DtEntered Date case was entered into site's database


DtRcvd Date case-pateint's specimen was received in laboratory for initial testing


DtRptComp Date case report form was completed


DtSpec Case-patient's specimen collection date


DtUSDepart If case-patient patient traveled internationally, date of departure from the U.S.


DtUSReturn If case-patient traveled internationally, date of return to the U.S.


EforsNum CDC FDOSS outbreak ID number


Fever Did the case-patient have fever (self-reported) during this illness?


HospTrans If case-patient was hospitalized, was s/he transferred to another hospital?


Immigrate Did case-patient immigrate to the U.S.? (within 15 days of illness onset)


Interview Was the case-patient interviewed by public health (i.e. state or local health department) ?


LabName Name of submitting laboratory


LocalID Ccase-patient's medical record number


OtherCdcTest For other pathogens: What was the result of specimen testing using another test at CDC? Results from DFA, IFA or other tests would be entered here.


OtherClinicTest What was the result of specimen testing using another test at a clinical laboratory? Results from DFA, IFA or other tests would be entered here.


OtherClinicTestType Name of other test used at a clinical laboratory


OtherSphlTest What was the result of specimen testing using another test at a state public health laboratory? Results from DFA, IFA or other tests would be entered here.


OtherSphlTestType Name of other test used at a state public health laboratory


OutbrkType Type of outbreak that the case-patient was part of


PatID Case-patient identification number


PcrCdc What was the result of specimen testing for diagnosis using PCR at CDC? (Do not enter PCR results if PCR was performed for speciation or subtyping).


PcrClinic What was the result of specimen testing using PCR at a clinical laboratory? (where goal of testing is primary detection not subtyping or speciation)


PcrClinicTestType Name of PCR assay used


PcrSphl What was the result of specimen testing for diagnosis using PCR at the state public health laboratory? (Do not enter PCR results if PCR was performed for speciation or subtyping).


PersonID Unique identification number for person or patient


ResultID Unique identifier for laboratory result


RptComp Is all of the information for this case complete?


SentCDC Was specimen or isolate forwarded to CDC for testing or confirmation?


SLabsID State lab identification number


SpecSite Case patient's specimen collection source


StLabRcvd Was the isolate sent to a state public health laboratory? (Answer 'Yes' if it was sent to any state lab, even if it was sent to a lab outside of the case's state of residence)


TravelDest If case-patient traveled internationally, to where did they travel?


TravelInt Did the case patient travel internationally? (within 15 days of onset)


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


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


Medication Administered What treatment did the case-patient receive?


Performing Laboratory Type Performing laboratory type


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


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

Sheet 19: Diphtheria

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

Sheet 20: Giardia

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

Sheet 21: Haemophilus Influenzae

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority
DAYCARE If <6 years of age, is the patient in daycare? PHVS_YesNoUnknown_CDC
FACNAME Name of the daycare facility. PHVS_YesNoUnknown_CDC
NURSHOME Does the patient reside in a nursing home or other chronic care facility? PHVS_YesNoUnknown_CDC
NHNAME Name of the nursing home or chronic care facility.

SYNDRM Types of infection that are caused by the organism. This is a multi-select field. TBD
SPECSYN Other infection that is caused by the organism.

SPECIES Bacterial species that was isolated from any normally sterile site. TBD
OTHBUG1 Other bacterial species that was isolated from any normally sterile site. TBD
STERSITE Sterile sites from which the organism was isolated. This is a multi-select field. TBD
OTHSTER Other sterile site from which the organism was isolated.

DATE Date the first positive culture was obtained. (This is considered diagnosis date.)

NONSTER Nonsterile sites from which the organism was isolated. This is a multi-select field. TBD
UNDERCOND Did the patient have any underlying conditions? PHVS_YesNoUnknown_CDC
COND Underlying conditions that the subject has. This is a multi-select field. TBD
OTHMALIG Other malignancy that the subject had as an underlying condition.

OTHORGAN Detail of the organ transplant that the subject had as an underlying condition.

OTHILL Other prior illness that the subject had as an underlying condition.

OTHOTHSPC Another Bacterial Species not listed in the Other Bacterial Species drop-down list.

Specify Internal Body Site Internal Body Site where the organism was located. TBD
Other Prior Illness 2 Other prior illness that the subject had as an underlying condition.

Other Prior Illness 3 Other prior illness that the subject had as an underlying condition.

Other Nonsterile Site Other nonsterile site from which the organism was isolated.

INSURANCE Patient's type of insurance (multi-selection). TBD
INSURANCEOTH Patient's other type of insurance.

WEIGHTLB Weight of the patient in pounds.

WEIGHTOZ Weight of the patient in ounces.

WEIGHTKG Weight of the patient in kilograms.

HEIGHTFT Height of the patient in feet.

HEIGHTIN Height of the patient in inches.

HEIGHTCM Height of the patient in centimeters.

WEIGHTUNK Indicator that the weight of the patient is unknown. PHVS_TrueFalse_CDC
HEIGHTUNK Indicator that the height of the patient is unknown. PHVS_TrueFalse_CDC
SEROTYPE Serotype of the culture. TBD
HIBVACC If <15 years of age and serotype is 'b' or 'unk', did the patient receive Haemophilus Influenzae b vaccine? PHVS_YesNoUnknown_CDC
MEDINS Type of medical insurance the family has. TBD
OTHINS Other medical insurance type.

HIBCON Is there a known previous contact with Hib disease within the preceding two months? PHVS_YesNoUnknown_CDC
CONTYPE Type of previous contact with Hib disease within the preceding two months.

SIGHIST Patient's significant past medical history. TBD
PREWEEKS Number of weeks of a preterm birth (less than 37 weeks).

SPECHIV Specify immunosupression/HIV.

OTHSIGHIST Specify other prior condition.

ACUTESER Is acute serum available? PHVS_YesNoUnknown_CDC
ACUTESERDT Date of acute serum availability.

CONVSER Is convalescent serum available? PHVS_YesNoUnknown_CDC
CONVSERDT Date of convalescent serum availability.

BIRTHCTRY Person's country of birth. PHVS_Country_ISO_3166-1
Other Serotype Another serotype not included in the serotype dropdown list.

Was the patient < 15 years of age at the time of first positive culture? Indicator whether the patient was less than 15 years of age at the time of first positive culture. PHVS_YesNoUnknown_CDC
Bacterial Infection Syndrome Types of infection caused by organism PHVS_InfectionType_RIBD P
Pregnancy Status at the Time of First Positive Culture At the time of first positive culture, was the patient pregnant or postpartum? (The postpartum period is defined as the 30 days following a delivery or miscarriage) PHVS_PregnacyStatus_RIBD P
Pregnancy Outcome If pregnant or postpartum, what was the outcome of fetus? PHVS_FetalOutcome_RIBD P
Gestational Age If patient <1 month of age, indicate gestational age (in weeks) N/A P
Birth Weight If patient <1 month of age, indicate birth weight N/A P
Birth Weight Units Birth Weight Units PHVS_WeightUnit_UCUM P
Previous Contact With Hib Disease Is there a known previous contact(s) with Hib disease within the preceding two months? PHVS_YesNoUnknown_CDC P
Hib Contact Type Type of previous contact(s) with Hib disease within the preceding two months. PHVS_ContactType_RIBD P
Previous Contact With Non-b or Nontypeable H. influenzae Case Did patient have known previous contact(s) with a non-b or nontypeable case of H. influenzae disease within the preceding 2 months? PHVS_YesNoUnknown_CDC P
Non-b or Nontypeable Contact Type Specify type of contact(s) with non-b or nontypeable case of H. influenzae PHVS_ContactType_RIBD P
Recurrent Disease with Same Pathogen this case have recurrent disease with the same pathogen? (For Streptococcus pneumoniae, the specimen from the current case must have been isolated 8 or more days after any previous case due to the same pathogen. For all other pathogens, the specimen from the current case must have been isolated 30 or more days after any previous case due to the same pathogen.) PHVS_YesNoUnknown_CDC P
Previous State ID (Recurrent Case) StateID of 1st occurrence for this pathogen and person. N/A P
Case Report Form Status Case Report Form Status PHVS_FormStatus_RIBD P
Illness Onset Age Illness onset age N/A P
Illness Onset Age Units Illness onset age units PHVS_AgeUnit_UCUM P
Residence Where was the patient a resident at time of initial culture? PHVS_ResidenceLocation_RIBD P
Premature Infant Premature at birth (for children ≤2 years old) PHVS_YesNoUnknown_CDC P
Epi-Linked to a Laboratory-Confirmed Case Is this case epi-linked to a laboratory-confirmed case? PHVS_YesNoUnknown_CDC P
ABCs Case ABCs case? PHVS_YesNoUnknown_CDC P
ABCs State ID ABCs State ID N/A P
Laboratory Testing Performed Was laboratory testing done to confirm the diagnosis? PHVS_YesNoUnknown_CDC P
Laboratory Confirmed Was the case laboratory confirmed? PHVS_YesNoUnknown_CDC P
Test Manufacturer Test Manufacturer N/A P
Lab Accession Number Lab Accession Number (including CDC Lab ID) N/A P
Did the Subject Ever Receive a Vaccine Against This Disease Did the subject ever receive a vaccine against this disease? PHVS_YesNoUnknown_CDC P
Date of Last Dose Prior to Illness Onset Date of last vaccine dose against this disease prior to illness onset N/A P
Vaccination Doses Prior to Onset Number of vaccine doses against this disease prior to illness onset N/A P
Vaccine History Comments Vaccine History Comments N/A P
Age at Vaccination The persons age at the time the vaccine was given N/A P
Age at Vaccination Units The age units of the person at the time the vaccine was given PHVS_AgeUnit_UCUM P
Vaccine History Information Source What sources were used for vaccination history? PHVS_InformationSource_RIBD P
Vaccine Information Source Indicator Vaccination History Information Source Indicator PHVS_YesNoUnknown_CDC P
Susceptibility Test Was any susceptibility data available? PHVS_YesNoUnknown_CDC P

Sheet 22: Hansen's

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
State Case ID States use this field to link NEDSS investigations back to their own state investigations.


Date of completion of Report Date the initial leprosy surveillance form was completed by a reporting source (physician or lab reported to the local/county/state health department).


Date of First Report to CDC Date the case was first reported to the CDC


Notification Result Status Status of the notification. PHVS_ResultStatus_NETSS

Condition Code Condition or event that constitutes the reason the notification is being sent PHVS_NotifiableEvent_Disease_Condition_CDC_NNDSS

Case Class Status Code Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. PHVS_CaseClassStatus_NND

MMWR Week MMWR Week for which case information is to be counted for MMWR publication.


MMWR Year MMWR Year (YYYY) for which case information is to be counted for MMWR publication.


Reporting State State reporting the notification. PHVS_State_FIPS_5-2

Reporting County County reporting the notification. PHVS_County_FIPS_6-4

National Reporting Jurisdiction National jurisdiction reporting the notification to CDC. PHVS_NationalReportingJurisdiction_NND

Reporting Source Type Code Type of facility or provider associated with the source of information sent to Public Health. PHVS_ReportingSourceType_NND

Reporting Source ZIP Code ZIP Code of the reporting source for this case.


Date First Reported PHD Earliest date the case was reported to the public health department whether at the local, county, or state public health level.


Person Reporting to CDC - Name Name of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Person Reporting to CDC - Phone Number Phone Number of the person who is reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Person Reporting to CDC - Title Job title / description of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Person Reporting to CDC - Affiliation Affiliated Facility of the person reporting the case to the CDC. This is the person that CDC should contract in a state if there are questions regarding this case notification.


Type of leprosy Classify the diagnosis based on one of the ICD-9-CM diagnosis codes PHVS_TypeofLeprosy_CDC

Subject Address County County of residence of the subject PHVS_County_FIPS_6-4

Subject Address State State of residence of the subject PHVS_State_FIPS_5-2

Age units at case investigation Subject age units at time of case investigation PHVS_AgeUnit_UCUM_NETSS

Country of Birth Country of Birth PHVS_CountryofBirth_CDC

Time in U.S. Length of time this subject has been living in the U.S. (if born out of the U.S.


Date first entered U.S. Provide the date that subject first entered U.S. in YYYYMM format (if born out of the U.S.)


Subject’s Sex Subject’s current sex PHVS_Sex_MFU

Race Category Field containing one or more codes that broadly refer to the subject’s race(s). PHVS_RaceCategory_CDC

Ethnic Group Code Based on the self-identity of the subject as Hispanic or Latino PHVS_EthnicityGroup_CDC_Unk

Country of Usual Residence Where does the person usually* live (defined as their residence)

*For the definition of ‘usual residence’ refer to CSTE position statement # 11-SI-04 titled “Revised Guidelines for Determining Residency for Disease Reporting” at http://www.cste.org/ps2011/11-SI-04.pdf .
PHVS_CountryofBirth_CDC

Earliest Date Reported to County Earliest date reported to county public health system


Earliest Date Reported to State Earliest date reported to state public health system


Diagnosis Date Earliest date of diagnosis (clinical or laboratory) of condition being reported to public health system


Case Disease Imported Code Indication of where the disease/condition was likely acquired. PHVS_DiseaseAcquiredJurisdiction_NETSS

Imported Country If the disease or condition was imported, indicates the country in which the disease was likely acquired. PHVS_Country_ISO_3166-1

Country of Exposure or Country Where Disease was Acquired

Note: use exposure or acquired consistently across variables
Indicates the country in which the disease was potentially acquired. PHVS_CountryofBirth_CDC

Date of Onset of symptoms Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system


Date Leprosy first diagnosed Provide month and year first diagnosis was made (if applicable)


Initial diagnosis Was subject diagnosed in the U.S. or outside the U.S.


Diagnosis_Biopsy Was biopsy performed in the U.S.? PHVS_DiagnosisBiopsy_CDC

Diagnosis_SkinSmear Was skin smear test performed PHVS_DiagnosisSkinSmear_Leprosy

Date test performed Provide date test was performed in YYYYMM format


Test Result Epidemiologic interpretation of the results of the tests performed for this case PHVS_LabTestInterpretation_Leprosy

Current antimicrobial Treatment Indicate all antimicrobial drugs used to treat subject
PHVS_MedicationTreatment_Leprosy

Date current antimicrobial Treatment Indicate the date antimicrobial treatment started
PHVS_MedicationTreatment_Date_Leprosy

Disability Indicate any sensory abnormalities or deformities of the hands, feet or eyes PHVS_HandsFeet_CDC

Armadillo exposure Did subject ever had direct contact with an armadillo? PHVS_YesNoUnknown_CDC

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

Sheet 23: Hantavirus Pulmonary Syndrome

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

Sheet 24: Hepatitis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Reason for Testing Listing of the reason(s) the subject was tested for hepatitis. PHVS_ReasonForTest_Hepatitis

Symptomatic Was the subject symptomatic for hepatitis? PHVS_YesNoUnknown_CDC

Date of Illness Onset Date of the beginning of the illness. Reported date of the onset of symptoms of the condition being reported to the public health system


Jaundiced (Symptom) Was the subject jaundiced? PHVS_YesNoUnknown_CDC

Due Date Subject's pregnancy due date


Previously Aware of Condition Was the subject aware they had Hepatitis prior to lab testing? PHVS_YesNoUnknown_CDC

Provider of Care for Condition Does the subject have a provider of care for Hepatitis? This is any healthcare provider that monitors or treats the patient for viral hepatitis. PHVS_YesNoUnknown_CDC

Liver Enzyme Test Type Liver Enzyme Test Type PHVS_LabTestTypeEnzymes_Hepatitis

Liver Enzyme Test Result Date Liver Enzyme Test Result Date


Liver Enzyme Upper Limit Normal Liver Enzyme Upper Limit Normal


Liver Enzyme Test Result Liver Enzyme Test Result


Test Type Epidemiologic interpretation of the type of test(s) performed for this case. PHVS_LabTestType_Hepatitis

Test Result Epidemiologic interpretation of the results of the test(s) performed for this case. PHVS_PosNegUnk_CDC

anti-HCV signal to cut-off ratio Used to specify the anti-HCV signal to cut-off ratio if antibody to Hepatitis C virus was the test performed.


Is this case Epi-linked to another confirmed or probable case?
Specify if this case is Epidemiologically-linked to another confirmed or probable case of hepatitis? PHVS_YesNoUnknown_CDC

Contact With Confirmed or Suspected Case During the 2-6 weeks prior to the onset of symptoms, was the subject a contact of a person with confirmed or suspected hepatitis virus infection? PHVS_YesNoUnknown_CDC

Contact Type During the 2-6 weeks prior to the onset of symptoms, type of contact the subject had with a person with confirmed or suspected hepatitis virus infection PHVS_ContactType_HepatitisA

Contact Type Indicator During the 2-6 weeks prior to the onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis virus infection PHVS_YesNoUnknown_CDC

In Day Care During the 2-6 weeks prior to the onset of symptoms, was the subject a child or employee in daycare center, nursery, or preschool? PHVS_YesNoUnknown_CDC

Day Care Contact During the 2-6 weeks prior to the onset of symptoms, was the subject a household contact of a child or employee in a daycare center, nursery, or preschool? PHVS_YesNoUnknown_CDC

Identified Day Care Case Was there an identified hepatitis case in the childcare facility? PHVS_YesNoUnknown_CDC

Sexual Preference What is/was the subject's sexual preference? PHVS_SexualPreference_NETSS

Number of Male Sexual Partners During the 2-6 weeks prior to the onset of symptoms, number of male sex partners the person had.


Number of Female Sexual Partners During the 2-6 weeks prior to the onset of symptoms, number of female sex partners the person had.


IV Drug Use During the 2-6 weeks prior to the onset of symptoms, did the subject inject drugs not prescribed by a doctor? PHVS_YesNoUnknown_CDC

Recreational Drug Use During the 2-6 weeks prior to the onset of symptoms, did the subject use street drugs but not inject? PHVS_YesNoUnknown_CDC

Travel or Live Outside U.S. or Canada During the 2-6 weeks prior to the onset of symptoms, did the subject travel or live outside the U.S.A. or Canada? PHVS_YesNoUnknown_CDC

Countries Traveled or Lived Outside U.S. or Canada The country(s) to which the subject traveled or lived (outside the U.S.A. or Canada) prior to symptom onset. PHVS_Country_ISO_3166-1

Principal reason for travel What was the principal reason for travel? PHVS_TravelReason_HepatitisA

Household Travel Outside U.S. or Canada During the 3 months prior to the onset of symptoms, did anyone in the subject's household travel outside the U.S.A. or Canada? PHVS_YesNoUnknown_CDC

Household Countries Traveled to Outside U.S. or Canada The country(s) to which anyone in the subject's household traveled (outside the U.S.A. or Canada) prior to symptom onset. PHVS_Country_ISO_3166-1

Common-Source Outbreak Is the subject suspected as being part of a common-source outbreak? PHVS_YesNoUnknown_CDC

Foodborne Outbreak- infected food handler Subject is associated with a foodborne outbreak that is asscociated with an infected food handler. PHVS_YesNoUnknown_CDC

Foodborne Outbreak - NOT an infected food handler Subject is associated with a foodborne outbreak that is not associated with an infected food handler. PHVS_YesNoUnknown_CDC

Food Item of Associated Outbreak Food item with which the foodborne outbreak is associated.


Waterborne Outbreak Subject is associated with a waterborne outbreak . PHVS_YesNoUnknown_CDC

Unidentified Source Outbreak Subject is associated with an outbreak that does not have an identifed source. PHVS_YesNoUnknown_CDC

Food Handler During the 2 weeks prior to the onset of symptoms or while ill, was the subject employed as a food handler? PHVS_YesNoUnknown_CDC

Diabetes Does subject have diabetes? PHVS_YesNoUnknown_CDC

Diabetes Diagnosis Date If subject has diabetes, date of diabetes diagnosis.


Ever Receive a Vaccine Did the subject ever receive the hepatitis A vaccine? PHVS_YesNoUnknown_CDC

Total Doses of Vaccine Number of doses of hepatitis A vaccine the subject received.


Date of Last Dose Year the subject received the last dose of hepatitis A vaccine.


Ever Receive Immune Globulin Has the subject ever received immune globulin? PHVS_YesNoUnknown_CDC

Date of Last IG Dose Date the subject received the last dose of immune globulin.


Mother's Race Race of the subject's mother. PHVS_RaceCategory_CDC

Mother's Ethnicity Ethnicity of the patient's mother. PHVS_EthnicityGroup_CDC_Unk

Mother Born Outside U.S. Was mother born outside of the United States of America? PHVS_YesNoUnknown_CDC

Mother's Birth Country What is the birth country of the mother? PHVS_Country_CDC

Mother Confirmed Positive Prior To Delivery Was the mother confirmed HBsAg positive prior to or at time of delivery? PHVS_YesNoUnknown_CDC

Mother Confirmed Positive After Delivery Was the mother confirmed HBsAg positive after delivery? PHVS_YesNoUnknown_CDC

Mother Confirmed Positive Date Date of mother's earliest HBsAg positive test result.


Total Doses of Vaccine Number of doses of hepatitis vaccine the child received.


Ever Receive Immune Globulin Has the child ever received immune globulin? PHVS_YesNoUnknown_CDC

Date the child received HBIG Date the child received the last dose of immune globulin.


Vaccine Dose Number The vaccine dose number in series of vaccination for hepatitis.


Vaccine Administered Date The date that the vaccine was administered.


Contact With Confirmed or Suspected Case For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis B virus infection?

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, was the patient a contact of a person with confirmed or suspected hepatitis C virus infection?
PHVS_YesNoUnknown_CDC

Contact Type For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis B virus infection?

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, type of contact with a person with confirmed or suspected hepatitis C virus infection?
PHVS_ContactType_HepatitisBandC

Contact Type Indicator For Acute Hepatitis B, in the 6 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection.

For Acute Hepatitis C, in the 2 weeks to 6 months prior to onset of symptoms, answer (Yes, No, Unknown) for each type of contact the subject had with a person with confirmed or suspected hepatitis B virus infection.
PHVS_YesNoUnknown_CDC

Sexual Preference What is/was the subject's sexual preference? PHVS_SexualPreference_NETSS

Number of Male Sexual Partners Prior to the onset of symptoms, number of male sex partners the person had.

For Acute Hep B, the time period prior to onset of symptoms is 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 6 months.



Number of Female Sexual Partners Prior to the onset of symptoms, number of female sex partners the person had.

For Acute Hep B, the time period prior to onset of symptoms is 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 6 months.



Number of Sex Partners How many sex partners (approximately) has subject ever had?


Treated for STD Was the subject ever treated for a sexually transmitted disease? PHVS_YesNoUnknown_CDC

Year of Recent Treatment for STD Year the patient received the most recent treatment for a sexually transmitted disease.



Ever IDU Has the patient ever injected drugs not prescribed by a doctor, even if only once or a few times? PHVS_YesNoUnknown_CDC

Ever Had Contact with Hepatitis Was the patient ever a contact of a person who had hepatitis? PHVS_YesNoUnknown_CDC

Ever Contact Type If the patient was ever a contact of a person who had hepatitis, what was the type of contact? PHVS_ContactType_HepatitisBandC

IV Drug Use Prior to the onset of symptoms, did the patient inject drugs not prescribed by a doctor?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Recreational Drug Use Prior to the onset of symptoms, did the patient use street drugs but not inject?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Long-Term Hemodialysis Was the patient ever on long-term hemodialysis? PHVS_YesNoUnknown_CDC

Hemodialysis Prior to the onset of symptoms, did the patient udergo hemodialysis?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Contaminated Stick Prior to the onset of symptoms, did the patient have an accidental stick or puncture with a needle or other object contaminated with blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Transfusion before 1992 Did the patient receive a blood transfusion prior to 1992? PHVS_YesNoUnknown_CDC

Transplant before 1992 Did the patient receive an organ transplant prior to 1992? PHVS_YesNoUnknown_CDC

Clotting Factor before1987 Did the patient receive clotting factor concentrates prior to 1987? PHVS_YesNoUnknown_CDC

Blood Transfusion Prior to the onset of symptoms, did the patient receive blood or blood products (transfusion)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Blood Transfusion Date Date the subject began receiving blood or blood products (transfusion) prior to symptom onset.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.



Outpatient IV Infusions and/or Injections Prior to the onset of symptoms, did the patient receive any IV infusions and/or injections in an outpatient setting?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Other Blood Exposure Prior to the onset of symptoms, did the patient have other exposure to someone else's blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Ever a Medical / Dental Blood Worker Was the patient ever employed in a medical or dental field involving direct contact with human blood? PHVS_YesNoUnknown_CDC

Medical / Dental Blood Worker Prior to the onset of symptoms, was the patient employed in a medical or dental field involving direct contact with human blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Medical / Dental Blood Worker - Frequency of Blood Contact Subject's frequency of blood contact as an employee in a medical or dental field involving direct contact with human blood.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_BloodContactFrequency_Hepatitis

Public Safety Blood Worker Prior to the onset of symptoms, was the subject employed as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Public Safety Blood Worker - Frequency of Blood Contact Subject's frequency of blood contact as a public safety worker (fire fighter, law enforcement, or correctional officer) having direct contact with human blood.

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_BloodContactFrequency_Hepatitis

Tattoo Prior to the onset of symptoms, did the patient receive a tattoo?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Location Tattoo Received from Location(s) where the patient received a tattoo PHVS_TattooObtainedFrom_Hepatitis

Piercing Prior to the onset of symptoms, did the patient receive a piercing (other than ear)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Location Piercing Received from Location(s) where the patient received a piercing (other than ear) PHVS_TattooObtainedFrom_Hepatitis

Dental Work / Oral Surgery Prior to the onset of symptoms, did the patient have dental work or oral surgery?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Surgery Other Than Oral Prior to the onset of symptoms, did the patient have surgery (other than oral surgery)?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Tested for Hepatitis D Was the patient tested for Hepatitis D PHVS_YesNoUnknown_CDC

Hepatitis Delta Infection Did patient have a co-infection with Hepatitis D? PHVS_YesNoUnknown_CDC

Prior Negative Hepatitis Test Did the patient have a negative hepatitis-related test in the previous 6 months?

For Hep B: Did patient have a negative HBsAg test in the previous 6 months?

For Hep C: Did patient have a negative HCV antibody test in the previous 6 months?
PHVS_YesNoUnknown_CDC

Verified Test Date If patient had a negative hepatitis-related test test in the previous 6 months, please enter the test date.


Hospitalized Prior to the onset of symptoms, was the patient hospitalized?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Long Term Care Resident Prior to the onset of symptoms, was the patient a resident of a long-term care facility?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Ever Incarcerated Was the patient ever incarcerated? PHVS_YesNoUnknown_CDC

Incarcerated More Than 24 hours Prior to the onset of symptoms, was the patient incarcerated for longer than 24 hours?

For Acute Hep B, the time period prior to onset of symptoms is 6 weeks - 6 months.

For Acute Hep C, the time period prior to onset of symptoms is 2 weeks - 6 months.
PHVS_YesNoUnknown_CDC

Diabetes Does subject have diabetes? PHVS_YesNoUnknown_CDC

Diabetes Diagnosis Date If subject has diabetes, date of diabetes diagnosis.


Type of Incarceration Facility Type of facility where the patient was incarcerated for longer than 24 hours before symptom onset. PHVS_IncarcerationType_Hepatitis

Incarceration Type Indicator
PHVS_YesNoUnknown_CDC

Incarcerated More Than 6 months Was the patient ever incarcerated for longer than six months during his or her lifetime? PHVS_YesNoUnknown_CDC

Year of Most Recent Incarceration Year the patient was most recently incarcerated for longer than six months.


Length of Incarceration Length of time the patient was most recently incarcerated for longer than six months.


Received Medication for Condition Has the subject ever received medication for the type of Hepatitis being reported? PHVS_YesNoUnknown_CDC

Mother's Birth Country What is the birth country of the mother? PHVS_Country_CDC

Did the subject ever receive a vaccine? Did the subject ever receive a hepatitis B vaccine? PHVS_YesNoUnknown_CDC

Total Doses of Vaccine Number of doses of hepatitis B vaccine the patient received.


Date of Last Dose Year the patient received the last dose of hepatitis B vaccine.


Tested for HBsAg Antibodies Was the patient tested for antibody to HBsAg (anti-HBs) within one to two months after the last dose? PHVS_YesNoUnknown_CDC

HBsAg Antibodies Positive Was the serum anti-HBs >= 10ml U/ml? (Answer 'Yes' if lab result reported as positive or reactive.) PHVS_YesNoUnknown_CDC

Maternal HBeAg result, date Maternal HBeAg result, date


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


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


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


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


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


Infant Birthweight Infant Birthweight


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


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


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


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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Note: If the symptom onset date is unknown, then the date that the patient first tested positive for hepatitis A virus (HAV) can be used as a proxy for symptom onset date.
PHVS_YesNoUnknown_CDC
1
Specify Different Travel Exposure Window If the travel exposure window used by the jurisdiction is different from that stated in the travel exposure questions, specify the time interval in days here. Otherwise, leave blank. N/A (text field)
1
International Destination(s) of Recent Travel International destination or countries the patient traveled to or lived in, in the 15 to 50 days before symptom onset date PHVS_Country_ISO_3166-1
1
Date of Arrival to Travel Destination Date of arrival to travel destination N/A (Date)
3
Date of Departure from Travel Destination Date of departure from travel destination N/A (Date)
3
Laboratory Test Ordering Facility Type Type of facility where the hepatitis laboratory screening, diagnostic, or monitoring test was ordered PHVS_SourceofLaboratoryTest _Hepatitis
2

Sheet 25: Hemolytic Uremic Syndrome

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

Sheet 26: Human Rabies

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

Sheet 27: Invasive Pneumococcal Disease

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority
Long Term Care Facilty Resident Does the patient reside in a long term care facility? PHVS_YesNoUnknown_CDC
Culture Date Date the first positive culture was obtained.

Bacterial Infection Syndrome Types of infection(s) that are caused by the bacterial organism. PHVS_BacterialInfectionSyndrome_IPD
Sterile Specimen Type Sterile body site(s) from which the organism was isolated. PHVS_SterileSpecimen_IPD
Did Underlying Condition(s) exist? Did the subject have any pre-existing medical conditions before the start of the illness/condition? PHVS_YesNoUnknown_CDC
Underlying Condition(s) Listing of pre-existing conditions as related to the condition/illness PHVS_UnderlyingConditions_IPD
Oxacillin Zone Size Oxacillin zone size for cases of Streptococcus pneumoniae

Oxacillin Interpretation Oxacillin interpretation for cases of Streptococcus pneumoniae PHVS_OxacillinInterpretation_IPD
Antimicrobial Agent Antimicrobial agent tested PHVS_AntimicrobialAgent_IPD
Antimicrobial Susceptibility Test Method Antimicrobial susceptibility testing method used PHVS_AntimicrobialSuceptiblilityTestMethod_IPD
Antimicrobial Susceptibility Test Result S/I/R/U result, indicating whether the microorganism is susceptible or not susceptible (intermediate or resistant) to the antimicrobial being tested. PHVS_SusceptibilityResult_CDC
Minimum Inhibitory Concentration Range MIC (minimum inhibitory concentration) range.

Serotyping Results Available Are serotyping results available for S pneumoniae isolate? PHVS_YesNoUnknown_CDC
Lab Result Coded Value If Serotyping results are available for S pneumoniae isolate, please specify. PHVS_SerotypeMethod_IPD
Serotype Method Serotyping Method Used PHVS_SerotypeMethod_IPD
23-Valent Pneumo Poly Vaccine Has patient ≥2yrs received 23-valent pneumococcal polysaccharide vaccine (Pneumovax)? PHVS_YesNoUnknown_CDC
7-Valent Pneumo Conjugate Vaccine If less than eighteen years of age, did the patient receive 7-valent pneumococcal conjugate vaccine (PCV7 or Prevnar)? PHVS_YesNoUnknown_CDC
13-Valent Pneumo Conjugate Vaccine If less than eighteen years of age, did the patient receive 13-valent pneumococcal conjugate vaccine (PCV13)? PHVS_YesNoUnknown_CDC
Vaccine Administered The type of vaccine administered PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered

Vaccine Administered Date The date that the vaccine was administered

Clinical syndrome Clinical diagnoses associated with a case of IPD

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

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

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

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

Sheet 28: Legionellosis

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

Hospitalization for treatment Was patient hospitalized during treatment for legionellosis?

Admission date Date of admission to hospital

Hospital name Name of hospital to which admitted

Hospital address City and state of hospital

Illness outcome Outcome of illness

Nights away from home In the 10 days before onset, did the patient spend any nights away from home (excluding healthcare settings)?

Accommodation name Name of lodging where patient stayed other than usual resident

Accommodation address Address of lodging away from home

Accommodation city City of lodging away from home

Accommodation state State of lodging away from home

Accommodation zip Zipcode of lodging away from home

Accommodation country Country of lodging away from home

Accommodation room number Room number at lodging where patient stayed other than usual resident

Arrival Date Date of stay arrival

Departure Date Date of stay departure

Reported CDC If yes, was this case reported to CDC at [email protected]? 1

Whirlpool/Spa vicinity In the 10 days before onset, did the patient get in or spend time near a whirlpool spa (i.e., hot tub)?

Respiratory trherapy equipment use In the 10 days before onset, did the patient use a nebulizer, CPAP, BiPAP or any other respiratory therapy equipment for the treatment of sleep apnea, COPD, asthma or for any other reason?

Humidifier use If yes, does this device use a humidifier?

Water type If yes, what type of water is used in the device? This is a multi-select field.

Healthcare setting visit/stay In the 10 days before onset, did the patient visit or stay in a healthcare setting (e.g., hospital, long term care/rehab/skilled nursing facility, clinic)?

Healthcare setting/facility Type of healthcare setting/facility

Exposure type Type of exposure in HC setting/facility

Facility name Name of healthcare facility

Transplant center Is this a transplant center?

Visit reason Reason for visit to HC facility

HC facility city City of HC facility

HC facility state State of HC facility

Admission date Start date of HC facility admission/visit

End date End date of HC facility admission/visit

Healthcare exposure Was this case associated with a healthcare exposure?

Assisted living facility exposure In the 10 days before onset, did the patient visit or stay in an assisted living facility or senior living facility?

AL facility type Type of assisted living facility exposure

AL exposure type Type of assisted living facility

AL facility name Name of AL facility

AL city Name of city of AL facility

AL state Name of state of AL facility

AL start date Start date of AL facility admission/visit

AL end date End date of AL facility admission/visit

Urine Ag positive Was the urine antigen positive?

Urine Ag collection date Date urine antigen was collected

Culture positive Was the culture positive?

Culture collection date Date culture was collected

Culture site Site of culture specimen

Culture species Species isolated from culture

Culture serogroup Serogroup of species from culture

Ab titer Was there a fourfold rise in Ab titer?

Acute titer Initial Ab titer to L. pneumophila serogroup 1

Acute collected Initial Ab titer specimen collection date

Convalescent titer Convalescent Ab titer to L. pneumophila serogroup 1

Convalescent collected Convalescent Ab specimen collection date

Ab titer other Was there a fourfold rise in Ab titer for other than L. pneumophila serogroup 1 or to multiple species or serogroups of Legionella using pooled antigen?

Acute titer other Initial Ab titer to other than L. pneumophila serogroup 1

Acute collected other Initial Ab titer specimen collection date for species other than L. pneumophila serogroup 1

Convalescent titer other Convalescent Ab titer to species other than L. pneumophila serogroup 1

Convalescent collected other Convalescent Ab specimen collection date for species other than L. pneumophila serogroup 1

Species other Species identified for other than L. pneumophila serogroup 1

Serogroup other Serogroup identified for other than L. pneumophila serogroup 1

DFA/IHC positive Was the DFA or IHC positive?

DFA/IHC collection date Date specimen for DFA/IHC collected

DFA/IHV specimen site Site of DFA/IHC specimen

Species other - DFA/IHC Species identified by DFA/IHC for other than L. pneumophila serogroup 1

Serogroup other - DFA/IHC Serogroup identified by DFA/IHC for other than L. pneumophila serogroup 1

Nucleic Acid Assay - other Was a nucleic acid assay (e.g., PCR) performed?

Nucleic Acid Assay collection date Date nucleic acid assay specimen collected

Nucleic Acid Assay specimen site Site of nucleic acid assay specimen

Species other - nucleic acid assay Species identified by nucleic acid assay for other than L. pneumophila serogroup 1

Serogroup other - nucleic acid assay Serogroup identified by nucleic acid assay for other than L. pneumophila serogroup 1

Whirlpool Spa, Location If Yes, describe where

Whirlpool Spa, Dates If Yes, list dates

Occupation Subject’s Occupation

Interviewer’s Name Interviewer’s Name

Interviewer’s Affiliation Interviewer’s Affiliation

Interviewer’s telephone number Interviewer’s telephone number

Name of State Health Department Official who reviewed this report Name of State Health Department Official who reviewed this report

Title of State Health Department Official who reviewed this report Title of State Health Department Official who reviewed this report

Telephone Number of State Health Department Official who reviewed this report Telephone Number of State Health Department Official who reviewed this report

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

Sheet 29: Leptospirosis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action) CDC Priority (Legacy) CDC Priority (New)
Date First Submitted Date/time the notification was first sent to CDC. This value does not change after the original notification.


State Case ID States use this field to link NEDSS investigations back to their own state investigations.


Health care provider Health care provider name


Health care provider phone Health care provider phone number


Case Class Status Code Status of the case/event as suspect, probable, confirmed, or not a case per CSTE/CDC/ surveillance case definitions. PHVS_CaseClassStatus_NND

Subject Address State State of residence of the subject PHVS_State_FIPS_5-2

Subject Address ZIP Code ZIP Code of residence of the subject


Subject Address County County of residence of the subject PHVS_County_FIPS_6-4

Subject’s Sex Subject’s current sex


Date of Birth Birth Date (mm/yyyy)


Age at case investigation Subject age at time of case investigation


Age units at case investigation Subject age units at time of case investigation PHVS_AgeUnit_UCUM_NETSS

Ethnic Group Code Based on the self-identity of the subject as Hispanic or Latino PHVS_EthnicityGroup_CDC_Unk

Race Category Field containing one or more codes that broadly refer to the subject’s race(s). PHVS_RaceCategory_CDC

Symptomatic Was the case-patient symptomatic? PHVS_YesNoUnknown_CDC

Date symptom onset If Symptomatic was "Yes", provide the Date of Onset of symptoms


Symptoms Select symptoms and signs reported or identified, from "Fever", "Myalgia", "Headache", "Jaundice ", "Hepatitis", "Conjunctival suffusion", "Rash (Maculopapular or petechial)", "Aseptic meningitis", "Gastrointestinal involvement", "Pulmonary complications", "Cardiac 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

Sheet 30: Listeria

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

Sheet 31: Latent TB 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
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

Sheet 32: Lyme

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

Sheet 33: Malaria

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

Sheet 34: Measles

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the subject have a rash? Did the subject being reported in this investigation have a rash? PHVS_YesNoUnknown_CDC
Rash onset date What was the onset date of the subject's rash?
Rash Duration How many days did the rash reported in this investigation last?
Was the rash generalized? Was the rash generalized? (Occurring on more than one or two parts of the body?) PHVS_YesNoUnknown_CDC
Rash onset occur within 21 days of entering USA Did rash onset occur within 21 days of entering the USA, following any travel or living outside the USA? PHVS_YesNoUnknown_CDC
Did the subject have a fever? Did the subject have a fever? I.E., a measured temperature >2 degrees above normal PHVS_YesNoUnknown_CDC
Highest Measured Temperature What was the subject's highest measured temperature during this illness?
Temperature units The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius. PHVS_TemperatureUnit_UCUM
Date of fever onset Date of fever onset
Cough Did the subject develop a cough during this illness? PHVS_YesNoUnknown_CDC
Coryza (runny nose) Did the subject develop coryza (runny nose) during this illness? PHVS_YesNoUnknown_CDC
Conjunctivitis Did the subject develop conjunctivitis during this illness? PHVS_YesNoUnknown_CDC
Otitis Media (Complication) Did the subject develop otitis media as a complication of this illness? PHVS_YesNoUnknown_CDC
Diarrhea (Complication) Did the subject develop diarrhea as a complication of this illness? PHVS_YesNoUnknown_CDC
Pneumonia (Complication) Did the subject develop pneumonia as a complication of this illness? PHVS_YesNoUnknown_CDC
Encephalitis (Complication) Did the subject develop encephalitis as a complication of this illness? PHVS_YesNoUnknown_CDC
Thrombocytopenia (Complication) Did the subject develop thrombocytopenia as a complication of this illness? PHVS_YesNoUnknown_CDC
Croup (Complication) Did the subject develop croup as a complication of this illness? PHVS_YesNoUnknown_CDC
Hepatitis (Complication) Did the subject develop hepatitis as a complication of this illness? PHVS_YesNoUnknown_CDC
Other Complication Did the subject develop other conditions as a complication of this illness? PHVS_YesNoUnknown_CDC
Specify Other Complication Please specify the other complication the subject developed, during or as a result of this illness.
Was laboratory testing done for measles? Was laboratory testing done to confirm a diagnosis of measles? PHVS_YesNoUnknown_CDC
Test Type Epidemiologic interpretation of the type of test(s) performed for this case PHVS_LabTestProcedure_Measles
Test Result Epidemiologic interpretation of the results of the tests performed for this case. PHVS_LabTestInterpretation_VPD
Sample Analyzed Date The date the specimen/isolate was tested.
Test Method The technique or method used to perform the test and obtain the test results. PHVS_LabTestMethod_CDC
Date Collected Date of specimen collection
Specimen Source The medium from which the specimen originated. PHVS_SpecimenSource_Measles
Were the specimens sent to CDC for genotyping (molecular typing)? Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)? PHVS_YesNoUnknown_CDC
Specimen type sent to CDC for genotyping Specimen type sent to CDC for genotyping PHVS_SpecimenSource_Measles
Date sent for genotyping The date the specimens were sent to the CDC laboratories for genotyping.
Was Measles virus genotype sequenced? Identifies whether the Measles virus was genotype sequenced. PHVS_YesNoUnknown_CDC
Type of Genotype Sequence Identifies the genotype sequence of the Measles virus PHVS_Genotype_Measles
Transmission Setting What was the transmission setting where the measles was acquired? PHVS_TransmissionSetting_NND
Source of Infection What was the source of the measles infection?
Were age and setting verified? Does the age of the case match or make sense for the transmission setting listed (i.e. A subject aged 80 probably would not have a transmission setting of child day care center.)? PHVS_YesNoUnknown_CDC
Is this case Epi-linked to another confirmed or probable case? Specify if this case is Epidemiologically-linked to another confirmed or probable case of measles? PHVS_YesNoUnknown_CDC
Is this case linked to an international imported case either directly or within same chain of transmission? A "Yes" answer to this question denotes this case was infected by another subject who acquired infection while outside of the U.S. PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel List any international destinations of recent travel PHVS_Country_ISO_3166-1
Date of return from travel. Date the subject returned from all travel
Did the subject ever receive a disease-containing vaccine? Did the subject ever receive a measles-containing vaccine? PHVS_YesNoUnknown_CDC
If no, reason subject did not receive a disease-containing vaccine If the subject did not receive a measles-containing vaccine, what was the reason? PHVS_VaccineNotGivenReasons_CDC
Number of doses received BEFORE first birthday The number of doses of measles-containing vaccine the subject received before their first birthday.
Number of doses received ON or AFTER first birthday The number of measles-containing vaccine doses the subject received on or after their first birthday.
Reason for vaccinating before first (1st) birthday but not after If the subject was vaccinated with measles-containing vaccine BEFORE the first birthday, but did not receive a vaccine dose after their first birthday, state the reason. PHVS_VaccineNotGivenReasons_CDC
Reason subject received one dose ON or AFTER first birthday, but never received a second dose after the first (1st) birthday If the subject received one dose of measles-containing vaccine ON or AFTER their first birthday, but did not receive a second dose after the first birthday, what was the reason? PHVS_VaccineNotGivenReasons_CDC
Total doses disease-containing vaccine Total doses measles-containing vaccine
Vaccine Administered The type of vaccine administered PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered
Vaccine Administered Date The date that the vaccine was administered
US Acquired Sub-classification of disease or condition acquired in the US
PHVS_CaseClassificationExposureSource_NND
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

Sheet 35: Melioidosis

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

Sheet 36: MIS

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

Sheet 37: Monkeypox

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

Sheet 38: Mumps

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the subject have a fever? Did the subject have a measured temperature greater than two degrees above normal? PHVS_YesNoUnknown_CDC
Date of Fever Onset Date of fever onset
Highest Measured Temperature What was the subject's highest measured temperature during this illness?
Temperature Units The units of measure of the highest measured temperature. This would be either Fahrenheit or Celsius. PHVS_TemperatureUnit_UCUM
Parotitis (opposite second (2nd) molars)? (Symptom) Did the subject have parotitis as a symptom of this illness? PHVS_YesNoUnknown_CDC
Unilateral or Bilateral Parotitis
(Symptom)
Indicates if the parotitis is unilateral or bilateral PHVS_ParotitisLaterality_Mumps
Jaw Pain (Symptom) Did the subject have jaw pain as a symptom of this illness? PHVS_YesNoUnknown_CDC
Salivary Gland Swelling Onset Date Date of subject's salivary gland swelling (including parotitis) onset.
Salivary Gland Swelling Duration The length of time that the subject exhibited swelling of the salivary gland.
Salivary Gland Swelling Duration Units The length of time units that the subject exhibited swelling of the salivary gland PHVS_AgeUnit_UCUM
Submandibular Swelling (Symptom) Did the subject have submandibular swelling as a symptom of this illness? PHVS_YesNoUnknown_CDC
Sublingual Swelling (Symptom) Did the subject have sublingual swelling as a symptom of this illness? PHVS_YesNoUnknown_CDC
Import Status Did symptom onset occur within 12-25 days of entering the U.S., following any travel or living outside the U.S.? PHVS_YesNoUnknown_CDC
International Destination(s) of recent travel List any international destinations of recent travel PHVS_Country_ISO_3166-1
Date of return from travel Date the subject returned from all travel
Encephalitis (Complication) Did the subject develop encephalitis as a complication of this illness? PHVS_YesNoUnknown_CDC
Meningitis (Complication) Did the subject develop meningitis as a complication of this illness? PHVS_YesNoUnknown_CDC
Deafness (Complication) Did the subject become deaf as a complication of this illness? PHVS_YesNoUnknown_CDC
Type of Deafness Was the type of deafness permanent or temporary? PHVS_DeafnessType_Mumps
Orchitis (Complication) Did the subject develop orchitis as a complication of this illness? PHVS_YesNoUnknown_CDC
Other Complication Did the subject develop an other condition as a complication of this illness? PHVS_YesNoUnknown_CDC
Specify Other Complication Please specify the other complication the subject developed, during or as a result of this illness.
Was laboratory testing done for mumps? Was laboratory testing done to confirm a diagnosis of mumps? PHVS_YesNoUnknown_CDC
Test Type Epidemiologic interpretation of the type of test(s) performed for this case. PHVS_LabTestProcedure_Mumps
Test Result Epidemiologic interpretation of the results of the tests performed for this case PHVS_LabTestInterpretation_VPD
Numeric Test Result Numeric quantitative result of the test(s) performed for this case
Numeric Test Result Units Numeric quantitative result unit of the test(s) performed for this case PHVS_UnitsOfMeasure_CDC
Sample Analyzed Date The date the specimen/isolate was tested.
Test Method The technique or method used to perform the test and obtain the test results. PHVS_LabTestMethods_CDC
Date Collected Date of specimen collection
Specimen Source The medium from which the specimen originated PHVS_SpecimenSource_Mumps
Were the specimens sent to CDC for genotyping (molecular typing)? Were clinical specimens sent to CDC laboratories for genotyping (molecular typing)? PHVS_YesNoUnknown_CDC
Date sent for genotyping The date the specimens were sent to the CDC laboratories for genotyping
Transmission Setting What was the transmission setting where the mumps was acquired? PHVS_TransmissionSetting_NND
Were Age and Setting Verified? Does the age of the case match or make sense for the transmission setting listed (e.g., a subject aged 80 probably would not have a transmission setting of child day care center)? PHVS_YesNoUnknown_CDC
Source of Infection What was the source of the mumps infection?
Case Class by Source If this is a case aquired in the U.S., how should the case be classified by source? PHVS_CaseClassificationExposureSource_NND
Is this Case Epi-Linked to Another Confirmed or Probable Case? Specify if this case is Epidemiologically-linked to another confirmed or probable case of mumps? PHVS_YesNoUnknown_CDC
Did the subject ever receive a disease-containing vaccine? Did the subject ever receive a mumps-containing vaccine? PHVS_YesNoUnknown_CDC
If no, reason subject did not receive a disease-containing vaccine Specifies reason the subject did not receive a mumps-containing vaccine PHVS_VaccineNotGivenReasons_CDC
Number of doses received ON or AFTER first birthday The number of measles-containing vaccine doses the subject received on or after their first birthday
Vaccine History Comments Comments about the subject's vaccination history.
Vaccine Administered The type of vaccine administered. PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine. PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered.
Vaccine Administered Date The date that the vaccine was administered.
US Acquired Sub-classification of disease or condition acquired in the US
PHVS_CaseClassificationExposureSource_NND
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

Sheet 39: Neisseria meningitidis

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

Sheet 40: 2019 Novel Coronavirus COVID-19

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

Sheet 41: Novel Influenza A

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Fever >38°C (100.4°F) Did/does the patient have a fever (specify max temp)?
Feverish but temp not taken Did/does the patient have a fever but temperature not taken?
Cough Was cough a symptom?
Headache Did/does the patient have a headache?
Seizures Did/does the patient have seizures?
Sore throat Did/does the patient have a sore throat?
Conjunctivitis Did/does the patient have conjunctivitis?
Shortness of breath Did/does the patient have shortness of breath?
Diarrhea Did/does the patient have shortness of breath?
Other Did/does the patient have any other symptoms (specify)?
Vaccinated Was the patient vaccinated against human influenza in the past year?
Vaccination date If yes, date of vaccination
Vaccine type If yes, type of vaccine received?
Antiviral medications Did the patient receive antiviral medications?
Date initiated oseltamivir What was the date that oseltamivir was intiated?
Date discontinued oseltamivir What was the date that oseltamivir was discontinued?
Oseltamivir dosage What was the dosage of oseltamivir?
Zanamivir What was the date that zanamivir was intiated?
Date initiated zanamivir What was the date that zanamivir was discontinued?
Date discontinued zanamivir What was the dosage of zanamivir?
Rimantidine What was the date that rimantidine was intiated?
Date initiated rimantidine What was the date that rimantidine was discontinued?
Date discontinued rimantidine What was the dosage of rimantidine?
Amantidine What was the date that amantidine was intiated?
Date initiated amantidine What was the date that amantidine was discontinued?
Date discontinued amantidine What was the dosage of amantidine?
Other antivial (specify) What was the date that an other antiviral was intiated?
Dateintiated other What was the date that an other antiviral was discontinued?
Date discontinued other What was the dosage of an other antiviral?
Leukopenia Was leukopenia a lab finding?
Lymphopenia Was lymphopenia a lab finding?
Thrombocytopenia Was thrombocytopenia a lab finding?
Underlying medical conditions Does the patient have any underlying medical conditions?
Compromised immune function Does the patient have compromised immune function such as HIV infection, cancer, chronic corticosteroid therapy, diabetes, or organ transplant recipient?
Compromised immune function specified If yes, specify function.
Mechanical ventilation Did the patient require mechanical ventilation?
Chest x-ray/CAT Did the patient have a chest x-ray or CAT scan performed?
Pneumonia If abnormal, was there evidence of pneumonia?
ARDS If abnormal, did the patient have acute respiratory distress syndrome??
Death Did the patient die a s a result of this illness?
Test 1 Specimen Type What was the specimen type for diagnostic test 1?
Test 1 Date collected Date of collection of specimen for test 1?
Test 1 type What is the test type for diagnostic test 1?
Test 2 Specimen Type What was the specimen type for diagnostic test 2?
Test 2 Date collected Date of collection of specimen for test 2?
Test 2 type What is the test type for diagnostic test 2?
Specimens to CDC Indicate when and what type of specimens (including sera) were sent to CDC
Epi Risk - Travel In the 10 days prior to illness onset, did the patient travel?
Country/Arrival/Departure If yes, fill in the arrival and departure dates for all countries visited.
Case close contact Did the patient have close contact with a person who is a suspected, probable,, or confirmed novel human influenza A case?
Animal touch Did the patient touch animals or their remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Animal exposure Was the patient exposed to animal remains in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Environmental exposure Was the patient exposed to environments contaminated by animal feces in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Raw/Undercooked animals Did the patient consume raw or undercooked animals in an area where influenza infection in animals or novel influenza in humans has been suspected or confirmed in the last month?
Animal contact Did the patient have any animal contact (specify)?
Laboratory sample handling Did the patient handle samples suspected of containing influenza virus in a laboratory or other setting?
HC setting Does the patient work in a healthcare facility or setting?
Household illness contact Did the patient visit or stay in the same household with anyone with pneumonia or severe influenza-like illness?
Household death contact Did the patient visit or stay in the same household with anyone who died following thevisit?
Porcine exposure Did the patient visit an agricultural event, farm, petting zoo, or place where pigs live or were exhibited in the last month?
Porcine contact Did the patient have direct contact with pigs at an agricultural event, farm, petting zoo, or place where pigs were exhibited in the last month?
Epidemiological link with lab-confirmed or probable case If this patient has a diagnosis of novel influenza A virus infection that has not been serologically confirmed, is there an epidemiologic link between this patient and a lab-confirmed or probable novel influenza A case?

Sheet 42: Ped Flu Deaths

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Autopsy Was an autopsy performed on the patient?
Cardiac/respiratory arrest Did the patient experience cardiac/respiratory arrest outside the hospital?
Location of death What was the location of the patient's death?
Hospital Admission Date If patient's death occurrred in a hospital, what was the date of admission?
Pathology specimens to CDC Were pathology specimens sent to CDC's Infectious Diseases Pathology Branch?
Lab ID for pathology specimen Provide the lab ID number(if known) for pathology specimen(s) sent to CDC.
Isolates/original clinical material Were influenza isolates or original clinical material sent to CDC Influenza Division?
Lab ID for isolates/clinical specimen Provide the lab ID number(if known) for isolates/clinical specimen(s) sent to CDC.
Staph aureus isolates Were staph aureus isolates sent to CDC's Healthcare Quality Promotion?
Lab ID for isolates Provide the lab ID number(if known) for isolate(s) sent to CDC.
Commercial Rapid Diagnostic Test Indicate if commercial rapid test used.
Rapid test result What is the result of the rapid test?
Rapid test specimen collection date What is the specimen collection date for the rapid test?
Viral Culture Indicate if viral culture used.
Viral culture result What is the result of the viral culture?
Viral culture specimen collection date What is the specimen collection date for the viral culture?
Fluorescent Antibody (IFA or DFA) Indicate if fluorescent antibody test used.
IFA/DFA result What is the result of the IFA/DFA?
IFA/DFA specimen collection date What is the specimen collection date for the IFA/DFA?
Enzyme Immunoassay Indicate if enzyme immunoassay used.
EIA result What is the result of the EIA?
EIA collection date What is the specimen collection date for the EIA?
RT-PCR test Indicate if an RT-PCR test was used.
RT-PCR result What is the result of the RT-PCR?
RT-PCR specimen collection date What is the specimen collection date for the RT-PCR?
IHC test Indicate if an immunohistochemistry test was used.
IHC result What is the result of the IHC?
IHC specimen collection date What is the specimen collection date for the IHC?
Bacterial Culture Was a specimen collected for bacterial culture from a normally sterile site?
Specimen Type What was the specimen type obtained for the bacterial culture? This is a multi-select field.
Collection Date What was the collection date for the bacterial culture?
Bacterial Culture Results What was the result of the bacterial culture?
Bacterial culture species isolated If bacterial culture positive, check the organism cultured. This is a multi-select field.
Other Respiratory Specimen/ Non-sterile site Were other respiratory specimens from non-sterile site(s) collected for bacterial culture (e.g., sputum, ET tube aspirate)?
Other respiratory specimen site If yes, indicate the site from which the specimen was obtained. This is a multi-select field.
Other respiratory specimen site If yes, indicate the date collected of the specimen.
Other respiratory specimen collection date If yes, indicate the date collected of the specimen.
Other respiratory specimen result If yes, indicate the result for the specimen culture.
Bacterial species cultured If positve, what was the organism cultured?
Autopsy Specimen Was a specimen (e.g., fixed lung tissue) collected from an autopsy for bacterial pathogen testing?
Autopsy Specimen Results If autopsy specimen was taken, what were the results (indicate in the comments section)?
Mechanical Ventilation Was the patient placed on mechanical ventilation?
Complications Did complications occur during the acute illness?
Type complications If yes, check all complications that occurred during the acute illness. This is a multi-select field.
Existing Medical Conditions Did the child have any medical conditions that existed before the start of the acute illness?
Medical conditions before acute illness If yes,check all medical conditions that exised before the start of the acute illness. This is a multi-select field
Medications and/or Therapies Was the patient receiving any of the listed therapies prior to illness onset?
Medications received before illness Check all medications/therapies patient was receiving before the acute illness. This is a multi-select field.
Medications received after illness Did the patient receive any of the following after illness onset? This is a multi-select field.
Influenza Vaccine Did the patient receive any seasonal influenza vaccine during the current season (before illness)?
Vaccine before illness If yes, specify the seasonal vaccine received before illness onset.
1 Dose <14 days If yes, did patient receive 1 dose of vaccine <14 days prior to illness onset (date given)?
1 Dose >14 days If yes, did patient receive1 dose of vaccine ≥14 days prior to illness onset (date given)?
2 Dose <14 days If yes, did patient receive vaccines <14 days prior to illness onset (dates given)?
2 Dose >14 days If yes, did patient receive 2 doses of vaccines ≥14 days prior to illness onset (dates given)?
Previous Seasonal Vaccine Did the patient receive any seasonal influenza vaccine in previous seasons?
1 Dose Seasonal If yes, and patient was between 6 months and ≤8 years of age at the time of death, was the 2009-2010 influenza season the first time the patient received seasonal influenza vaccine?
2 Dose Seasonal If yes, did patient receive 2 doses of seasonal influenza vaccine during the 2009-2010 influenza season?
1 Dose AT Least If the patient was between 6 months and ≤8 years of age at the time of death, did they receive at least 1 dose of 2009 influenza A (H1N1) vaccine during the previous season?

Sheet 43: Pertussis

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Did the patient have a cough? Did the patient's illness include the symptom of cough? PHVS_YesNoUnknown_CDC
Cough Onset Date Cough onset date
Paroxysmal Cough Did the patient's illness include the symptom of paroxysmal cough? PHVS_YesNoUnknown_CDC
Whoop Did the patient's illness include the symptom of whoop? PHVS_YesNoUnknown_CDC
Post-tussive Vomiting Did the patient's illness include the symptom of post-tussive vomiting? PHVS_YesNoUnknown_CDC
Apnea Did the patient's illness include the symptom of apnea? PHVS_YesNoUnknown_CDC
Date of Final Interview Date of the patient's final interview
Did the patient have a cough at final interview? Was there a cough at the patient's final interview? PHVS_YesNoUnknown_CDC
Total Cough Duration What was the duration (in days) of the patient's cough?
Result of chest X-ray for pneumonia Result of chest x-ray for pneumonia PHVS_ChestXrayResult_CDC
Did the patient have generalized or focal seizures due to pertussis? Did the patient have generalized or focal seizures due to pertussis? PHVS_YesNoUnknown_CDC
Did the patient have acute encephalopathy due to pertussis? Did the patient have acute encephalopathy due to pertussis? PHVS_YesNoUnknown_CDC
Were antibiotics given? Were antibiotics given to the patient? PHVS_YesNoUnknown_CDC
Antibiotic Name What antibiotic did the patient receive? PHVS_AntibioticReceived_Pertussis
Antibiotic Start Date Date the patient first started taking the antibiotic
Number of days antibiotic actually taken. Number of days the patient actually took the antibiotic referenced
Second antibiotic patient received? If Other, please specify antibiotic PHVS_AntibioticReceived_Pertussis
Date second antibiotic started Date second antibiotic started
Number of days second antibiotic actually taken Number of days second antibiotic actually taken
Was laboratory testing done for pertussis? Was laboratory testing done for pertussis? PHVS_YesNoUnknown_CDC
Test Type Epidemiologic interpretation of the type of test(s) performed for this case PHVS_LabTestProcedure_Pertussis
Test Result Epidemiologic interpretation of the results of the tests performed for this case. PHVS_LabTestInterpretation_Pertussis
Date Collected Date of specimen collection
Did the subject ever receive a disease-containing vaccine? Did the patient ever receive a pertussis-containing vaccine? PHVS_YesNoUnknown_CDC
Vaccine Administered The type of vaccine administered. PHVS_VaccinesAdministeredCVX_CDC_NIP
Vaccine Manufacturer Manufacturer of the vaccine. PHVS_ManufacturersOfVaccinesMVX_CDC_NIP
Vaccine Lot Number The vaccine lot number of the vaccine administered.
Vaccine Administered Date The date that the vaccine was administered.
Is this case epi-linked to a laboratory-confirmed case? Is this case epi-linked to a laboratory-confirmed case? PHVS_YesNoUnknown_CDC
Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? Is this case part of a cluster or outbreak (e.g. total is 2 or more cases)? PHVS_YesNoUnknown_CDC
Transmission Setting Transmission setting (Where did this case acquire pertussis?) PHVS_TransmissionSetting_NND
Was there documented transmission from this case of pertussis to a new setting? (not in household) Was there documented transmission (outside of the household) for transmission from this case? PHVS_YesNoUnknown_CDC
Number of contacts of this case recommended to receive antibiotic prophylaxis Number of contacts of this case recommended to receive antibiotic prophylaxis
Age of person contracted patient contracted pertussis from Age of the person from whom this patient contracted pertussis
Age Type Age Type Age_Type
Setting where patient contracted pertussis Transmission setting (Where did this patient acquire pertussis?) PHVS_TransmissionSetting_NND
Specify In which setting was pertussis acquired. setting in which pertussis was acquired
Specify In which setting was there secondary spread In which setting was there secondary spread
Name Of Contacts Name Of Contacts
Birth Date of contacts Birth Date of contacts
Contact Relationship to Subject Relationship of contact PHVS_Relationship_Flu
Case? Case
Contact Case ID Unique case identifier of the contact. This would be the same as INV168 (Case Local ID)
Cough Onset Date(If Present Cough Onset Date(If Present
Number of PCVs* Number of PCVs*
Date of Last PCV Date of Last PCV
Parent’s Name (If Applicable) Parent’s Name (If Applicable)
Parent’s Phone # (If Applicable) Parent’s Phone # (If Applicable)
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

Sheet 44: Plague

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

Sheet 45: Polio

Label/Short Name Description Value Set Code. Search in PHIN VADS using the following link (https://phinvads.cdc.gov/vads/SearchHome.action)
Paralysis onset date Date of onset of paralysis
Clinical course Clinical course
CSF date Date of CSF results
WBCs White blood cell test results for cerebral spinal fluid
RBCs Red blood cell test results for cerebral spinal fluid
%Lymph %lymphs test results for CSF
%polys %polys test results for CSF
Protein Protein test results for CSF
Glucose Glucose test results for CSF
60-day follow up date Date of 60-day follow up
Paralysis site Sites of paralysis
Specific sites Specific sites of paralysis
60-day residual 60-day paralysis residual
TOPV immunization history TOPV within 30 days prior to onset of symptoms?
Date of TOPV TOPV immunization date
Lot number TOPV vaccine lot number
IPV-containing vaccine Total doses ever received of IPV-containing vaccine
Date 1 IPV First IPV vaccine date
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?

Sheet 46: Polio Nonparalytic

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?

Sheet 47: Psittacosis

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

Sheet 48: QFever

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

Sheet 49: STSS

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

Sheet 50: Rubella

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.

Sheet 51: S.Paratyphi 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 (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

Sheet 52: S. Typhi 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 (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

Sheet 53: Salmonellosis

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

Sheet 54: SARS

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

Sheet 55: Shigella

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

Sheet 56: STD (not congenital)

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.



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.



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.



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.



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.



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


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


Had sex with a male within past 12 months? Had sex with a male within past 12 months? New Value Set
PHVS_YNRD_CDC


Had sex with a female within past 12 months? Had sex with a female within past 12 months? New Value Set
PHVS_YNRD_CDC


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


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


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


Exchanged drugs/money for sex within past 12 months? Exchanged drugs/money for sex within past 12 months? New Value Set
PHVS_YNRD_CDC


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


Engaged in injection drug use within past 12 months? Engaged in injection drug use within past 12 months? New Value Set
PHVS_YNRD_CDC


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


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


Been incarcerated with past 12 months? Been incarcerated within past 12 months? New Value Set
PHVS_YNRD_CDC


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


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


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


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.



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


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


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


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


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


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


Nontreponemal serologic syphilis test (qualitative) Qualitative test result of STD123 Nontreponemal serologic syphilis test result (quantitative) New Value Set
PHVS_LabTestReactivity_NND


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


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

Sheet 57: STEC

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

Sheet 58: TBRD

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

Sheet 59: Tetanus

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

Sheet 60: Trichinellosis

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.).

Sheet 61: Tuberculosis

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

Sheet 62: Tularemia

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

Sheet 63: Varicella

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).







Sheet 64: Vibriosis

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

Sheet 65: Viral Hemorrhagic Fevers

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
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