CHHGQ Data Elements

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Page Position

Page Name
Field order
1 Page 2 General Laboratory Intervie
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1 Page 2 General Laboratory Intervie
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1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
1 Page 2 General Laboratory Intervie
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic

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2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
2 Page 3 Demographic
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information
3 Page 4 Clinical Information

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4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
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4 Page 5 Travel

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4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
4 Page 5 Travel
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
5 Page 6 Events ill contacts
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5 Page 6 Events ill contacts
5 Page 6 Events ill contacts

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5 Page 6 Events ill contacts
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
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6 Page 7 Grocery Stores
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6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
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6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
6 Page 7 Grocery Stores
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants

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7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants

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7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
7 Page 8 Restaurants
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
8 Page 9 Fresh Herbs
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries

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9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
9 Page 10 Fresh Berries
10 Page 11 Fresh Berries continued
10 Page 11 Fresh Berries continued
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11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit

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11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit

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11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
11 Page 12 Fresh Fruit
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens

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12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
12 Page 13 Leafy Greens
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued

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13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
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13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
13 Page 14 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
14 Page 15 Leafy Greens continued
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14 Page 15 Leafy Greens continued

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15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
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15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
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15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
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15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
15 Page 16 Other Fresh Vegetables
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16 Page 17 Other Fresh Veg continued
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17 Page 18 Interview Completed

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17 Page 18 Interview Completed
17 Page 18 Interview Completed

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Prompt
State/NNDSS ID (Required)
1. Classify case based on CDC case definition (Required):
2. Date(s) stool collected for Cyclospora testing (use format MM/DD/YYYY):
3. Test results:

5. Was the patient co-infected with another intestinal pathogen?
a. Specify name(s) of lab-confirmed coinfection:
6. Name:
7. Agency or Organization:
8. Contact phone number:
9. Date of Interview:
10. Before this interview how many times has the case-patient been interviewed about
his/her illness?
11. Respondent for current interview was:
If other, specify:
Check if case was lost to follow up
If case was lost to follow up, was information extracted from the medical record?
Entered at CDC
UserID
1. State:
2. County:
3. Zip Code:

5. Age (years)
6. Sex
7. Do you consider yourself of Hispanic or Latino origin?
White
American Indian/Alaskan Native
Black/African American

Field Type
Text
Comment Legal
Date
Date
Comment Legal
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Checkbox
Yes/No
Text
Text
Text
Number
Date
Comment Legal
Legal Values
Text
Checkbox
Yes/No
Checkbox
Text
Number
Text
Text
Text
Text
Text
Number
Legal Values
Legal Values
Checkbox
Checkbox
Checkbox

Asian
Native Hawaiian/Other Pacific Islander
Unknown
Other
If other, specify:
9. What date did you (your child) first feel sick?
Approximate date
Unknown
a. Diarrhea (defined as loose or watery stools that you do not normally have)?
a. Date diarrhea started:
b. Date diarrhea stopped:
Ongoing
b. Weight Loss?
c. Fever?
d. Fatigue?
e. Anorexia?
f. Nausea?
g. Vomiting?
h. Abdominal Cramps?
11. Have your (your child's) other symptoms stopped?
a. If yes, date symptoms stopped:
Unknown
12. Were you (your child) hospitalized overnight?
a. How many nights were you (your child) hospitalized?
b. Admission Date:
c. Hospital name:
13. Did you (your child) travel to another state or country during the 14 days before
onset of illness?
Did not travel to other counties within home state
Unknown
Counties within home state
Departed
Returned
Foods Eaten

Did not travel to other U.S. states
Unknown
U.S. States
U.S. cities
Departed
Returned

Checkbox
Checkbox
Checkbox
Checkbox
Text
Date
Checkbox
Checkbox
Legal Values
Date
Date
Checkbox
Legal Values
Legal Values
Legal Values
Legal Values
Legal Values
Legal Values
Legal Values
Legal Values
Date
Checkbox
Yes/No
Number
Date
Text
Option
Checkbox
Checkbox
Text
Date
Date
Text
Text
Date
Date
Text
Text
Date
Date
Text
Checkbox
Checkbox
Legal Values
Text
Date
Date

Foods Eaten

Did not travel outside U.S.
Unknown
Cities outside U.S.
Departed
Returned
Foods Eaten

(e.g., parties, fairs, concerts, tournaments, conventions)?
Event Name
Date attended event
Location of Event
Foods eaten at event

Live in same household
Attended same event
Traveled together

Text
Legal Values
Text
Date
Date
Text
Legal Values
Text
Date
Date
Text
Checkbox
Checkbox
1 Legal Values
Text
Text
Date
Date
Text
2 Legal Values
2 Legal Values
Text
Date
Date
Text
3 Legal Values
3 Text
Text
Date
Date
Text
Legal Values
Text
Date
Text
Text
Text
Date
Text
Text
Text
Date
Text
Text
Legal Values
Checkbox
Checkbox
Checkbox

Other, specify:
18b. If yes, please provide information for other ill person(s) including number of ill
persons and relationship to you (e.g. son, mother, neighbor, friend, etc.)*.
Store Name
Address
City
State
Zip Code
Date shopped
Food purchased
*Shopper card #

Checkbox
Text
Text
Legal Values
Text
Text
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(refused to give shopper card #)
Additional comments about grocery store purchases:
Restaurant Name
Address
City
State
Zip Code
Meal Date
Foods eaten

Text
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Text
Text
Text
Text
Text
Yes/No
Checkbox
Text
Legal Values
Text
Text
Text
Text
Text
Text
Text

Text
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Additional comments about restaurants
Is the case associated with a cluster?
If yes, what is the cluster name?
21. Fresh basil?
Sweet
Purple (i.e., purple leaves and stems)
Thai (i.e., green leaves and purple stems)
Other, specify:
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
22. Fresh cilantro?
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
23. Fresh parsley?
24. Fresh oregano?
25. Fresh thyme?
26. Fresh mint?
27. Fresh dill?
28. Fresh sage?
29. Fresh rosemary?
30. Other fresh herbs?
a. Type(s):
Unknown
Additional comments about fresh herbs:
31. Fresh red raspberries?
Brand(s):

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Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
32. Fresh blackberries?
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
33. Fresh strawberries?
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
34. Fresh blueberries?
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
35. Other fresh berries?
Black raspberries
Golden raspberries
Boysenberries
Other type(s):
Unknown
36. Apples?
37. Grapes?
38. Pears?
39. Peaches?
40. Nectarines?
41. Plums?
42. Oranges?
43. Tangerines or clementines? (e.g., "Cuties")
44. Grapefruit?
45. Fresh lemon or lime? This could include a garnish on a drink.
46. Cherries?
47. Cantaloupe?
48. Honeydew melon?
49. Watermelon?
50. Precut melon or melon salad? (e.g., premade, in a container) This could also include
melon in a fruit cup or fruit salad.
51. Other melon?
52. Pineapple?
53. Mango?

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54. Other fruit?
Bananas
Kiwi
Papaya
Guava
Pomegranate
Coconut (whole or shredded)
Other, specify:
Additional comments about fresh fruit:
55. Bagged salad kits?
Ingredients (lettuce, cabbage, carrots, etc.):
Brand(s):
Place(s) purchased (names, locations):
56. Pre-made, single serving salad (e.g., ready to eat salads with toppings, meats,
dressing, in a hard plastic container)?
Ingredients (lettuce, cabbage, carrots, etc.):
Brand(s):
Place(s) purchased (names, locations):
57. Iceberg lettuce?
Prepackaged, precut/shredded in a bag
Head/Loose (not prepackaged)
Topping/Garnish
Part of a pre-made salad or bagged salad kit
Unknown
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
58. Romaine lettuce?
Prepackaged, precut/shredded in a bag
Head (prepackaged, in a bag)
Head/Loose (not prepackaged)
Topping/Garnish
Part of a pre-made salad or bagged salad kit
Unknown
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List the name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
59. Mesclun lettuce (e.g., spring mix, field greens, baby greens)?
Prepackaged in a hard plastic container
Prepackaged in a bag
Head/Loose (not prepackaged)
Topping/Garnish
Part of a pre-made salad or bagged salad kit

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Unknown
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
60. Butter lettuce (also called Boston or Bibb lettuce)?
Red
Green
Mixed
Prepackaged in a bag
Prepackaged in a hard plastic container
Head/Loose (not prepackaged)
Part of a pre-made salad or bagged salad kit
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List the name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
61. Fresh Cabbage?
Red, head/loose (not prepackaged)
Green, head/loose (not prepackaged)
Precut/shredded, prepackaged in a bag (e.g., coleslaw mix)
Part of a pre-made salad or bagged salad kit
Savoy (aka curly)
Napa
Bok choy
Brussels sprouts
Other, specify:
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List the name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
62. Fresh Spinach?
Prepackaged, in a bag
Prepackaged, in a hard plastic container
Head/Loose (not prepackaged)
Topping/Garnish
Part of a pre-made or bagged salad kit
Unknown
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List the name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
63. Other lettuce or leafy greens?

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Arugula
Endive
Mustard Greens
Radicchio
Kale
Other, specify:
64. Other prepackaged salad mix (not previously identified)?
Ingredients (lettuce, cabbage, carrots, etc.):
Brand(s):
Place(s) purchased (names, locations):
Additional comments about leafy greens:
65. Cucumbers?
66. Raw, uncooked zucchini?
67. Raw, uncooked squash? (e.g., yellow squash)
68. Raw, uncooked bell peppers?
Red
Green
Orange
Yellow
Unknown
69. Hot chili/chili peppers (e.g., jalapenos or serranos)?
70. Celery?
71. Raw carrots?
"Mini" or "baby" carrots
Other, specify
72. Other raw, uncooked root vegetables?
Radishes
Beets
Turnips
Unknown
Other, specify:
73. Fresh, raw peas? (May be shelled or in the pod)
Garden peas
Snow peas (i.e., flat, shiny pods containing tiny peas)
Sugar snap peas (i.e, plump, crisp, edible pods)
Unknown
Other, specify:
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat at home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
74. Broccoli?
75. Cauliflower?

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76. Sprouts?
77. Raw, uncooked onions?
White
Yellow
Red/Purple
Green onion/scallion
Unknown
Other, specify:
78. Fresh tomatoes?
Red Round
Roma (oval-shaped)
Grape/Cherry (bite-sized)
Unknown
Other, Specify:
79. Fresh made salsa or pico de gallo (i.e., not from a vacuum-sealed jar)?
Brand(s):
Place(s) purchased (names, locations):
Not applicable (did not eat home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
80. Fresh made guacamole (i.e., not from a vacuum-sealed jar)?
Brand(s)
Place(s) purchased (names, locations):
Not applicable (did not eat home)
List name(s) of establishment(s) and location(s):
Not applicable (did not eat outside the home)
Additional comments, including other types of fresh vegetables:
Would you like to provide any additional thoughts or perspective about anything we've
discussed or about this outbreak investigation?
Date Submitted

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Date

Name
StateID1
LabConfirmedCyclo1
DateCycloStool1
DateCycloStool21
CycloStoolResult1
ClinicalPanel
ClinicalNonPanel
ClinicalOP
ClinicalOther
CommericalOP
CommericalPanel
CommercialNonPanel
CommericalOther
StatePanel
StateOP
StateNonpanel
StateOther
CDCOther
CDCOP
CDCPanel
CDCNonpanel
Coinfection
Coinfection_Specify
Interviewer1
IntAgency1
IntPhoneAreaCode1
InterviewDate1

Variable Type
Text
Text
Date
Date
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
YesNo
Text
Text
Text
Number
Date

TimesInt1
Respondent1
RespondentOtherSpec1
Lost_to_followup
MedicalExtract
EnteredatCDC1
UserID
BirthYr1
State
County
ZipCode
BirthMonth
BirthYear
Age
Sex
Ethnicity
Race_white
Race_AIAN
Race_Black

Text
Text
Text
Boolean
YesNo
Boolean
Text
Number
Text
Text
Text
Text
Text
Number
Text
Text
Boolean
Boolean
Boolean

Format

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD

Race_Asian
Race_NHOPI
Race_Unknown
Race_Other
RaceOtherSpec
OnsetDate
SickApproximateDate
OnsetDateUnknown
Diarrhea
DiarrheaDate
DateDiarrheaStop
DiarrheaOngoing
WeightLoss
Fever
Fatigue
Anorexia
Nausea
Vomiting
AbdominalCramps
Symptomsstopped
DateSymptomsStop
DateSymptomsStoppedUnknown
Hospitalized
NightsHosp
DateHospitalized
HospName

Boolean
Boolean
Boolean
Boolean
Text
Date
Boolean
Boolean
Text
Date
Date
Boolean
Text
Text
Text
Text
Text
Text
Text
Text
Date
Boolean
YesNo
Number
Date
Text

Travel
NoTravelHomeState
UnkHomeStateTravel
CitiesTraveledHomeState
DateDepartedHome
DateReturnedHome
FoodsEatenHome1
CitiesTraveledHomeState2
DateDepartedHome2
DateReturnedHome2
FoodsEatenHome2
CitiesTraveledHomeState3
DateDepartedHome3
DateReturnedHome3
FoodsEatenHome3
NoStateTravel
UnkStateTravel
StatesTraveledUS1
CitiesOutsideHomeState1
DateDepartedUS1
DateReturnedUS1

Number
Boolean
Boolean
Text
Date
Date
Text
Text
Date
Date
Text
Text
Date
Date
Text
Boolean
Boolean
Text
Text
Date
Date

YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD

YYYY-MM-DD

Horizontal,Left

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

FoodsEatenUS1
StatesTraveledUS2
CitiesOutsideHomeState2
DateDepartedUS2
DateReturnedUS2
FoodsEatenUS2
StatesTraveledUS3
CitiesOutsideHomeState3
DateDepartedUS3
DateReturnedUS3
FoodsEatenUS3
NoIntlTravel
UnkTravelOutsideUS
CountryTraveledList1
Citiesoutsidecountry1_1
CountryTraveled1
CountryDateDeparted1
CountryDateReturned1
CountryFoodsEaten1
CountryTraveled2
CountryTraveledList2
Citiesoutsidecountry1_2
CountryDateDeparted2
CountryDateReturned2
CountryFoodsEaten2
CountryTraveledList3
CountryTraveled3
Citiesoutsidecountry1_3
CountryDateDeparted3
CountryDateReturned3
CountryFoodsEaten3
Event1
EventType1
EventDate1
EventLocation1
EventFoods1
EventType2
EventDate2
EventLocation2
EventFoods2
EventType3
EventDate3
EventLocation3
EventFoods3
OtherIllPrompt1
SameHousehold
SameEvent
Traveledtogether

Text
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Date
Date
Text
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Text
Date
Date
Text
Boolean
Boolean
Text
Text
Text
Date
Date
Text
Text
Text
Text
Date
Date
Text
Text
Text
Text
Date
Date
Text
Text
Text
Date
Text
Text
Text
Date
Text
Text
Text
Date
Text
Text
Text
Boolean
Boolean
Boolean

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD
YYYY-MM-DD

YYYY-MM-DD

YYYY-MM-DD

YYYY-MM-DD

OtherspecifyIllPerson
lllPersonOtherAnswer

Boolean
Text

OtherIllInfo1
FoodHome
StoreName1
StoreAddress1
StoreCity1
StoreState1
StoreZip1
DatesShopped1
ItemsPurchased1
ShoppercardNum1
StoreName2
StoreAddress2
StoreCity2
StoreState2
StoreZip2
DatesShopped2
ItemsPurchased2
ShopperCardNum2
StoreName3
StoreAddress3
StoreCity3
StoreState3
StoreZip3
DatesShopped3
ItemsPurchased3
ShoppercardNum3
StoreName4
StoreAddress4
StoreCity4
StoreState4
StoreZip4
DatesShopped4
ItemsPurchased4
ShoppercardNum4
StoreName5
StoreAddress5
StoreCity5
StoreState5
StoreZip5
DatesShopped5
ItemsPurchased5
ShoppercardNum5
StoreName6
StoreAddress6
StoreCity6

Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
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Text
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Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
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Text
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Text

StoreState6
StoreZip6
DatesShopped6
ItemsPurchased6
ShoppercardNum6
StoreName7
StoreAddress7
StoreCity7
StoreState7
StoreZip7
DatesShopped7
ItemsPurchased7
ShoppercardNum7
StoreName8
StoreAddress8
StoreCity8
StoreState8
StoreZip8
DatesShopped8
ItemsPurchased8
ShoppercardNum8
StoreName9
StoreAddress9
StoreCity9
StoreState9
StoreZip9
DatesShopped9
ItemsPurchased9
ShoppercardNum9
StoreName10
StoreAddress10
StoreCity10
StoreState10
StoreZip10
DatesShopped10
ItemsPurchased10
ShoppercardNum10
ShopperNumber
RefusedShopperCard
Additionalcommentsgrocery
FoodAway
RestaurantName1
RestaurantAddress1
RestaurantCity1
RestaurantState1
RestaurantZip1
DatesPatronized1
FoodsEaten1

Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
YesNo
Boolean
Text
Text
Text
Text
Text
Text
Text
Text
Text

RestaurantName2
RestaurantAddress2
RestaurantCity2
RestaurantState2
RestaurantZip2
DatesPatronized2
FoodsEaten2
RestaurantName3
RestaurantAddress3
RestaurantCity3
RestaurantState3
RestaurantZip3
DatesPatronized3
FoodsEaten3
RestaurantName4
RestaurantAddress4
RestaurantCity4
RestaurantState4
RestaurantZip4
DatesPatronized4
FoodsEaten4
RestaurantName5
RestaurantAddress5
RestaurantCity5
RestaurantState5
RestaurantZip5
DatesPatronized5
FoodsEaten5
RestaurantName6
RestaurantAddress6
RestaurantCity6
RestaurantState6
RestaurantZip6
DatesPatronized6
FoodsEaten62
RestaurantName7
RestaurantAddress7
RestaurantCity7
RestaurantState7
RestaurantZip7
DatesPatronized7
FoodsEaten7
RestaurantName8
RestaurantAddress8
RestaurantCity8
RestaurantState8
RestaurantZip8
DatesPatronized8

Text
Text
Text
Text
Text
Text
Text
Text
Text
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Text
Text
Text
Text
Text
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Text
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Text
Text
Text
Text
Text
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Text
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Text
Text
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FoodsEaten8
RestaurantName9
RestaurantAddress9
RestaurantCity9
RestaurantState9
RestaurantZip9
DatesPatronized9
FoodsEaten9
RestaurantName10
RestaurantAddress10
RestaurantCity10
RestaurantState10
RestaurantZip10
DatesPatronized10
FoodsEaten10
AdditionalFoodComments
Cluster
ClusterName
Basil
Sweetbasil1
PurpleBasil
ThaiBasil
OthUnkBasilType1
OtherBasilSpecify
BasilBrand1
BasilPlacePurch1
NothomeBasil
BasilAwayName1
homeBasil1
Cilantro
CilantrolBrand1
CilantrolPlacePurch1
NothomeCilantro1
CilantroAwayName1
homeCilantro1
Parsley
Oregano
Thyme
Mint
Dill
Sage
Rosemary
OtherHerb
OtherHerbDesc
UnkOtherHerbType1
HerbComments
RedRasp
RaspBrand

Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text
Text
Text
Text
Text
Text
Text
Text
Boolean
Text
Text
Text

RedRaspPlacePurch
NothomeRasp
RedRaspAwayName
homeredraspberries
Blackberry
blackberriesBrand
blackberriesPlacePurch
NothomeBlackberries
BlackberriesAwayName
homeblackberries
Strawberry
strawberriesBrand
strawberriesPlacePurch
NothomeStrawberries
StrawberriesAwayName
homestrawberries
Blueberry
blueberriesBrand1
blueberriesPlacePurch
NothomeBlueberries
BlueberriesAwayName
homeblueberries
AnyOtherBerries
BlackRasp
GoldenRasp
Boysenberry
OtherBerry
OtherSpecificBerries
UnknownOthFreshBerries
Apple
Grape
Pear
Peach
Nectarine
Plum
Orange
Tangerine
Grapefruit
LemonLime
Cherry
Cantaloupe
Honeydew
Watermelon

Text
Boolean
Text
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Text
Boolean
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text

PreCutMelon
OtherMelon
Pineapple
Mango

Text
Text
Text
Text

OtherTropical
Bananas
Kiwi
Papaya
Guava
Pomegranate
Coconut
Othertropicalfruittype
Othertropicalfruittypespecify
FreshFruitComments1
SaladKit
SaladKitIngred
SaladKitBrand
SaladKitPlacePurch

Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Text
Text
Text

PremadeSal
PremadeSalIngred
PremadeSalBrand
PremadeSalPlacePurch
Iceberg
PrepackagedIceberg
HeadLooseIceberg
ToppingGarnishIceberg
PartofSaladIceberg
OthUnkIcerbergType
IcebergBrand
IcebergPlacePurch
NotHomeIceberg
IcerbergEstandLoc
HomeIceberg
Romaine
PrepackagedRomaine
HeadRomaine
HeadLooseRomaine
ToppingGarnishRomaine
PartofSaladRomaine
OthUnkRomaineType
RomaineBrand
RomainePlacePurch
NotHomeRomaine
RomaineEstandLoc
HomeRomaine
Mesclun
PrepackMesclunContainer
PrepackMesclunBag
HeadLooseMesclun
ToppingGarnishMesclun
PartofSaladMesclun

Text
Text
Text
Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Boolean

OthUnkMesclunType
MesclunBrand1
MesclunPlacePurch1
NotHomeMesclun
MesclunAwayName1
HomeMesculan
Butter
RedButter
GreenButter
MixedButter
PrepackButterBag
PrepackButterContainer
HeadLooseButter
PartofSaladButter
ButterBrand
ButterPlacePurch
NotHomeButter
ButterEstandLoc
HomeButter
Cabbage
RedCabbage
GreenCabbage
PrecutCabbage
PartofSaladCabbage
SavoyCabbage
NapaCabbage
BokChoy
BrusselSprouts
OthUnkCabbageType
SpecifiedCabbageType
CabbageBrand
CabbagePlacePurch
NotHomeCabbage
CabbageEstandLoc
HomeCabbage
Spinach
PrepackSpinachBag
PrepackSpinachContainer
HeadLooseSpinach
ToppingGarnishSpinach
PartofSaladSpinach
OthUnkSpinachType
SpinachBrand
SpinachPlacePurch
NotHomeSpinach
SpinachEstandLoc
HomeSpinach
OtherGreens

Boolean
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Text
Boolean
Text

Arugula
Endive
MustardGreens
Radicchio
Kale
OtherGreenTypes
SpecifiedLettuceType
BaggedSaladMix
BaggedSaladMixIngred
BaggedSaladMixBrand
BaggedSaladMixPlacePurch1
Addcommentsgreens
Cucumber
Zucchini
Squash
BellPepper
RedBellPepper
GreenBellPepper
OrangeBellPepper
YellowBellPepper
UnknownBellPepper
HotPepper
Celery
Carrot
MiniCarrot
OtherCarrot
OtherCarrotSpecify
RootVeg
Radishes
Beets
Turnips
UnkRootVeg
OtherRootVeg
OtherRootVegSpec
Peas
GardenPeas
SnowPeas
SugarSnapPeas1
UnkPeas
OthPeas
OtherPeaType
PeasBrand1
PeasPlacePurch
NotHomePeas
PeasEstandLoc
Homepeas
Broccoli
Cauliflower

Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Text
Text
Text
Text
Text
Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Boolean
Boolean
Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text

Sprouts
Onion
WhiteOnion
YellowOnion
RedPurpleOnion
Scallion
UnkOnion
OthOnion
OthOnionSpec
Tomato
RedRoundTom
RomaovalshapedTom
GrapeCherryTom
UnkTom
OthTom
OthTomSpec
Pico
PicoBrand
PicoPlacePurch
NotHomePico
PicoAwayName
HomePico
Guacamole
GuacBrand
GuacPlacePurch
NotHomeGuac
GuacAwayName
HomeGuac
FreshVegComments
AdditionalThoughts

Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Boolean
Boolean
Boolean
Boolean
Boolean
Text
Text
Text
Text
Boolean
Text
Boolean
Text
Text
Text
Boolean
Text
Boolean
Text
Text

AdditionalComments
DateSubmitted

Text
Date

YYYY-MM-DD

Special Info
Required
Required; 1 = Confirmed, 2 = Probable

1=Positive, 2=Negative, 77=Indeterminate, 99=Pending

0=None, 1=Once, 2=Twice, 3=Three or more, 99=Unknown

This field has been altered for the 2026 revision
This field has been removed for the 2026 revision
This field has been removed for the 2026 revision

Yes,No,Unknown

RANGE [1/1/0001,SYSTEMDATE]

RANGE [1/1/0001,SYSTEMDATE]

RANGE [1/1/0001,SYSTEMDATE]

Read Only