Survey Text

2003
2002
2001
2000
1999
1998
1997
top
2003
Survey form view entire document:  text  image

CIM.110

[If age LE 6]
What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitis A vaccine
OTHEV04 (4) Tetramune
OTHEV05 (5) ACTHib
OTHEV06 (6) Other
(7) Refused
(9) Don't Know

FR: ENTER "N" FOR NO MORE
[p. 8]
Check item CIMCCI4: (LOOP UNTIL ALL SELECTIONS HAVE BEEN EXHAUSTED)
If CIM.110 equals 1 go to CIM.121, else; If CIM.110 equals 3 go to CIM.123, else;
If CIM.110 equals 4 go to CIM.125, else; If CIM.110 equals 5 go to CIM.127, else;
If CIM.110 equals 6 go to CIM.129, else; go to CIM.140

top
2002
Survey form view entire document:  text  image

CIM.110

[If age LE 6 ]
What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV04 (4) Tetramune
OTHEV05 (5) ACTHib
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

[else]
What are the names of OTHER immunizations listed on the shot record AND given after {Child:s name}:s 6th birthday that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

FR: ENTER "N" FOR NO MORE

top
2001
Survey form view entire document:  text  image

CIM.110

[If age LE 6 ]
What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV04 (4) Tetramune
OTHEV05 (5) ACTHib
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

[else]
What are the names of OTHER immunizations listed on the shot record AND given after {Child:s name}:s 6th birthday that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

FR: ENTER "N" FOR NO MORE

top
2000
Survey form view entire document:  text  image

CIM.110

[If age LE 6 ]
What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV04 (4) Tetramune
OTHEV05 (5) ACTHib
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

[else]
What are the names of OTHER immunizations listed on the shot record AND given after {Child:s name}:s 6th birthday that I have NOT asked you about?
OTHEV01 (1) Influenza vaccine
OTHEV03 (3) Hepatitus A vaccine
OTHEV06 (6) Other
(7) Refused
(9) Don:t Know

FR: ENTER "N" FOR NO MORE

top
1999
Survey form view entire document:  text  image

CIM.110

What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?

(1) Influenza vaccine
(2) Pneumococcal vaccine
(3) Hepatitis A vaccine

[If less than 7 years old add: ]
(4) Tetramune(5) ActHib

[Else continue to read: ]
(6) Other
(7) Refused(9) DK

[ ] OTHEV_1
[ ] OTHEV_2
[ ] OTHEV_3
[ ] OTHEV_4
[ ] OTHEV_5
[ ] OTHEV_6
Check item OTHREDIT:
If CIM.110 equals 1 go to CIM.121, else; If CIM.110 equals 2 go to CIM.123, else;
If CIM.110 equals 3 go to CIM.125, else; If CIM.110 equals 4 go to CIM.127, else;
If CIM.110 equals 5 go to CIM.129, else; If CIM.110 equals 6 go to CIM.120, else;
If CIM.110 equals 7 go to CIM.140.

top
1998
Survey form view entire document:  text  image

CIM.110

What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?

(1) Influenza vaccine
(2) Pneumococcal vaccine
(3) Hepatitis A vaccine

[If less than 7 years old add: ]
(4) Tetramune(5) ActHib

[Else continue to read: ]
(6) Other
(7) Refused(9) DK

[ ] OTHEV_1
[ ] OTHEV_2
[ ] OTHEV_3
[ ] OTHEV_4
[ ] OTHEV_5
[ ] OTHEV_6
Check item OTHREDIT:
If CIM.110 equals 1 go to CIM.121, else; If CIM.110 equals 2 go to CIM.123, else;
If CIM.110 equals 3 go to CIM.125, else; If CIM.110 equals 4 go to CIM.127, else;
If CIM.110 equals 5 go to CIM.129, else; If CIM.110 equals 6 go to CIM.120, else;
If CIM.110 equals 7 go to CIM.140.

top
1997
Survey form view entire document:  text  image

CIM.110

What are the names of OTHER immunizations listed on the shot record that I have NOT asked you about?

(1) Influenza vaccine
(2) Pneumococcal vaccine
(3) Hepatitis A vaccine

[If less than 7 years old add: ]
(4) Tetramune(5) ActHib

[Else continue to read: ]
(6) Other
(7) Refused(9) DK

[ ] OTHEV_1
[ ] OTHEV_2
[ ] OTHEV_3
[ ] OTHEV_4
[ ] OTHEV_5
[ ] OTHEV_6
Check item OTHREDIT:
If CIM.110 equals 1 go to CIM.121, else; If CIM.110 equals 2 go to CIM.123, else;
If CIM.110 equals 3 go to CIM.125, else; If CIM.110 equals 4 go to CIM.127, else;
If CIM.110 equals 5 go to CIM.129, else; If CIM.110 equals 6 go to CIM.120, else;
If CIM.110 equals 7 go to CIM.140.