Survey Text

1996
1995
1994
1993
1992
1991
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1996
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2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

(4) An HIB shot? (This is for meningitis and called Haemophilus influenzae (HA-MA-FI-LUS IN-FLU- EN-ZI) HIB vaccine or H. flu vaccine)

(4) An HIB shot? (This is for meningitis and called Haemophilus influenzae (HA-MA-FI-LUS IN-FLU- EN-ZI) HIB vaccine or H. flu vaccine)


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1995
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2. Transcribe from shot record - If telephone ask: Looking at the shot record, please tell me how many times -- has received (name of vaccines)?
Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third, etc. shots.

(4) An HIB shot? (This is for meningitis and called Haemophilus influenzae (HA-MA-FI-LUS IN-FLU- EN-ZI) HIB vaccine or H. flu vaccine)

Shots ____ (Record dates)
[] 00 None (Next vaccine)
[] 99 DK (Next vaccine)



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1994
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2. Transcribe from shot record -- If telephone ask: Looking at the shot record, please tell me how many times -- have received (names of vaccines)? Record number of times for each vaccine. What is the date on the record for (first) (vaccine)? Repeat for second, third [and other] shots.

(4) An HIB shot? (This is for meningitis and called Haemophilus influenza (HA-MA-FI-LUS IN-FLU-EN-ZI) HIB vaccine or H. flu vaccine)

Shots ____ (Record dates)
[] 00 None (Next vaccine)
[] 99 DK (Next vaccine)

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1993
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1. Transcribe from shot record

HIB (Shot)

1 [] Yes (Record dates)
2 [] No (Next vaccine)

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1992
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1. Transcribe from shot record

HIB (Shot)

1 [] Yes (Record dates)
2 [] No (Next vaccine)

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1991

No questionnaire text is available for this sample.


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1. Transcribe from shot record

Immunization: HIB (shot)

1st Shot:
Months ____
Day ____
Year 19 ____