Survey Text

1978
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1978
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There are two basic types of measles for which shots can be received: German measles, sometimes known as Rubella or 3 day measles AND Red measles, sometimes known as 8 day measles.
4a. Since the first of (month) 1978 has -- received any kind of measles shot?

1 [] Y
2 [] N (NP)
9 [] DK (NP)

b. What types of measles shots did -- receive?
(was it for German measles, sometimes known as Rubella or 3 day measles, OR was it for Red measles, sometimes known as 8 day measles, or did -- received shots for both?)

1 [] Both Red and German (6)
2 [] Red measles (8 day) only
3 [] German measles (Rubella, 3 day) only
9 [] DK kind

5a. When did -- receive the measles shot?

Mo. ________
Date ________

6a. When did -- receive the shot for Red measles, sometimes known as 8 day measles?

Mo. ________
Date. ________