Survey Text

1996
1995
1994
1993
1992
1991
1978
top
1996
Survey form view entire document:  text  image

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.

(3) A measles or MMR (Measles - Mumps - Rubella) shot?
If telephone ask: Was each shot measles only or MMR?

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



top
1995
Survey form view entire document:  text  image

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.

(3) A measles or MMR (Measles - Mumps - Rubella) shot?
If telephone ask: Was each shot measles only or MMR?

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

top
1994
Survey form view entire document:  text  image

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.

(3) A measles or MMR (Measles-Mumps-Rubella) shot? If telephone ask: Was each shot measles only or MMR?

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

top
1993
Survey form view entire document:  text  image

1. Transcribe from shot record

Measles/MMR (Shots)

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

top
1992
Survey form view entire document:  text  image

1. Transcribe from shot record

Measles/MMR (Shots)

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

top
1991

No questionnaire text is available for this sample.


Survey form view entire document:  text  image

1. Transcribe from shot record

Immunization: Measles/MMR (shots)

1st shot:
1[] Measles
2[] MMR
Month ____
Day ____
Year 19____

top
1978
Survey form view entire document:  text  image

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)