Survey Text

1999
1998
1997
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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.

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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.