1 of 2
During what month and year did ^SCNAME receive the flu vaccine before that one?
Enter month of the flu vaccine.

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
97 - Refused
99 - Don't Know

Sample Children 0-17 who have had two or more flu shots in the past 12 months

1-12,DK [goto FLUVAC2Y_C]
RF [goto next section]

* 1 of 2
During what month and year did ^SCNAME receive the flu vaccine before that one?
* Enter month of the flu vaccine.

Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1

01 - January
02 - February
03 - March
04 - April
05 - May
06 - June
07 - July
08 - August
09 - September
10 - October
11 - November
12 - December
97 - Refused
99 - Don't Know

Sample Children 0-17 who have had two or more flu shots in the past 12 months

1-12,DK [goto FLUVAC2Y_C]
RF [goto next section]

1 of 2

During what month and year did ^SCNAME receive the flu vaccine before that one?

Enter month of the flu vaccine.

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Do not Know

Sample Children 0-17 who have had two or more flu shots in the past 12 months

1-12,DK = [goto FLUVAC2Y_C]
RF = [goto next section]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name:: CH1N1_6M
QuestionText:

1 of 2 During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y]
(R) [goto CH1N1_8]

Instrument Variable Name: CH1N1_6M : Sample Child
QuestionText:

1 of 2
During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y] (R) [goto CH1N1_8]

Instrument Variable Name: CH1N1_7Y : Sample Child
QuestionText:

2 of 2
*Enter year of next most recent flu vaccine.

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses and gave month/don't know month of vaccine dose
SkipInstructions:

(valid year,R,D) [goto CH1N1_8]
[If CH1N1_6M and CH1N1_7Y = a future date] goto ERR1_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to birth] goto ERR2_ CH1N1_7Y]
[If CH1N1_6M and CH1N1_7Y = a date prior to 12 months ago] goto ERR3_ CH1N1_7Y]
ERR1_ CH1N1_7Y
Hard Edit:
*Future date invalid.
ERR2_ CH1N1_7Y
*Date before birth.
ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name: CH1N1_6M
QuestionText:

This question was added to the instrument in August 2010.
1 of2
During what month and year did {S.C. name} receive {fill: his/her} next most recent flu vaccine?

01 January
02 February
03 March
04 April
05 May
06 June
07 July
08 August
09 September
10 October
11 November
12 December
97 Refused
99 Don't know

UniverseText: Sample Child LE 17 years who have had more than one vaccine doses
SkipInstructions:

(1-12,D) [ goto CH1N1_7Y] (R) [goto CH1N1_8]