Survey Text

2022 2018 2014 2010
2021 2017 2013
2020 2016 2012
2019 2015 2011
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2022
Survey form view entire document:  text  image
Question ID: IMM.0040.01.1
Variable: FLUVAC2M_C
Interview Module: Child
Content Type: Annual Core

Question text:

* 1 of 2
During what month and year did ^SCNAME receive the flu vaccine before that one?
* Enter month of the flu vaccine.
Fills:
^SCNAME
Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1
Response:
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
Universe:
Sample Children 0-17 who have had two or more flu shots in the past 12 months
Skip Instructions:
1-12,DK [goto FLUVAC2Y_C]
RF [goto next section]

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2021
Survey form view entire document:  text  image
Question ID: IMM.0040.01.1
Variable: FLUVAC2M_C
Interview Module: Child
Content Type: Annual Core
Question text:
1 of 2
During what month and year did ^SCNAME receive the flu vaccine before that one?
Enter month of the flu vaccine.
Fills:
^SCNAME
Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1
Response:
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
Universe:
Sample Children 0-17 who have had two or more flu shots in the past 12 months
Skip Instructions:
1-12,DK [goto FLUVAC2Y_C]
RF [goto next section]

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2020
Survey form view entire document:  text  image
Question ID: IMM.0040.01.1
Variable: FLUVAC2M_C
Interview Module: Child
Content Type: Annual Core
Question text:
* 1 of 2
During what month and year did ^SCNAME receive the flu vaccine before that one?
* Enter month of the flu vaccine.
Fills:
^SCNAME
Description: Sample child's name
Instruction:
Fill ALIAS of HHSTAT_C=1
Response:
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
Universe:
Sample Children 0-17 who have had two or more flu shots in the past 12 months
Skip Instructions:
1-12,DK [goto FLUVAC2Y_C]
RF [goto next section]

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2019
Survey form view entire document:  text  image
Question ID: IMM.0040.01.1
Variable: FLUVAC2M_C
Interview Module: Child
Content Type: Annual Core

Question Text:
1 of 2

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

Enter month of the flu vaccine.
Fills:
^SCNAME

Description Sample child's name
Instruction Fill ALIAS of HHSTAT_C=1
Response:
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
Universe:
Sample Children 0-17 who have had two or more flu shots in the past 12 months
Skip Instructions:
1-12,DK = [goto FLUVAC2Y_C]
RF = [goto next section]

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2018
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2017
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2016
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2015
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2014
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2013
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2012
Survey form view entire document:  text  image
Question ID:: CFI.005_00.060

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]

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2011
Survey form view entire document:  text  image
Question ID: CFI.005_00.060

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]
Question ID: CFI.005_00.070

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.

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2010
Survey form view entire document:  text  image
Question ID: CFI.005_00.060.

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]