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

Year - Year
9997 - Refused
9999 - Don't Know

Sample Children 0-17 who have had two or more flu shots and gave month/don't know month of 2nd vaccine dose

current year, current year-1,RF,DK [goto next section]
If FLUVAC2M_C and FLUVAC2Y_C = a date in the future [goto ERR1_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth [goto ERR2_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to 12 months ago [goto ERR3_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date more recent than answer given in (FLUVAC1M_C and
FLUVA1Y_C) [goto ERR4_FLUVAC2Y_C]

Check Text: ERR3_FLUVAC2Y_C
Check Description: 2nd flu vaccine before 12 mos
Check Text: {check ERR3_FLUVAC2Y_C}
Date before 12 months ago

Check Text: ERR1_FLUVAC2Y_C
Check Description: 2nd flu vaccine in future
Check Text: {check ERR1_FLUVAC2Y_C} Future date invalid

Check Text: ERR2_FLUVAC2Y_C
Check Description: 2nd flu vaccine before dob
Check Text: {check ERR2_FLUVAC2Y_C} Date prior to birth

Check Text: ERR4_FLUVAC2Y_C
Check Description: 2nd flu vaccine after 1st flu vaccine
Check Text: {check ERR4_FLUVAC2Y_C}
The date entered for the second most recent flu vaccine is after the date of the most recent flu vaccine. Please verify.

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

2000-2030 - Range of values
9997 - Refused
9999 - Don't Know

Sample Children 0-17 who have had two or more flu shots and gave month/don't know month of 2nd vaccine dose

current year, current year-1,RF,DK [goto next section]
If FLUVAC2M_C and FLUVAC2Y_C = a date in the future [goto ERR1_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth [goto ERR2_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to 12 months ago [goto ERR3_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date more recent than answer given in (FLUVAC1M_C and
FLUVA1Y_C) [goto ERR4_FLUVAC2Y_C]

Check Text: ERR3_FLUVAC2Y_C
Check Description: 2nd flu vaccine before 12 mos
Check Text: {check ERR3_FLUVAC2Y_C}
Date before 12 months ago
Check Text: ERR2_FLUVAC2Y_C
Check Description: 2nd flu vaccine before dob
Check Text: {check ERR2_FLUVAC2Y_C} Date prior to birth
Check Text: ERR1_FLUVAC2Y_C
Check Description: 2nd flu vaccine in future
Check Text: {check ERR1_FLUVAC2Y_C} Future date invalid

Check Text: ERR4_FLUVAC2Y_C
Check Description: 2nd flu vaccine after 1st flu vaccine
Check Text: {check ERR4_FLUVAC2Y_C}
The date entered for the second most recent flu vaccine is after the date of the most recent flu vaccine. Please verify.

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

2000-2030 - Range of values
9997 - Refused
9999 - Don't Know

Sample Children 0-17 who have had two or more flu shots and gave month/don't know month of 2nd vaccine dose

current year, current year-1,RF,DK [goto next section]
If FLUVAC2M_C and FLUVAC2Y_C = a date in the future [goto ERR1_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth [goto ERR2_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to 12 months ago [goto ERR3_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date more recent than answer given in (FLUVAC1M_C and
FLUVA1Y_C) [goto ERR4_FLUVAC2Y_C]

Check Text: ERR1_FLUVAC2Y_C
Check Description: 2nd flu vaccine in future
Check Text: {check ERR1_FLUVAC2Y_C} Future date invalid
Check Text: ERR3_FLUVAC2Y_C
Check Description: 2nd flu vaccine before 12 mos
Check Text: {check ERR3_FLUVAC2Y_C}
Date before 12 months ago
Check Text: ERR2_FLUVAC2Y_C
Check Description: 2nd flu vaccine before dob
Check Text: {check ERR2_FLUVAC2Y_C} Date prior to birth

Check Text: ERR4_FLUVAC2Y_C
Check Description: 2nd flu vaccine after 1st flu vaccine
Check Text: {check ERR4_FLUVAC2Y_C}
The date entered for the second most recent flu vaccine is after the date of the most recent flu vaccine. Please verify.

2 of 2

Enter year of next most recent flu vaccine.

2000-2030 Range of values
9997 Refused
9999 Do not Know

Sample Children 0-17 who have had two or more flu shots and gave month/do not know month of 2nd vaccine dose

current year, current year-1,RF,DK+ [goto next section]
If FLUVAC2M_C and FLUVAC2Y_C = a date in the future [goto ERR1_FLUVAC2Y_C] If FLUVAC2M_C and FLUVAC2Y_C = a date prior to birth [goto ERR2_FLUVAC2Y_C]
If FLUVAC2M_C and FLUVAC2Y_C = a date prior to 12 months ago [goto ERR3_FLUVAC2Y_C] If FLUVAC2M_C and FLUVAC2Y_C = a date more recent than answer given in (FLUVAC1M_C and FLUVA1Y_C) [goto ERR4_FLUVAC2Y_C]

Check Description: 2nd flu vaccine before 12 mos
Check Text: {check ERR3_FLUVAC2Y_C}

Date before 12 months ago

Check Description: 2nd flu vaccine in future
Check Text: {check ERR1_FLUVAC2Y_C}

Future date invalid

Check Description: 2nd flu vaccine before dob
Check Text: {check ERR2_FLUVAC2Y_C}

Date prior to birth

Check Description: 2nd flu vaccine after 1st flu vaccine
Check Text: {check ERR4_FLUVAC2Y_C}; The date entered for the second most recent flu vaccine is after the date of the most recent flu vaccine. Please verify.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

Instrument Variable Name:: CH1N1_7Y
QuestionText:

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

Year Year
9997 Refused
9999 Don't know

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]

Hard Edit: ERR1_ CH1N1_7Y
*Future date invalid.

ERR2_ CH1N1_7Y
*Date before birth.

ERR3_ CH1N1_7Y
*Date before 12 months ago.

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_7Y
QuestionText:

This question was added to the instrument in August 2010.
2 of 2
*Enter year of next most recent flu vaccine.

Year Year
9997 Refused
9999 Don't know

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]