Document
Data elements
ICR 202309-0920-007 · OMB 0920-1198 · Object 135397700.
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| Page Position | Page Name | Field order | Prompt | Field Type | Name | Variable Type | Format | Special Info |
| 1 | Page 2 General Laboratory Interviewer Information | 2 | State/NNDSS ID (Required) | Text | StateID1 | Text | Required | |
| 1 | Page 2 General Laboratory Interviewer Information | 3 | 1. Classify case based on CDC case definition (Required): | Comment Legal | LabConfirmedCyclo1 | Text | Required; 1 = Confirmed, 2 = Probable | |
| 1 | Page 2 General Laboratory Interviewer Information | 5 | 2. Date(s) stool collected for Cyclospora testing (use format MM/DD/YYYY): | Date | DateCycloStool1 | Date | YYYY-MM-DD | |
| 1 | Page 2 General Laboratory Interviewer Information | 6 | Date | DateCycloStool21 | Date | YYYY-MM-DD | ||
| 1 | Page 2 General Laboratory Interviewer Information | 7 | 3. Test results: | Comment Legal | CycloStoolResult1 | Text | 1=Positive, 2=Negative, 77=Indeterminate, 99=Pending | |
| 1 | Page 2 General Laboratory Interviewer Information | 15 | Checkbox | ClinicalPanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 16 | Checkbox | ClinicalNonPanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 17 | Checkbox | ClinicalOP | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 18 | Checkbox | ClinicalOther | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 19 | Checkbox | CommericalOP | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 20 | Checkbox | CommericalPanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 21 | Checkbox | CommercialNonPanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 22 | Checkbox | CommericalOther | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 24 | Checkbox | StatePanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 25 | Checkbox | StateOP | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 26 | Checkbox | StateNonpanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 27 | Checkbox | StateOther | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 29 | Checkbox | CDCOther | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 30 | Checkbox | CDCOP | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 31 | Checkbox | CDCPanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 32 | Checkbox | CDCNonpanel | Boolean | |||
| 1 | Page 2 General Laboratory Interviewer Information | 33 | 5. Was the patient co-infected with another intestinal pathogen? | Yes/No | Coinfection | YesNo | ||
| 1 | Page 2 General Laboratory Interviewer Information | 34 | a. Specify name(s) of lab-confirmed coinfection: | Text | Coinfection_Specify | Text | ||
| 1 | Page 2 General Laboratory Interviewer Information | 36 | 6. Name: | Text | Interviewer1 | Text | ||
| 1 | Page 2 General Laboratory Interviewer Information | 37 | 7. Agency or Organization: | Text | IntAgency1 | Text | ||
| 1 | Page 2 General Laboratory Interviewer Information | 38 | 8. Contact phone number: | Number | IntPhoneAreaCode1 | Number | ||
| 1 | Page 2 General Laboratory Interviewer Information | 40 | 9. Date of Interview: | Date | InterviewDate1 | Date | YYYY-MM-DD | |
| 1 | Page 2 General Laboratory Interviewer Information | 41 | 10. Before this interview how many times has the case-patient been interviewed about his/her illness? | Comment Legal | TimesInt1 | Text | 0=None, 1=Once, 2=Twice, 3=Three or more, 99=Unknown | |
| 1 | Page 2 General Laboratory Interviewer Information | 42 | 11. Respondent for current interview was: | Legal Values | Respondent1 | Text | ||
| 1 | Page 2 General Laboratory Interviewer Information | 43 | If other, specify: | Text | RespondentOtherSpec1 | Text | ||
| 1 | Page 2 General Laboratory Interviewer Information | 45 | Check if case was lost to follow up | Checkbox | Lost_to_followup | Boolean | ||
| 1 | Page 2 General Laboratory Interviewer Information | 46 | If case was lost to follow up, was information extracted from the medical record? | Yes/No | MedicalExtract | YesNo | ||
| 1 | Page 2 General Laboratory Interviewer Information | 47 | Entered at CDC | Checkbox | EnteredatCDC1 | Boolean | ||
| 1 | Page 2 General Laboratory Interviewer Information | 48 | UserID | Text | UserID | Text | ||
| 2 | Page 3 Demographic | 1 | Number | BirthYr1 | Number | |||
| 2 | Page 3 Demographic | 10 | 1. State: | Text | State | Text | ||
| 2 | Page 3 Demographic | 11 | 2. County: | Text | County | Text | ||
| 2 | Page 3 Demographic | 12 | 3. Zip Code: | Text | ZipCode | Text | ||
| 2 | Page 3 Demographic | 13 | Text | BirthMonth | Text | |||
| 2 | Page 3 Demographic | 14 | Text | BirthYear | Text | |||
| 2 | Page 3 Demographic | 15 | 5. Age (years) | Number | Age | Number | ||
| 2 | Page 3 Demographic | 16 | 6. Sex | Legal Values | Sex | Text | ||
| 2 | Page 3 Demographic | 17 | 7. Do you consider yourself of Hispanic or Latino origin? | Legal Values | Ethnicity | Text | ||
| 2 | Page 3 Demographic | 21 | White | Checkbox | Race_white | Boolean | ||
| 2 | Page 3 Demographic | 22 | American Indian/Alaskan Native | Checkbox | Race_AIAN | Boolean | ||
| 2 | Page 3 Demographic | 23 | Black/African American | Checkbox | Race_Black | Boolean | ||
| 2 | Page 3 Demographic | 24 | Asian | Checkbox | Race_Asian | Boolean | ||
| 2 | Page 3 Demographic | 25 | Native Hawaiian/Other Pacific Islander | Checkbox | Race_NHOPI | Boolean | ||
| 2 | Page 3 Demographic | 26 | Unknown | Checkbox | Race_Unknown | Boolean | ||
| 2 | Page 3 Demographic | 27 | Other | Checkbox | Race_Other | Boolean | ||
| 2 | Page 3 Demographic | 28 | If other, specify: | Text | RaceOtherSpec | Text | ||
| 3 | Page 4 Clinical Information | 1 | 9. What date did you (your child) first feel sick? | Date | OnsetDate | Date | YYYY-MM-DD | |
| 3 | Page 4 Clinical Information | 2 | Approximate date | Checkbox | SickApproximateDate | Boolean | ||
| 3 | Page 4 Clinical Information | 3 | Unknown | Checkbox | OnsetDateUnknown | Boolean | ||
| 3 | Page 4 Clinical Information | 4 | a. Diarrhea (defined as loose or watery stools that you do not normally have)? | Legal Values | Diarrhea | Text | ||
| 3 | Page 4 Clinical Information | 5 | a. Date diarrhea started: | Date | DiarrheaDate | Date | YYYY-MM-DD | |
| 3 | Page 4 Clinical Information | 6 | b. Date diarrhea stopped: | Date | DateDiarrheaStop | Date | YYYY-MM-DD | |
| 3 | Page 4 Clinical Information | 7 | Ongoing | Checkbox | DiarrheaOngoing | Boolean | ||
| 3 | Page 4 Clinical Information | 8 | b. Weight Loss? | Legal Values | WeightLoss | Text | ||
| 3 | Page 4 Clinical Information | 9 | c. Fever? | Legal Values | Fever | Text | ||
| 3 | Page 4 Clinical Information | 10 | d. Fatigue? | Legal Values | Fatigue | Text | ||
| 3 | Page 4 Clinical Information | 11 | e. Anorexia? | Legal Values | Anorexia | Text | ||
| 3 | Page 4 Clinical Information | 12 | f. Nausea? | Legal Values | Nausea | Text | ||
| 3 | Page 4 Clinical Information | 13 | g. Vomiting? | Legal Values | Vomiting | Text | ||
| 3 | Page 4 Clinical Information | 14 | h. Abdominal Cramps? | Legal Values | AbdominalCramps | Text | ||
| 3 | Page 4 Clinical Information | 15 | 11. Have your (your child's) other symptoms stopped? | Legal Values | Symptomsstopped | Text | ||
| 3 | Page 4 Clinical Information | 16 | a. If yes, date symptoms stopped: | Date | DateSymptomsStop | Date | YYYY-MM-DD | |
| 3 | Page 4 Clinical Information | 17 | Unknown | Checkbox | DateSymptomsStoppedUnknown | Boolean | ||
| 3 | Page 4 Clinical Information | 18 | 12. Were you (your child) hospitalized overnight? | Yes/No | Hospitalized | YesNo | ||
| 3 | Page 4 Clinical Information | 19 | a. How many nights were you (your child) hospitalized? | Number | NightsHosp | Number | ||
| 3 | Page 4 Clinical Information | 20 | b. Admission Date: | Date | DateHospitalized | Date | YYYY-MM-DD | |
| 3 | Page 4 Clinical Information | 21 | c. Hospital name: | Text | HospName | Text | ||
| 4 | Page 5 Travel | 4 | 13. Did you (your child) travel to another state or country during the 14 days before onset of illness? | Option | Travel | Number | Horizontal,Left | Yes,No,Unknown |
| 4 | Page 5 Travel | 6 | Did not travel to other counties within home state | Checkbox | NoTravelHomeState | Boolean | ||
| 4 | Page 5 Travel | 7 | Unknown | Checkbox | UnkHomeStateTravel | Boolean | ||
| 4 | Page 5 Travel | 9 | Counties within home state | Text | CitiesTraveledHomeState | Text | ||
| 4 | Page 5 Travel | 10 | Departed | Date | DateDepartedHome | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 11 | Returned | Date | DateReturnedHome | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 12 | Foods Eaten | Text | FoodsEatenHome1 | Text | ||
| 4 | Page 5 Travel | 14 | Text | CitiesTraveledHomeState2 | Text | |||
| 4 | Page 5 Travel | 15 | Date | DateDepartedHome2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 16 | Date | DateReturnedHome2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 17 | Text | FoodsEatenHome2 | Text | |||
| 4 | Page 5 Travel | 19 | Text | CitiesTraveledHomeState3 | Text | |||
| 4 | Page 5 Travel | 20 | Date | DateDepartedHome3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 21 | Date | DateReturnedHome3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 22 | Text | FoodsEatenHome3 | Text | |||
| 4 | Page 5 Travel | 25 | Did not travel to other U.S. states | Checkbox | NoStateTravel | Boolean | ||
| 4 | Page 5 Travel | 26 | Unknown | Checkbox | UnkStateTravel | Boolean | ||
| 4 | Page 5 Travel | 28 | U.S. States | Legal Values | StatesTraveledUS1 | Text | ||
| 4 | Page 5 Travel | 29 | U.S. cities | Text | CitiesOutsideHomeState1 | Text | ||
| 4 | Page 5 Travel | 30 | Departed | Date | DateDepartedUS1 | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 31 | Returned | Date | DateReturnedUS1 | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 32 | Foods Eaten | Text | FoodsEatenUS1 | Text | ||
| 4 | Page 5 Travel | 34 | Legal Values | StatesTraveledUS2 | Text | |||
| 4 | Page 5 Travel | 35 | Text | CitiesOutsideHomeState2 | Text | |||
| 4 | Page 5 Travel | 36 | Date | DateDepartedUS2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 37 | Date | DateReturnedUS2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 38 | Text | FoodsEatenUS2 | Text | |||
| 4 | Page 5 Travel | 40 | Legal Values | StatesTraveledUS3 | Text | |||
| 4 | Page 5 Travel | 41 | Text | CitiesOutsideHomeState3 | Text | |||
| 4 | Page 5 Travel | 42 | Date | DateDepartedUS3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 43 | Date | DateReturnedUS3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 44 | Text | FoodsEatenUS3 | Text | |||
| 4 | Page 5 Travel | 47 | Did not travel outside U.S. | Checkbox | NoIntlTravel | Boolean | ||
| 4 | Page 5 Travel | 48 | Unknown | Checkbox | UnkTravelOutsideUS | Boolean | ||
| 4 | Page 5 Travel | 50 | 1 | Legal Values | CountryTraveledList1 | Text | ||
| 4 | Page 5 Travel | 51 | Cities outside U.S. | Text | Citiesoutsidecountry1_1 | Text | ||
| 4 | Page 5 Travel | 51 | Text | CountryTraveled1 | Text | |||
| 4 | Page 5 Travel | 52 | Departed | Date | CountryDateDeparted1 | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 53 | Returned | Date | CountryDateReturned1 | Date | YYYY-MM-DD | |
| 4 | Page 5 Travel | 54 | Foods Eaten | Text | CountryFoodsEaten1 | Text | ||
| 4 | Page 5 Travel | 55 | 2 | Legal Values | CountryTraveled2 | Text | ||
| 4 | Page 5 Travel | 55 | 2 | Legal Values | CountryTraveledList2 | Text | ||
| 4 | Page 5 Travel | 56 | Text | Citiesoutsidecountry1_2 | Text | |||
| 4 | Page 5 Travel | 57 | Date | CountryDateDeparted2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 58 | Date | CountryDateReturned2 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 59 | Text | CountryFoodsEaten2 | Text | |||
| 4 | Page 5 Travel | 60 | 3 | Legal Values | CountryTraveledList3 | Text | ||
| 4 | Page 5 Travel | 60 | 3 | Text | CountryTraveled3 | Text | ||
| 4 | Page 5 Travel | 61 | Text | Citiesoutsidecountry1_3 | Text | |||
| 4 | Page 5 Travel | 62 | Date | CountryDateDeparted3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 63 | Date | CountryDateReturned3 | Date | YYYY-MM-DD | ||
| 4 | Page 5 Travel | 64 | Text | CountryFoodsEaten3 | Text | |||
| 5 | Page 6 Events ill contacts | 8 | (e.g., parties, fairs, concerts, tournaments, conventions)? | Legal Values | Event1 | Text | ||
| 5 | Page 6 Events ill contacts | 10 | Event Name | Text | EventType1 | Text | ||
| 5 | Page 6 Events ill contacts | 11 | Date attended event | Date | EventDate1 | Date | YYYY-MM-DD | RANGE [1/1/0001,SYSTEMDATE] |
| 5 | Page 6 Events ill contacts | 12 | Location of Event | Text | EventLocation1 | Text | ||
| 5 | Page 6 Events ill contacts | 13 | Foods eaten at event | Text | EventFoods1 | Text | ||
| 5 | Page 6 Events ill contacts | 14 | Text | EventType2 | Text | |||
| 5 | Page 6 Events ill contacts | 15 | Date | EventDate2 | Date | YYYY-MM-DD | RANGE [1/1/0001,SYSTEMDATE] | |
| 5 | Page 6 Events ill contacts | 16 | Text | EventLocation2 | Text | |||
| 5 | Page 6 Events ill contacts | 17 | Text | EventFoods2 | Text | |||
| 5 | Page 6 Events ill contacts | 18 | Text | EventType3 | Text | |||
| 5 | Page 6 Events ill contacts | 19 | Date | EventDate3 | Date | YYYY-MM-DD | RANGE [1/1/0001,SYSTEMDATE] | |
| 5 | Page 6 Events ill contacts | 20 | Text | EventLocation3 | Text | |||
| 5 | Page 6 Events ill contacts | 21 | Text | EventFoods3 | Text | |||
| 5 | Page 6 Events ill contacts | 23 | Legal Values | OtherIllPrompt1 | Text | |||
| 5 | Page 6 Events ill contacts | 25 | Live in same household | Checkbox | SameHousehold | Boolean | ||
| 5 | Page 6 Events ill contacts | 26 | Attended same event | Checkbox | SameEvent | Boolean | ||
| 5 | Page 6 Events ill contacts | 27 | Traveled together | Checkbox | Traveledtogether | Boolean | ||
| 5 | Page 6 Events ill contacts | 28 | Other, specify: | Checkbox | OtherspecifyIllPerson | Boolean | ||
| 5 | Page 6 Events ill contacts | 29 | Text | lllPersonOtherAnswer | Text | |||
| 5 | Page 6 Events ill contacts | 31 | 18b. If yes, please provide information for other ill person(s) including number of ill persons and relationship to you (e.g. son, mother, neighbor, friend, etc.)*. | Text | OtherIllInfo1 | Text | ||
| 6 | Page 7 Grocery Stores | 1 | Legal Values | FoodHome | Text | |||
| 6 | Page 7 Grocery Stores | 2 | Store Name | Text | StoreName1 | Text | ||
| 6 | Page 7 Grocery Stores | 3 | Address | Text | StoreAddress1 | Text | ||
| 6 | Page 7 Grocery Stores | 4 | City | Text | StoreCity1 | Text | ||
| 6 | Page 7 Grocery Stores | 5 | State | Text | StoreState1 | Text | ||
| 6 | Page 7 Grocery Stores | 6 | Zip Code | Text | StoreZip1 | Text | ||
| 6 | Page 7 Grocery Stores | 7 | Date shopped | Text | DatesShopped1 | Text | ||
| 6 | Page 7 Grocery Stores | 8 | Food purchased | Text | ItemsPurchased1 | Text | ||
| 6 | Page 7 Grocery Stores | 9 | *Shopper card # | Text | ShoppercardNum1 | Text | ||
| 6 | Page 7 Grocery Stores | 10 | Text | StoreName2 | Text | |||
| 6 | Page 7 Grocery Stores | 11 | Text | StoreAddress2 | Text | |||
| 6 | Page 7 Grocery Stores | 12 | Text | StoreCity2 | Text | |||
| 6 | Page 7 Grocery Stores | 13 | Text | StoreState2 | Text | |||
| 6 | Page 7 Grocery Stores | 14 | Text | StoreZip2 | Text | |||
| 6 | Page 7 Grocery Stores | 15 | Text | DatesShopped2 | Text | |||
| 6 | Page 7 Grocery Stores | 16 | Text | ItemsPurchased2 | Text | |||
| 6 | Page 7 Grocery Stores | 17 | Text | ShopperCardNum2 | Text | |||
| 6 | Page 7 Grocery Stores | 18 | Text | StoreName3 | Text | |||
| 6 | Page 7 Grocery Stores | 19 | Text | StoreAddress3 | Text | |||
| 6 | Page 7 Grocery Stores | 20 | Text | StoreCity3 | Text | |||
| 6 | Page 7 Grocery Stores | 21 | Text | StoreState3 | Text | |||
| 6 | Page 7 Grocery Stores | 22 | Text | StoreZip3 | Text | |||
| 6 | Page 7 Grocery Stores | 23 | Text | DatesShopped3 | Text | |||
| 6 | Page 7 Grocery Stores | 24 | Text | ItemsPurchased3 | Text | |||
| 6 | Page 7 Grocery Stores | 25 | Text | ShoppercardNum3 | Text | |||
| 6 | Page 7 Grocery Stores | 26 | Text | StoreName4 | Text | |||
| 6 | Page 7 Grocery Stores | 27 | Text | StoreAddress4 | Text | |||
| 6 | Page 7 Grocery Stores | 28 | Text | StoreCity4 | Text | |||
| 6 | Page 7 Grocery Stores | 29 | Text | StoreState4 | Text | |||
| 6 | Page 7 Grocery Stores | 30 | Text | StoreZip4 | Text | |||
| 6 | Page 7 Grocery Stores | 31 | Text | DatesShopped4 | Text | |||
| 6 | Page 7 Grocery Stores | 32 | Text | ItemsPurchased4 | Text | |||
| 6 | Page 7 Grocery Stores | 33 | Text | ShoppercardNum4 | Text | |||
| 6 | Page 7 Grocery Stores | 34 | Text | StoreName5 | Text | |||
| 6 | Page 7 Grocery Stores | 35 | Text | StoreAddress5 | Text | |||
| 6 | Page 7 Grocery Stores | 36 | Text | StoreCity5 | Text | |||
| 6 | Page 7 Grocery Stores | 37 | Text | StoreState5 | Text | |||
| 6 | Page 7 Grocery Stores | 38 | Text | StoreZip5 | Text | |||
| 6 | Page 7 Grocery Stores | 39 | Text | DatesShopped5 | Text | |||
| 6 | Page 7 Grocery Stores | 40 | Text | ItemsPurchased5 | Text | |||
| 6 | Page 7 Grocery Stores | 41 | Text | ShoppercardNum5 | Text | |||
| 6 | Page 7 Grocery Stores | 42 | Text | StoreName6 | Text | |||
| 6 | Page 7 Grocery Stores | 43 | Text | StoreAddress6 | Text | |||
| 6 | Page 7 Grocery Stores | 44 | Text | StoreCity6 | Text | |||
| 6 | Page 7 Grocery Stores | 45 | Text | StoreState6 | Text | |||
| 6 | Page 7 Grocery Stores | 46 | Text | StoreZip6 | Text | |||
| 6 | Page 7 Grocery Stores | 47 | Text | DatesShopped6 | Text | |||
| 6 | Page 7 Grocery Stores | 48 | Text | ItemsPurchased6 | Text | |||
| 6 | Page 7 Grocery Stores | 49 | Text | ShoppercardNum6 | Text | |||
| 6 | Page 7 Grocery Stores | 50 | Text | StoreName7 | Text | |||
| 6 | Page 7 Grocery Stores | 51 | Text | StoreAddress7 | Text | |||
| 6 | Page 7 Grocery Stores | 52 | Text | StoreCity7 | Text | |||
| 6 | Page 7 Grocery Stores | 53 | Text | StoreState7 | Text | |||
| 6 | Page 7 Grocery Stores | 54 | Text | StoreZip7 | Text | |||
| 6 | Page 7 Grocery Stores | 55 | Text | DatesShopped7 | Text | |||
| 6 | Page 7 Grocery Stores | 56 | Text | ItemsPurchased7 | Text | |||
| 6 | Page 7 Grocery Stores | 57 | Text | ShoppercardNum7 | Text | |||
| 6 | Page 7 Grocery Stores | 58 | Text | StoreName8 | Text | |||
| 6 | Page 7 Grocery Stores | 59 | Text | StoreAddress8 | Text | |||
| 6 | Page 7 Grocery Stores | 60 | Text | StoreCity8 | Text | |||
| 6 | Page 7 Grocery Stores | 61 | Text | StoreState8 | Text | |||
| 6 | Page 7 Grocery Stores | 62 | Text | StoreZip8 | Text | |||
| 6 | Page 7 Grocery Stores | 63 | Text | DatesShopped8 | Text | |||
| 6 | Page 7 Grocery Stores | 64 | Text | ItemsPurchased8 | Text | |||
| 6 | Page 7 Grocery Stores | 65 | Text | ShoppercardNum8 | Text | |||
| 6 | Page 7 Grocery Stores | 66 | Text | StoreName9 | Text | |||
| 6 | Page 7 Grocery Stores | 67 | Text | StoreAddress9 | Text | |||
| 6 | Page 7 Grocery Stores | 68 | Text | StoreCity9 | Text | |||
| 6 | Page 7 Grocery Stores | 69 | Text | StoreState9 | Text | |||
| 6 | Page 7 Grocery Stores | 70 | Text | StoreZip9 | Text | |||
| 6 | Page 7 Grocery Stores | 71 | Text | DatesShopped9 | Text | |||
| 6 | Page 7 Grocery Stores | 72 | Text | ItemsPurchased9 | Text | |||
| 6 | Page 7 Grocery Stores | 73 | Text | ShoppercardNum9 | Text | |||
| 6 | Page 7 Grocery Stores | 74 | Text | StoreName10 | Text | |||
| 6 | Page 7 Grocery Stores | 75 | Text | StoreAddress10 | Text | |||
| 6 | Page 7 Grocery Stores | 76 | Text | StoreCity10 | Text | |||
| 6 | Page 7 Grocery Stores | 77 | Text | StoreState10 | Text | |||
| 6 | Page 7 Grocery Stores | 78 | Text | StoreZip10 | Text | |||
| 6 | Page 7 Grocery Stores | 79 | Text | DatesShopped10 | Text | |||
| 6 | Page 7 Grocery Stores | 80 | Text | ItemsPurchased10 | Text | |||
| 6 | Page 7 Grocery Stores | 81 | Text | ShoppercardNum10 | Text | |||
| 6 | Page 7 Grocery Stores | 82 | Yes/No | ShopperNumber | YesNo | |||
| 6 | Page 7 Grocery Stores | 83 | (refused to give shopper card #) | Checkbox | RefusedShopperCard | Boolean | ||
| 6 | Page 7 Grocery Stores | 84 | Additional comments about grocery store purchases: | Text | Additionalcommentsgrocery | Text | ||
| 7 | Page 8 Restaurants | 1 | Legal Values | FoodAway | Text | |||
| 7 | Page 8 Restaurants | 2 | Restaurant Name | Text | RestaurantName1 | Text | ||
| 7 | Page 8 Restaurants | 3 | Address | Text | RestaurantAddress1 | Text | ||
| 7 | Page 8 Restaurants | 4 | City | Text | RestaurantCity1 | Text | ||
| 7 | Page 8 Restaurants | 5 | State | Text | RestaurantState1 | Text | ||
| 7 | Page 8 Restaurants | 6 | Zip Code | Text | RestaurantZip1 | Text | ||
| 7 | Page 8 Restaurants | 7 | Meal Date | Text | DatesPatronized1 | Text | ||
| 7 | Page 8 Restaurants | 8 | Foods eaten | Text | FoodsEaten1 | Text | ||
| 7 | Page 8 Restaurants | 9 | Text | RestaurantName2 | Text | |||
| 7 | Page 8 Restaurants | 10 | Text | RestaurantAddress2 | Text | |||
| 7 | Page 8 Restaurants | 11 | Text | RestaurantCity2 | Text | |||
| 7 | Page 8 Restaurants | 12 | Text | RestaurantState2 | Text | |||
| 7 | Page 8 Restaurants | 13 | Text | RestaurantZip2 | Text | |||
| 7 | Page 8 Restaurants | 14 | Text | DatesPatronized2 | Text | |||
| 7 | Page 8 Restaurants | 15 | Text | FoodsEaten2 | Text | |||
| 7 | Page 8 Restaurants | 16 | Text | RestaurantName3 | Text | |||
| 7 | Page 8 Restaurants | 17 | Text | RestaurantAddress3 | Text | |||
| 7 | Page 8 Restaurants | 18 | Text | RestaurantCity3 | Text | |||
| 7 | Page 8 Restaurants | 19 | Text | RestaurantState3 | Text | |||
| 7 | Page 8 Restaurants | 20 | Text | RestaurantZip3 | Text | |||
| 7 | Page 8 Restaurants | 21 | Text | DatesPatronized3 | Text | |||
| 7 | Page 8 Restaurants | 22 | Text | FoodsEaten3 | Text | |||
| 7 | Page 8 Restaurants | 23 | Text | RestaurantName4 | Text | |||
| 7 | Page 8 Restaurants | 24 | Text | RestaurantAddress4 | Text | |||
| 7 | Page 8 Restaurants | 25 | Text | RestaurantCity4 | Text | |||
| 7 | Page 8 Restaurants | 26 | Text | RestaurantState4 | Text | |||
| 7 | Page 8 Restaurants | 27 | Text | RestaurantZip4 | Text | |||
| 7 | Page 8 Restaurants | 28 | Text | DatesPatronized4 | Text | |||
| 7 | Page 8 Restaurants | 29 | Text | FoodsEaten4 | Text | |||
| 7 | Page 8 Restaurants | 30 | Text | RestaurantName5 | Text | |||
| 7 | Page 8 Restaurants | 31 | Text | RestaurantAddress5 | Text | |||
| 7 | Page 8 Restaurants | 32 | Text | RestaurantCity5 | Text | |||
| 7 | Page 8 Restaurants | 33 | Text | RestaurantState5 | Text | |||
| 7 | Page 8 Restaurants | 34 | Text | RestaurantZip5 | Text | |||
| 7 | Page 8 Restaurants | 35 | Text | DatesPatronized5 | Text | |||
| 7 | Page 8 Restaurants | 36 | Text | FoodsEaten5 | Text | |||
| 7 | Page 8 Restaurants | 37 | Text | RestaurantName6 | Text | |||
| 7 | Page 8 Restaurants | 38 | Text | RestaurantAddress6 | Text | |||
| 7 | Page 8 Restaurants | 39 | Text | RestaurantCity6 | Text | |||
| 7 | Page 8 Restaurants | 40 | Text | RestaurantState6 | Text | |||
| 7 | Page 8 Restaurants | 41 | Text | RestaurantZip6 | Text | |||
| 7 | Page 8 Restaurants | 42 | Text | DatesPatronized6 | Text | |||
| 7 | Page 8 Restaurants | 43 | Text | FoodsEaten62 | Text | |||
| 7 | Page 8 Restaurants | 44 | Text | RestaurantName7 | Text | |||
| 7 | Page 8 Restaurants | 45 | Text | RestaurantAddress7 | Text | |||
| 7 | Page 8 Restaurants | 46 | Text | RestaurantCity7 | Text | |||
| 7 | Page 8 Restaurants | 47 | Text | RestaurantState7 | Text | |||
| 7 | Page 8 Restaurants | 48 | Text | RestaurantZip7 | Text | |||
| 7 | Page 8 Restaurants | 49 | Text | DatesPatronized7 | Text | |||
| 7 | Page 8 Restaurants | 50 | Text | FoodsEaten7 | Text | |||
| 7 | Page 8 Restaurants | 51 | Text | RestaurantName8 | Text | |||
| 7 | Page 8 Restaurants | 52 | Text | RestaurantAddress8 | Text | |||
| 7 | Page 8 Restaurants | 53 | Text | RestaurantCity8 | Text | |||
| 7 | Page 8 Restaurants | 54 | Text | RestaurantState8 | Text | |||
| 7 | Page 8 Restaurants | 55 | Text | RestaurantZip8 | Text | |||
| 7 | Page 8 Restaurants | 56 | Text | DatesPatronized8 | Text | |||
| 7 | Page 8 Restaurants | 57 | Text | FoodsEaten8 | Text | |||
| 7 | Page 8 Restaurants | 58 | Text | RestaurantName9 | Text | |||
| 7 | Page 8 Restaurants | 59 | Text | RestaurantAddress9 | Text | |||
| 7 | Page 8 Restaurants | 60 | Text | RestaurantCity9 | Text | |||
| 7 | Page 8 Restaurants | 61 | Text | RestaurantState9 | Text | |||
| 7 | Page 8 Restaurants | 62 | Text | RestaurantZip9 | Text | |||
| 7 | Page 8 Restaurants | 63 | Text | DatesPatronized9 | Text | |||
| 7 | Page 8 Restaurants | 64 | Text | FoodsEaten9 | Text | |||
| 7 | Page 8 Restaurants | 65 | Text | RestaurantName10 | Text | |||
| 7 | Page 8 Restaurants | 66 | Text | RestaurantAddress10 | Text | |||
| 7 | Page 8 Restaurants | 67 | Text | RestaurantCity10 | Text | |||
| 7 | Page 8 Restaurants | 68 | Text | RestaurantState10 | Text | |||
| 7 | Page 8 Restaurants | 69 | Text | RestaurantZip10 | Text | |||
| 7 | Page 8 Restaurants | 70 | Text | DatesPatronized10 | Text | |||
| 7 | Page 8 Restaurants | 71 | Text | FoodsEaten10 | Text | |||
| 7 | Page 8 Restaurants | 72 | Additional comments about restaurants | Text | AdditionalFoodComments | Text | ||
| 7 | Page 8 Restaurants | 73 | Is the case associated with a cluster? | Legal Values | Cluster | Text | ||
| 7 | Page 8 Restaurants | 74 | If yes, what is the cluster name? | Text | ClusterName | Text | ||
| 8 | Page 9 Fresh Herbs | 1 | 21. Fresh basil? | Legal Values | Basil | Text | ||
| 8 | Page 9 Fresh Herbs | 2 | Sweet | Checkbox | Sweetbasil1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 3 | Purple (i.e., purple leaves and stems) | Checkbox | PurpleBasil | Boolean | ||
| 8 | Page 9 Fresh Herbs | 4 | Thai (i.e., green leaves and purple stems) | Checkbox | ThaiBasil | Boolean | ||
| 8 | Page 9 Fresh Herbs | 5 | Other, specify: | Checkbox | OthUnkBasilType1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 6 | Text | OtherBasilSpecify | Text | |||
| 8 | Page 9 Fresh Herbs | 7 | Brand(s): | Text | BasilBrand1 | Text | ||
| 8 | Page 9 Fresh Herbs | 8 | Place(s) purchased (names, locations): | Text | BasilPlacePurch1 | Text | ||
| 8 | Page 9 Fresh Herbs | 9 | Not applicable (did not eat at home) | Checkbox | NothomeBasil | Boolean | ||
| 8 | Page 9 Fresh Herbs | 10 | List name(s) of establishment(s) and location(s): | Text | BasilAwayName1 | Text | ||
| 8 | Page 9 Fresh Herbs | 11 | Not applicable (did not eat outside the home) | Checkbox | homeBasil1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 12 | 22. Fresh cilantro? | Legal Values | Cilantro | Text | ||
| 8 | Page 9 Fresh Herbs | 13 | Brand(s): | Text | CilantrolBrand1 | Text | ||
| 8 | Page 9 Fresh Herbs | 14 | Place(s) purchased (names, locations): | Text | CilantrolPlacePurch1 | Text | ||
| 8 | Page 9 Fresh Herbs | 15 | Not applicable (did not eat at home) | Checkbox | NothomeCilantro1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 16 | List name(s) of establishment(s) and location(s): | Text | CilantroAwayName1 | Text | ||
| 8 | Page 9 Fresh Herbs | 17 | Not applicable (did not eat outside the home) | Checkbox | homeCilantro1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 18 | 23. Fresh parsley? | Legal Values | Parsley | Text | ||
| 8 | Page 9 Fresh Herbs | 19 | 24. Fresh oregano? | Legal Values | Oregano | Text | ||
| 8 | Page 9 Fresh Herbs | 20 | 25. Fresh thyme? | Legal Values | Thyme | Text | ||
| 8 | Page 9 Fresh Herbs | 21 | 26. Fresh mint? | Legal Values | Mint | Text | ||
| 8 | Page 9 Fresh Herbs | 22 | 27. Fresh dill? | Legal Values | Dill | Text | ||
| 8 | Page 9 Fresh Herbs | 23 | 28. Fresh sage? | Legal Values | Sage | Text | ||
| 8 | Page 9 Fresh Herbs | 24 | 29. Fresh rosemary? | Legal Values | Rosemary | Text | ||
| 8 | Page 9 Fresh Herbs | 25 | 30. Other fresh herbs? | Legal Values | OtherHerb | Text | ||
| 8 | Page 9 Fresh Herbs | 26 | a. Type(s): | Text | OtherHerbDesc | Text | ||
| 8 | Page 9 Fresh Herbs | 27 | Unknown | Checkbox | UnkOtherHerbType1 | Boolean | ||
| 8 | Page 9 Fresh Herbs | 28 | Additional comments about fresh herbs: | Text | HerbComments | Text | ||
| 9 | Page 10 Fresh Berries | 4 | 31. Fresh red raspberries? | Legal Values | RedRasp | Text | ||
| 9 | Page 10 Fresh Berries | 7 | Brand(s): | Text | RaspBrand | Text | ||
| 9 | Page 10 Fresh Berries | 8 | Place(s) purchased (names, locations): | Text | RedRaspPlacePurch | Text | ||
| 9 | Page 10 Fresh Berries | 9 | Not applicable (did not eat at home) | Checkbox | NothomeRasp | Boolean | ||
| 9 | Page 10 Fresh Berries | 11 | List name(s) of establishment(s) and location(s): | Text | RedRaspAwayName | Text | ||
| 9 | Page 10 Fresh Berries | 12 | Not applicable (did not eat outside the home) | Checkbox | homeredraspberries | Boolean | ||
| 9 | Page 10 Fresh Berries | 13 | 32. Fresh blackberries? | Legal Values | Blackberry | Text | ||
| 9 | Page 10 Fresh Berries | 16 | Brand(s): | Text | blackberriesBrand | Text | ||
| 9 | Page 10 Fresh Berries | 17 | Place(s) purchased (names, locations): | Text | blackberriesPlacePurch | Text | ||
| 9 | Page 10 Fresh Berries | 18 | Not applicable (did not eat at home) | Checkbox | NothomeBlackberries | Boolean | ||
| 9 | Page 10 Fresh Berries | 20 | List name(s) of establishment(s) and location(s): | Text | BlackberriesAwayName | Text | ||
| 9 | Page 10 Fresh Berries | 21 | Not applicable (did not eat outside the home) | Checkbox | homeblackberries | Boolean | ||
| 9 | Page 10 Fresh Berries | 22 | 33. Fresh strawberries? | Legal Values | Strawberry | Text | ||
| 9 | Page 10 Fresh Berries | 24 | Brand(s): | Text | strawberriesBrand | Text | ||
| 9 | Page 10 Fresh Berries | 25 | Place(s) purchased (names, locations): | Text | strawberriesPlacePurch | Text | ||
| 9 | Page 10 Fresh Berries | 26 | Not applicable (did not eat at home) | Checkbox | NothomeStrawberries | Boolean | ||
| 9 | Page 10 Fresh Berries | 28 | List name(s) of establishment(s) and location(s): | Text | StrawberriesAwayName | Text | ||
| 9 | Page 10 Fresh Berries | 29 | Not applicable (did not eat outside the home) | Checkbox | homestrawberries | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 1 | 34. Fresh blueberries? | Legal Values | Blueberry | Text | ||
| 10 | Page 11 Fresh Berries continued | 3 | Brand(s): | Text | blueberriesBrand1 | Text | ||
| 10 | Page 11 Fresh Berries continued | 4 | Place(s) purchased (names, locations): | Text | blueberriesPlacePurch | Text | ||
| 10 | Page 11 Fresh Berries continued | 5 | Not applicable (did not eat at home) | Checkbox | NothomeBlueberries | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 7 | List name(s) of establishment(s) and location(s): | Text | BlueberriesAwayName | Text | ||
| 10 | Page 11 Fresh Berries continued | 8 | Not applicable (did not eat outside the home) | Checkbox | homeblueberries | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 9 | 35. Other fresh berries? | Legal Values | AnyOtherBerries | Text | ||
| 10 | Page 11 Fresh Berries continued | 11 | Black raspberries | Checkbox | BlackRasp | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 12 | Golden raspberries | Checkbox | GoldenRasp | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 13 | Boysenberries | Checkbox | Boysenberry | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 14 | Other type(s): | Checkbox | OtherBerry | Boolean | ||
| 10 | Page 11 Fresh Berries continued | 15 | Text | OtherSpecificBerries | Text | |||
| 10 | Page 11 Fresh Berries continued | 16 | Unknown | Checkbox | UnknownOthFreshBerries | Boolean | ||
| 11 | Page 12 Fresh Fruit | 1 | 36. Apples? | Legal Values | Apple | Text | ||
| 11 | Page 12 Fresh Fruit | 2 | 37. Grapes? | Legal Values | Grape | Text | ||
| 11 | Page 12 Fresh Fruit | 3 | 38. Pears? | Legal Values | Pear | Text | ||
| 11 | Page 12 Fresh Fruit | 4 | 39. Peaches? | Legal Values | Peach | Text | ||
| 11 | Page 12 Fresh Fruit | 5 | 40. Nectarines? | Legal Values | Nectarine | Text | ||
| 11 | Page 12 Fresh Fruit | 6 | 41. Plums? | Legal Values | Plum | Text | ||
| 11 | Page 12 Fresh Fruit | 7 | 42. Oranges? | Legal Values | Orange | Text | ||
| 11 | Page 12 Fresh Fruit | 8 | 43. Tangerines or clementines? (e.g., "Cuties") | Legal Values | Tangerine | Text | ||
| 11 | Page 12 Fresh Fruit | 9 | 44. Grapefruit? | Legal Values | Grapefruit | Text | ||
| 11 | Page 12 Fresh Fruit | 10 | 45. Fresh lemon or lime? This could include a garnish on a drink. | Legal Values | LemonLime | Text | ||
| 11 | Page 12 Fresh Fruit | 11 | 46. Cherries? | Legal Values | Cherry | Text | ||
| 11 | Page 12 Fresh Fruit | 12 | 47. Cantaloupe? | Legal Values | Cantaloupe | Text | ||
| 11 | Page 12 Fresh Fruit | 13 | 48. Honeydew melon? | Legal Values | Honeydew | Text | ||
| 11 | Page 12 Fresh Fruit | 14 | 49. Watermelon? | Legal Values | Watermelon | Text | ||
| 11 | Page 12 Fresh Fruit | 15 | 50. Precut melon or melon salad? (e.g., premade, in a container) This could also include melon in a fruit cup or fruit salad. | Legal Values | PreCutMelon | Text | ||
| 11 | Page 12 Fresh Fruit | 16 | 51. Other melon? | Legal Values | OtherMelon | Text | ||
| 11 | Page 12 Fresh Fruit | 17 | 52. Pineapple? | Legal Values | Pineapple | Text | ||
| 11 | Page 12 Fresh Fruit | 18 | 53. Mango? | Legal Values | Mango | Text | ||
| 11 | Page 12 Fresh Fruit | 20 | 54. Other fruit? | Legal Values | OtherTropical | Text | ||
| 11 | Page 12 Fresh Fruit | 21 | Bananas | Checkbox | Bananas | Boolean | ||
| 11 | Page 12 Fresh Fruit | 22 | Kiwi | Checkbox | Kiwi | Boolean | ||
| 11 | Page 12 Fresh Fruit | 23 | Papaya | Checkbox | Papaya | Boolean | ||
| 11 | Page 12 Fresh Fruit | 24 | Guava | Checkbox | Guava | Boolean | ||
| 11 | Page 12 Fresh Fruit | 25 | Pomegranate | Checkbox | Pomegranate | Boolean | ||
| 11 | Page 12 Fresh Fruit | 26 | Coconut (whole or shredded) | Checkbox | Coconut | Boolean | ||
| 11 | Page 12 Fresh Fruit | 27 | Other, specify: | Checkbox | Othertropicalfruittype | Boolean | ||
| 11 | Page 12 Fresh Fruit | 28 | Text | Othertropicalfruittypespecify | Text | |||
| 11 | Page 12 Fresh Fruit | 29 | Additional comments about fresh fruit: | Text | FreshFruitComments1 | Text | ||
| 12 | Page 13 Leafy Greens | 4 | 55. Bagged salad kits? | Legal Values | SaladKit | Text | ||
| 12 | Page 13 Leafy Greens | 8 | Ingredients (lettuce, cabbage, carrots, etc.): | Text | SaladKitIngred | Text | ||
| 12 | Page 13 Leafy Greens | 9 | Brand(s): | Text | SaladKitBrand | Text | ||
| 12 | Page 13 Leafy Greens | 10 | Place(s) purchased (names, locations): | Text | SaladKitPlacePurch | Text | ||
| 12 | Page 13 Leafy Greens | 12 | 56. Pre-made, single serving salad (e.g., ready to eat salads with toppings, meats, dressing, in a hard plastic container)? | Legal Values | PremadeSal | Text | ||
| 12 | Page 13 Leafy Greens | 16 | Ingredients (lettuce, cabbage, carrots, etc.): | Text | PremadeSalIngred | Text | ||
| 12 | Page 13 Leafy Greens | 17 | Brand(s): | Text | PremadeSalBrand | Text | ||
| 12 | Page 13 Leafy Greens | 18 | Place(s) purchased (names, locations): | Text | PremadeSalPlacePurch | Text | ||
| 12 | Page 13 Leafy Greens | 20 | 57. Iceberg lettuce? | Legal Values | Iceberg | Text | ||
| 12 | Page 13 Leafy Greens | 24 | Prepackaged, precut/shredded in a bag | Checkbox | PrepackagedIceberg | Boolean | ||
| 12 | Page 13 Leafy Greens | 25 | Head/Loose (not prepackaged) | Checkbox | HeadLooseIceberg | Boolean | ||
| 12 | Page 13 Leafy Greens | 26 | Topping/Garnish | Checkbox | ToppingGarnishIceberg | Boolean | ||
| 12 | Page 13 Leafy Greens | 27 | Part of a pre-made salad or bagged salad kit | Checkbox | PartofSaladIceberg | Boolean | ||
| 12 | Page 13 Leafy Greens | 28 | Unknown | Checkbox | OthUnkIcerbergType | Boolean | ||
| 12 | Page 13 Leafy Greens | 29 | Brand(s): | Text | IcebergBrand | Text | ||
| 12 | Page 13 Leafy Greens | 30 | Place(s) purchased (names, locations): | Text | IcebergPlacePurch | Text | ||
| 12 | Page 13 Leafy Greens | 31 | Not applicable (did not eat at home) | Checkbox | NotHomeIceberg | Boolean | ||
| 12 | Page 13 Leafy Greens | 33 | List name(s) of establishment(s) and location(s): | Text | IcerbergEstandLoc | Text | ||
| 12 | Page 13 Leafy Greens | 34 | Not applicable (did not eat outside the home) | Checkbox | HomeIceberg | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 17 | 58. Romaine lettuce? | Legal Values | Romaine | Text | ||
| 13 | Page 14 Leafy Greens continued | 19 | Prepackaged, precut/shredded in a bag | Checkbox | PrepackagedRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 20 | Head (prepackaged, in a bag) | Checkbox | HeadRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 21 | Head/Loose (not prepackaged) | Checkbox | HeadLooseRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 22 | Topping/Garnish | Checkbox | ToppingGarnishRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 23 | Part of a pre-made salad or bagged salad kit | Checkbox | PartofSaladRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 24 | Unknown | Checkbox | OthUnkRomaineType | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 25 | Brand(s): | Text | RomaineBrand | Text | ||
| 13 | Page 14 Leafy Greens continued | 26 | Place(s) purchased (names, locations): | Text | RomainePlacePurch | Text | ||
| 13 | Page 14 Leafy Greens continued | 27 | Not applicable (did not eat at home) | Checkbox | NotHomeRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 29 | List the name(s) of establishment(s) and location(s): | Text | RomaineEstandLoc | Text | ||
| 13 | Page 14 Leafy Greens continued | 30 | Not applicable (did not eat outside the home) | Checkbox | HomeRomaine | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 31 | 59. Mesclun lettuce (e.g., spring mix, field greens, baby greens)? | Legal Values | Mesclun | Text | ||
| 13 | Page 14 Leafy Greens continued | 34 | Prepackaged in a hard plastic container | Checkbox | PrepackMesclunContainer | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 35 | Prepackaged in a bag | Checkbox | PrepackMesclunBag | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 36 | Head/Loose (not prepackaged) | Checkbox | HeadLooseMesclun | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 37 | Topping/Garnish | Checkbox | ToppingGarnishMesclun | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 38 | Part of a pre-made salad or bagged salad kit | Checkbox | PartofSaladMesclun | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 39 | Unknown | Checkbox | OthUnkMesclunType | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 40 | Brand(s): | Text | MesclunBrand1 | Text | ||
| 13 | Page 14 Leafy Greens continued | 41 | Place(s) purchased (names, locations): | Text | MesclunPlacePurch1 | Text | ||
| 13 | Page 14 Leafy Greens continued | 42 | Not applicable (did not eat at home) | Checkbox | NotHomeMesclun | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 44 | List name(s) of establishment(s) and location(s): | Text | MesclunAwayName1 | Text | ||
| 13 | Page 14 Leafy Greens continued | 45 | Not applicable (did not eat outside the home) | Checkbox | HomeMesculan | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 46 | 60. Butter lettuce (also called Boston or Bibb lettuce)? | Legal Values | Butter | Text | ||
| 13 | Page 14 Leafy Greens continued | 48 | Red | Checkbox | RedButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 49 | Green | Checkbox | GreenButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 50 | Mixed | Checkbox | MixedButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 52 | Prepackaged in a bag | Checkbox | PrepackButterBag | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 53 | Prepackaged in a hard plastic container | Checkbox | PrepackButterContainer | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 54 | Head/Loose (not prepackaged) | Checkbox | HeadLooseButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 55 | Part of a pre-made salad or bagged salad kit | Checkbox | PartofSaladButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 57 | Brand(s): | Text | ButterBrand | Text | ||
| 13 | Page 14 Leafy Greens continued | 58 | Place(s) purchased (names, locations): | Text | ButterPlacePurch | Text | ||
| 13 | Page 14 Leafy Greens continued | 59 | Not applicable (did not eat at home) | Checkbox | NotHomeButter | Boolean | ||
| 13 | Page 14 Leafy Greens continued | 61 | List the name(s) of establishment(s) and location(s): | Text | ButterEstandLoc | Text | ||
| 13 | Page 14 Leafy Greens continued | 62 | Not applicable (did not eat outside the home) | Checkbox | HomeButter | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 2 | 61. Fresh Cabbage? | Legal Values | Cabbage | Text | ||
| 14 | Page 15 Leafy Greens continued | 3 | Red, head/loose (not prepackaged) | Checkbox | RedCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 4 | Green, head/loose (not prepackaged) | Checkbox | GreenCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 7 | Precut/shredded, prepackaged in a bag (e.g., coleslaw mix) | Checkbox | PrecutCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 8 | Part of a pre-made salad or bagged salad kit | Checkbox | PartofSaladCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 9 | Savoy (aka curly) | Checkbox | SavoyCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 10 | Napa | Checkbox | NapaCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 11 | Bok choy | Checkbox | BokChoy | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 12 | Brussels sprouts | Checkbox | BrusselSprouts | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 13 | Other, specify: | Checkbox | OthUnkCabbageType | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 14 | Text | SpecifiedCabbageType | Text | |||
| 14 | Page 15 Leafy Greens continued | 15 | Brand(s): | Text | CabbageBrand | Text | ||
| 14 | Page 15 Leafy Greens continued | 16 | Place(s) purchased (names, locations): | Text | CabbagePlacePurch | Text | ||
| 14 | Page 15 Leafy Greens continued | 17 | Not applicable (did not eat at home) | Checkbox | NotHomeCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 19 | List the name(s) of establishment(s) and location(s): | Text | CabbageEstandLoc | Text | ||
| 14 | Page 15 Leafy Greens continued | 20 | Not applicable (did not eat outside the home) | Checkbox | HomeCabbage | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 21 | 62. Fresh Spinach? | Legal Values | Spinach | Text | ||
| 14 | Page 15 Leafy Greens continued | 24 | Prepackaged, in a bag | Checkbox | PrepackSpinachBag | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 25 | Prepackaged, in a hard plastic container | Checkbox | PrepackSpinachContainer | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 26 | Head/Loose (not prepackaged) | Checkbox | HeadLooseSpinach | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 27 | Topping/Garnish | Checkbox | ToppingGarnishSpinach | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 28 | Part of a pre-made or bagged salad kit | Checkbox | PartofSaladSpinach | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 29 | Unknown | Checkbox | OthUnkSpinachType | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 30 | Brand(s): | Text | SpinachBrand | Text | ||
| 14 | Page 15 Leafy Greens continued | 31 | Place(s) purchased (names, locations): | Text | SpinachPlacePurch | Text | ||
| 14 | Page 15 Leafy Greens continued | 32 | Not applicable (did not eat at home) | Checkbox | NotHomeSpinach | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 34 | List the name(s) of establishment(s) and location(s): | Text | SpinachEstandLoc | Text | ||
| 14 | Page 15 Leafy Greens continued | 35 | Not applicable (did not eat outside the home) | Checkbox | HomeSpinach | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 36 | 63. Other lettuce or leafy greens? | Legal Values | OtherGreens | Text | ||
| 14 | Page 15 Leafy Greens continued | 38 | Arugula | Checkbox | Arugula | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 39 | Endive | Checkbox | Endive | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 40 | Mustard Greens | Checkbox | MustardGreens | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 41 | Radicchio | Checkbox | Radicchio | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 42 | Kale | Checkbox | Kale | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 43 | Other, specify: | Checkbox | OtherGreenTypes | Boolean | ||
| 14 | Page 15 Leafy Greens continued | 44 | Text | SpecifiedLettuceType | Text | |||
| 14 | Page 15 Leafy Greens continued | 45 | 64. Other prepackaged salad mix (not previously identified)? | Legal Values | BaggedSaladMix | Text | ||
| 14 | Page 15 Leafy Greens continued | 47 | Ingredients (lettuce, cabbage, carrots, etc.): | Text | BaggedSaladMixIngred | Text | ||
| 14 | Page 15 Leafy Greens continued | 48 | Brand(s): | Text | BaggedSaladMixBrand | Text | ||
| 14 | Page 15 Leafy Greens continued | 49 | Place(s) purchased (names, locations): | Text | BaggedSaladMixPlacePurch1 | Text | ||
| 14 | Page 15 Leafy Greens continued | 50 | Additional comments about leafy greens: | Text | Addcommentsgreens | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 40 | 65. Cucumbers? | Legal Values | Cucumber | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 41 | 66. Raw, uncooked zucchini? | Legal Values | Zucchini | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 42 | 67. Raw, uncooked squash? (e.g., yellow squash) | Legal Values | Squash | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 43 | 68. Raw, uncooked bell peppers? | Legal Values | BellPepper | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 45 | Red | Checkbox | RedBellPepper | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 46 | Green | Checkbox | GreenBellPepper | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 47 | Orange | Checkbox | OrangeBellPepper | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 48 | Yellow | Checkbox | YellowBellPepper | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 49 | Unknown | Checkbox | UnknownBellPepper | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 51 | 69. Hot chili/chili peppers (e.g., jalapenos or serranos)? | Legal Values | HotPepper | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 52 | 70. Celery? | Legal Values | Celery | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 53 | 71. Raw carrots? | Legal Values | Carrot | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 55 | "Mini" or "baby" carrots | Checkbox | MiniCarrot | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 56 | Other, specify | Checkbox | OtherCarrot | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 57 | Text | OtherCarrotSpecify | Text | |||
| 15 | Page 16 Other Fresh Vegetables | 58 | 72. Other raw, uncooked root vegetables? | Legal Values | RootVeg | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 60 | Radishes | Checkbox | Radishes | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 61 | Beets | Checkbox | Beets | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 62 | Turnips | Checkbox | Turnips | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 63 | Unknown | Checkbox | UnkRootVeg | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 64 | Other, specify: | Checkbox | OtherRootVeg | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 65 | Text | OtherRootVegSpec | Text | |||
| 15 | Page 16 Other Fresh Vegetables | 66 | 73. Fresh, raw peas? (May be shelled or in the pod) | Legal Values | Peas | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 68 | Garden peas | Checkbox | GardenPeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 69 | Snow peas (i.e., flat, shiny pods containing tiny peas) | Checkbox | SnowPeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 70 | Sugar snap peas (i.e, plump, crisp, edible pods) | Checkbox | SugarSnapPeas1 | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 71 | Unknown | Checkbox | UnkPeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 72 | Other, specify: | Checkbox | OthPeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 73 | Text | OtherPeaType | Text | |||
| 15 | Page 16 Other Fresh Vegetables | 74 | Brand(s): | Text | PeasBrand1 | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 75 | Place(s) purchased (names, locations): | Text | PeasPlacePurch | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 76 | Not applicable (did not eat at home) | Checkbox | NotHomePeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 78 | List name(s) of establishment(s) and location(s): | Text | PeasEstandLoc | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 79 | Not applicable (did not eat outside the home) | Checkbox | Homepeas | Boolean | ||
| 15 | Page 16 Other Fresh Vegetables | 80 | 74. Broccoli? | Legal Values | Broccoli | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 81 | 75. Cauliflower? | Legal Values | Cauliflower | Text | ||
| 15 | Page 16 Other Fresh Vegetables | 82 | 76. Sprouts? | Legal Values | Sprouts | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 1 | 77. Raw, uncooked onions? | Legal Values | Onion | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 2 | White | Checkbox | WhiteOnion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 3 | Yellow | Checkbox | YellowOnion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 4 | Red/Purple | Checkbox | RedPurpleOnion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 5 | Green onion/scallion | Checkbox | Scallion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 6 | Unknown | Checkbox | UnkOnion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 7 | Other, specify: | Checkbox | OthOnion | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 8 | Text | OthOnionSpec | Text | |||
| 16 | Page 17 Other Fresh Veg continued | 9 | 78. Fresh tomatoes? | Legal Values | Tomato | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 10 | Red Round | Checkbox | RedRoundTom | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 11 | Roma (oval-shaped) | Checkbox | RomaovalshapedTom | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 12 | Grape/Cherry (bite-sized) | Checkbox | GrapeCherryTom | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 13 | Unknown | Checkbox | UnkTom | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 14 | Other, Specify: | Checkbox | OthTom | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 15 | Text | OthTomSpec | Text | |||
| 16 | Page 17 Other Fresh Veg continued | 16 | 79. Fresh made salsa or pico de gallo (i.e., not from a vacuum-sealed jar)? | Legal Values | Pico | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 17 | Brand(s): | Text | PicoBrand | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 18 | Place(s) purchased (names, locations): | Text | PicoPlacePurch | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 19 | Not applicable (did not eat home) | Checkbox | NotHomePico | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 20 | List name(s) of establishment(s) and location(s): | Text | PicoAwayName | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 21 | Not applicable (did not eat outside the home) | Checkbox | HomePico | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 22 | 80. Fresh made guacamole (i.e., not from a vacuum-sealed jar)? | Legal Values | Guacamole | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 23 | Brand(s) | Text | GuacBrand | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 24 | Place(s) purchased (names, locations): | Text | GuacPlacePurch | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 25 | Not applicable (did not eat home) | Checkbox | NotHomeGuac | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 26 | List name(s) of establishment(s) and location(s): | Text | GuacAwayName | Text | ||
| 16 | Page 17 Other Fresh Veg continued | 27 | Not applicable (did not eat outside the home) | Checkbox | HomeGuac | Boolean | ||
| 16 | Page 17 Other Fresh Veg continued | 28 | Additional comments, including other types of fresh vegetables: | Text | FreshVegComments | Text | ||
| 17 | Page 18 Interview Completed | 1 | Legal Values | AdditionalThoughts | Text | |||
| 17 | Page 18 Interview Completed | 2 | Would you like to provide any additional thoughts or perspective about anything we've discussed or about this outbreak investigation? | Text | AdditionalComments | Text | ||
| 17 | Page 18 Interview Completed | 3 | Date Submitted | Date | DateSubmitted | Date | YYYY-MM-DD | Read Only |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Title | Data elements |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |