Tx
section
Variable name
Short label EN
Description
Data type
Format
Permissible values EN
(response options)
Response
Reporting
report_whoID
WHO case ID
WHO assigned sequential
number
String
Free text
Reporting
report_date
Date (DD/MM/YYYY)*:
_____/____/______
Date of reporting
Date
DD/MM/YYYY
Select Date>>
Reporting
report_orginst
reporting institution
Unit/Department/Organization
that interviewer is representing. Note, label should be adapted to suite
local context.
String
Free text
Reporting
report_country
reporting country
Country/territory/national
boundary within which the case currently/usually resides.
If transborders or international spread of outbreak
String
Free text
Choose a Country>>
Select Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Reporting
report_diag_class
case classification
Is the case confirmed,
probable, or suspected, as per case definition
Numeric
#
1 = Confirmed 2 = Probable
1 - Confirmed   2 - Probable  
Reporting
report_pointofentry
detected at point of entry
Was the case detected at a
point of entry?
Numeric
#
1 = Yes, 2 = No, 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Reporting
report_pointofentry_date
date detected at point of
entry
What date was the case
detected at a point of entry
Date
DD/MM/YYYY
Select Date>>
Patient
information
patinfo_ID
country case ID*:
Unique case identification
number (used in country)
String
Free text
Patient
information
patinfo_DoB
Date of
birth*:_____/______/________
Date that the case was born
on.
Date
DD/MM/YYYY
Select Date>>
Patient
information
patinfo_ageonset
or Age:_______
Age in units on the date of
illness onset.
Numeric
###
0-110
Patient
information
patinfo_ageonsetunit
unit of age
Years or months or days
Numeric
#
1 = years 2 = months 3=days
1 - Years   2 - Months   3 - Days  
Patient
information
patinfo_sex
Sex at birth: Male Female
Biological sex. That is the
biological differential characteristics (chromosomes, hormonal profiles,
internal and external sex organs) that best describes the case.
Numeric
#
1 = Male; 2 = Female;
1 - Male   2 - Female  
Patient
information
patinfo_idadmin0
where the case was
diagnosed, admin level 0 (country)
Administrative level 0:
Country where the case was diagnosed.
String
Free text
Choose a Country>>
Select Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Patient
information
patinfo_idadmin1
identified Admin Level 1
(province):
Administrative level 1:
First sub-national boundary (e.g. province, state, territory prefecture,
region, etc.) where the case was diagnosed.
String
Free text
  Cities    
Patient
information
patinfo_idadmin2
identified Admin Level
2(district):
Administrative level 2:
Second sub-national level boundary (e.g. district, county, local government
area, department, province, municipality, etc.) where the case was diagnosed.
String
Free text
Patient
information
patinfo_resadmin0
place of residence admin
level 0
Administrative level 0:
Country within which the case's currently/usually resides.
String
Free text
Choose a Country>>
Select Country
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Patient
information
patinfo_resadmin1
place of residence admin
level 1
Administrative level 1:
First sub-national boundary (e.g. province, state, territory prefecture,
region, etc.) within which the case's currently/usually resides.
String
Free text
  Cities    
Patient
information
patinfo_resadmin2
place of residence admin
level 2
Administrative level 2:
Second sub-national level boundary (e.g. district, county, local government
area, department, province, municipality, etc.) within which the case's
currently/usually resides.
String
Free text
Patient
clinical course
patcourse_dateonset
Date of onset of first
symptoms:____/____/______
Date of first appearance of
the signs or symptoms of the illness/disease.
Date
DD/MM/YYYY
Select Date>>
Patient
clinical course
patcourse_asymp
Patient asymptomatic
Is the case asymptomatic?
Numeric
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
clinical course
patcourse_dateonset_unk
Patient date of onset
unknown
Is the date of the case's
symptom onset unknown?
Numeric
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
clinical course
patcourse_admit
admission to hospital?:
Was the case hospitalized,
admitted to a hospital or other health facility as an inpatient?
Numeric
#
1 = Yes; 2 = No, 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Patient
clinical course
patcourse_presHCF
For this episode, date first
admitted in hospital :___/___/_____
Date the case was first
admitted to any health facility.
Date
DD/MM/YYYY
Select Date>>
Patient
clinical course
patcourse_admitname
name of hospital
Name of health facility
where the case was admitted.
String
Free text
Patient
clinical course
patcourse_dateiso
date of isolation
What date was the case
isolated?
Date
DD/MM/YYYY
Select Date>>
Patient
clinical course
patcourse_vent
Was the patient
ventilated?
Was the patient ever
ventilated for this episode at time of reporting?
Numeric
#
1 = Yes; 2 = No, 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Patient
clinical course
patcourse_status
Outcome of illness (circle):
Health Status at time of
reporting.
Numeric
#
1 = recovered ; 2 = not
recovered; 3 = death; 4 = unknown
1 - Recovered   2 - Not Recovered   3 - Death   4 - Unknown  
Patient
clinical course
patcourse_datedeath
Date of death:___/___/_____
Date of death
Date
DD/MM/YYYY
Select Date>>
Patient
symptoms
patsympt_fever
History of fever/chills
Fever associated with
chills or not
Numeric
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
symptoms
patsympt_weak
General weakness
Intense fatigue, an abnormal
state of drowsiness (lethargy or feeling lethargic), cannot conduct daily
activity, lack of strengh
Numeric
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
symptoms
patsympt_irritability
Irritability/confusion
Presence of any conscious
disorder
Number
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
symptoms
patsympt_sorethroat
Sore throat
Increase volume of the neck
due to swollen glands
Number
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
symptoms
patsympt_produ
Cough
When coughing the patient
produces or not phlegm or mucus/sputum or bloody sputum
Numeric
#
1 = Yes; 2 = No
1 - Yes  
2 - No  
Patient
symptoms
patsympt_runnynose
Runny nose
Runny nose
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_short
Shortness of breath
Patient has difficulty
breathing with short respiratory cycles
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_diarr
Diarrhoea
Diarrhoea, three or more
loose or liquid stools (bowel movements) in a 24 hour period (or more
frequent passage than is normal for the individual).
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_vomit
Nausea/vomiting
Include nausea, vomiting,
abdominal pain, loss of appetite, diarrhea, dysentery, increased liver and/or
spleen volume, anorexia.
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_headache
Headache
Headache
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_pain
Pain
Patient complains of pain,
at any site
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_muscupain
Muscular pain
Muscular pain
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_chestpain
Chest pain
Chest pain
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_abdopain
Abdominal pain
Abdominal pain
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_jointpain
Joint pain
Joint pain
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
symptoms
patsympt_other
Other, specify
Describe other symptoms
String
Free text
Patient
signs
pat_sign_temp
Temperature:
Body temperature measured at
time of interview or upon admission to the medical facility
Expressed in degree celcius
Numeric
##
between 35 and 43 or 95 and
110
Patient
signs
pat_sign_temp_unit
Celsius or Farenheight
Temperature recorded in
degrees Celsius or Farenheight
Numeric
#
1 = Celsius 2 = Farenheight
1 - Celsius   2 - Farenheight  
Patient
signs
pat_sign_pharyn
Pharyngeal exsudate
Pharyngitis or
laryngitis
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_conjunc
Conjunctival injection
Bleeding/haemorrhage into
the eyes (conjunctival injections).
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_dysp
Dyspnea, tachypnea
Rapid respiration
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_ausc
Abnormal lung
auscultation
Any sign resulting from
pulmonary auscultation
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_xray
Abnormal lung x-ray findings
Pulmonary Xrays showing
abnormal patterns
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_seize
Seizures
Myoclonies, tremors,
epilepsy, seizures/convulsions
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_coma
Coma
Absence of reaction to
orders
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Patient
signs
pat_sign_other
Other signs, specify
Describe other signs
String
Free text
Comorbidity
or underlying conditions
Comcond_preg
Pregnancy
Is the patient
pregnant?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_pregt
Trimester of pregancy
Numeric
#
1 = 1st trimester; 2 = 2nd
trimester; 3= 3rd trimester
1 - 1st trimester   2 - 2nd
trimester   3 - 3rd trimester  
Comorbidity
or underlying conditions
Comcond_partum
Post-partum (<6 weeks)
Is the patient in the post
partum period defined as less than 6 weeks after delivery date
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_immuno
Immunodeficiency including
HIV
has the patient an adquired
immunodeficiency (HIV) or is the patient treated with drugs that decreased
immune response (corticoides, anti cancer chemotherapy)?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_cardi
Cardiovacsular disease
including hypertension
any cardiovacsular disease
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_diabetes
Diabetes
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_liver
Liver disease
any liver diseases
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_renal
Renal disease
any renal diseases
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_neuro
Chronic neurological or
neuromuscular disease
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_malig
Malignancy
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_lung
Chronic lung disease
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Comorbidity
or underlying conditions
Comcond_other
Other, specify
Describe other underlying
conditions and comorbidity
String
Free text
Exposure
and travel information
patinfo_occus
Student
is the patient a
student?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
patinfo_occuhcw
Health care worker
Is the patient working in a
health care setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
patinfo_occulab
Health laboratory worker
Is the patient working in a
health laboratory setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
patinfo_occuani
Working with animals
Is the patient working in
contact with animals?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
patinfo_occuother
Other, specify
Please specify any other
occupation not listed
String
Free text
Exposure
and travel information
expo_travel
Has the patient travelled in
the 14 days prior to symptom onset?
Has the patient travelled in
the 14 days prior to symptom onset?
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Exposure
and travel information
expo_travel_country1
Specify country travelled to
1
List the country from
location 1 that the case has travelled to in the 14 days prior to symptom
onset
String
Free text
Choose a Country>>
Select Country1
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Exposure
and travel information
expo_travel_city1
Specify city travelled to 1
List the city from location
1 that the case has travelled to in the 14 days prior to symptom onset
String
Free text
  Cities    
Exposure
and travel information
expo_travel_country2
Specify country travelled to
2
List the country from
location 2 that the case has travelled to in the 14 days prior to symptom
onset
String
Free text
Choose a Country>>
Select Country2
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Exposure
and travel information
expo_travel_city2
Specify city travelled to 2
List the city from location
2 that the case has travelled to in the 14 days prior to symptom onset
String
Free text
  Cities    
Exposure
and travel information
expo_travel_country3
Specify country travelled to
3
List the country from
location 3 that the case has travelled to in the 14 days prior to symptom
onset
String
Free text
Choose a Country>>
Select Country3
Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia, Plurinational State of
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Congo, the Democratic Republic of the
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See (Vatican City State)
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran, Islamic Republic of
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia, the former Yugoslav Republic of
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia, Federated States of
Moldova, Republic of
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestinian Territory, Occupied
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Réunion
Romania
Russian Federation
Rwanda
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syrian Arab Republic
Taiwan, Province of China
Tajikistan
Tanzania, United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela, Bolivarian Republic of
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Exposure
and travel information
expo_travel_city3
Specify city travelled to 3
List the city from location
3 that the case has travelled to in the 14 days prior to symptom onset
String
Free text
  Cities    
Exposure
and travel information
expo_visit_healthcare
Has the patient visited any
health care facilities in the 14 days prior to symptom onset
Has the patient visited any
health care facilities in the 14 days prior to symptom onset
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Exposure
and travel information
expo_ari
Has the patient had close
contact with a person with acute respiratory infection in the 14 days prior
to symptom onset
Has the patient had close
contact with a person with acute respiratory infection in the 14 days prior
to symptom onset
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Exposure
and travel information
expo_ari_healthcare
ARI close contact in Health
care setting
Has the patient had close
contact with a person with acute
respiratory infection in the 14 days prior to symptom onset in a health care
setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_ari_family
ARI close contact in Family
setting
Has the patient had close
contact with a person with acute
respiratory infection in the 14 days prior to symptom onset in a family
setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_ari_workplace
ARI close contact in Work
place
Has the patient had close
contact with a person with acute
respiratory infection in the 14 days prior to symptom onset in a workplace
setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_ari_settingother
ARI close contact in other
location (specify)
Please specify any close
contact setting with a person with acute respiratory infection not listed.
String
Free text
Exposure
and travel information
expo_ari_settingunknown
ARI close contact unkown
Please select unkown if
there was no known close contact with a person with acute respiratory
infection
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_contact_case
Has the patient had contact
with a probable or confirmed cases?
Has the patient had contact
with a probable or confirmed cases in the 14 days prior to disease onset?
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Exposure
and travel information
expo_ID1
ID number of confirmed or
probable case 1
List the unique case
identifier 1 with whom the patient had contact with
String
Free text
Exposure
and travel information
expo_ID2
ID number of confimred or
probable case 2
List the unique case
identifier 2 with whom the patient had contact with
String
Free text
Exposure
and travel information
expo_ID3
ID number of confimred or
probable case 3
List the unique case
identifier 3 with whom the patient had contact with
String
Free text
Exposure
and travel information
expo_ID4
ID number of confimred or
probable case 4
List the unique case
identifier 4 with whom the patient had contact with
String
Free text
Exposure
and travel information
expo_case_healthcare
Case contact health care
setting
Was the patient most likely
exposed to another case in a health care setting?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_case_family
Case contact family setting
Was the patient most likely
exposed to another case in family settings?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_case_workplace
Case contact in work place
Was the patient most likely
exposed to another case at work?
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_case_settingother
Case contact in other
location (specify)
Please specify any contact
setting not listed.
String
Free text
Exposure
and travel information
expo_case_settingunknown
Case contact unknown
Please select unkown if
there were no known contact setting
Numeric
#
1 = Yes; 2 = No
1 - Yes   2 - No  
Exposure
and travel information
expo_case_location
Likely location/city/country
for exposure to case?
Specify the location of
possible exposure to a case?
String
Free text
  Cities    
Exposure
and travel information
expo_animal
Did the patient visit any
live animals markets?
Did the patient visit any
live animal marker 14 days prior to symptom onset?
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Exposure
and travel information
expo_animal_location
Likely location/city/country
for exposure to live animals
Specify the location of
possible exposure to live animals
String
Free text
  Cities    
Laboratory
information
Lab_name
Name of confirming
laboratory:
Name of testing laboratory
String
Free text
Laboratory
information
Lab_assay
Assay used by confirming
laboratory
Please specify which assay
was used by the confirming laboratory
String
Free text
Laboratory
information
Lab_sequencing
Sequencing performed by
confirming laboratory
Please specify is sequencing
was used by the confirming laboratory
Numeric
#
1 = Yes; 2 = No; 3 = Unknown
1 - Yes   2 - No   3 - Unknown  
Laboratory
information
Lab_date1
Date of laboratory
confirmation
Date of laboratory
confirmation
Date
DD/MM/YYYY
Select Date>>