Protocol - Conditions Relevant to Immune Response - Screener, Child

Personnel and Training Required

None

Equipment Needs

None

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	No
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Proxy-administered questionnaire

Lifestage

Infant, Child, Adolescent

Participants

Infants, children, and teenagers younger than 18 years old.

Selection Rationale

The Centers for Disease Control and Prevention (CDC) Screening Questionnaire for Child and Teen Immunization was selected because this screener is recommended by many state health departments.

Language

Chinese, English

Standards

Standard	Name	ID	Source
Logical Observation Identifiers Names and Codes (LOINC)	Immune response - child proto	62880-0	LOINC
Human Phenotype Ontology	Abnormality of the immune system	HP:0002715	HPO
caDSR Form	PhenX PX160802 - Conditions Relevant To Immune Response Screener Child	6185326	caDSR Form

Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

Centers for Disease Control and Prevention (CDC), Screening Questionnaire for Child and Teen Immunization, 2009

Source

Department of Health and Human Services. Centers for Disease Control and Prevention (2009). Screening Questionnaire for Child and Teen Immunization. Questions 1–9.

General References

None

Protocol ID

160802

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX160802_Allergies
	PX160802020000	Does the child have allergies to more medications, food, or any vaccine? show less	N/A
PX160802_Immune_System_Problem
	PX160802050000	Does the child have cancer, leukemia, AIDS, more or any other immune system problem? show less	N/A
PX160802_Pregnant
	PX160802080000	Is the child/teen pregnant, or is there a more chance she could become pregnant during the next month? show less	Variable Mapping
PX160802_Seizure_Brain_Problem
	PX160802040000	Has the child had a seizure or a brain problem?	N/A
PX160802_Sick_Today
	PX160802010000	Is the child sick today?	N/A
PX160802_Steroids_AntiCancerDrugs_Radiation
	PX160802060000	Has the child take cortisone, prednisone, more other steroids, or anticancer drugs or had x-ray treatments in the past 3 months? show less	N/A
PX160802_Transfusion_ImmuneGlobulin
	PX160802070000	Has the child received a transfusion of more blood or blood products or been given a medicine called immune (gamma) globulin in the past year? show less	N/A
PX160802_Vaccination
	PX160802090000	Has the child received vaccinations in the more past 4 weeks? show less	N/A
PX160802_Vaccine_Reaction
	PX160802030000	Has the child had a serious reaction to a more vaccine in the past? show less	N/A

Infectious Diseases and Immunity

Measure Name

Conditions Relevant to Immune Response - Screener

Release Date

November 12, 2010

Definition

This is a questionnaire to screen for personal history of adverse events from vaccinations.

Purpose

This measure is used to identify individuals' history of adverse events from vaccination or other conditions that may suggest unusual response to vaccination to include in any initial assessments of immune response profiles.

Keywords

Immunizations, Vaccinations, Infectious Diseases and Immunity

Measure Protocols

Protocol ID	Protocol Name
160801	Conditions Relevant to Immune Response - Screener, Adult
160802	Conditions Relevant to Immune Response - Screener, Child

Publications

There are no publications listed for this protocol.