Protocol - Immunizations
Description
This protocol is a self- or proxy-administered questionnaire from the American Health Information Management Association (AHIMA) that collects information on the age and date at which a respondent was immunized for specific diseases.
Specific Instructions
The Infectious Diseases and Immunity Working Group (WG) recommends that when choosing this protocol, please also refer to the Centers for Disease Control and Preventions (CDCs) annually updated list of immunizations recommended by the Advisory Committee on Immunization Practices.
The Infectious Diseases and Immunity WG also recommends that, for older adults, medical records from a participants physician may be necessary to provide this information.
Availability
Protocol
A. Immunizations
| Booster 1 | Booster 2 | Booster 3 | ||||
| Immunization for | Age | Date | Age | Date | Age | Date |
| Diphtheria | ||||||
| Hepatitis B | ||||||
| Measles | ||||||
| Mumps | ||||||
| Pertussis/ Whooping Cough | ||||||
| Polio | ||||||
| Rubella | ||||||
| Smallpox | ||||||
| Tetanus | ||||||
| Tuberculosis | ||||||
| Typhoid | ||||||
| Other | ||||||
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
Self- or proxy-administered questionnaire
Lifestage
Infant, Toddler, Child, Adolescent, Adult, Senior, Pregnancy
Participants
Any age group
Selection Rationale
The American Health Information Management Associations (AHIMAs) My Personal Health Record (MyPHR) protocol is a national program used by several state health information management associations in community-based settings.
Language
English, Spanish
Standards
| Standard | Name | ID | Source |
|---|---|---|---|
| Logical Observation Identifiers Names and Codes (LOINC) | Immunizations proto | 62884-2 | LOINC |
| Human Phenotype Ontology | Triggered by vaccination | HP:0025219 | HPO |
| caDSR Form | PhenX PX161001 - Immunizations | 6185420 | caDSR Form |
Derived Variables
None
Process and Review
Not applicable.
Protocol Name from Source
My Personal Health Record (MyPHR), Adult PHR Form, 2006
Source
American Health Information Management Association (AHIMA). My Personal Health Record (MyPHR). Adult PHR Form 2006, Section H.
General References
None
Protocol ID
161001
Variables
Export Variables| Variable Name | Variable ID | Variable Description | dbGaP Mapping | |
|---|---|---|---|---|
| PX161001_Diphtheria_Booster_1_Age | ||||
| PX161001010100 | Diphtheria Booster 1 Age | N/A | ||
| PX161001_Diphtheria_Booster_1_Date_Day | ||||
| PX161001010201 | Diphtheria Booster 1 Date - Day | N/A | ||
| PX161001_Diphtheria_Booster_1_Date_Month | ||||
| PX161001010202 | Diphtheria Booster 1 Date - Month | N/A | ||
| PX161001_Diphtheria_Booster_1_Date_Year | ||||
| PX161001010203 | Diphtheria Booster 1 Date - Year | N/A | ||
| PX161001_Diphtheria_Booster_2_Age | ||||
| PX161001010300 | Diphtheria Booster 2 Age | N/A | ||
| PX161001_Diphtheria_Booster_2_Date_Day | ||||
| PX161001010401 | Diphtheria Booster 2 Date - Day | N/A | ||
| PX161001_Diphtheria_Booster_2_Date_Month | ||||
| PX161001010402 | Diphtheria Booster 2 Date - Month | N/A | ||
| PX161001_Diphtheria_Booster_2_Date_Year | ||||
| PX161001010403 | Diphtheria Booster 2 Date - Year | N/A | ||
| PX161001_Diphtheria_Booster_3_Age | ||||
| PX161001010500 | Diphtheria Booster 3 Age | N/A | ||
| PX161001_Diphtheria_Booster_3_Date_Day | ||||
| PX161001010601 | Diphtheria Booster 3 Date - Day | N/A | ||
| PX161001_Diphtheria_Booster_3_Date_Month | ||||
| PX161001010602 | Diphtheria Booster 3 Date - Month | N/A | ||
| PX161001_Diphtheria_Booster_3_Date_Year | ||||
| PX161001010603 | Diphtheria Booster 3 Date - Year | N/A | ||
| PX161001_Hepatitis_B_Booster_1_Age | ||||
| PX161001020100 | Hepatitis B Booster 1 Age | N/A | ||
| PX161001_Hepatitis_B_Booster_1_Date_Day | ||||
| PX161001020201 | Hepatitis B Booster 1 Date - Day | N/A | ||
| PX161001_Hepatitis_B_Booster_1_Date_Month | ||||
| PX161001020202 | Hepatitis B Booster 1 Date - Month | N/A | ||
| PX161001_Hepatitis_B_Booster_1_Date_Year | ||||
| PX161001020203 | Hepatitis B Booster 1 Date - Year | N/A | ||
| PX161001_Hepatitis_B_Booster_2_Age | ||||
| PX161001020300 | Hepatitis B Booster 2 Age | N/A | ||
| PX161001_Hepatitis_B_Booster_2_Date_Day | ||||
| PX161001020401 | Hepatitis B Booster 2 Date - Day | N/A | ||
| PX161001_Hepatitis_B_Booster_2_Date_Month | ||||
| PX161001020402 | Hepatitis B Booster 2 Date - Month | N/A | ||
| PX161001_Hepatitis_B_Booster_2_Date_Year | ||||
| PX161001020403 | Hepatitis B Booster 2 Date - Year | N/A | ||
| PX161001_Hepatitis_B_Booster_3_Age | ||||
| PX161001020500 | Hepatitis B Booster 3 Age | N/A | ||
| PX161001_Hepatitis_B_Booster_3_Date_Day | ||||
| PX161001020601 | Hepatitis B Booster 3 Date - Day | N/A | ||
| PX161001_Hepatitis_B_Booster_3_Date_Month | ||||
| PX161001020602 | Hepatitis B Booster 3 Date - Month | N/A | ||
| PX161001_Hepatitis_B_Booster_3_Date_Year | ||||
| PX161001020603 | Hepatitis B Booster 3 Date - Year | N/A | ||
| PX161001_Measles_Booster_1_Age | ||||
| PX161001030100 | Measles Booster 1 Age | N/A | ||
| PX161001_Measles_Booster_1_Date_Day | ||||
| PX161001030201 | Measles Booster 1 Date - Day | N/A | ||
| PX161001_Measles_Booster_1_Date_Month | ||||
| PX161001030202 | Measles Booster 1 Date - Month | N/A | ||
| PX161001_Measles_Booster_1_Date_Year | ||||
| PX161001030203 | Measles Booster 1 Date - Year | N/A | ||
| PX161001_Measles_Booster_2_Age | ||||
| PX161001030300 | Measles Booster 2 Age | N/A | ||
| PX161001_Measles_Booster_2_Date_Day | ||||
| PX161001030401 | Measles Booster 2 Date - Day | N/A | ||
| PX161001_Measles_Booster_2_Date_Month | ||||
| PX161001030402 | Measles Booster 2 Date - Month | N/A | ||
| PX161001_Measles_Booster_2_Date_Year | ||||
| PX161001030403 | Measles Booster 2 Date - Year | N/A | ||
| PX161001_Measles_Booster_3_Age | ||||
| PX161001030500 | Measles Booster 3 Age | N/A | ||
| PX161001_Measles_Booster_3_Date_Day | ||||
| PX161001030601 | Measles Booster 3 Date - Day | N/A | ||
| PX161001_Measles_Booster_3_Date_Month | ||||
| PX161001030602 | Measles Booster 3 Date - Month | N/A | ||
| PX161001_Measles_Booster_3_Date_Year | ||||
| PX161001030603 | Measles Booster 3 Date - Year | N/A | ||
| PX161001_Mumps_Booster_1_Age | ||||
| PX161001040100 | Mumps Booster 1 Age | N/A | ||
| PX161001_Mumps_Booster_1_Date_Day | ||||
| PX161001040201 | Mumps Booster 1- Date - Day | N/A | ||
| PX161001_Mumps_Booster_1_Date_Month | ||||
| PX161001040202 | Mumps Booster 1 - Date- Month | N/A | ||
| PX161001_Mumps_Booster_1_Date_Year | ||||
| PX161001040203 | Mumps Booster 1 - Date- Year | N/A | ||
| PX161001_Mumps_Booster_2_Age | ||||
| PX161001040300 | Mumps Booster 2 Age | N/A | ||
| PX161001_Mumps_Booster_2_Date_Day | ||||
| PX161001040401 | Mumps Booster 2- Date - Day | N/A | ||
| PX161001_Mumps_Booster_2_Date_Month | ||||
| PX161001040402 | Mumps Booster 2 - Date- Month | N/A | ||
| PX161001_Mumps_Booster_2_Date_Year | ||||
| PX161001040403 | Mumps Booster 2 - Date- Year | N/A | ||
| PX161001_Mumps_Booster_3_Age | ||||
| PX161001040500 | Mumps Booster 3 Age | N/A | ||
| PX161001_Mumps_Booster_3_Date_Day | ||||
| PX161001040601 | Mumps Booster 3 - Date - Day | N/A | ||
| PX161001_Mumps_Booster_3_Date_Month | ||||
| PX161001040602 | Mumps Booster 3 - Date- Month | N/A | ||
| PX161001_Mumps_Booster_3_Date_Year | ||||
| PX161001040603 | Mumps Booster 3 - Date- Year | N/A | ||
| PX161001_Other_Booster_1_Age | ||||
| PX161001120100 | Other Booster 1 Age | N/A | ||
| PX161001_Other_Booster_1_Date_Day | ||||
| PX161001120201 | Other Booster 1 Date - Day | N/A | ||
| PX161001_Other_Booster_1_Date_Month | ||||
| PX161001120202 | Other Booster 1 Date - Month | N/A | ||
| PX161001_Other_Booster_1_Date_Year | ||||
| PX161001120203 | Other Booster 1 Date - Year | N/A | ||
| PX161001_Other_Booster_2_Age | ||||
| PX161001120300 | Other Booster 2 Age | N/A | ||
| PX161001_Other_Booster_2_Date_Day | ||||
| PX161001120401 | Other Booster 2 Date - Day | N/A | ||
| PX161001_Other_Booster_2_Date_Month | ||||
| PX161001120402 | Other Booster 2 Date - Month | N/A | ||
| PX161001_Other_Booster_2_Date_Year | ||||
| PX161001120403 | Other Booster 2 Date - Year | N/A | ||
| PX161001_Other_Booster_3_Age | ||||
| PX161001120500 | Other Booster 3 Age | N/A | ||
| PX161001_Other_Booster_3_Date_Day | ||||
| PX161001120601 | Other Booster 3 Date - Day | N/A | ||
| PX161001_Other_Booster_3_Date_Month | ||||
| PX161001120602 | Other Booster 3 Date - Month | N/A | ||
| PX161001_Other_Booster_3_Date_Year | ||||
| PX161001120603 | Other Booster 3 Date - Year | N/A | ||
| PX161001_Other_Booster_Specify | ||||
| PX161001120000 | Other Booster, specify | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_1_Date_Day | ||||
| PX161001050201 | Pertussis/Whooping Cough Booster 1 Date - Day | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_1_Date_Month | ||||
| PX161001050202 | Pertussis/Whooping Cough Booster 1 Date - Month | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_1_Date_Year | ||||
| PX161001050203 | Pertussis/Whooping Cough Booster 1 Date - Year | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_2_Date_Day | ||||
| PX161001050401 | Pertussis/Whooping Cough Booster 2 Date - Day | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_2_Date_Month | ||||
| PX161001050402 | Pertussis/Whooping Cough Booster 2 Date - Month | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_2_Date_Year | ||||
| PX161001050403 | Pertussis/Whooping Cough Booster 2 Date - Year | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_3_Date_Day | ||||
| PX161001050601 | Pertussis/Whooping Cough Booster 3 Date - Day | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_3_Date_Month | ||||
| PX161001050602 | Pertussis/Whooping Cough Booster 3 Date - Month | N/A | ||
| PX161001_Pertussis/WhoopingCough_Booster_3_Date_Year | ||||
| PX161001050603 | Pertussis/Whooping Cough Booster 3 Date - Year | N/A | ||
| PX161001_Pertussis/Whooping_Cough_Booster_1_Age | ||||
| PX161001050100 | Pertussis/Whooping Cough Booster 1 Age | N/A | ||
| PX161001_Pertussis/Whooping_Cough_Booster_2_Age | ||||
| PX161001050300 | Pertussis/Whooping Cough Booster 2 Age | N/A | ||
| PX161001_Pertussis/Whooping_Cough_Booster_3_Age | ||||
| PX161001050500 | Pertussis/Whooping Cough Booster 3 Age | N/A | ||
| PX161001_Polio_Booster_1_Age | ||||
| PX161001060100 | Polio Booster 1 Age | N/A | ||
| PX161001_Polio_Booster_1_Date_Day | ||||
| PX161001060201 | Polio Booster 1 Date - Day | N/A | ||
| PX161001_Polio_Booster_1_Date_Month | ||||
| PX161001060202 | Polio Booster 1 Date -Month | N/A | ||
| PX161001_Polio_Booster_1_Date_Year | ||||
| PX161001060203 | Polio Booster 1 Date - Year | N/A | ||
| PX161001_Polio_Booster_2_Age | ||||
| PX161001060300 | Polio Booster 2 Age | N/A | ||
| PX161001_Polio_Booster_2_Date_Day | ||||
| PX161001060401 | Polio Booster 2 Date - Day | N/A | ||
| PX161001_Polio_Booster_2_Date_Month | ||||
| PX161001060402 | Polio Booster 2 Date -Month | N/A | ||
| PX161001_Polio_Booster_2_Date_Year | ||||
| PX161001060403 | Polio Booster 2 Date - Year | N/A | ||
| PX161001_Polio_Booster_3_Age | ||||
| PX161001060500 | Polio Booster 3 Age | N/A | ||
| PX161001_Polio_Booster_3_Date_Day | ||||
| PX161001060601 | Polio Booster 3 Date - Day | N/A | ||
| PX161001_Polio_Booster_3_Date_Month | ||||
| PX161001060602 | Polio Booster 3 Date -Month | N/A | ||
| PX161001_Polio_Booster_3_Date_Year | ||||
| PX161001060603 | Polio Booster 3 Date - Year | N/A | ||
| PX161001_Rubella_Booster_1_Age | ||||
| PX161001070100 | Rubella Booster 1 Age | N/A | ||
| PX161001_Rubella_Booster_1_Date_Day | ||||
| PX161001070201 | Rubella Booster 1 Date - Day | N/A | ||
| PX161001_Rubella_Booster_1_Date_Month | ||||
| PX161001070202 | Rubella Booster 1 Date - Month | N/A | ||
| PX161001_Rubella_Booster_1_Date_Year | ||||
| PX161001070203 | Rubella Booster 1 Date - Year | N/A | ||
| PX161001_Rubella_Booster_2_Age | ||||
| PX161001070300 | Rubella Booster 2 Age | N/A | ||
| PX161001_Rubella_Booster_2_Date_Day | ||||
| PX161001070401 | Rubella Booster 2 Date - Day | N/A | ||
| PX161001_Rubella_Booster_2_Date_Month | ||||
| PX161001070402 | Rubella Booster 2 Date - Month | N/A | ||
| PX161001_Rubella_Booster_2_Date_Year | ||||
| PX161001070403 | Rubella Booster 2 Date - Year | N/A | ||
| PX161001_Rubella_Booster_3_Age | ||||
| PX161001070500 | Rubella Booster 3 Age | N/A | ||
| PX161001_Rubella_Booster_3_Date_Day | ||||
| PX161001070601 | Rubella Booster 3 Date - Day | N/A | ||
| PX161001_Rubella_Booster_3_Date_Month | ||||
| PX161001070602 | Rubella Booster 3 Date - Month | N/A | ||
| PX161001_Rubella_Booster_3_Date_Year | ||||
| PX161001070603 | Rubella Booster 3 Date - Year | N/A | ||
| PX161001_Smallpox_Booster_1_Age | ||||
| PX161001080100 | Smallpox Booster 1 Age | N/A | ||
| PX161001_Smallpox_Booster_1_Date_Day | ||||
| PX161001080201 | Smallpox Booster 1 Date - Day | N/A | ||
| PX161001_Smallpox_Booster_1_Date_Month | ||||
| PX161001080202 | Smallpox Booster 1 Date - Month | N/A | ||
| PX161001_Smallpox_Booster_1_Date_Year | ||||
| PX161001080203 | Smallpox Booster 1 Date - Year | N/A | ||
| PX161001_Smallpox_Booster_2_Age | ||||
| PX161001080300 | Smallpox Booster 2 Age | N/A | ||
| PX161001_Smallpox_Booster_2_Date_Day | ||||
| PX161001080401 | Smallpox Booster 2 Date - Day | N/A | ||
| PX161001_Smallpox_Booster_2_Date_Month | ||||
| PX161001080402 | Smallpox Booster 2 Date - Month | N/A | ||
| PX161001_Smallpox_Booster_2_Date_Year | ||||
| PX161001080403 | Smallpox Booster 2 Date - Year | N/A | ||
| PX161001_Smallpox_Booster_3_Age | ||||
| PX161001080500 | Smallpox Booster 3 Age | N/A | ||
| PX161001_Smallpox_Booster_3_Date_Day | ||||
| PX161001080601 | Smallpox Booster 3 Date - Day | N/A | ||
| PX161001_Smallpox_Booster_3_Date_Month | ||||
| PX161001080602 | Smallpox Booster 3 Date - Month | N/A | ||
| PX161001_Smallpox_Booster_3_Date_Year | ||||
| PX161001080603 | Smallpox Booster 3 Date - Year | N/A | ||
| PX161001_Tetanus_Booster_1_Age | ||||
| PX161001090100 | Tetanus Booster 1 Age | N/A | ||
| PX161001_Tetanus_Booster_1_Date_Day | ||||
| PX161001090201 | Tetanus Booster 1 Date - Day | N/A | ||
| PX161001_Tetanus_Booster_1_Date_Month | ||||
| PX161001090202 | Tetanus Booster 1 Date - Month | N/A | ||
| PX161001_Tetanus_Booster_1_Date_Year | ||||
| PX161001090203 | Tetanus Booster 1 Date - Year | N/A | ||
| PX161001_Tetanus_Booster_2_Age | ||||
| PX161001090300 | Tetanus Booster 2 Age | N/A | ||
| PX161001_Tetanus_Booster_2_Date_Day | ||||
| PX161001090401 | Tetanus Booster 1 Date - Day | N/A | ||
| PX161001_Tetanus_Booster_2_Date_Month | ||||
| PX161001090402 | Tetanus Booster 2 Date - Month | N/A | ||
| PX161001_Tetanus_Booster_2_Date_Year | ||||
| PX161001090403 | Tetanus Booster 2 Date - Year | N/A | ||
| PX161001_Tetanus_Booster_3_Age | ||||
| PX161001090500 | Tetanus Booster 3 Age | N/A | ||
| PX161001_Tetanus_Booster_3_Date_Day | ||||
| PX161001090601 | Tetanus Booster 3 Date - Day | N/A | ||
| PX161001_Tetanus_Booster_3_Date_Month | ||||
| PX161001090602 | Tetanus Booster 3 Date - Month | N/A | ||
| PX161001_Tetanus_Booster_3_Date_Year | ||||
| PX161001090603 | Tetanus Booster 3 Date - Year | N/A | ||
| PX161001_Tuberculosis_Booster_1_Age | ||||
| PX161001100100 | Tuberculosis Booster 1 Age | N/A | ||
| PX161001_Tuberculosis_Booster_1_Date_Day | ||||
| PX161001100201 | Tuberculosis Booster 1 Date - Day | N/A | ||
| PX161001_Tuberculosis_Booster_1_Date_Month | ||||
| PX161001100202 | Tuberculosis Booster 1 Date - Month | N/A | ||
| PX161001_Tuberculosis_Booster_1_Date_Year | ||||
| PX161001100203 | Tuberculosis Booster 1 Date - Year | N/A | ||
| PX161001_Tuberculosis_Booster_2_Age | ||||
| PX161001100300 | Tuberculosis Booster 2 Age | N/A | ||
| PX161001_Tuberculosis_Booster_2_Date_Day | ||||
| PX161001100401 | Tuberculosis Booster 2 Date - Day | N/A | ||
| PX161001_Tuberculosis_Booster_2_Date_Month | ||||
| PX161001100402 | Tuberculosis Booster 2 Date - Month | N/A | ||
| PX161001_Tuberculosis_Booster_2_Date_Year | ||||
| PX161001100403 | Tuberculosis Booster 2 Date - Year | N/A | ||
| PX161001_Tuberculosis_Booster_3_Age | ||||
| PX161001100500 | Tuberculosis Booster 3 Age | N/A | ||
| PX161001_Tuberculosis_Booster_3_Date_Day | ||||
| PX161001100601 | Tuberculosis Booster 3 Date - Day | N/A | ||
| PX161001_Tuberculosis_Booster_3_Date_Month | ||||
| PX161001100602 | Tuberculosis Booster 3 Date - Month | N/A | ||
| PX161001_Tuberculosis_Booster_3_Date_Year | ||||
| PX161001100603 | Tuberculosis Booster 3 Date - Year | N/A | ||
| PX161001_Typhoid_Booster_1_Age | ||||
| PX161001110100 | Typhoid Booster 1 Age | N/A | ||
| PX161001_Typhoid_Booster_1_Date_Day | ||||
| PX161001110201 | Typhoid Booster 1 Date - Day | N/A | ||
| PX161001_Typhoid_Booster_1_Date_Month | ||||
| PX161001110202 | Typhoid Booster 1 Date - Month | N/A | ||
| PX161001_Typhoid_Booster_1_Date_Year | ||||
| PX161001110203 | Typhoid Booster 1 Date - Year | N/A | ||
| PX161001_Typhoid_Booster_2_Age | ||||
| PX161001110300 | Typhoid Booster 2 Age | N/A | ||
| PX161001_Typhoid_Booster_2_Date_Day | ||||
| PX161001110401 | Typhoid Booster 2 Date - Day | N/A | ||
| PX161001_Typhoid_Booster_2_Date_Month | ||||
| PX161001110402 | Typhoid Booster 2 Date - Month | N/A | ||
| PX161001_Typhoid_Booster_2_Date_Year | ||||
| PX161001110403 | Typhoid Booster 2 Date - Year | N/A | ||
| PX161001_Typhoid_Booster_3_Age | ||||
| PX161001110500 | Typhoid Booster 3 Age | N/A | ||
| PX161001_Typhoid_Booster_3_Date_Day | ||||
| PX161001110601 | Typhoid Booster 3 Date - Day | N/A | ||
| PX161001_Typhoid_Booster_3_Date_Month | ||||
| PX161001110602 | Typhoid Booster 3 Date - Month | N/A | ||
| PX161001_Typhoid_Booster_3_Date_Year | ||||
| PX161001110603 | Typhoid Booster 3 Date - Year | N/A | ||
Infectious Diseases and Immunity
Measure Name
Immunizations
Release Date
November 12, 2010
Definition
This measure is a questionnaire to collect information on a respondent's personal medical history of immunizations.
Purpose
This measure can be used to establish a respondent's history of immunizations.
Keywords
Immunization, Vaccine, Infectious Diseases, American Health Information Management Association, AHIMA, My Personal Health Record, MyPHR, Infectious Diseases and Immunity
Measure Protocols
| Protocol ID | Protocol Name |
|---|---|
| 161001 | Immunizations |
Publications
There are no publications listed for this protocol.