Protocol - Conditions Relevant to Immune Response - Screener, Adult

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

Adult

Participants

Adults, aged 18 years and older

Selection Rationale

The Centers for Disease Control and Prevention (CDC) Screening Questionnaire for Adult 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 - adult proto	62879-2	LOINC
Human Phenotype Ontology	Abnormality of the immune system	HP:0002715	HPO
caDSR Form	PhenX PX160801 - Conditions Relevant To Immune Response Screener Adult	6185274	caDSR Form

Derived Variables

None

Process and Review

Not applicable.

Protocol Name from Source

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

Source

Department of Health and Human Services. Centers for Disease Control and Prevention (2009). Screening Questionnaire for Adult Immunization. Questions 1–10.

General References

None

Protocol ID

160801

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX160801_Allergies
	PX160801020000	Do you have allergies to medications, food, more or any vaccine? show less	N/A
PX160801_Immune_System_Problem
	PX160801050000	Do you have cancer, leukemia, AIDS, or any more other immune system problem? show less	N/A
PX160801_Long_Term_Health_Problem
	PX160801040000	Do you have a long-term health problem with more heart disease, lung disease, asthma, kidney disease, metabolic disease (e.g., diabetes), anemia, or other blood disorder? show less	N/A
PX160801_Nervous_System_Problem
	PX160801070000	Have you had a seizure, brain, or other more nervous system problem? show less	N/A
PX160801_Pregnant
	PX160801090000	For women: Are you pregnant, or is there a more chance you could become pregnant during the next month? show less	Variable Mapping
PX160801_Reaction_To_Vaccine
	PX160801030000	Have you ever had a serious reaction after more receiving a vaccination? show less	N/A
PX160801_Sick_Today
	PX160801010000	Are you sick today?	N/A
PX160801_Steroids_AntiCancerDrugs_Radiation
	PX160801060000	Do you take cortisone, prednisone, other more steroids, or anticancer drugs, or have you had radiation treatments? show less	N/A
PX160801_Transfusion_ImmuneGlobulin_Antiviral
	PX160801080000	During the past year, have you received a more transfusion of blood or blood products, or have you been given immune (gamma) globulin or an antiviral drug? show less	N/A
PX160801_Vaccinations
	PX160801100000	Have you received any vaccinations in the more past 4 weeks? 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.