| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 1 |
IM1 |
Vaccination card for child |
Continuous |
numeric 1.0 |
4986
|
53
|
Is there a vaccination card for (name)? |
| 2 |
IM2D |
Day of BCG immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 3 |
IM2M |
Month of BCG immunization |
Continuous |
numeric 2.0 |
28
|
5011
|
|
| 4 |
IM2Y |
Year of BCG immunization |
Continuous |
numeric 4.0 |
28
|
5011
|
|
| 5 |
IM3AD |
Day of OPV0 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 6 |
IM3AM |
Month of OPV0 immunization |
Continuous |
numeric 2.0 |
26
|
5013
|
|
| 7 |
IM3AY |
Year of OPV0 immunization |
Continuous |
numeric 4.0 |
26
|
5013
|
|
| 8 |
IM3BD |
Day of OPV1 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 9 |
IM3BM |
Month of OPV1 immunization |
Continuous |
numeric 2.0 |
25
|
5014
|
|
| 10 |
IM3BY |
Year of OPV1 immunization |
Continuous |
numeric 4.0 |
25
|
5014
|
|
| 11 |
IM3CD |
Day of OPV2 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 12 |
IM3CM |
Month of OPV2 immunization |
Continuous |
numeric 2.0 |
23
|
5016
|
|
| 13 |
IM3CY |
Year of OPV2 immunization |
Continuous |
numeric 4.0 |
23
|
5016
|
|
| 14 |
IM3DD |
Day of OPV3 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 15 |
IM3DM |
Month of OPV3 immunization |
Continuous |
numeric 2.0 |
20
|
5019
|
|
| 16 |
IM3DY |
Year of OPV3 immunization |
Continuous |
numeric 4.0 |
20
|
5019
|
|
| 17 |
IM3ED |
Day of OPV4 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 18 |
IM3EM |
Month of OPV4 immunization |
Continuous |
numeric 2.0 |
13
|
5026
|
|
| 19 |
IM3EY |
Year of OPV4 immunization |
Continuous |
numeric 4.0 |
13
|
5026
|
|
| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 20 |
IM4AD |
Day of DPT1 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 21 |
IM4AM |
Month of DPT1 immunization |
Continuous |
numeric 2.0 |
23
|
5016
|
|
| 22 |
IM4AY |
Year of DPT1 immunization |
Continuous |
numeric 4.0 |
23
|
5016
|
|
| 23 |
IM4BD |
Day of DPT2 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 24 |
IM4BM |
Month of DPT2 immunization |
Continuous |
numeric 2.0 |
21
|
5018
|
|
| 25 |
IM4BY |
Year of DPT2 immunization |
Continuous |
numeric 4.0 |
21
|
5018
|
|
| 26 |
IM4CD |
Day of DPT3 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 27 |
IM4CM |
Month of DPT3 immunization |
Continuous |
numeric 2.0 |
17
|
5022
|
|
| 28 |
IM4CY |
Year of DPT3 immunization |
Continuous |
numeric 4.0 |
17
|
5022
|
|
| 29 |
IM4DD |
Day of DPT4 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 30 |
IM4DM |
Month of DPT4 immunization |
Continuous |
numeric 2.0 |
13
|
5026
|
|
| 31 |
IM4DY |
Year of DPT4 immunization |
Continuous |
numeric 4.0 |
13
|
5026
|
|
| 32 |
IM5AD |
Day of HepB1 or DPTHepB1 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 33 |
IM5AM |
Month of HepB1 or DPThepB1 immunization |
Continuous |
numeric 2.0 |
26
|
5013
|
|
| 34 |
IM5AY |
Year of HepB1 or DPTHepB1 immunization |
Continuous |
numeric 4.0 |
26
|
5013
|
|
| 35 |
IM5BD |
Day HepB2 or DPTHepB2 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 36 |
IM5BM |
Month of HepB2 or DPTHepB2 imunization |
Continuous |
numeric 2.0 |
22
|
5017
|
|
| 37 |
IM5BY |
Year of HepB2 or DPTHepB2 immunization |
Continuous |
numeric 4.0 |
22
|
5017
|
|
| 38 |
IM5CD |
Day of DPTHepB3 or HepB3 immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 39 |
IM5CM |
Month of DPTHepB3 or HepB3 ummunization |
Continuous |
numeric 2.0 |
19
|
5020
|
|
| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 40 |
IM5CY |
Year of DPTHepB3 or HepB3 immunization |
Continuous |
numeric 4.0 |
19
|
5020
|
|
| 41 |
IM6D |
Day measles or MMR immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 42 |
IM6M |
Month Measles or MMR immunization |
Continuous |
numeric 2.0 |
15
|
5024
|
|
| 43 |
IM6Y |
Year of Measles or MMR immunization |
Continuous |
numeric 4.0 |
15
|
5024
|
|
| 44 |
IM7D |
Day of mumps immunization |
Continuous |
numeric 2.0 |
29
|
5010
|
|
| 45 |
IM7M |
Month of mumps immunization |
Continuous |
numeric 2.0 |
4
|
5035
|
|
| 46 |
IM7Y |
Year of mumps immunization |
Continuous |
numeric 4.0 |
4
|
5035
|
|
| 47 |
IM10 |
Child ever received any vaccinations |
Continuous |
numeric 1.0 |
4986
|
53
|
Has (name) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign
or immunization day?
|
| 48 |
IM11 |
Child ever given BCG vaccination |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (name) ever been given a BCG vaccination against tuberculosis - that is, an injection in the arm or shoulder that caused
a scar?
|
| 49 |
IM12 |
Child ever given Polio vaccination |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (name) ever been given any "vaccination drops in the mouth" to protect him/her from getting diseases - that is, polio? |
| 50 |
IM13 |
Polio first given just after birth or later |
Continuous |
numeric 1.0 |
4879
|
160
|
How old was he/she when the first dose was given - just after birth (within two weeks) or later? |
| 51 |
IM14 |
Times child given Polio vaccination |
Continuous |
numeric 2.0 |
4879
|
160
|
How many times has he/she been given these drops? |
| 52 |
IM15 |
Child ever given DPT vaccination |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (name) ever been given "DPT vaccination injections" - that is, an injection in the thigh or buttocks - to prevent him/her
from getting tetanus, whooping cough, diphtheria? (sometimes given at the same time as polio)
|
| 53 |
IM16 |
Times child given DPT vaccination |
Continuous |
numeric 2.0 |
4634
|
405
|
How many times? |
| 54 |
IM16A |
Child ever given HepB vaccination |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (name) ever been given "Hepatitis B vaccination injections" - that is, an injection in the thigh or buttocks - to prevent
him/her from getting Hepatitis B? (sometimes given at the same time as DPT)
|
| 55 |
IM16B |
Times child given HepB vaccination |
Continuous |
numeric 2.0 |
4588
|
451
|
How many times? |
| 56 |
IM17 |
Child ever given Measles |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (name) ever been given "Measles vaccination injections" or MMR - that is, a shot in the arm at the age of 9 months or
older - to prevent him/her from getting measles?
|
| 57 |
IM18 |
Child has ever been given mamps |
Continuous |
numeric 1.0 |
4939
|
100
|
Has (NAME) ever been given "Yellow Fever vaccination injections" - that is, a shot in the arm at the age of 9 months or older
- to prevent him/her from getting yellow fever? (sometimes given at the same time as measles)
|
| 58 |
IM19A |
Child participated in national immunization day A |
Continuous |
numeric 1.0 |
4986
|
53
|
Please tell me if (name) has participated in any of the following campaigns, national immunization days and/or vitamin A or
child health days: Date/type of campaign A
|
| 59 |
IMF1A |
Information has received from medical center |
Discrete |
numeric 1.0 |
4986
|
53
|
Have you got the information on medical institution, where immunization card is being kept? |
| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 60 |
IMF1B |
Medical center has attended |
Discrete |
numeric 1.0 |
4871
|
168
|
Was the medical institution visited? |
| 61 |
IMF1C |
There is a information in medical center |
Discrete |
numeric 1.0 |
4846
|
193
|
Are there available immunization records for (Child's name) in that medical institution? |
| 62 |
IMF2D |
Day of BCG immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 63 |
IMF2M |
Month of BCG immunization |
Continuous |
numeric 2.0 |
4661
|
378
|
|
| 64 |
IMF2Y |
Year of BCG immunisation |
Continuous |
numeric 4.0 |
4661
|
378
|
|
| 65 |
IMF3AD |
Day of OPV0 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 66 |
IMF3AM |
Month of OPV0 immunization |
Continuous |
numeric 2.0 |
4674
|
365
|
|
| 67 |
IMF3AY |
Year of OPV0 immunization |
Continuous |
numeric 4.0 |
4674
|
365
|
|
| 68 |
IMF3BD |
Day of OPV1 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 69 |
IMF3BM |
Month of OPV1 immunization |
Continuous |
numeric 2.0 |
4353
|
686
|
|
| 70 |
IMF3BY |
Year of OPV1 immunization |
Continuous |
numeric 4.0 |
4353
|
686
|
|
| 71 |
IMF3CD |
Day of OPV2 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 72 |
IMF3CM |
Month of OPV2 immunization |
Continuous |
numeric 2.0 |
4138
|
901
|
|
| 73 |
IMF3CY |
Year of OPV2 immunization |
Continuous |
numeric 4.0 |
4138
|
901
|
|
| 74 |
IMF3DD |
Day of OPV3 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 75 |
IMF3DM |
Month of OPV3 immunization |
Continuous |
numeric 2.0 |
3909
|
1130
|
|
| 76 |
IMF3DY |
Year of OPV3 immunization |
Continuous |
numeric 4.0 |
3909
|
1130
|
|
| 77 |
IMF3ED |
Day of OPV4 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 78 |
IMF3EM |
Month of OPV4 immunization |
Continuous |
numeric 2.0 |
2984
|
2055
|
|
| 79 |
IMF3EY |
Year of OPV4 immunization |
Continuous |
numeric 4.0 |
2984
|
2055
|
|
| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 80 |
IMF4AD |
Day of DPT1 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 81 |
IMF4AM |
Month of DPT1 immunization |
Continuous |
numeric 2.0 |
4325
|
714
|
|
| 82 |
IMF4AY |
Year of DPT1 immunization |
Continuous |
numeric 4.0 |
4325
|
714
|
|
| 83 |
IMF4BD |
Day of DPT2 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 84 |
IMF4BM |
Month of DPT2 immunization |
Continuous |
numeric 2.0 |
4110
|
929
|
|
| 85 |
IMF4BY |
Year of DPT2 immunization |
Continuous |
numeric 4.0 |
4110
|
929
|
|
| 86 |
IMF4CD |
Day of DPT3 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 87 |
IMF4CM |
Month of DPT3 immunization |
Continuous |
numeric 2.0 |
3873
|
1166
|
|
| 88 |
IMF4CY |
Year of DPT3 immunization |
Continuous |
numeric 4.0 |
3873
|
1166
|
|
| 89 |
IMF4DD |
Day of DPT4 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 90 |
IMF4DM |
Month of DPT4 immunization |
Continuous |
numeric 2.0 |
2999
|
2040
|
|
| 91 |
IMF4DY |
Year of DPT4 immunization |
Continuous |
numeric 4.0 |
2999
|
2040
|
|
| 92 |
IMF5AD |
Day of HepB1 or DPTHepB1 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 93 |
IMF5AM |
Month of HepB1 or DPThepB1 immunization |
Continuous |
numeric 2.0 |
4187
|
852
|
|
| 94 |
IMF5AY |
Year of HepB1 or DPTHepB1 immunization |
Continuous |
numeric 4.0 |
4187
|
852
|
|
| 95 |
IMF5BD |
Day HepB2 or DPTHepB2 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 96 |
IMF5BM |
Month of HepB2 or DPTHepB2 imunization |
Continuous |
numeric 2.0 |
3946
|
1093
|
|
| 97 |
IMF5BY |
Year of HepB2 or DPTHepB2 immunization |
Continuous |
numeric 4.0 |
3946
|
1093
|
|
| 98 |
IMF5CD |
Day of DPTHepB3 or HepB3 immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 99 |
IMF5CM |
Month of DPTHepB3 or HepB3 ummunization |
Continuous |
numeric 2.0 |
3458
|
1581
|
|
| # |
Name |
Label |
Type |
Format |
Valid |
Invalid |
Question |
| 100 |
IMF5CY |
Year of DPTHepB3 or HepB3 immunization |
Continuous |
numeric 4.0 |
3458
|
1581
|
|
| 101 |
IMF6D |
Day measles or MMR immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 102 |
IMF6M |
Month Measles or MMR immunization |
Continuous |
numeric 2.0 |
3292
|
1747
|
|
| 103 |
IMF6Y |
Year of Measles or MMR immunization |
Continuous |
numeric 4.0 |
3292
|
1747
|
|
| 104 |
IMF7D |
Day of mumps immunization |
Continuous |
numeric 2.0 |
4726
|
313
|
|
| 105 |
IMF7M |
Month of mumps immunization |
Continuous |
numeric 2.0 |
569
|
4470
|
|
| 106 |
IMF7Y |
Year of mumps immunization |
Continuous |
numeric 4.0 |
569
|
4470
|
|