DENGUE PATIENTS FILE
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{PAT}IENT {ID} STUDY # CONSENTIMIENTO #
ת This is also the SERUM 1 ID ת {ETNIA} {ETNIA} {N}AME
NAME
{AD}DRE{S}S < >
{STATE} CODE ## {STATE} {N}AME < >
{MUNI}CIPALITY CODE ### {MUNI}CIPALITY {N}AME < >
AGE ## AGE TYPE # BABY AGE ## SEX
{PREG}NANCY WEEKS ##
{PHYS}ICIAN
{HOSP}ITAL ## {HOSP}ITAL {N}AME < >
{D}ATE OF {ONSET} {EPI}DEMIOLOGIC {WEEK} ##
mm/dd/yyyy תתת OF THE DATE OF ONSET תתת
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DATES BLOOD OR SERUM SAMPLES ARE OBTAINED OR RECEIVED IN THE LABORATORY
{D}ATE {S}AMPLE {1} {F}IRST {S}AMPLE #
{D}ATE {S}AMPLE {2} {S}ECOND {S}AMPLE #
mm/dd/yyyy
CSF # {D}ATE {S}AMPLE {CSF}
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CLINICAL DATA
YES = 1 NO = 2 MISSING VALUE = 9
FEVER # {MYAL}GIA # {ARTH}RAGIA # {HEAD}ACHE #
RET-ORB. PAIN # {CONJ}UNCTIVITIS # {PHOT}OPHOBIA # RASH #
CHILLS # {AB}DOMINAL {PA}IN #{S}ORE {THR}OAT #{NAUS}EA #
{VOMI}TING # {EP}ISTA{XI}S #{BL}EEDING {GU}MS #{ECCH}IMOSES #
{P}ETE{CHI}AE #{PRUR}ITUS # {JAUN}DICE # COUGH #
{RHIN}ITIS # {DIAR}RHEA # {EDEM}A # {HEPA}TOMEGALY #
{PA}LP.{SPLE}EN #{LYMPH}ADENOPATHY # {HEMATE}MESIS # {HEMATU}RIA #
{MELE}NA # {SOMNO}LENCIA # ALT. CONC. # {CONVUL}SIONES #
{TOURNI}QUETE # {NUM} {PETE}QUIAE ## T.A. < >
{CON}CURRENT {D}ISEASE {A}CUTE, {C}HRONIC OR {B}OTH < >
{AC}UTE {D}ISEASE < >
{CH}RONIC {D}ISEASE < >
NOTES
{HOSP}ITALIZED #
LABORATORY DATA
{NA}ME
{DA}TE OF {O}NSET
SERUM 1 SERUM 2 SERUM 3
DATE 1 DATE 2 DATE 3
mm/dd/yyyy mm/dd/yyyy mm/dd/yyyy
{D}AYS 1 ###
{D}AYS {2} ###
HI 1 ##### HI 2 ##### HI 3 #####
ELISA 1 #.### ELISA 2 #.### ELISA 3 #.###
PLATE 1 ### PLATE 2 ### PLATE 3 ###
(x1000) (x1000) (x1000)
HT 1 ## HT 2 ## HT 3 ##
{VIRUS} ISOLATED VIRUS ID OTHER ID
{YEAR} THE VIRUS {TRA}NSSMITED ####
{DIAG}NOSIS (DENGUE) < >
{SEROL}OGIC RESPONSE < >
{RTPCR} RESULT {C}ODE # RTPCR < >
{FIN}AL {RES}ULT {C}ODE ## FINRES < >