Header Type Description of Contents VAERS_ID Num(6) VAERS Identification Number S_DATE Date(mm/dd/yyyy) Date report entered into the system STATE Char(2) Box 1: State AGE_YRS Num(xxx.x) Box 4: Age in Years SEX Char(1) Box 5: Sex RPT_DATE Date(mm/dd/yyyy) Box 6: Date Form Completed SYMPTOM_TEXT Char(512) Box 7: Reported symptom text SYM_CNT Num(2) COSTART Symptom Count SYM01 Char(21) Box 7a: Adverse Event COSTART Term #1 SYM02 Char(21) Box 7b Adverse Event COSTART Term #2 SYM03 Char(21) Box 7c Adverse Event COSTART Term #3 SYM04 Char(21) Box 7d: Adverse Event COSTART Term #4 SYM05 Char(21) Box 7e: Adverse Event COSTART Term #5 SYM06 Char(21) Box 7f: Adverse Event COSTART Term #6 SYM07 Char(21) Box 7g: Adverse Event COSTART Term #7 SYM08 Char(21) Box 7h: Adverse Event COSTART Term #8 SYM09 Char(21) Box 7i: Adverse Event COSTART Term #9 SYM10 Char(21) Box 7j: Adverse Event COSTART Term #10 SYM11 Char(21) Box 7k: Adverse Event COSTART Term #11 SYM12 Char(21) Box 7l: Adverse Event COSTART Term #12 SYM13 Char(21) Box 7m: Adverse Event COSTART Term #13 SYM14 Char(21) Box 7n: Adverse Event COSTART Term #14 SYM15 Char(21) Box 7o: Adverse Event COSTART Term #15 SYM16 Char(21) Box 7p: Adverse Event COSTART Term #16 SYM17 Char(21) Box 7q: Adverse Event COSTART Term #17 SYM18 Char(21) Box 7r: Adverse Event COSTART Term #18 SYM19 Char(21) Box 7s: Adverse Event COSTART Term #19 SYM20 Char(21) Box 7t: Adverse Event COSTART Term #20 DIED Char(1) Box 8a1: Died ('Y' - Yes) DATEDIED Date(mm/dd/yyyy) Box 8a2: Date of Death L_THREAT Char(1) Box 8b: Life-Threatening Illness ('Y' - Yes) ER_VISIT Char(1) Box 8c: Emergency Room or Doctor Visit ('Y' - Yes) HOSPITAL Char(1) Box 8d1: Hospitalized ('Y' - Yes) HOSPDAYS Num(3) Box 8d2: Number of days Hospitalized X_STAY Char(1) Box 8e: Prolonged Hospitalization (‘Y’ - Yes) DISABLE Char(1) Box 8f: Disability ('Y' - Yes) RECOVD Char(1) Box 9: Recovered ('Y' - Yes, 'N' - No, 'U' - Unknown) VAX_DATE Date(mm/dd/yyyy) Box 10: Vaccination Date ONSET_DATE Date(mm/dd/yyyy) Box 11: Adverse Event Onset Date NUMDAYS Num(5) Number of days (Onset date - Vax. Date) LAB_DATA Char(240) Box 12: Diagnostic laboratory data VAX_CNT Num(2) Box 13: Vaccine Count VAX1 Char(6) Box 13a: Administered Vaccine #1 VAX2 Char(6) Box 13b: Administered Vaccine #2 VAX3 Char(6) Box 13c: Administered Vaccine #3 VAX4 Char(6) Box 13d: Administered Vaccine #4 VAX5 Char(6) Box 13e: Administered Vaccine #5 VAX6 Char(6) Box 13f: Administered Vaccine #6 VAX7 Char(6) Box 13g: Administered Vaccine #7 VAX8 Char(6) Box 13h: Administered Vaccine #8 V_ADMINBY Char(3) Box 15: Vaccines Administered at (PUB=Public, PVT=Private, OTH=Other, MIL=Military) V_FUNDBY Char(3) Box 16: Vaccines purchased with (PUB=Public, PVT=Private, OTH=Other, MIL=Military) funds OTHER_MEDS Char(240) Box 17: Other Medications CUR_ILL Char(128) Box 18: Current Illnesses HISTORY Char(240) Box 19: Pre-existing physician diagnosed allergies, birth defects, medical conditions PRIOR_VAX Char(128) Box 21: Prior Vaccination Event information

Varivax Report Details