Tx section Variable name Short label EN

Reporting report_date Date (DD/MM/YYYY)*: _____/____/______

Reporting report_country reporting country

Reporting report_test_reason Why the case was tested for COVID-19
Reporting report_test_reason_other Other reason the case was tested for COVID-19
Patient information patinfo_ID country case ID*:
Patient information patinfo_ageonset or Age:_______
Patient information patinfo_ageonsetunit unit of age
Patient information patinfo_sex Sex at birth: Male Female
Patient information patinfo_idadmin0 where the case was diagnosed, admin level 0 (country)
Patient information patinfo_idadmin1 identified Admin Level 1 (province):
Patient information patinfo_resadmin0 place of residence admin level 0
Clinical status Lab_date1 Date of first laboratory confirmation
Clinical status patcourse_dateonset Date of onset of first symptoms:____/___
Clinical status patcourse_asymp Patient asymptomatic at time of speciment
Clinical status Comcond_present Does the patient have any underlying conditions?
Clinical status Comcond_preg Pregnancy
Clinical status Comcond_pregt Trimester of pregancy
Clinical status Comcond_partum Post-partum (<6 weeks)
Clinical status Comcond_immuno Immunodeficiency including HIV
Clinical status Comcond_cardi Cardiovacsular disease including hypertension
Clinical status Comcond_diabetes Diabetes
Clinical status Comcond_liver Liver disease
Clinical status Comcond_renal Renal disease
Clinical status Comcond_neuro Chronic neurological or neuromuscular disease
Clinical status Comcond_malig Malignancy
Clinical status Comcond_lung Chronic lung disease
Clinical status Comcond_other Other, specify
Clinical status patcourse_admit admission to hospital?:
Clinical status patcourse_presHCF For this episode, date first admitted in hosp
Clinical status patcourse_icu Did the patient receive care in an ICU?
Clinical status patcourse_vent Was the patient ventilated?
Clinical status patcourse_ecmo Did the patient receive ECMO?
Clinical status patcourse_iso Was the case isolated?
Clinical status patcourse_dateiso date of isolation
Exposure and travel information patinfo_occuhcw Health care worker
Exposure and travel information patinfo_occuhcw_country Healthcare worker country
Exposure and travel information patinfo_occuhcw_city Healthcare worker city
Exposure and travel information patinfo_occuhcw_name Healthcare worker facility name
Exposure and travel information expo_travel Has the patient travelled in the 14 days pr
Exposure and travel information expo_travel_country1 Specify country travelled to 1
Exposure and travel information expo_travel_city1 Specify city travelled to 1
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Exposure and travel information
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
Outcome
expo_travel_date1 Specify date departed from 1
expo_travel_country2 Specify country travelled to 2
expo_travel_city2 Specify city travelled to 2
expo_travel_date2 Specify date departed from 2
expo_travel_country3 Specify country travelled to 3
expo_travel_city3 Specify city travelled to 3
expo_travel_date3 Specify date departed from 3
expo_visit_healthcare Has the patient visited any health care faci
expo_contact_case Has the patient had contact with a confir
expo_case_setting_detail Explain contact setting
expo_ID1 ID number of confirmed case 1
expo_ID2 ID number of confirmed case 2
expo_ID3 ID number of confirmed case 3
expo_ID4 ID number of confirmed case 4
expo_ID5 ID number of confirmed case 5
expo_case_date_first1 Date of first exposure to confirmed case 1
expo_case_date_first2 Date of first exposure to confirmed case 2
expo_case_date_first3 Date of first exposure to confirmed case 3
expo_case_date_first4 Date of first exposure to confirmed case 4
expo_case_date_first5 Date of first exposure to confirmed case 5
expo_case_date_last1 Date of last exposure to confirmed case 1
expo_case_date_last2 Date of last exposure to confirmed case 2
expo_case_date_last3 Date of last exposure to confirmed case 3
expo_case_date_last4 Date of last exposure to confirmed case 4
expo_case_date_last5 Date of last exposure to confirmed case 5
expo_case_location Likely country for exposure to case?
outcome_submitted Outcome section submitted
outcome_submitted_date Date of outcome submission
outcome_asymp Case developed symptoms
outcome_asymp_date Date case developed symptoms
outcome_patcourse_admitPatient admitted to hospital
outcome_patcourse_presHDate patient admitted to hospital
outcome_patcourse_icu Did the patient receive care in an ICU?
outcome_patcourse_vent Was the patient ventilated?
outcome_patcourse_ecmo Did the patient receive ECMO?
outcome_patcourse_statusPatient status (outcome)
outcome_patcourse_statusOther patient status (outcome)
outcome_date_of_outcom Date of patient release or date of death
outcome_lab_date If released, date of last laboratory test
outcome_lab_result laboratory result from last test
outcome_contacts_followeHigh risk contacts followed from case
outcome_contacts_follow Number of high risk contacts followed unknown
 Short label FR Short label ES
Date*: _____/____/______ Fecha*: _____/____/______

Pays*: País que reporta

ed for COVID-19
Numéro d'identification unique*:
ou Age *: ______
Unité de l'âge
Sexe a la naissance*: Homme Femme
admin level 0 (country)
Niveau admin 1*(préfecture):

Date prélèvement1
Date de début des premiers symptomes*:
Patient asymptomatique
erlying conditions?
Grossesse
Trimestre de grossesse
Post-partum (<6 semaines)
Immunodéficience, y compris le VIH
g hypertension

muscular disease
Malignité
Maladie aiguë ou chronique associée:
Autre spécifier
Hospitalisation* ?:
Pour cet épisode, quelle est la date de première présentation aux se

Est ce que le patient a été ventilé mécaniquement?

Est ce que le patient a été ventilé mécaniquement?

date d'isolement

Le patient a-t-il voyagé au cours des 14 jours précédant l'appariti

Précisez le pays visité jusqu'à 1
Précisez la ville parcourue au 1
 Précisez la ville parcourue au 1
Précisez le pays visité jusqu'à 2
Précisez la ville parcourue au 2
Précisez la ville parcourue au 1
Précisez le pays visité jusqu'à 3
Précisez la ville parcourue au 3
Précisez la ville parcourue au 1
Le patient a-t-il visité un établissement de santé au cours des 14 j
Le patient a-t-il eu un contact ave cun cas probable ou confirmé dans

Numero identification du cas contact probable ou confirmé

Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Numero identification du cas contact probable ou confirmé
Quel est l'endroit le plus probable d'exposition à la maladie?

Est ce que le patient a été ventilé mécaniquement?

Est ce que le patient a été ventilé mécaniquement?

llowed unknown
Description Data type Format
Date of reporting Date DD/MM/YYYY

Country/territory/national boundary within which the

case currently/usually resides.
If transborders or international spread of outbreak String Free text
Why the case was tested for COVID-19 Coded Coded variables
Any other reason the case was tested for COVID-19 String Free text
Unique case identification number (used in country) String Free text
Age in units on the date of illness onset. Numeric ###
Years or months or days Coded Coded variables
Biological sex. That is the biological differential character Coded Coded variables
Administrative level 0: Country where the case was diagnosString Free text
Administrative level 1: First sub-national boundary (e.g. proString Free text
Administrative level 0: Country within which the case's currString Free text
Date of first laboratory confirmation Date DD/MM/YYYY
Date of first appearance of the signs or symptoms of the ill Date DD/MM/YYYY
Is the case asymptomatic? Coded Coded variables
Does the patient have any underlying conditions? Coded Coded variables
Is the patient pregnant? Coded Coded variables
Coded Coded variables
Is the patient in the post partum period defined as less tha Coded Coded variables
has the patient an adquired immunodeficiency (HIV) or is t Coded Coded variables
any cardiovacsular disease Coded Coded variables
Coded Coded variables
any liver diseases Coded Coded variables
any renal diseases Coded Coded variables
Coded Coded variables
Coded Coded variables
Coded Coded variables
Describe other underlying conditions and comorbidity String Free text
Was the case hospitalized, admitted to a hospital or other he Coded Coded variables
Date the case was first admitted to any health facility. Date DD/MM/YYYY
Did the patient receive care in an intensive care unit (ICU)? Coded Coded variables
Was the patient ever ventilated for this episode at time of Coded Coded variables
Did the patient receive extracorporeal membrane oxygena Coded Coded variables
Was the case isolated with proper IPC controls implementeCoded Coded variables
What date was the case isolated? Date DD/MM/YYYY
Is the patient working in a health care setting? Coded Coded variables
If case is a healthcare worker, in which country do they wo String Free text
If case is a healthcare worker, in which city do they work? String Free text
If case is a healthcare worker, what is the name of the facil String Free text
Has the patient travelled in the 14 days prior to symptom oCoded Coded variables
List the country from location 1 that the case has travelled String Free text
List the city from location 1 that the case has travelled to String Free text
List the date departed from location 1 that the case has tr Date DD/MM/YYYY
List the country from location 2 that the case has travelled String Free text
List the city from location 2 that the case has travelled to String Free text
List the date departed from location 2 that the case has tr Date DD/MM/YYYY
List the country from location 3 that the case has travelled String Free text
List the city from location 3 that the case has travelled to String Free text
List the date departed from location 3 that the case has tr Date DD/MM/YYYY
Has the patient visited any health care facilities in the 14 Coded Coded variables
Has the patient had contact with a confirmed case in the 14Coded Coded variables
If the patient has had contact with a confirmed case in the String Free text
List the unique case identifier 1 with whom the patient hadString Free text
List the unique case identifier 2 with whom the patient hadString Free text
List the unique case identifier 3 with whom the patient hadString Free text
List the unique case identifier 4 with whom the patient hadString Free text
List the unique case identifier 5 with whom the patient hadString Free text
Date of first exposure to confirmed case 1 Date DD/MM/YYYY
Date of first exposure to confirmed case 2 Date DD/MM/YYYY
Date of first exposure to confirmed case 3 Date DD/MM/YYYY
Date of first exposure to confirmed case 4 Date DD/MM/YYYY
Date of first exposure to confirmed case 5 Date DD/MM/YYYY
Date of last exposure to confirmed case 1 Date DD/MM/YYYY
Date of last exposure to confirmed case 2 Date DD/MM/YYYY
Date of last exposure to confirmed case 3 Date DD/MM/YYYY
Date of last exposure to confirmed case 4 Date DD/MM/YYYY
Date of last exposure to confirmed case 5 Date DD/MM/YYYY
Specify the location of possible exposure to a case String Free text
Has the outcome section been submitted? Coded Coded variables
Date of outcome submission Date DD/MM/YYYY
If case was asymptomatic at time of specimen collection resCoded Coded variables
If case was asymptomatic and developed symptoms, what isDate DD/MM/YYYY
Patient was first admitted to hospital (outcome) Coded Coded variables
Date patient was first admitted to hospital (outcome) Date DD/MM/YYYY
Did the patient receive care in an intensive care unit (ICU) Coded Coded variables
Was the patient ever ventilated for this episode? (outcomeCoded Coded variables
Did the patient receive extracorporeal membrane oxygena Coded Coded variables
Patient status (outcome) Coded Coded variables
Other patient status (outcome) String Free text
Date of Release from isolation/hospital or Date of Death Date DD/MM/YYYY
If released from hospital /isolation, date of last laboratory tDate DD/MM/YYYY
laboratory result from last test Coded Coded variables
Total number of high-risk contacts followed for this case Numeric ###
Number of high risk contacts followed unknown Coded Coded variables
Permissible values EN Permissible values FR
(response options) (response options)

CASE_CONTACT, SEEKING_HC, POE_DETECTION, REPATRIATION, SURVEILLANCE, UNKNOWN, OTHER

0-110 0-110
YEARS, MONTHS, DAYS 1 = année 2 = mois 3=jours
MALE, FEMALE 1 = Homme; 2 = Femme;

YES, NO, UNKNOWN 1 = Oui; 2 = Non

YES, NO, UNKNOWN
YES, NO 1 = Oui; 2 = Non
FIRST, SECOND, THIRD
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non
YES, NO 1 = Oui; 2 = Non

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue

YES, NO, PARTIAL

YES, NO, UNKNOWN

YES, NO, UNKNOWN

YES, NO, UNKNOWN
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
RECOVERED, NOTRECOVERED, DEATH, UNKNOWN, OTHER

POSITIVE, NEGATIVE,INCONCLUSIVE, UNKNOWN

YES, NO, UNKNOWN

 Nombre de la variable
Sección
Informe report_date
Informe
report_country

Informe

report_test_reason

Informe report_test_reason_other
Información del
paciente patinfo_ID
Información del
paciente patinfo_ageonset
Información del
paciente patinfo_ageonsetunit
Información del
paciente patinfo_sex

Información del
paciente patinfo_idadmin0
Información del
paciente patinfo_idadmin1
Información del
paciente patinfo_resadmin0

Estado clínico Lab_date1

patcourse_dateonset
Estado clínico
Estado clínico patcourse_asymp
Estado clínico Comcond_present
Estado clínico Comcond_preg

Comcond_pregt
Estado clínico
Comcond_partum
Estado clínico

Comcond_immuno
Estado clínico
Estado clínico Comcond_cardi
Estado clínico Comcond_diabetes
Estado clínico Comcond_liver
Estado clínico Comcond_renal
Estado clínico Comcond_neuro
Estado clínico Comcond_malig
Estado clínico Comcond_lung
Estado clínico Comcond_other

patcourse_admit
Estado clínico
patcourse_presHCF
Estado clínico
Estado clínico patcourse_icu

patcourse_vent
Estado clínico
patcourse_ecmo
Estado clínico
Estado clínico patcourse_iso
Estado clínico patcourse_dateiso
Información de
exposición y viajes patinfo_occuhcw
Información de
exposición y viajes patinfo_occuhcw_country
Información de
exposición y viajes patinfo_occuhcw_city
Información de
exposición y viajes patinfo_occuhcw_name
Información de
exposición y viajes expo_travel
Información de
exposición y viajes expo_travel_country1
Información de
exposición y viajes expo_travel_city1
Información de
exposición y viajes expo_travel_date1
Información de
exposición y viajes expo_travel_country2
Información de
exposición y viajes expo_travel_city2
Información de
exposición y viajes expo_travel_date2
Información de
exposición y viajes expo_travel_country3
Información de
exposición y viajes expo_travel_city3
Información de
exposición y viajes expo_travel_date3
Información de
exposición y viajes expo_visit_healthcare
Información de
exposición y viajes expo_contact_case
Información de
exposición y viajes expo_case_setting_detail

Información de
exposición y viajes expo_ID1
Información de
exposición y viajes expo_ID2
Información de
exposición y viajes expo_ID3
Información de
exposición y viajes expo_ID4
Información de
exposición y viajes expo_ID5
Información de
exposición y viajes expo_case_date_first1
Información de
exposición y viajes expo_case_date_first2
Información de
exposición y viajes expo_case_date_first3
Información de
exposición y viajes expo_case_date_first4
Información de
exposición y viajes expo_case_date_first5
Información de
exposición y viajes expo_case_date_last1
Información de
exposición y viajes expo_case_date_last2
Información de
exposición y viajes expo_case_date_last3
Información de
exposición y viajes expo_case_date_last4
Información de
exposición y viajes expo_case_date_last5
Información de
exposición y viajes expo_case_location

Desenlace outcome_submitted
Desenlace outcome_submitted_date

outcome_asymp

Desenlace
 outcome_asymp_date
Desenlace
Desenlace outcome_patcourse_admit

outcome_patcourse_presHCF
Desenlace
outcome_patcourse_icu
Desenlace
Desenlace outcome_patcourse_vent

outcome_patcourse_ecmo
Desenlace

outcome_patcourse_status
Desenlace
Desenlace outcome_patcourse_status_ot

outcome_date_of_outcome
Desenlace
outcome_lab_date
Desenlace

outcome_lab_result
Desenlace
Desenlace outcome_contacts_followed
Desenlace outcome_contacts_followed_
 Etiqueta corta ESP

Fecha (DD/MM/AAAA)*: _____/____/______

País que informa

Por qué se hizo la prueba para COVID-19

Otra razón por la que el caso fue probado para COVID-19

ID de caso de país*:

o Edad:_______

unidad de edad

Sexo al nacer: Mujer Hombre

donde se diagnosticó el caso, nivel de administración 0 (país)

nivel de administrador 1 identificado (provincia):

lugar de residencia admin nivel 0

Fecha de la primera confirmación de laboratorio

Fecha de inicio de los primeros síntomas:____/____/______

Paciente asintomático en el momento de la recolección de muestras

¿Tiene el paciente alguna condición subyacente?
Embarazo

Trimestre de embarazo

Postparto (<6 semanas)

Inmunodeficiencia incluyendo VIH

Enfermedad cardiovascular incluyendo hipertensión

Diabetes
Enfermedad hepática
Enfermedad renal
Enfermedad neurológica o neuromuscular crónica
Malignidad
Enfermedad pulmonar crónica
Otros, especifique

ingreso hospitalario?:

Para este episodio, fecha de ingreso por primera vez en el hospital

¿Recibió el paciente atención en una UCI?

¿El paciente estaba ventilado?

¿Recibió el paciente ECMO?

¿Estaba aislado el caso?

fecha de aislamiento

Trabajador de la salud

País de los trabajadores sanitarios

Ciudad de los trabajadores sanitarios

Nombre del centro de trabajo sanitario

¿El paciente ha viajado en los 14 días anteriores a la aparición de los síntom

Especificar el país al cual viajó 1

Especifique la ciudad ala cual viajó 1

Especifique la fecha de salida de 1

Especificar el país al cual viajó 2

Especifique la ciudad a la cual viajó 2

Especifique la fecha de salida de 2

Especificar el país al cual viajó 3

Especifique la ciudad a la cual viajó 3

Especificar la fecha de salida de 3

¿Ha visitado el paciente algún centro de atención médica en los 14 días anter

¿Ha tenido contacto el paciente con un caso confirmado?

Explicar el escenario en el cual se realizó el contacto

Número de identificación del caso confirmado 1

Número de identificación del caso confirmado 2

Número de identificación del caso confirmado 3

Número de identificación del caso confirmado 4

Número de identificación del caso confirmado 5

Fecha de primera exposición al caso confirmado 1

Fecha de primera exposición al caso confirmado 2

Fecha de primera exposición al caso confirmado 3

Fecha de primera exposición al caso confirmado 4

Fecha de primera exposición al caso confirmado 5

Fecha de la última exposición al caso confirmado 1

Fecha de la última exposición al caso confirmado 2

Fecha de la última exposición al caso confirmado 3

Fecha de la última exposición al caso confirmado 4

Fecha de la última exposición al caso confirmado 5

¿País probable de exposición al caso?

Sección de envío de desenlace

Fecha deenvío de desenlaces

El caso desarrolló síntomas

Fecha en la que el caso desarrolló los síntomas

Ingreso del paciente al hospital

Fecha de ingreso del paciente al hospital

¿Recibió el paciente atención en una UCI?

¿El paciente estaba ventilado?

¿Recibió el paciente ECMO?

Estado del paciente (desenlace)

Otro estado del paciente (desenlace)

Fecha de alta del paciente o fecha de fallecimiento

Si se dio de alta, fecha de la última prueba de laboratorio

resultado de la última prueba de laboratorio

Seguimiento a contactos de alto riesgo

Número de contactos de alto riesgo seguidos desconocidos
 Descripción

Fecha de presentación de informes

País/territorio/límite nacional dentro del cual reside actualmente/normalmente el caso.
Si es transfronterizo o propagación internacinal del brote

Por qué se hizo la prueba para COVID-19

Cualquier otra razón por la que el caso fue probado para COVID-19
Número único de identificación del caso (utilizado en el país)

Edad del paciente el día en que inició la enfermedad

Años, meses o días

Sexo biológico. Esas son las características biológicas diferenciales (cromosomas,

perfiles hormonales, órganos sexuales internos y externos) que mejor describen el caso.

Nivel administrativo 0: País donde se diagnosticó el caso.

Nivel administrativo 1: Primer límite subnacional (por ejemplo, provincia, estado,

prefectura territorial, región, etc.) donde se diagnosticó el caso.
Nivel administrativo 0: País en el que reside actualmente/normalmente el caso.

Fecha de la primera confirmación de laboratorio

Fecha de primera aparición de los signos o síntomas de la afección/enfermedad.

¿El caso es asintomático?

¿Tiene el paciente alguna condición subyacente?
¿Está embarazada la paciente?

¿Se define el paciente en el período pos parto como menos de 6 semanas después de la
fecha de parto
¿Tiene el paciente una inmunodeficiencia adquirida (VIH) o el paciente es tratado con
medicamentos que disminuyeron la respuesta inmunitaria (corticoides, quimioterapia
contra el cáncer)?

cualquier enfermedad cardiovacisular

cualquier enfermedad hepática

cualquier enfermedad renal

Describir otras afecciones subyacentes y comorbilidad

¿El caso fue hospitalizado, ingresado en un hospital u otro centro de salud como
paciente hospitalizado?
Fecha en que el caso fue admitido por primera vez en cualquier institución de salud.

¿Recibió el paciente atención en una unidad de cuidados intensivos (UCI)?

¿Al momento de este informe, recibió alguna vez el paciente ventilación para este
episodio?
¿Recibió el paciente oxigenación a través de membrana extracorpórea (ECMO)?

¿Se aisló el caso con los controles de IPC adecuados?

¿En qué fecha se aisló el caso?
¿El paciente trabaja en un entorno de atención médica?

Si el caso es un trabajador sanitario, ¿en qué país trabaja?

Si el caso es un trabajador sanitario, ¿en qué ciudad trabaja?

Si el caso es un trabajador sanitario, ¿cuál es el nombre de la institución en la que

trabaja?
¿Ha viajado el paciente en los 14 días previos a la aparición de los síntomas?

Liste el país de la ubicación 1 a la que el caso ha viajado en los 14 días anteriores al

inicio de los síntomas
Liste la ciudad de la ubicación 1 a la que el caso ha viajado en los 14 días anteriores al
inicio de los síntomas
Liste la fecha de salida de la ubicación 1 a la que el caso ha viajado en los 14 días
anteriores al inicio de los síntomas
Liste el país de la ubicación 2 a la que el caso ha viajado en los 14 días anteriores al
inicio de los síntomas
Liste la ciudad de la ubicación 2 a la que el caso ha viajado en los 14 días anteriores al
inicio de los síntomas
Liste la fecha de salida de la ubicación 2 a la que el caso ha viajado en los 14 días
anteriores al inicio de los síntomas
Liste el país de la ubicación 3 a la que el caso ha viajado en los 14 días anteriores al
inicio de los síntomas
Liste la ciudad de la ubicación 3 a la que el caso ha viajado en los 14 días anteriores al
inicio de los síntomas
Liste la fecha de salida de la ubicación 3 a la que el caso ha viajado en los 14 días
anteriores al inicio de los síntomas
¿Ha visitado el paciente algún centro de atención médica en los 14 días anteriores a la
aparición de los síntomas
¿Ha tenido contacto el paciente con un caso confirmado en los 14 días anteriores al
inicio de la enfermedad?
Si el paciente ha tenido contacto con un caso confirmado en los 14 días anteriores al
inicio de los síntomas, explique el escenario en el que se produjo el contacto

Escriba el identificador único del caso 1 con el que el paciente tuvo contacto

Escriba el identificador único del caso 2 con el que el paciente tuvo contacto

Escriba el identificador único del caso 3 con el que el paciente tuvo contacto

Escriba el identificador único del caso 4 con el que el paciente tuvo contacto

Escriba el identificador único del caso 5 con el que el paciente tuvo contacto

Fecha de primera exposición al caso confirmado 1

Fecha de primera exposición al caso confirmado 2

Fecha de primera exposición al caso confirmado 3

Fecha de primera exposición al caso confirmado 4

Fecha de primera exposición al caso confirmado 5

Fecha de la última exposición al caso confirmado 1

Fecha de la última exposición al caso confirmado 2

Fecha de la última exposición al caso confirmado 3

Fecha de la última exposición al caso confirmado 4

Fecha de la última exposición al caso confirmado 5

Especifique la localidad de la posible exposición a un caso

¿Se ha enviado la sección de desenlace?

Fecha del envío de la sección de desenlace presentación de resultados
Si el caso era asintomático en el momento de la recolección de muestras, cuyo
resultado fue la primera confirmación de laboratorio, ¿desarrolló el caso algún síntoma
o signo en cualquier momento antes del alta del hospital o de su fallecimiento?
Si el caso era asintomático y desarrolló síntomas, ¿cuál es la fecha de inicio de los
síntomas/signos de la enfermedad
El paciente fue ingresado por primera vez en el hospital (desenlace)
Fecha en que el paciente fue ingresado por primera vez en el hospital (desenlace)

¿Recibió el paciente atención en una unidad de cuidados intensivos (UCI)? (desenlace)

¿El paciente ha sido ventilado alguna vez para este episodio? (desenlace)
¿Recibió el paciente oxigenación por membrana extracorpórea (ECMO)? (desenlace)

Estado del paciente (desenlace)

Otro estado del paciente (desenlace)

Fecha de terminación del aislamiento/alta del hospital o fecha de fallecimiento

Si se dio de alta del hospital /aislamiento, fecha de la última prueba de laboratorio

resultado de la última prueba de laboratorio

Número total de contactos de alto riesgo de este caso seguidos

Número de contactos de alto riesgo de seguidos desconocidos
 Permissible values EN
Valores permitidos ESP (opciones (response options) Data type Format
de respuesta)

Date DD/MM/YYYY

String Free text

CONTACTO_CASO, CASE_CONTACT, Coded Coded variables
BÚSQUEDA_ATENCIÓN DE SEEKING_HC,
SALUD, DETECCIÓN EN PE*, POE_DETECTION,
REPATRIACIÓN, VIGILANCIA, REPATRIATION,
DESCONOCIDO, OTROS * SURVEILLANCE,
punto de entrada UNKNOWN, OTHER

String Free text

String Free text

0-110 0-110
Numeric ###
AÑOS, MESES, DÍAS YEARS, MONTHS, DAY
Coded Coded variables
MASCULINO, FEMENINO MALE, FEMALE

Coded Coded variables

String Free text

String Free text

String Free text

Date DD/MM/YYYY

Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
SI, NO YES, NO Coded Coded variables
PRIMERO, SEGUNDO, FIRST, SECOND, THIRD
TERCERO
Coded Coded variables
SI, NO YES, NO
Coded Coded variables
SI, NO YES, NO

Coded Coded variables

SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
SI, NO YES, NO Coded Coded variables
String Free text
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables

Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables

String Free text

String Free text

String Free text

SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables

String Free text

String Free text

Date DD/MM/YYYY

String Free text

String Free text

Date DD/MM/YYYY

String Free text

String Free text

Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables

String Free text

String Free text

String Free text

String Free text

String Free text

String Free text

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

Date DD/MM/YYYY

String Free text

SI, NO, PARCIAL YES, NO, PARTIAL Coded Coded variables
Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN

Coded Coded variables

 Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Date DD/MM/YYYY
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
SI, NO, DESCONOCIDO YES, NO, UNKNOWN
Coded Coded variables
RECUPERADO, NO RECOVERED, NOTRECOVERED, DEATH, UNKNOWN, OTHER
RECUPERADO, MUERTE,
DESCONOCIDO, OTROS
Coded Coded variables
String Free text

Date DD/MM/YYYY

Date DD/MM/YYYY
POSITIVO, POSITIVE, NEGATIVE,INCONCLUSIVE, UNKNOWN
NEGATIVO,INCONCLUSO,
DESCONOCIDO
Coded Coded variables
Numeric ###
SI, NO, DESCONOCIDO YES, NO, UNKNOWN Coded Coded variables
Tx section Variable name
Reporting report_whoID
Reporting report_date
Reporting report_orginst
Reporting report_country
Reporting report_test_reason
Reporting report_test_reason_other
Reporting report_diag_class
Reporting report_pointofentry
Reporting report_pointofentry_date
Patient information patinfo_ID
Patient information patinfo_DoB
Patient information patinfo_ageonset
Patient information patinfo_ageonsetunit
Patient information patinfo_sex
Patient information patinfo_idadmin0
Patient information patinfo_idadmin1
Patient information patinfo_idadmin2
Patient information patinfo_resadmin0
Patient information patinfo_resadmin1
Patient information patinfo_resadmin2
Clinical status Lab_date1
Clinical status patcourse_dateonset
Clinical status patcourse_asymp
Clinical status patcourse_dateonset_unk
Clinical status Comcond_present
Clinical status Comcond_preg
Clinical status Comcond_pregt
Clinical status Comcond_partum
Clinical status Comcond_immuno
Clinical status Comcond_cardi
Clinical status Comcond_diabetes
Clinical status Comcond_liver
Clinical status Comcond_renal
Clinical status Comcond_neuro
Clinical status Comcond_malig
Clinical status Comcond_lung
Clinical status Comcond_other
Clinical status patcourse_admit
Clinical status patcourse_presHCF
Clinical status patcourse_admitname
Clinical status patcourse_icu
Clinical status patcourse_vent
Clinical status patcourse_ecmo
Clinical status patcourse_iso
Clinical status patcourse_dateiso
Clinical status patcourse_status
Clinical status patcourse_datedeath
Patient symptoms patsympt_fever
Patient symptoms patsympt_weak
Patient symptoms patsympt_irritability
Patient symptoms patsympt_sorethroat
Patient symptoms patsympt_produ
Patient symptoms patsympt_runnynose
Patient symptoms patsympt_short
Patient symptoms patsympt_diarr
Patient symptoms patsympt_vomit
Patient symptoms patsympt_headache
Patient symptoms patsympt_pain
Patient symptoms patsympt_muscupain
Patient symptoms patsympt_chestpain
Patient symptoms patsympt_abdopain
Patient symptoms patsympt_jointpain
Patient symptoms patsympt_other
Patient signs pat_sign_temp
Patient signs pat_sign_temp_unit
Patient signs pat_sign_pharyn
Patient signs pat_sign_conjunc
Patient signs pat_sign_dysp
Patient signs pat_sign_ausc
Patient signs pat_sign_xray
Patient signs pat_sign_seize
Patient signs pat_sign_coma
Patient signs pat_sign_other
Exposure and travel informatio patinfo_occus
Exposure and travel informatio patinfo_occuhcw
Exposure and travel informatio patinfo_occulab
Exposure and travel informatio patinfo_occuani
Exposure and travel informatio patinfo_occuother
Exposure and travel informatio patinfo_occuhcw_country
Exposure and travel informatio patinfo_occuhcw_city
Exposure and travel informatio patinfo_occuhcw_name
Exposure and travel informatio expo_travel
Exposure and travel informatio expo_travel_country1
Exposure and travel informatio expo_travel_city1
Exposure and travel informatio expo_travel_date1
Exposure and travel informatio expo_travel_country2
Exposure and travel informatio expo_travel_city2
Exposure and travel informatio expo_travel_date2
Exposure and travel informatio expo_travel_country3
Exposure and travel informatio expo_travel_city3
Exposure and travel informatio expo_travel_date3
Exposure and travel informatio expo_visit_healthcare
Exposure and travel informatio expo_ari
Exposure and travel informatio expo_ari_healthcare
Exposure and travel informatio expo_ari_family
Exposure and travel informatio expo_ari_workplace
Exposure and travel informatio expo_ari_settingother
Exposure and travel informatio expo_ari_settingunknown
Exposure and travel informatio expo_contact_case
Exposure and travel informatio expo_case_setting_detail
Exposure and travel informatio expo_ID1
Exposure and travel informatio expo_ID2
Exposure and travel informatio expo_ID3
Exposure and travel informatio expo_ID4
Exposure and travel informatio expo_ID5
Exposure and travel informatio expo_date_first1
Exposure and travel informatio expo_date_first2
Exposure and travel informatio expo_date_first3
Exposure and travel informatio expo_date_first4
Exposure and travel informatio expo_date_first5
Exposure and travel informatio expo_date_last1
Exposure and travel informatio expo_date_last2
Exposure and travel informatio expo_date_last3
Exposure and travel informatio expo_date_last4
Exposure and travel informatio expo_date_last5
Exposure and travel informatio expo_case_healthcare
Exposure and travel informatio expo_case_family
Exposure and travel informatio expo_case_workplace
Exposure and travel informatio expo_case_settingother
Exposure and travel informatio expo_case_settingunknown
Exposure and travel informatio expo_case_location
Exposure and travel informatio expo_animal
Exposure and travel informatio expo_animal_location
Laboratory information Lab_name
Laboratory information Lab_assay
Laboratory information Lab_sequencing
Outcome outcome_submitted
Outcome outcome_submitted_date
Outcome outcome_asymp
Outcome outcome_asymp_date
Outcome outcome_patcourse_admit
Outcome outcome_patcourse_presHCF
Outcome outcome_patcourse_icu
Outcome outcome_patcourse_vent
Outcome outcome_patcourse_ecmo
Outcome outcome_patcourse_status
Outcome outcome_patcourse_status_other
Outcome outcome_date_of_outcome
Outcome outcome_lab_date
Outcome outcome_lab_result
Outcome outcome_contacts_followed
Outcome outcome_contacts_followed_unk
Short label EN
WHO case ID
Date (DD/MM/YYYY)*: _____/____/______
reporting institution
reporting country
Why the case was tested for COVID-19
Other reason the case was tested for COVID-19
case classification
detected at point of entry
date detected at point of entry
country case ID*:
Date of birth*:_____/______/________
or Age:_______
unit of age
Sex at birth: Male Female
where the case was diagnosed, admin level 0 (country)
identified Admin Level 1 (province):
identified Admin Level 2(district):
place of residence admin level 0
place of residence admin level 1
place of residence admin level 2
Date of first laboratory confirmation
Date of onset of first symptoms:____/____/______
Patient asymptomatic at time of speciment collection
Patient date of onset unknown
Does the patient have any underlying conditions?
Pregnancy
Trimester of pregancy
Post-partum (<6 weeks)
Immunodeficiency including HIV
Cardiovacsular disease including hypertension
Diabetes
Liver disease
Renal disease
Chronic neurological or neuromuscular disease
Malignancy
Chronic lung disease
Other, specify
admission to hospital?:
For this episode, date first admitted in hospital
name of hospital
Did the patient receive care in an ICU?
Was the patient ventilated?
Did the patient receive ECMO?
Was the case isolated?
date of isolation
Outcome of illness (circle):
Date of death
History of fever/chills
General weakness
Irritability/confusion
Sore throat
Cough
Runny nose
Shortness of breath
Diarrhoea
Nausea/vomiting
Headache
Pain
Muscular pain
Chest pain
Abdominal pain
Joint pain
Other, specify
Temperature:
Celsius or Farenheight
Pharyngeal exsudate
Conjunctival injection
Dyspnea, tachypnea
Abnormal lung auscultation
Abnormal lung x-ray findings
Seizures
Coma
Other signs, specify
Student
Health care worker
Health laboratory worker
Working with animals
Other, specify
Healthcare worker country
Healthcare worker city
Healthcare worker facility name
Has the patient travelled in the 14 days prior to symptom
Specify country travelled to 1
Specify city travelled to 1
Specify date departed from 1
Specify country travelled to 2
Specify city travelled to 2
Specify date departed from 1
Specify country travelled to 3
Specify city travelled to 3
Specify date departed from 1
Has the patient visited any health care facilities in the 14
Has the patient had close contact with a person with acute
ARI close contact in Health care setting
ARI close contact in Family setting
ARI close contact in Work place
ARI close contact in other location (specify)
ARI close contact unkown
Has the patient had contact with a confirmed case?
Explain contact setting
ID number of confirmed case 1
ID number of confirmed case 2
ID number of confirmed case 3
ID number of confirmed case 4
ID number of confirmed case 5
Date of first exposure to confirmed case 1
Date of first exposure to confirmed case 2
Date of first exposure to confirmed case 3
Date of first exposure to confirmed case 4
Date of first exposure to confirmed case 5
Date of last exposure to confirmed case 1
Date of last exposure to confirmed case 2
Date of last exposure to confirmed case 3
Date of last exposure to confirmed case 4
Date of last exposure to confirmed case 5
Case contact health care setting
Case contact family setting
Case contact in work place
Case contact in other location (specify)
Case contact unknown
Likely country for exposure to case?
Did the patient visit any live animals markets?
Likely location/city/country for exposure to live animals
Name of confirming laboratory:
Assay used by confirming laboratory
Sequencing performed by confirming laboratory
Outcome section submitted
Date of outcome submission
Case developed symptoms
Date case developed symptoms
Patient admitted to hospital
Date patient admitted to hospital
Did the patient receive care in an ICU?
Was the patient ventilated?
Did the patient receive ECMO?
Patient status (outcome)
Other patient status (outcome)
Date of patient release or date of death
If released, date of last laboratory test
laboratory result from last test
High risk contacts followed from case
Number of high risk contacts followed unknown
Short label FR

Date*: _____/____/______
Organisation/institution*:
Pays*:

classification des cas

détecté au point d'entrée
date détectée au point d'entrée
Numéro d'identification unique*:
Date de naissance*: ____/____/______
ou Age *: ______
Unité de l'âge
Sexe a la naissance*: Homme Femme

Niveau admin 1*(préfecture):

Niveau admin 2*(département):

Date prélèvement1
Date de début des premiers symptomes*:
Patient asymptomatique
Date d'apparition des symptomes inconnue

Grossesse
Trimestre de grossesse
Post-partum (<6 semaines)
Immunodéficience, y compris le VIH

Malignité
Maladie aiguë ou chronique associée:
Autre spécifier
Hospitalisation* ?:
Pour cet épisode, quelle est la date de première présenta
veuillez préciser où:

Est ce que le patient a été ventilé mécaniquement?

Est ce que le patient a été ventilé mécaniquement?

date d'isolement
Evolution* (entourer):
Date* du décès:
Fièvre / frissons
Asthénie
confusion/irritabilité
Maux de gorge
Toux
Nez qui coule
Difficulté à respirer
Diarrhée
Nausée/vomissements
Maux de tete
Douleur
Douleurs musculaires
Douleurs thoraciques
Douleurs abdominales
Douleurs articulaires
Autre symptômes, spécifier
Température : ___________________
Celsius ou Farenheight
Exsudat pharyngé
Injection conjonctivale
Dyspnée, tachypnée
Auscultation pulmonaire anormale
Anomalies radiographies pulmonaires
Convulsions
Coma
Autre signes observés, spécifier:_______________
Etudiant

Le patient a-t-il voyagé au cours des 14 jours précédant

Précisez le pays visité jusqu'à 1
Précisez la ville parcourue au 1
Précisez la ville parcourue au 1
Précisez le pays visité jusqu'à 2
Précisez la ville parcourue au 2
Précisez la ville parcourue au 1
Précisez le pays visité jusqu'à 3
Précisez la ville parcourue au 3
Précisez la ville parcourue au 1
Le patient a-t-il visité un établissement de santé au cou
Le patient a-t-il été en contact étroit avec une personne
Le patient a-t-il eu un contact ave cun cas probable ou co

Numero identification du cas contact probable ou confir

Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Numero identification du cas contact probable ou confir
Milieu hospitalier
Dans la famillle
Milieu professionel
Autre contexte
Ne sait pas dans quel contexte
Quel est l'endroit le plus probable d'exposition à la mala
Le patient a-t-il eu des contacts, direct ou indeirect ave
Quel est l'endroit le plus probable d'exposition à les ani
Nom du laboratoire
Dosage utilisé par le laboratoire de confirmation
Séquençage effectué par le laboratoire de confirmation

Est ce que le patient a été ventilé mécaniquement?

Est ce que le patient a été ventilé mécaniquement?
Description
WHO assigned sequential number
Date of reporting
Unit/Department/Organization that interviewer
Country/territory/national boundary within which is representing. Note, label should
the case currently/usually be adapted to suite local context.
resides.
If transborders or international spread of outbreak
Why the case was tested for COVID-19
Any other reason the case was tested for COVID-19
Is the case confirmed, probable, or suspected, as per case definition
Was the case detected at a point of entry?
What date was the case detected at a point of entry
Unique case identification number (used in country)
Date that the case was born on.
Age in units on the date of illness onset.
Years or months or days
Biological sex. That is the biological differential characteristics (chromosomes, hormonal profiles, internal and external sex
Administrative level 0: Country where the case was diagnosed.
Administrative level 1: First sub-national boundary (e.g. province, state, territory prefecture, region, etc.) where the case w
Administrative level 2: Second sub-national level boundary (e.g. district, county, local government area, department, provi
Administrative level 0: Country within which the case's currently/usually resides.
Administrative level 1: First sub-national boundary (e.g. province, state, territory prefecture, region, etc.) within which the
Administrative level 2: Second sub-national level boundary (e.g. district, county, local government area, department, provi
Date of first laboratory confirmation
Date of first appearance of the signs or symptoms of the illness/disease.
Is the case asymptomatic?
Is the date of the case's symptom onset unknown?
Does the patient have any underlying conditions?
Is the patient pregnant?

Is the patient in the post partum period defined as less than 6 weeks after delivery date
has the patient an adquired immunodeficiency (HIV) or is the patient treated with drugs that decreased immune response
any cardiovacsular disease

any liver diseases

any renal diseases

Describe other underlying conditions and comorbidity

Was the case hospitalized, admitted to a hospital or other health facility as an inpatient?
Date the case was first admitted to any health facility.
Name of health facility where the case was admitted.
Did the patient receive care in an intensive care unit (ICU)?
Was the patient ever ventilated for this episode at time of reporting?
Did the patient receive extracorporeal membrane oxygenation (ECMO)?
Was the case isolated with proper IPC controls implemented?
What date was the case isolated?
Health Status at time of reporting.
Date of death
Fever associated with chills or not
Intense fatigue, an abnormal state of drowsiness (lethargy or feeling lethargic), cannot conduct daily activity, lack of streng
Presence of any conscious disorder
Increase volume of the neck due to swollen glands
When coughing the patient produces or not phlegm or mucus/sputum or bloody sputum
Runny nose
Patient has difficulty breathing with short respiratory cycles
Diarrhoea, three or more loose or liquid stools (bowel movements) in a 24 hour period (or more frequent passage than is n
Include nausea, vomiting, abdominal pain, loss of appetite, diarrhea, dysentery, increased liver and/or spleen volume, ano
Headache
Patient complains of pain, at any site
Muscular pain
Chest pain
Abdominal pain
Joint pain
Describe other symptoms
Body temperature measured at time of interview or upon admission to the medical facility
Expressed in degree celcius
Temperature recorded in degrees Celsius or Farenheight
Pharyngitis or laryngitis
Bleeding/haemorrhage into the eyes (conjunctival injections).
Rapid respiration
Any sign resulting from pulmonary auscultation
Pulmonary Xrays showing abnormal patterns
Myoclonies, tremors, epilepsy, seizures/convulsions
Absence of reaction to orders
Describe other signs
is the patient a student?
Is the patient working in a health care setting?
Is the patient working in a health laboratory setting?
Is the patient working in contact with animals?
Please specify any other occupation not listed
If case is a healthcare worker, in which country do they work?
If case is a healthcare worker, in which city do they work?
If case is a healthcare worker, what is the name of the facility in which they work?
Has the patient travelled in the 14 days prior to symptom onset?
List the country from location 1 that the case has travelled to in the 14 days prior to symptom onset
List the city from location 1 that the case has travelled to in the 14 days prior to symptom onset
List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onset
List the country from location 2 that the case has travelled to in the 14 days prior to symptom onset
List the city from location 2 that the case has travelled to in the 14 days prior to symptom onset
List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onset
List the country from location 3 that the case has travelled to in the 14 days prior to symptom onset
List the city from location 3 that the case has travelled to in the 14 days prior to symptom onset
List the date departed from location 1 that the case has travelled to in the 14 days prior to symptom onset
Has the patient visited any health care facilities in the 14 days prior to symptom onset
Has the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset
Has the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset in
Has the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset in
Has the patient had close contact with a person with acute respiratory infection in the 14 days prior to symptom onset in
Please specify any close contact setting with a person with acute respiratory infection not listed.
Please select unkown if there was no known close contact with a person with acute respiratory infection
Has the patient had contact with a confirmed case in the 14 days prior to disease onset?
If the patient has had contact with a confirmed case in the 14 days prior to symptom onset, explain contact setting
List the unique case identifier 1 with whom the patient had contact with
List the unique case identifier 2 with whom the patient had contact with
List the unique case identifier 3 with whom the patient had contact with
List the unique case identifier 4 with whom the patient had contact with
List the unique case identifier 5 with whom the patient had contact with
Date of first exposure to confirmed case 1
Date of first exposure to confirmed case 2
Date of first exposure to confirmed case 3
Date of first exposure to confirmed case 4
Date of first exposure to confirmed case 5
Date of last exposure to confirmed case 1
Date of last exposure to confirmed case 2
Date of last exposure to confirmed case 3
Date of last exposure to confirmed case 4
Date of last exposure to confirmed case 5
Was the patient most likely exposed to another case in a health care setting?
Was the patient most likely exposed to another case in family settings?
Was the patient most likely exposed to another case at work?
Please specify any contact setting not listed.
Please select unkown if there were no known contact setting
Specify the location of possible exposure to a case
Did the patient visit any live animal marker 14 days prior to symptom onset?
Specify the location of possible exposure to live animals
Name of testing laboratory
Please specify which assay was used by the confirming laboratory
Please specify is sequencing was used by the confirming laboratory
Has the outcome section been submitted?
Date of outcome submission
If case was asymptomatic at time of specimen collection resulting in first laboratory confirmation, did the case develop any
If case was asymptomatic and developed symptoms, what is the date of onset for symptoms/signs of illness
Patient was first admitted to hospital (outcome)
Date patient was first admitted to hospital (outcome)
Did the patient receive care in an intensive care unit (ICU)? (outcome)
Was the patient ever ventilated for this episode? (outcome)
Did the patient receive extracorporeal membrane oxygenation (ECMO)? (outcome)
Patient status (outcome)
Other patient status (outcome)
Date of Release from isolation/hospital or Date of Death
If released from hospital /isolation, date of last laboratory test
laboratory result from last test
Total number of high-risk contacts followed for this case
Number of high risk contacts followed unknown
 Permissible values EN Permissible values FR (response
Data type Format (response options) options)
String Free text
Date DD/MM/YYYY
String Free text
String Free text
Coded Coded variables CASE_CONTACT, SEEKING_HC, POE_DETECTION, REPATRIATION, SURVEILLANC
String Free text
Numeric # CONFIRMED, PROBABLE
Numeric # YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Date DD/MM/YYYY
String Free text
Date DD/MM/YYYY
Numeric ### 0-110 0-110
Coded Coded variables YEARS, MONTHS, DAYS 1 = année 2 = mois 3=jours
Coded Coded variables MALE, FEMALE 1 = Homme; 2 = Femme;
String Free text
String Free text
String Free text
String Free text
String Free text
String Free text
Date DD/MM/YYYY
Date DD/MM/YYYY
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non
Numeric # YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO, UNKNOWN
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables FIRST, SECOND, THIRD
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
Coded Coded variables YES, NO 1 = Oui; 2 = Non
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Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Date DD/MM/YYYY
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Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Date DD/MM/YYYY
Numeric # 1 = recovered ; 2 = not recovered; 3 = death; 4 = unknown
Date DD/MM/YYYY
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Number # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Number # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
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Numeric ## between 35 and 43 or 95 and entre 35 and 43 ou 95 and 110
Numeric # 1 = Celsius 2 = Farenheight 1 = Celsius 2 = Farenheight
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
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Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
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Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
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Date DD/MM/YYYY
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Date DD/MM/YYYY
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Date DD/MM/YYYY
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Numeric # 1 = Yes; 2 = No; 3 = Unknown 1 = Oui; 2 = Non; 3 = Inconnue
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
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Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
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Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Date DD/MM/YYYY
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
String Free text
Numeric # 1 = Yes; 2 = No 1 = Oui; 2 = Non
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Numeric # 1 = Yes; 2 = No; 3 = Unknown 1 = Oui; 2 = Non; 3 = Inconnue
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Numeric # 1 = Yes; 2 = No; 3 = Unknown 1 = Oui; 2 = Non; 3 = Inconnue
Coded Coded variables YES, NO
Date DD/MM/YYYY
Coded Coded variables YES, NO, UNKNOWN
Date DD/MM/YYYY
Coded Coded variables YES, NO, UNKNOWN
Date DD/MM/YYYY YES, NO, UNKNOWN
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables YES, NO, UNKNOWN 1 = Oui; 2 = Non, 3 = Inconnue
Coded Coded variables RECOVERED, NOTRECOVERED, DEATH, UNKNOWN, OTHER
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Date DD/MM/YYYY
Date DD/MM/YYYY
Coded Coded variables POSITIVE, NEGATIVE, INCONCLUSIVE, UNKNOWN
Numeric ###
Coded Coded variables YES, NO
TRIATION, SURVEILLANCE, UNKNOWN, OTHER
Retained variable
Removed variable
New variable
Removed variable that can be populated by new variables