Contact ID: Interviewer initials: Linked measles case ID: Date of interview: Fever Fever Cough Cough Runny Runny Conjunctivitis Rash Rash nose nose (red/pink eye) No Yes No Date of Yes No Yes No Yes No Interview Yes Onset date Onset date Onset date Onset date Duration Duration Duration Onset date Duration Highest temp Duration . . . . If rash is present, describe appearance and progression: comments:
Contact ID: Linked measles case ID: Interviewer initials: Date of interview: Date of Interview Fever Yes Onset date Duration Highest temp Fever No Cough Yes Onset date Duration Cough No Runny nose Yes Onset date Duration Runny nose No Conjunctivitis (red/pink eye) Yes Onset date Duration No Rash Yes Onset date Duration Rash No . . . . If rash is present, describe appearance and progression: comments: