|
PGP Participant Survey
|
Responses submitted 7/16/2011 13:43:45.
Show responses
|
| Timestamp |
7/16/2011 13:43:45 |
| Year of birth |
60-69 years |
| Which statement best describes you? |
I am comfortable making my genome sequence data publicly available without prior review. |
| Severe disease or rare genetic trait |
No |
| Sex/Gender |
Male |
| Race/ethnicity |
White |
| Maternal grandmother: Country of origin |
Other / don't know / no response |
| Paternal grandmother: Country of origin |
United States |
| Paternal grandfather: Country of origin |
United States |
| Maternal grandfather: Country of origin |
United States |
| Enrollment of relatives |
No |
| Enrollment of older individuals |
Yes |
| Enrollment of parents |
No |
| Have you uploaded genetic data to your PGP participant profile? |
No, I have no genetic data. |
| Have you used the PGP web interface to record a designated proxy? |
Yes |
| Have you uploaded health record data using our Google Health or Microsoft Healthvault interfaces? |
Yes |
| Uploaded health records: Update status |
Yes |
| Uploaded health records: Extensiveness |
3 |
| Blood sample |
Yes |
| Saliva sample |
Yes |
| Microbiome samples |
Yes |
| Tissue samples from surgery |
Yes |
| Tissue samples from autopsy |
Yes |
|
PGP Trait & Disease Survey 2012: Cancers
|
Responses submitted 6/16/2014 15:22:15.
Show responses
|
| Timestamp |
6/16/2014 15:22:15 |
| Have you ever been diagnosed with one of the following conditions? |
Prostate cancer |
|
PGP Trait & Disease Survey 2012: Endocrine, Metabolic, Nutritional, and Immunity
|
Responses submitted 6/20/2014 18:30:53.
Show responses
|
| Timestamp |
6/20/2014 18:30:53 |
|
PGP Trait & Disease Survey 2012: Blood
|
Responses submitted 6/20/2014 18:31:22.
Show responses
|
| Timestamp |
6/20/2014 18:31:22 |
|
PGP Trait & Disease Survey 2012: Nervous System
|
Responses submitted 6/20/2014 18:31:46.
Show responses
|
| Timestamp |
6/20/2014 18:31:46 |
|
PGP Trait & Disease Survey 2012: Endocrine, Metabolic, Nutritional, and Immunity
|
Responses submitted 6/20/2014 18:32:19.
Show responses
|
| Timestamp |
6/20/2014 18:32:19 |
|
PGP Trait & Disease Survey 2012: Blood
|
Responses submitted 6/20/2014 18:32:49.
Show responses
|
| Timestamp |
6/20/2014 18:32:49 |
|
PGP Trait & Disease Survey 2012: Nervous System
|
Responses submitted 6/20/2014 18:33:10.
Show responses
|
| Timestamp |
6/20/2014 18:33:10 |
|
PGP Trait & Disease Survey 2012: Vision and hearing
|
Responses submitted 6/20/2014 18:34:58.
Show responses
|
| Timestamp |
6/20/2014 18:34:58 |
| Have you ever been diagnosed with one of the following conditions? |
Myopia (Nearsightedness), Astigmatism |
| Other condition not listed here? |
Anterior Ischemic Optic Neuropathy |
|
PGP Trait & Disease Survey 2012: Circulatory System
|
Responses submitted 6/20/2014 18:35:22.
Show responses
|
| Timestamp |
6/20/2014 18:35:22 |
|
PGP Trait & Disease Survey 2012: Respiratory System
|
Responses submitted 6/20/2014 18:35:48.
Show responses
|
| Timestamp |
6/20/2014 18:35:48 |
|
PGP Trait & Disease Survey 2012: Digestive System
|
Responses submitted 6/20/2014 18:36:09.
Show responses
|
| Timestamp |
6/20/2014 18:36:09 |
| Have you ever been diagnosed with any of the following conditions? |
Dental cavities |
|
PGP Trait & Disease Survey 2012: Genitourinary Systems
|
Responses submitted 6/20/2014 18:36:33.
Show responses
|
| Timestamp |
6/20/2014 18:36:33 |
|
PGP Trait & Disease Survey 2012: Skin and Subcutaneous Tissue
|
Responses submitted 6/20/2014 18:37:00.
Show responses
|
| Timestamp |
6/20/2014 18:37:00 |
| Have you ever been diagnosed with any of the following conditions? |
Skin tags, Hair loss (includes female and male pattern baldness) |
|
PGP Trait & Disease Survey 2012: Musculoskeletal System and Connective Tissue
|
Responses submitted 6/20/2014 18:38:58.
Show responses
|
| Timestamp |
6/20/2014 18:38:58 |
|
PGP Trait & Disease Survey 2012: Congenital Traits and Anomalies
|
Responses submitted 6/20/2014 18:39:16.
Show responses
|
| Timestamp |
6/20/2014 18:39:16 |
|
PGP Participant Survey
|
Responses submitted 12/2/2015 18:24:55.
Show responses
|
| Timestamp |
12/2/2015 18:24:55 |
| Year of birth |
1942 |
| Sex/Gender |
Male |
| Race/ethnicity |
White |
| Maternal grandmother: Country of origin |
United Kingdom |
| Paternal grandmother: Country of origin |
United States |
| Paternal grandfather: Country of origin |
United States |
| Maternal grandfather: Country of origin |
United States |
| Month of birth |
January |
| Anatomical sex at birth |
Male |
| Maternal grandmother: Race/ethnicity |
White |
| Maternal grandfather: Race/ethnicity |
White |
| Paternal grandmother: Race/ethnicity |
White |
| Paternal grandfather: Race/ethnicity |
White |
|
PGP Trait & Disease Survey 2012: Cancers
|
Responses submitted 12/2/2015 18:26:09.
Show responses
|
| Timestamp |
12/2/2015 18:26:09 |
| Have you ever been diagnosed with one of the following conditions? |
Prostate cancer |
|
PGP Trait & Disease Survey 2012: Endocrine, Metabolic, Nutritional, and Immunity
|
Responses submitted 12/2/2015 18:26:41.
Show responses
|
| Timestamp |
12/2/2015 18:26:41 |
|
Harvard PGP: COVID-19 Demographics Survey
|
Responses submitted 3/23/2020 19:38:52.
Show responses
|
| Timestamp |
3/23/2020 19:38:52 |
| What is the zip code of your primary residence? |
02135 |
| Do have another residence where you spend more than 30 days a year? |
No |
| What is your age (in years)? |
78 |
| What is your gender? |
Male |
| Select all the following that apply to your current living arrangements. |
Live with partner/spouse |
| What is your race? Pick all that apply. |
White |
| What is your ethnicity? |
Not Hispanic or Latino or Spanish Origin |
| Select which one of the following applies to you and your birth status. |
None of the above |
| Have you ever been diagnosed with any of the following? [Asthma (Adult)] |
No |
| Have you ever been diagnosed with any of the following? [Asthma (Childhood)] |
No |
| Have you ever been diagnosed with any of the following? [Chronic obstructive pulmonary disease (COPD)] |
No |
| Have you ever been diagnosed with any of the following? [Emphysema] |
No |
| Have you ever been diagnosed with any of the following? [Chronic bronchitis] |
No |
| Have you ever been diagnosed with any of the following? [Pneumonia] |
No |
| Have you ever been diagnosed with any of the following? [Type 1 Diabetes] |
No |
| Have you ever been diagnosed with any of the following? [Type 2 Diabetes] |
No |
| Have you ever smoked tobacco products? |
Yes |
| Do you currently smoke tobacco products? |
No |
| What is the average number of cigarettes (# of cigarettes not packs) you smoke per day? |
Don't currently smoke |
| Have you ever used e-cigarettes (e.g. JUUL, Vuse, MarkTen)? |
No |
| Which one of the following best describes your employment status for the past 3 months? |
I'm retired but I do a lot of volunteer work. |
|
Harvard PGP: COVID-19 Health Assessment for Week of 22-28 March 2020
|
Responses submitted 3/23/2020 19:45:03.
Show responses
|
| Timestamp |
3/23/2020 19:45:03 |
| Since Jan 1, 2020, have you been ill with a cold or flu-like illness? |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Feeling cold, chills or shivers] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Headache] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Aches all over the body] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Cough] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Rapid breathing] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Shortness of breath] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Wheezing or chest tightness] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Persistent pain or pressure in the chest] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Bluish lips or face] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Dizziness] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Confusion or inability to arouse] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Running nose] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Sore throat] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Nausea] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Vomiting] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Abdominal pain] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Diarrhea] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Pink eye (conjunctivitis)] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Loss of sense of smell] |
Unknown |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Loss of sense of taste] |
No |
| Are you currently experiencing any of the following symptoms? [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Are you currently experiencing any of the following symptoms? [Feeling cold, chills or shivers] |
No |
| Are you currently experiencing any of the following symptoms? [Headache] |
No |
| Are you currently experiencing any of the following symptoms? [Aches all over the body] |
No |
| Are you currently experiencing any of the following symptoms? [Cough] |
Yes |
| Are you currently experiencing any of the following symptoms? [Rapid breathing] |
No |
| Are you currently experiencing any of the following symptoms? [Shortness of breath] |
No |
| Are you currently experiencing any of the following symptoms? [Wheezing or chest tightness] |
No |
| Are you currently experiencing any of the following symptoms? [Persistent pain or pressure in the chest] |
No |
| Are you currently experiencing any of the following symptoms? [Bluish lips or face] |
No |
| Are you currently experiencing any of the following symptoms? [Dizziness] |
No |
| Are you currently experiencing any of the following symptoms? [Confusion or inability to arouse] |
No |
| Are you currently experiencing any of the following symptoms? [Running nose] |
Yes |
| Are you currently experiencing any of the following symptoms? [Sore throat] |
No |
| Are you currently experiencing any of the following symptoms? [Nausea] |
No |
| Are you currently experiencing any of the following symptoms? [Vomiting] |
No |
| Are you currently experiencing any of the following symptoms? [Abdominal Pain] |
No |
| Are you currently experiencing any of the following symptoms? [Diarrhea] |
No |
| Are you currently experiencing any of the following symptoms? [Pink eye (conjunctivitis)] |
No |
| Are you currently experiencing any of the following symptoms? [Loss of sense of smell] |
Unknown |
| Are you currently experiencing any of the following symptoms? [Loss of sense of taste] |
No |
| Are you regularly taking any of the following medications? Please choose all those that apply. |
None of these medications |
| Have you been tested for coronavirus (COVID-19) by a medical doctor or other official testing service? |
No, I have not tried to get tested |
| In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)? |
No |
| In the past 4 weeks, have you been in close contact with a person who has symptoms consistent with coronavirus (COVID-19) but has not been tested? |
No |
|
Harvard PGP: COVID-19 Health Assessment for Week of 29 March- 4 April 2020
|
Responses submitted 3/30/2020 12:25:31.
Show responses
|
| Timestamp |
3/30/2020 12:25:31 |
| Since Jan 1, 2020, have you been ill with a cold or flu-like illness? |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Feeling cold, chills or shivers] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Headache] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Aches all over the body] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Cough] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Rapid breathing] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Shortness of breath] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Wheezing or chest tightness] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Persistent pain or pressure in the chest] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Bluish lips or face] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Dizziness] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Confusion or inability to arouse] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Running nose] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Sore throat] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Nausea] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Vomiting] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Abdominal pain] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Diarrhea] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Pink eye (conjunctivitis)] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Loss of sense of smell] |
No |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Loss of sense of taste] |
No |
| Are you currently experiencing any of the following symptoms? [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Are you currently experiencing any of the following symptoms? [Feeling cold, chills or shivers] |
No |
| Are you currently experiencing any of the following symptoms? [Headache] |
No |
| Are you currently experiencing any of the following symptoms? [Aches all over the body] |
No |
| Are you currently experiencing any of the following symptoms? [Cough] |
Yes |
| Are you currently experiencing any of the following symptoms? [Rapid breathing] |
No |
| Are you currently experiencing any of the following symptoms? [Shortness of breath] |
No |
| Are you currently experiencing any of the following symptoms? [Wheezing or chest tightness] |
No |
| Are you currently experiencing any of the following symptoms? [Persistent pain or pressure in the chest] |
No |
| Are you currently experiencing any of the following symptoms? [Bluish lips or face] |
No |
| Are you currently experiencing any of the following symptoms? [Dizziness] |
No |
| Are you currently experiencing any of the following symptoms? [Confusion or inability to arouse] |
No |
| Are you currently experiencing any of the following symptoms? [Running nose] |
No |
| Are you currently experiencing any of the following symptoms? [Sore throat] |
No |
| Are you currently experiencing any of the following symptoms? [Nausea] |
No |
| Are you currently experiencing any of the following symptoms? [Vomiting] |
No |
| Are you currently experiencing any of the following symptoms? [Abdominal Pain] |
No |
| Are you currently experiencing any of the following symptoms? [Diarrhea] |
No |
| Are you currently experiencing any of the following symptoms? [Pink eye (conjunctivitis)] |
No |
| Are you currently experiencing any of the following symptoms? [Loss of sense of smell] |
No |
| Are you currently experiencing any of the following symptoms? [Loss of sense of taste] |
No |
| Are you regularly taking any of the following medications? Please choose all those that apply. |
None of these medications |
| Have you been tested for coronavirus (COVID-19) by a medical doctor or other official testing service? |
No, I have not tried to get tested |
| In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)? |
No |
| In the past 4 weeks, have you been in close contact with a person who has symptoms consistent with coronavirus (COVID-19) but has not been tested? |
No |
|
Harvard PGP COVID-19 Health Assessment Week 4: 12 April - 18 April 2020
|
Responses submitted 4/13/2020 19:37:20.
Show responses
|
| Timestamp |
4/13/2020 19:37:20 |
| Are you currently ill with a cold or flu-like illness? |
Unknown |
| Since Jan 1, 2020, have you been ill with a cold or flu-like illness? |
Unknown |
| Currently are you experiencing ANY of the above list of symptoms? |
Yes |
| Indicate which of the following symptoms you are currently experiencing. [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Feeling cold, chills or shivers] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Headache] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Aches all over the body] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Cough] |
Yes |
| Indicate which of the following symptoms you are currently experiencing. [Rapid breathing] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Shortness of breath] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Wheezing or chest tightness] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Persistent pain or pressure in the chest] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Bluish lips or face] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Dizziness] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Confusion or inability to arouse] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Running nose] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Sore throat] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Nausea] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Vomiting] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Abdominal Pain] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Diarrhea] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Pink eye (conjunctivitis)] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Loss of sense of smell] |
No |
| Indicate which of the following symptoms you are currently experiencing. [Loss of sense of taste] |
No |
| In the past two weeks, have you experienced ANY of the above list of symptoms? |
Yes |
| In the past 2 weeks, which symptoms have you experienced. [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Feeling cold, chills or shivers] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Headache] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Aches all over the body] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Cough] |
Yes |
| In the past 2 weeks, which symptoms have you experienced. [Rapid breathing] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Shortness of breath] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Wheezing or chest tightness] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Persistent pain or pressure in the chest] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Bluish lips or face] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Dizziness] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Confusion or inability to arouse] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Running nose] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Sore throat] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Nausea] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Vomiting] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Abdominal pain] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Diarrhea] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Pink eye (conjunctivitis)] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Loss of sense of smell] |
No |
| In the past 2 weeks, which symptoms have you experienced. [Loss of sense of taste] |
No |
| Since Jan 1, 2020, to the best of your recollection,have you experienced ANY of the above list of symptoms? |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Persistent high fever of 38°C (100.4°F) or higher, lasting for a day or more] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Feeling cold, chills or shivers] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Headache] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Aches all over the body] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Cough] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Rapid breathing] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Shortness of breath] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Wheezing or chest tightness] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Persistent pain or pressure in the chest] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Bluish lips or face] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Dizziness] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Confusion or inability to arouse] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Running nose] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Sore throat] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Nausea] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Vomiting] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Abdominal pain] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Diarrhea] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Pink eye (conjunctivitis)] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Loss of sense of smell] |
No |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Loss of sense of taste] |
No |
| Are you regularly taking any of the following medications? Please choose all those that apply. |
None of these medications |
| Have you been tested for coronavirus (COVID-19) by a medical doctor or other official testing service? |
No, I have not tried to get tested |
| In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)? |
Not to my knowledge |
|
Harvard PGP COVID-19 Health Assessment [Ongoing]
|
Responses submitted 6/12/2020 17:51:33.
Show responses
|
| Timestamp |
6/12/2020 17:51:33 |
| Are you currently ill with a cold or flu-like illness? |
No |
| Currently are you experiencing ANY of the above list of symptoms? |
No |
| In the past two weeks, have you experienced ANY of the above list of symptoms? |
Yes |
| In the past 2 weeks, which symptoms have you experienced. [Headache] |
Yes |
| Are you regularly taking any of the following medications? Please choose all those that apply. |
None of these medications |
| Have you been tested for coronavirus (COVID-19) by a medical doctor or other official testing service? |
Yes, and the test was negative for coronavirus (COVID-19) |
| In the past 4 weeks, have you been in close contact with a person who has tested positive for coronavirus (COVID-19)? |
No |
| In the past 4 weeks, have you been in close contact with a person who has symptoms consistent with coronavirus (COVID-19) but has not been tested? |
No |
