|
PGP Participant Survey
|
Responses submitted 7/16/2011 10:14:28.
Show responses
|
| Timestamp |
7/16/2011 10:14:28 |
| Year of birth |
21-29 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 |
Female |
| Race/ethnicity |
White |
| Maternal grandmother: Country of origin |
Ireland |
| Paternal grandmother: Country of origin |
Hungary |
| Paternal grandfather: Country of origin |
Hungary |
| Maternal grandfather: Country of origin |
Finland |
| Enrollment of relatives |
No |
| Enrollment of older individuals |
No |
| Enrollment of parents |
Maybe |
| 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 |
4 |
| Blood sample |
Yes |
| Saliva sample |
Yes |
| Microbiome samples |
Yes |
| Tissue samples from surgery |
Yes |
| Tissue samples from autopsy |
Yes |
|
PGP Participant Survey
|
Responses submitted 11/23/2011 11:59:25.
Show responses
|
| Timestamp |
11/23/2011 11:59:25 |
| Year of birth |
21-29 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 |
Female |
| Race/ethnicity |
White |
| Maternal grandmother: Country of origin |
Finland |
| Paternal grandmother: Country of origin |
France |
| Paternal grandfather: Country of origin |
Hungary |
| Maternal grandfather: Country of origin |
Finland |
| Enrollment of relatives |
No |
| Enrollment of older individuals |
No |
| 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 Participant Survey
|
Responses submitted 11/23/2011 12:17:40.
Show responses
|
| Timestamp |
11/23/2011 12:17:40 |
| Year of birth |
21-29 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 |
Yes |
| Do you have a severe genetic disease or rare genetic trait? If so, you can add a description for your public profile. |
Balanced translocation on chromosome 18, which resulted in child born with monosomy 18p (microdeletion). |
| Disease/trait: Onset |
Congenital / present at birth |
| Disease/trait: Rarity |
Very rare/uncommon |
| Disease/trait: Severity |
Not applicable |
| Disease/trait: Relative enrollment |
Maybe |
| Disease/trait: Diagnosis |
Yes |
| Disease/trait: Genetic confirmation |
Yes |
| Disease/trait: Documentation |
Yes |
| Disease/trait: Documentation description |
Microarray test results |
| Sex/Gender |
Female |
| Race/ethnicity |
White |
| Maternal grandmother: Country of origin |
Ireland |
| Paternal grandmother: Country of origin |
France |
| Paternal grandfather: Country of origin |
Hungary |
| Maternal grandfather: Country of origin |
Finland |
| Enrollment of relatives |
No |
| Enrollment of older individuals |
No |
| 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 10/19/2012 21:06:16.
Show responses
|
| Timestamp |
10/19/2012 21:06:16 |
|
PGP Trait & Disease Survey 2012: Endocrine, Metabolic, Nutritional, and Immunity
|
Responses submitted 10/19/2012 21:06:57.
Show responses
|
| Timestamp |
10/19/2012 21:06:57 |
| Have you ever been diagnosed with any of the following conditions? |
Hypothyroidism, Hashimoto's thyroiditis |
|
PGP Trait & Disease Survey 2012: Blood
|
Responses submitted 10/19/2012 21:07:21.
Show responses
|
| Timestamp |
10/19/2012 21:07:21 |
|
PGP Trait & Disease Survey 2012: Nervous System
|
Responses submitted 10/19/2012 21:08:00.
Show responses
|
| Timestamp |
10/19/2012 21:08:00 |
| Have you ever been diagnosed with one of the following conditions? |
Chronic tension headaches (15+ days per month, at least 6 months) |
|
PGP Trait & Disease Survey 2012: Vision and hearing
|
Responses submitted 10/19/2012 21:08:41.
Show responses
|
| Timestamp |
10/19/2012 21:08:41 |
| Have you ever been diagnosed with one of the following conditions? |
Myopia (Nearsightedness), Astigmatism, Dry eye syndrome |
|
PGP Trait & Disease Survey 2012: Respiratory System
|
Responses submitted 10/19/2012 21:09:35.
Show responses
|
| Timestamp |
10/19/2012 21:09:35 |
|
PGP Trait & Disease Survey 2012: Digestive System
|
Responses submitted 10/19/2012 21:10:15.
Show responses
|
| Timestamp |
10/19/2012 21:10:15 |
| Have you ever been diagnosed with any of the following conditions? |
Impacted tooth, Dental cavities, Temporomandibular joint (TMJ) disorder, Appendicitis, Gallstones |
|
PGP Trait & Disease Survey 2012: Genitourinary Systems
|
Responses submitted 10/19/2012 21:10:44.
Show responses
|
| Timestamp |
10/19/2012 21:10:44 |
| Have you ever been diagnosed with any of the following conditions? |
Kidney stones, Urinary tract infection (UTI), Ovarian cysts |
|
PGP Trait & Disease Survey 2012: Skin and Subcutaneous Tissue
|
Responses submitted 10/19/2012 21:11:17.
Show responses
|
| Timestamp |
10/19/2012 21:11:17 |
| Have you ever been diagnosed with any of the following conditions? |
Hair loss (includes female and male pattern baldness), Acne |
|
PGP Trait & Disease Survey 2012: Musculoskeletal System and Connective Tissue
|
Responses submitted 10/19/2012 21:11:41.
Show responses
|
| Timestamp |
10/19/2012 21:11:41 |
|
PGP Trait & Disease Survey 2012: Congenital Traits and Anomalies
|
Responses submitted 10/19/2012 21:12:10.
Show responses
|
| Timestamp |
10/19/2012 21:12:10 |
|
PGP Trait & Disease Survey 2012: Circulatory System
|
Responses submitted 12/20/2012 22:49:25.
Show responses
|
| Timestamp |
12/20/2012 22:49:25 |
|
PGP Trait & Disease Survey 2012: Endocrine, Metabolic, Nutritional, and Immunity
|
Responses submitted 1/3/2015 23:11:58.
Show responses
|
| Timestamp |
1/3/2015 23:11:58 |
| Have you ever been diagnosed with any of the following conditions? |
Hypothyroidism, Hashimoto's thyroiditis, Polycystic ovary syndrome (PCOS) |
|
PGP Trait & Disease Survey 2012: Congenital Traits and Anomalies
|
Responses submitted 1/3/2015 23:13:13.
Show responses
|
| Timestamp |
1/3/2015 23:13:13 |
|
Harvard PGP: COVID-19 Demographics Survey
|
Responses submitted 3/23/2020 18:53:06.
Show responses
|
| Timestamp |
3/23/2020 18:53:06 |
| What is the zip code of your primary residence? |
83713 |
| Do have another residence where you spend more than 30 days a year? |
No |
| What is your gender? |
Female |
| Select all the following that apply to your current living arrangements. |
Live with child/children under age 18 |
| 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 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)? |
Yes |
| Do you currently use e-cigarettes (e.g. JUUL, Vuse, MarkTen) ? |
Yes |
| During the past 30 days, during how many days did you use e-cigarettes (e.g. JUUL, Vuse, MarkTen)? |
5 |
| Which one of the following best describes your employment status for the past 3 months? |
Employed: Working 40 or more hrs per week |
| Select the category that best describes your occupation. |
Production |
| What is the zip code of your primary workplace/worksite? |
83714 |
| Do you have a secondary workplace/worksite where you work more than 30 days a year? |
No |
| If a vaccine against coronovirus (COVID-19) would reach the stage where it must be tested for safety and efficacy in humans, would you - assuming that you are eligible - be interested in taking part in that trial? |
Yes |
|
Harvard PGP: COVID-19 Health Assessment for Week of 29 March- 4 April 2020
|
Responses submitted 3/30/2020 13:21:19.
Show responses
|
| Timestamp |
3/30/2020 13:21:19 |
| 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] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Feeling cold, chills or shivers] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Headache] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Aches all over the body] |
Yes |
| Since Jan 1, 2020, have you experienced any of the following symptoms? [Cough] |
No |
| 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] |
Yes |
| 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? [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] |
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? |
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 |
|
Harvard PGP: COVID-19 Health Assessment for Week of 5 April - 11 April 2020
|
Responses submitted 4/6/2020 14:22:52.
Show responses
|
| Timestamp |
4/6/2020 14:22:52 |
| Since Jan 1, 2020, have you been ill with a cold or flu-like illness? |
Yes |
| 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] |
Yes |
| Indicate which of the following symptoms you are currently experiencing. [Headache] |
Yes |
| 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] |
Yes |
| 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] |
Yes |
| 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] |
Unknown |
| 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] |
Yes |
| 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] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Headache] |
Yes |
| 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] |
Yes |
| 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? |
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 |
|
Harvard PGP COVID-19 Health Assessment Week 4: 12 April - 18 April 2020
|
Responses submitted 4/13/2020 18:07:34.
Show responses
|
| Timestamp |
4/13/2020 18:07:34 |
| Are you currently ill with a cold or flu-like illness? |
Yes |
| Since Jan 1, 2020, have you been ill with a cold or flu-like illness? |
Yes |
| 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] |
Yes |
| 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] |
Yes |
| Indicate which of the following symptoms you are currently experiencing. [Sore throat] |
Yes |
| 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] |
Yes |
| 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] |
Yes |
| In the past 2 weeks, which symptoms have you experienced. [Sore throat] |
Yes |
| In the past 2 weeks, which symptoms have you experienced. [Nausea] |
Yes |
| 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] |
Yes |
| 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] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Headache] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Aches all over the body] |
Yes |
| 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] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Sore throat] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Nausea] |
Yes |
| Since Jan 1, 2020, to the best of your recollection which symptoms have you experienced. [Vomiting] |
Yes |
| 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] |
Yes |
| 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? |
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? |
Yes |
| How long ago was your contact with a person who has symptoms consistent with coronavirus (COVID-19) but has not been tested? |
In current contact |
