COVID Questionnaire - Vaccine
| Name | Description | Question text |
|---|---|---|
| W12_vac_YN | Vaccine 6 mo | Have you received the COVID-19 vaccine in the past 6 months? |
| W12_vac_type | Vaccine type | Do you know which COVID-19 vaccine you got? |
| W12_vac_type_spec_2 | Vaccine type other | Please specify other |
| W12_vac_effects_1 | Vax Side Effect - Pain | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Pain at the injection site) |
| W12_vac_effects_2 | Vax Side Effect - Redness | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Redness at the injection site) |
| W12_vac_effects_3 | Vax Side Effect - Swelling | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Swelling at the injection site) |
| W12_vac_effects_4 | Vax Side Effect - Tiredness | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Tiredness) |
| W12_vac_effects_5 | Vax Side Effect - Headache | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Headache) |
| W12_vac_effects_6 | Vax Side Effect - Chills | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Chills) |
| W12_vac_effects_7 | Vax Side Effect - Fever | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Fever) |
| W12_vac_effects_8 | Vax Side Effect - Nausea | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Nausea) |
| W12_vac_effects_9 | Vax Side Effect - Muscle Pain | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Muscle Pain) |
| W12_vac_effects_10 | Vax Side Effect - Other | Did you have any side effects from the COVID-19 vaccine? (choose all that apply) (choice=Other) |
| W12_vac_effects_specify | Vax Side Effect - Specify Other | Please specify other |
| W12_vac_int_1 | Vaccine Offer | Which of the following describes you? (Please select one) |
| W12_vac_again | Vax Again | If offered, would you get the COVID-19 vaccine again? |