COVID Questionnaire - Medical
| Name | Description | Question text |
|---|---|---|
| W10_covid_1 | Has had COVID-19 coronavarus | Have you had COVID-19 coronavirus? |
| W10_covid_2a | Tested positive for COVID-19 coronavirus with medical test | Select all of the following that are true: (choice=I tested positive for COVID-19 coronavirus with a medical test) |
| W10_covid_2b | Doctor or medical professional said they had COVID-19 based on symptoms | Select all of the following that are true: (choice=A doctor or medical professional said I had COVID-19 based on my symptoms) |
| W10_covid_2c | Had COVID-19 coronavirus-like symptoms | Select all of the following that are true: (choice=I had symptoms that seemed like COVID-19 coronavirus) |
| W10_covid_2d | Had inconclusive COVID-19 coronavirus test | Select all of the following that are true: (choice=I had an inconclusive test for COVID-19 coronavirus) |
| W10_covid_2e | Was in close contact with someone who had COVID-19 coronavirus | Select all of the following that are true: (choice=I was in close contact with someone who had COVID-19 coronavirus) |
| W10_covid_2f | Travelled to location with COVID-19 coronavirus outbreak | Select all of the following that are true: (choice=I travelled to a location where there was an outbreak of COVID-19 coronavirus) |
| W10_covid3a | Fever greater than 100.4 degrees F | Fever greater than 100.4� F |
| W10_covid3b | Chills | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Chills |
| W10_covid3c | Sore throat | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Sore throat |
| W10_covid3f | Dry cough | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Dry cough |
| W10_covid3g | Cough with phlegm | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Cough with phlegm |
| W10_covid3h | Shortness of Breath | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Feeling like you can't catch your breath (shortness of breath) |
| W10_covid3i | Feeling chest pain/tightness/pressure | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Feeling chest pain, tightness or pressure, or like a weight is on your chest |
| W10_covid3j | Body or muscle aches | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Body or muscle aches |
| W10_covid3k | Fatigue | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Fatigue (tired) |
| W10_covid3l | Loss of taste or smell | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Loss of taste or smell |
| W10_covid3n | Diarrhea | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Diarrhea |
| W10_covid3o | Confusion/Disorientation | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Felt confused or disoriented |
| W10_covid3p | Loss of appetite | When you had (or when you think you might have had) COVID-19 coronavirus, did you have any of the following symptoms? Loss of appetite |
| W10_covid_5 | Date COVID-19 symptoms started | When you had (or when you think you might have had) COVID-19 coronavirus, about when did your symptoms start? |
| W10_covid_6 | Length of time symptoms lasted | How long did your symptoms last? |
| W10_covid_7 | How bad COVID-19 coronavirus symptoms felt | When you had (or when you think you might have had) COVID-19 coronavirus, on a scale from 1 to 10, how bad did you feel when you felt the worst? |
| W10_covid_8 | Looked for medical care | When you had (or when you think you might have had) COVID-19 coronavirus, did you seek medical care? |
| W10_covid_9a | Doctor's office | Where did you seek care? Select all that apply. (choice=Doctors office) |
| W10_covid_9b | Telemedicine/telephone triage | Where did you seek care? Select all that apply. (choice=Telemedicine/telephone triage) |
| W10_covid_9c | Retail clinic/pharmacy | Where did you seek care? Select all that apply. (choice=Retail clinic/pharmacy) |
| W10_covid_9d | Urgent care | Where did you seek care? Select all that apply. (choice=Urgent care) |
| W10_covid_9e | Emergency department | Where did you seek care? Select all that apply. (choice=Emergency department) |
| W10_covid_9f | Health department/Public health clinic | Where did you seek care? Select all that apply. (choice=Health department/Public health clinic) |
| W10_covid_9g | Other | Where did you seek care? Select all that apply. (choice=Other) |
| W10_covid_10 | Delay between COVID-19 symptoms and seeking care | How long after your symptoms started did you seek care? |
| W10_covid_11 | Told they had pneumonia by medical professional | Were you told by a medical professional that you had pneumonia? |
| W10_covid_12 | Received oxygen tank | Did you get an oxygen tank to take home? |
| W10_covid_13 | Stayed overnight in hospital | Did you stay overnight in the hospital? |
| W10_covid_14 | Number of nights in hospital | How many nights? |
| W10_covid_15 | Given oxygen in hospital | Were you given oxygen in the hospital? |
| W10_covid_16 | Put on ventilator | Were you on a ventilator? |
| W10_covid_17 | Has had cold/flu-like illness (Since Feb 2020) | Since February 2020, have you had any illness with cold or flu-like symptoms (for example, a cough, sore throat or fever)? |
| W10_covid_18 | Number of times sick | How many times have you been sick since February 2020 with cold or flu-like symptoms? |
| W10_covid_91 | Date illness began | About when did this illness start? |
| W10_covid92a | Fever greater than 100.4 degrees F | For your next most recent illness, did you have any of the following symptoms? - Fever greater than 100.4� F |
| W10_covid92b | Chills | For your next most recent illness, did you have any of the following symptoms? - Chills |
| W10_covid92c | Sore throat | For your next most recent illness, did you have any of the following symptoms? - Sore throat |
| W10_covid92f | Dry cough | For your next most recent illness, did you have any of the following symptoms? - Dry cough |
| W10_covid92g | Cough with phlegm | For your next most recent illness, did you have any of the following symptoms? - Cough with phlegm |
| W10_covid92h | Shortness of Breath | For your next most recent illness, did you have any of the following symptoms? - Feeling like you can't catch your breath (shortness of breath) |
| W10_covid92i | Feeling chest pain/tightness/pressure | For your next most recent illness, did you have any of the following symptoms? - Feeling chest pain, tightness or pressure, or like a weight is on your chest |
| W10_covid92j | Body or muscle aches | For your next most recent illness, did you have any of the following symptoms? - Body or muscle aches |
| W10_covid92k | Fatigue | For your next most recent illness, did you have any of the following symptoms? - Fatigue (tired) |
| W10_covid92l | Loss of taste or smell | For your next most recent illness, did you have any of the following symptoms? - Loss of taste or smell |
| W10_covid92n | Diarrhea | For your next most recent illness, did you have any of the following symptoms? - Diarrhea |
| W10_covid92o | Confusion/Disorientation | For your next most recent illness, did you have any of the following symptoms? - Felt confused or disoriented |
| W10_covid92p | Loss of appetite | For your next most recent illness, did you have any of the following symptoms? - Loss of appetite |
| W10_covid_93 | How bad illness symptoms felt | On a scale of 1 to 10, how bad was this illness? |
| W10_covid_94 | Length of time symptoms lasted | How long did your symptoms last? |
| W10_covid_95 | Looked for medical care | Did you seek medical care? |
| W10_covid_96a | Doctor's office | Where did you seek care? Select all that apply. (choice=Doctors office) |
| W10_covid_96b | Telemedicine/telephone triage | Where did you seek care? Select all that apply. (choice=Telemedicine/telephone triage) |
| W10_covid_96c | Retail clinic/pharmacy | Where did you seek care? Select all that apply. (choice=Retail clinic/pharmacy) |
| W10_covid_96d | Urgent care | Where did you seek care? Select all that apply. (choice=Urgent care) |
| W10_covid_96e | Emergency department | Where did you seek care? Select all that apply. (choice=Emergency department) |
| W10_covid_96f | Health department/Public health clinic | Where did you seek care? Select all that apply. (choice=Health department/Public health clinic) |
| W10_covid_96g | Other | Where did you seek care? Select all that apply. (choice=Other) |
| W10_covid_97 | Delay between illness symptoms and seeking care | How long after your symptoms started did you seek care? |
| W10_covid_98 | Told they had pneumonia by medical professional | Were you told by a medical professional that you had pneumonia? |
| W10_covid_99 | Received oxygen tank | Did you get an oxygen tank to take home? |
| W10_covid_100 | Stayed overnight in hospital | Did you stay overnight in the hospital? |
| W10_covid_101 | Number of nights in hospital | How many nights? |
| W10_covid_102 | Given oxygen in hospital | Were you given oxygen in the hospital? |
| W10_covid_103 | Put on ventilator | Were you on a ventilator? |
| W10_covid_19 | Date illness began | About when did this illness start? |
| W10_covid20a | Fever greater than 100.4 degrees F | For your second most recent illness, did you have any of the following symptoms? - Fever greater than 100.4� F |
| W10_covid20b | Chills | For your second most recent illness, did you have any of the following symptoms? - Chills |
| W10_covid20c | Sore throat | For your second most recent illness, did you have any of the following symptoms? - Sore throat |
| W10_covid20f | Dry cough | For your second most recent illness, did you have any of the following symptoms? - Dry cough |
| W10_covid20g | Cough with phlegm | For your second most recent illness, did you have any of the following symptoms? - Cough with phlegm |
| W10_covid20h | Shortness of Breath | For your second most recent illness, did you have any of the following symptoms? - Feeling like you can't catch your breath (shortness of breath) |
| W10_covid20i | Feeling chest pain/tightness/pressure | For your second most recent illness, did you have any of the following symptoms? - Feeling chest pain, tightness or pressure, or like a weight is on your chest |
| W10_covid20j | Body or muscle aches | For your second most recent illness, did you have any of the following symptoms? - Body or muscle aches |
| W10_covid20k | Fatigue | For your second most recent illness, did you have any of the following symptoms? - Fatigue (tired) |
| W10_covid20l | Loss of taste or smell | For your second most recent illness, did you have any of the following symptoms? - Loss of taste or smell |
| W10_covid20n | Diarrhea | For your second most recent illness, did you have any of the following symptoms? - Diarrhea |
| W10_covid20o | Confusion/Disorientation | For your second most recent illness, did you have any of the following symptoms? - Felt confused or disoriented |
| W10_covid20p | Loss of appetite | For your second most recent illness, did you have any of the following symptoms? - Loss of appetite |
| W10_covid_21 | How bad illness symptoms felt | On a scale of 1 to 10, how bad was this illness? |
| W10_covid_22 | Length of time symptoms lasted | How long did your symptoms last? |
| W10_covid_23 | Looked for medical care | Did you seek medical care? |
| W10_covid_24a | Doctor's office | Where did you seek care? Select all that apply. (choice=Doctors office) |
| W10_covid_24b | Telemedicine/telephone triage | Where did you seek care? Select all that apply. (choice=Telemedicine/telephone triage) |
| W10_covid_24c | Retail clinic/pharmacy | Where did you seek care? Select all that apply. (choice=Retail clinic/pharmacy) |
| W10_covid_24d | Urgent care | Where did you seek care? Select all that apply. (choice=Urgent care) |
| W10_covid_24e | Emergency department | Where did you seek care? Select all that apply. (choice=Emergency department) |
| W10_covid_24f | Health department/Public health clinic | Where did you seek care? Select all that apply. (choice=Health department/Public health clinic) |
| W10_covid_24g | Other | Where did you seek care? Select all that apply. (choice=Other) |
| W10_covid_25 | Delay between illness symptoms and seeking care | How long after your symptoms started did you seek care? |
| W10_covid_26 | Told they had pneumonia by medical professional | Were you told by a medical professional that you had pneumonia? |
| W10_covid_27 | Received oxygen tank | Did you get an oxygen tank to take home? |
| W10_covid_28 | Stayed overnight in hospital | Did you stay overnight in the hospital? |
| W10_covid_29 | Number of nights in hospital | How many nights? |
| W10_covid_30 | Given oxygen in hospital | Were you given oxygen in the hospital? |
| W10_covid_31 | Put on ventilator | Were you on a ventilator? |
| W10_covid_32 | Date illness began | About when did this illness start? |
| W10_covid33a | Fever greater than 100.4 degrees F | Fever greater than 100.4� F |
| W10_covid33b | Chills | Chills |
| W10_covid33c | Sore throat | Sore throat |
| W10_covid33f | Dry cough | Dry cough |
| W10_covid33g | Cough with phlegm | Cough with phlegm |
| W10_covid33h | Shortness of Breath | Feeling like you can't catch your breath (shortness of breath) |
| W10_covid33i | Feeling chest pain/tightness/pressure | Feeling chest pain, tightness or pressure, or like a weight is on your chest |
| W10_covid33j | Body or muscle aches | Body or muscle aches |
| W10_covid33k | Fatigue | Fatigue (tired) |
| W10_covid33l | Loss of taste or smell | Loss of taste or smell |
| W10_covid33n | Diarrhea | Diarrhea |
| W10_covid33o | Confusion/Disorientation | Felt confused or disoriented |
| W10_covid33p | Loss of appetite | Loss of appetite |
| W10_covid_34 | How bad illness symptoms felt | On a scale of 1 to 10, how bad was this illness? |
| W10_covid_35 | Length of time symptoms lasted | How long did your symptoms last? |
| W10_covid_36 | Looked for medical care | Did you seek medical care? |
| W10_covid_37a | Doctor's office | Where did you seek care? Select all that apply. (choice=Doctors office) |
| W10_covid_37b | Telemedicine/telephone triage | Where did you seek care? Select all that apply. (choice=Telemedicine/telephone triage) |
| W10_covid_37c | Retail clinic/pharmacy | Where did you seek care? Select all that apply. (choice=Retail clinic/pharmacy) |
| W10_covid_37d | Urgent care | Where did you seek care? Select all that apply. (choice=Urgent care) |
| W10_covid_37e | Emergency department | Where did you seek care? Select all that apply. (choice=Emergency department) |
| W10_covid_37f | Health department/Public health clinic | Where did you seek care? Select all that apply. (choice=Health department/Public health clinic) |
| W10_covid_37g | Other | Where did you seek care? Select all that apply. (choice=Other) |
| W10_covid_38 | Delay between illness symptoms and seeking care | How long after your symptoms started did you seek care? |
| W10_covid_39 | Told they had pneumonia by medical professional | Were you told by a medical professional that you had pneumonia? |
| W10_covid_40 | Received oxygen tank | Did you get an oxygen tank to take home? |
| W10_covid_41 | Stayed overnight in hospital | Did you stay overnight in the hospital? |
| W10_covid_42 | Number of nights in hospital | How many nights? |
| W10_covid_43 | Given oxygen in hospital | Were you given oxygen in the hospital? |
| W10_covid_44 | Put on ventilator | Were you on a ventilator? |
| W10_covid_45 | Date illness began | About when did this illness start? |
| W10_covid46a | Fever greater than 100.4 degrees F | Fever greater than 100.4� F |
| W10_covid46b | Chills | Chills |
| W10_covid46c | Sore throat | Sore throat |
| W10_covid46f | Dry cough | Dry cough |
| W10_covid46g | Cough with phlegm | Cough with phlegm |
| W10_covid46h | Shortness of Breath | Feeling like you can't catch your breath (shortness of breath) |
| W10_covid46i | Feeling chest pain/tightness/pressure | Feeling chest pain, tightness or pressure, or like a weight is on your chest |
| W10_covid46j | Body or muscle aches | Body or muscle aches |
| W10_covid46k | Fatigue | Fatigue (tired) |
| W10_covid46l | Loss of taste or smell | Loss of taste or smell |
| W10_covid46n | Diarrhea | Diarrhea |
| W10_covid46o | Confusion/Disorientation | Felt confused or disoriented |
| W10_covid46p | Loss of appetite | Loss of appetite |
| W10_covid_47 | How bad illness symptoms felt | On a scale of 1 to 10, how bad was this illness? |
| W10_covid_48 | Length of time symptoms lasted | How long did your symptoms last? |
| W10_covid_49 | Looked for medical care | Did you seek medical care? |
| W10_covid_50a | Doctor's office | Where did you seek care? Select all that apply. (choice=Doctors office) |
| W10_covid_50b | Telemedicine/telephone triage | Where did you seek care? Select all that apply. (choice=Telemedicine/telephone triage) |
| W10_covid_50c | Retail clinic/pharmacy | Where did you seek care? Select all that apply. (choice=Retail clinic/pharmacy) |
| W10_covid_50d | Urgent care | Where did you seek care? Select all that apply. (choice=Urgent care) |
| W10_covid_50e | Emergency department | Where did you seek care? Select all that apply. (choice=Emergency department) |
| W10_covid_50f | Health department/Public health clinic | Where did you seek care? Select all that apply. (choice=Health department/Public health clinic) |
| W10_covid_50g | Other | Where did you seek care? Select all that apply. (choice=Other) |
| W10_covid_51 | Delay between illness symptoms and seeking care | How long after your symptoms started did you seek care? |
| W10_covid_52 | Told they had pneumonia by medical professional | Were you told by a medical professional that you had pneumonia? |
| W10_covid_53 | Received oxygen tank | Did you get an oxygen tank to take home? |
| W10_covid_54 | Stayed overnight in hospital | Did you stay overnight in the hospital? |
| W10_covid_55 | Number of nights in hospital | How many nights? |
| W10_covid_56 | Given oxygen in hospital | Were you given oxygen in the hospital? |
| W10_covid_57 | Put on ventilator | Were you on a ventilator? |
| W10_covid_58 | Told they had pneumonia | Pneumonia? |
| W10_covid_59 | Told they had influenza (flu) | Influenza (flu)? |
| W10_covid_60 | Had blood test diagnosis | Did you have a blood test diagnosis? |
| W10_covid_61 | Went to emergency room/urgent care | Did you go to an emergency room or urgent care? |
| W10_covid_62 | Date illness began | About when did this illness start? |