COVID Questionnaire - Vaccine
NameDescriptionQuestion text
W11_vac_YNCovid vaccine - y/nHave you received the COVID-19 vaccine?
W11_vac_locCovid vaccine - SiteWhere did you get the vaccine?
W11_vac_loc_specCovid vaccine - Site other specifyPlease specify other
W11_vaccine_dose_num_toldCovid vaccine - DosesHow many doses of the vaccine were you told to get?
W11_one_vac_timeCovid vaccine - Date of first doseWhen did you receive the dose?
W11_vac_2nd_doseCovid vaccine - Number of dosesHow many doses of the vaccine have you received?
W11_vac_2nd_dose_whenCovid vaccine - Date of second doseWhen did you receive the second dose?
W11_vac_typeCovid vaccine - ManufacturerDo you know which COVID-19 vaccine you got?
W11_vac_type_spec_2Covid vaccine - Manufacturer specify otherPlease specify other
W11_vac_int_1Covid vaccine - AttitudeWhich of the following describes you? (Please select one)
W11_vac_getCovid vaccine - AccessibiltyIf the COVID-19 vaccine were easily available to you, how likely would you be to get it?
W11_vac_learnCovid vaccine - Learning moreAre you interested in learning more about the vaccine?
W11_vac_info_confCovid vaccine - How confident do you feel that you know where to obtain information about the vaccine?
W11_vac_eff_cov19_sickCovid vaccine - ProtectHow effective do you believe the current government approved vaccines (Moderna, Pfizer) are at preventing people from getting sick with COVID-19?
W11_vac_eff_cov19_sevCovid vaccine - Protect against severe covidHow effective do you believe the current government approved vaccines (Moderna, Pfizer) are at preventing people from getting sick with a severe case of COVID-19?
W11_vac_tierCovid vaccine - TierDo you know what COVID-19 vaccine tier you are in? (i.e. when it will be your turn to get the vaccine?)
W11_vac_turnCovid vaccine - TurnDo you know how you will be told when it's your turn for a COVID-19 vaccine?
W11_vac_costCovid vaccine - CostDo you know how much the COVID-19 vaccine costs?
W11_vac_hes_1Hesitancy - ProtectThe vaccine could protect me against getting COVID-19.
W11_vac_hes_2Hesitancy - Protect family and friendsIf I get the vaccine, that could protect my family and friends from getting COVID-19
W11_vac_hes_3Hesitancy - Unpleasant side effectsI worry that the vaccine might cause some unpleasant side effects.
W11_vac_hes_4Hesitancy - Long term side effectsI worry that the vaccine might cause long term health effects for me.
W11_vac_hes_5Hesitancy - HarmfulI worry that the vaccine might cause more harm than getting COVID-19.
W11_vac_hes_6Hesitancy - DifussionIf enough other people get the vaccine, I do not need to get it.
W11_vac_hes_7Hesitancy - QuickI am worried that the vaccine was developed too quickly.
W11_vac_hes_8Hesitancy - SickI am worried that I could get sick with COVID-19 by taking the vaccine.
W11_vac_hes_9Hesitancy - FreeI would get a vaccine for COVID-19 if it was available for free to anyone who wanted it.
W11_vac_hes_10Hesitancy - EveryoneI believe it is important for everyone to take the COVID-19 vaccine to help end the pandemic.
W11_vac_hes_11Hesitancy - Family and friendsGetting the COVID-19 vaccine is important so I can see my friends and family.
W11_vac_hes_12Hesitancy - SocializingGetting the COVID-19 vaccine is important so I can go to bars, clubs, and restaurants.
W11_vac_hes_13Hesitancy - TrustI trust that the U.S. government approval of the vaccine means it is safe and effective.
W11_vac_hes_14Hesitancy - Not afriadI am not afraid of COVID-19, so I don't think getting a vaccine is necessary.
W11_vac_hes_15Hesitancy - Health insuranceI am concerned I can't get the vaccine because I don't have health insurance, or my insurance won't cover the vaccine.
W11_vac_hes_16Hesitancy - AccessibilityI am concerned I can't get the vaccine because I don't know where or how to get the vaccine.
W11_vac_hes_17Hesitancy - Too complicatedTrying to get the vaccine is too complicated or is too much trouble.
W11_vac_hes_18Hesitancy - No trustI don't plan to get the vaccine because I don't trust doctors.
W11_vac_hes_19Hesitancy - YoungI don't need to get the vaccine because I am young and healthy.
W11_vac_info_imp_1Vaccine info - AccessibleWhat type of information about the COVID-19 vaccine is most important for you?... Where and how to get the vaccine.
W11_vac_info_imp_2Vaccine info - CostWhat type of information about the COVID-19 vaccine is most important for you?... How much the vaccine costs.
W11_vac_info_imp_3Vaccine info - EffectiveWhat type of information about the COVID-19 vaccine is most important for you?... If the vaccine is effective in preventing COVID-19.
W11_vac_info_imp_5Vaccine info - Side effectsWhat type of information about the COVID-19 vaccine is most important for you?... The types of negative side effects that people can get from the vaccine.
W11_vac_info_trust_1Vaccine info trust - CDCIndicate how much you trust the following sources of information about the COVID-19 vaccine... The CDC (U.S. Center for Disease Control and Prevention)
W11_vac_info_trust_2Vaccine info trust - PresidentIndicate how much you trust the following sources of information about the COVID-19 vaccine... President Joe Biden
W11_vac_info_trust_3Vaccine info trust - Vice presidentIndicate how much you trust the following sources of information about the COVID-19 vaccine... Vice President Kamala Harris
W11_vac_info_trust_4Vaccine info trust - FauciIndicate how much you trust the following sources of information about the COVID-19 vaccine... Dr. Anthony Fauci
W11_vac_info_trust_5Vaccine info trust - TrumpIndicate how much you trust the following sources of information about the COVID-19 vaccine... Former President Donald Trump
W11_vac_info_trust_6Vaccine info trust - Governor or mayorIndicate how much you trust the following sources of information about the COVID-19 vaccine... The governor of my state or the mayor of my city/town
W11_vac_info_trust_8Vaccine info trust - Department of public healthIndicate how much you trust the following sources of information about the COVID-19 vaccine... The state or city department of public health
W11_vac_info_trust_9Vaccine info trust - DoctorsIndicate how much you trust the following sources of information about the COVID-19 vaccine... My own doctors
W11_vac_info_trust_12Vaccine info trust - ReligionIndicate how much you trust the following sources of information about the COVID-19 vaccine... My religion's church, temple, or synagogue
W11_vac_info_trust_13Vaccine info trust - EmployerIndicate how much you trust the following sources of information about the COVID-19 vaccine... My employer
W11_vac_info_trust_14Vaccine info trust - SchoolIndicate how much you trust the following sources of information about the COVID-19 vaccine... My college, university, or school
W11_vac_info_trust_15Vaccine info trust - ParentsIndicate how much you trust the following sources of information about the COVID-19 vaccine... My parents
W11_vac_info_trust_16Vaccine info trust - FriendsIndicate how much you trust the following sources of information about the COVID-19 vaccine... My friends
W11_vac_pref_receive_1Vaccine info preference - TextWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... Text
W11_vac_pref_receive_2Vaccine info preference - PhoneWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... Phone call
W11_vac_pref_receive_3Vaccine info preference - EmailWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... Email
W11_vac_pref_receive_4Vaccine info preference - WebsiteWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... Website
W11_vac_pref_receive_5Vaccine info preference - Social mediaWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... On my social media feed
W11_vac_pref_receive_6Vaccine info preference - YouTubeWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... YouTube video
W11_vac_pref_receive_7Vaccine info preference - TV commercialWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... TV commercial
W11_vac_pref_receive_8Vaccine info preference - In personWhat would be the most preferred way for you to receive information about the COVID-19 vaccine?... In person
W11_vac_priority_1Priority - Health conditionPlease check if any of the below currently apply to you... Have had cancer, kidney disease, severe lung or heart disease, type-2 diabetes, or sickle cell anemia
W11_vac_priority_2Priority - HealthcarePlease check if any of the below currently apply to you... Work in healthcare
W11_vac_priority_3Priority - EducationPlease check if any of the below currently apply to you... Work in either education and childcare, emergency services, food services, or agriculture
W11_vac_priority_4Priority - CriticalPlease check if any of the below currently apply to you... Work in either critical manufacturing, transportation services, logistics, or industrial, commercial, residential, and sheltering facilities and services.
W11_vac_priority_5Priority - HomelessnessPlease check if any of the below currently apply to you... Homelessness
W11_vac_priority_6Priority - IncarceratedPlease check if any of the below currently apply to you... Incarcerated
W11_vac_priority_7Priority - Waste and energyPlease check if any of the below currently apply to you... Work in either water and wastewater, defense, energy, chemical and hazardous materials, communications and IT, or financial services industries or government operations / community-based essential functions