Generated Narrative: Questionnaire ActiveMonitoringDay3Survey Structure LinkID Text Cardinality Type Description & Constraints ActiveMonitoringDay3Survey Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey. Questionnaire https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey#0.2.2 #xD; p01-Intro page 01. This is the first of two surveys about your experience with receiving your vaccine. This survey will take approximately five minutes to complete. You will be asked about any reactions you had after your vaccination(s). If you did not have any there is also a section at the end for you to comment on any other parts of your vaccination experience. Your responses are important and will help contribute to the safety monitoring of vaccines in New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccinations: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’ 0..1 display #xD; p02-Screening page 02. Screening 0..1 group #xD; p02-q01-VaccineType page 02 question 1. Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago 1..1 choice Options: 5 options #xD; p02-q02-SideEffects page 02 question 2. We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination? 1..1 choice Options: 3 options #xD; p02-q03-SideEffectsScreening page 02 question 3. null 0..1 group #xD; p02-q03.1-WhoReceived page 02 question 3.1. Who received the vaccine? 1..1 choice Options: 2 options #xD; p02-q03.2-WhereReceived page 02 question 3.2. Where did you/they go to receive your/their vaccination? 1..1 choice Options: 6 options #xD; p02-q03.3-Pregnant page 02 question 3.3. Were you/they pregnant/Hapu at the time of your/their vaccination? 1..1 boolean #xD; p03-EarlyOnsetReactions page 03. Early onset reactions 0..1 group #xD; p03-q01-SelectedSideEffects page 03 question 1. Did you/they experience any of the following after vaccination? (choose all that apply) 1..* choice Options: 5 options #xD; p03-q02-AnaphylaxisDelay page 03 question 2. How long after vaccination did anaphylaxis occur? 1..1 choice Enable When: p03-q01-SelectedSideEffects = Options: 5 options #xD; p03-q03-SyncopeDelay page 03 question 3. How long after vaccination did syncope occur? 1..1 choice Enable When: p03-q01-SelectedSideEffects = Options: 5 options #xD; p03-q04-SeizureDelay page 03 question 4. How long after vaccination did the seizure/ convulsions occur? 1..1 choice Enable When: p03-q01-SelectedSideEffects = Options: 5 options #xD; p03-q05-SeizureComorbidity page 03 question 5. Did seizure/ convulsions occur with: 1..1 choice Enable When: p03-q01-SelectedSideEffects = Options: 4 options #xD; p04-Reactions page 04. Reactions 0..1 group #xD; p04-q01-ReactionsIntro page 04 question 1. Please choose all the reactions that you/they experienced, and if yes describe, on a scale from Minor, Mild, Moderate, Serious, to Severe. For your rating take into account levels of pain, how long symptoms lasted and impact on daily life. 0..1 display #xD; p04-q02-InjectionSiteDisorder page 04 question 2. Injection site reaction (pain, redness, swelling, or itching at or near the injection site) 1..1 boolean #xD; p04-q03-InjectionSiteSeverity page 04 question 3. Injection site reaction severity 1..1 choice Enable When: p04-q02-InjectionSiteDisorder = Options: 5 options #xD; p04-q04-Fever page 04 question 4. Fever (a temperature of 38°C or higher) 1..1 boolean #xD; p04-q05-FeverSeverity page 04 question 5. Temperature/fever severity 1..1 choice Enable When: p04-q04-Fever = Options: 5 options #xD; p04-q06-Swelling page 04 question 6. Swelling of glands (i.e., lymph nodes) 1..1 boolean #xD; p04-q07-SwellingLocation page 04 question 7. Where abouts did you experience swelling? 1..1 choice Enable When: p04-q06-Swelling = Options: 3 options #xD; p04-q08-SwellingSeverity page 04 question 8. Swelling of glands severity 1..1 choice Enable When: p04-q06-Swelling = Options: 5 options #xD; p04-q09-Chills page 04 question 9. Chills, shivering, or cold sweats 1..1 boolean #xD; p04-q10-ChillsSeverity page 04 question 10. Chills/shivering/cold sweats severity 1..1 choice Enable When: p04-q09-Chills = Options: 5 options #xD; p04-q11-Headaches page 04 question 11. Headaches 1..1 boolean #xD; p04-q12-HeadachesSeverity page 04 question 12. Headache severity 1..1 choice Enable When: p04-q11-Headaches = Options: 5 options #xD; p04-q13-Rash page 04 question 13. Rash (not at the injection site) 1..1 boolean #xD; p04-q14-RashSeverity page 04 question 14. Rash severity 1..1 choice Enable When: p04-q13-Rash = Options: 5 options #xD; p04-q15-AchesPains page 04 question 15. Aches and pains 1..1 boolean #xD; p04-q16-AchesPainsSeverity page 04 question 16. Aches and pains severity 1..1 choice Enable When: p04-q15-AchesPains = Options: 5 options #xD; p04-q17-DigestiveDisorder page 04 question 17. Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite) 1..1 boolean #xD; p04-q18-DigestiveDisorderSeverity page 04 question 18. Stomach symptoms severity 1..1 choice Enable When: p04-q17-DigestiveDisorder = Options: 5 options #xD; p04-q19-Fatigue page 04 question 19. Fatigue or tiredness 1..1 boolean #xD; p04-q20-FatigueSeverity page 04 question 20. Fatigue or tiredness severity 1..1 choice Enable When: p04-q19-Fatigue = Options: 5 options #xD; p04-q21-ChestSymptoms page 04 question 21. Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing) 1..1 boolean #xD; p04-q22-ChestSymptomsSeverity page 04 question 22. Chest symptoms severity 1..1 choice Enable When: p04-q21-ChestSymptoms = Options: 5 options #xD; p04-q23-DifficultyBreathing page 04 question 23. Difficulty breathing 1..1 boolean #xD; p04-q24-DifficultyBreathingSeverity page 04 question 24. Difficulty breathing severity 1..1 choice Enable When: p04-q23-DifficultyBreathing = Options: 5 options #xD; p04-q25-Dizziness page 04 question 25. Dizziness or feeling lightheaded 1..1 boolean #xD; p04-q26-DizzinessSeverity page 04 question 26. Dizziness or lightheaded severity 1..1 choice Enable When: p04-q25-Dizziness = Options: 5 options #xD; p04-q27-OtherSymptoms page 04 question 27. Did you/they experience any symptoms that were not listed above? 1..1 boolean #xD; p04-q28-OtherSymptomsDetail page 04 question 28. Please explain 1..1 string Enable When: p04-q27-OtherSymptoms = #xD; p05-DailyImpact page 05. Impact on daily activities 0..1 group #xD; p05-q01-MissedWork page 05 question 1. Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities? 1..1 boolean #xD; p05-q02-MissedWorkDetail page 05 question 2. How many days did you miss? 1..1 choice Enable When: p05-q01-MissedWork = Options: 4 options #xD; p06-CareSought page 06. Medical advice/care sought 0..1 group #xD; p06-q01-SymptomRelief page 06 question 1. Did any of the symptoms cause you/them to seek advice or care from a healthcare professional? 1..1 boolean #xD; p06-q02-SymptomReliefDetail page 06 question 2. Please choose the type of advice or care you/they sought. Please choose all that apply 1..* choice Enable When: p06-q01-SymptomRelief = Options: 8 options #xD; p07-VaccinationExperience page 07. Vaccination experience 0..1 group #xD; p07-q01-OverallExperience page 07 question 1. How would you/they rate the overall experience at the vaccination site? For your rating take into account informed consent process, staff helpfulness, vaccination site cleanliness etc. 1..1 choice Options: 5 options #xD; p07-q02-Comments page 07 question 2. Do you/they have any comments about your/their vaccine experience? 1..1 boolean #xD; p07-q03-CommentsDetail page 07 question 3. Please explain 1..1 text Enable When: p07-q02-Comments = #xD; p08-Thanks page 08. Thank you for completing the Day 3 post vaccine survey, your answers have been submitted. You will receive your next survey 42 days after your vaccination. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential. 0..1 display #xD; Documentation for this format Options Sets Answer options for p02-q01-VaccineType null#COVID-19 and flu vaccines at the same time ("COVID-19 and flu vaccines at the same time") null#Only flu vaccine ("Only flu vaccine") null#Only COVID-19 vaccine ("Only COVID-19 vaccine") null#Other vaccine ("Other vaccine") null#Was not vaccinated or do not recall ("Was not vaccinated or do not recall") Answer options for p02-q02-SideEffects null#Yes ("Yes") null#No ("No") null#Can't remember ("Can't remember") Answer options for p02-q03.1-WhoReceived null#Myself ("Myself") null#My dependent/whānau member ("My dependent/whānau member") Answer options for p02-q03.2-WhereReceived null#Community vaccination centre ("Community vaccination centre") null#General practice ("General practice") null#Pharmacy ("Pharmacy") null#Mobile vaccination unit ("Mobile vaccination unit") null#Hospital or emergency room ("Hospital or emergency room") null#Other ("Other") Answer options for p03-q01-SelectedSideEffects null#Anaphylaxis ("Anaphylaxis") null#Syncope (fainting) ("Syncope (fainting)") null#Seizure/ convulsion ("Seizure/ convulsion") null#I don't know/ unsure ("I don't know/ unsure") null#None of the above ("None of the above") Answer options for p03-q02-AnaphylaxisDelay null#0-5 minutes ("0-5 minutes") null#6-10 minutes ("6-10 minutes") null#11-15 minutes ("11-15 minutes") null#16-20 minutes ("16-20 minutes") null#21+ minutes ("21+ minutes") Answer options for p03-q03-SyncopeDelay null#0-5 minutes null#6-10 minutes ("6-10 minutes") null#11-15 minutes ("11-15 minutes") null#16-20 minutes ("16-20 minutes") null#21+ minutes ("21+ minutes") Answer options for p03-q04-SeizureDelay null#0-5 minutes null#6-10 minutes ("6-10 minutes") null#11-15 minutes ("11-15 minutes") null#16-20 minutes ("16-20 minutes") null#21+ minutes ("21+ minutes") Answer options for p03-q05-SeizureComorbidity null#Syncope (fainting) ("Syncope (fainting)") null#Fever ("Fever") null#Other ("Other") null#I don't know ("I don't know") Answer options for p04-q03-InjectionSiteSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q05-FeverSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q07-SwellingLocation null#Same arm as vaccination ("Same arm as vaccination") null#Opposite arm to vaccination ("Opposite arm to vaccination") null#Other ("Other") Answer options for p04-q08-SwellingSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q10-ChillsSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q12-HeadachesSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q14-RashSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q16-AchesPainsSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q18-DigestiveDisorderSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q20-FatigueSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q22-ChestSymptomsSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q24-DifficultyBreathingSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p04-q26-DizzinessSeverity null#Minor ("Minor") null#Mild ("Mild") null#Moderate ("Moderate") null#Serious ("Serious") null#Severe ("Severe") Answer options for p05-q02-MissedWorkDetail null#Less than 1 day ("Less than 1 day") null#1 day ("1 day") null#2 days ("2 days") null#3 or more days ("3 or more days") Answer options for p06-q02-SymptomReliefDetail null#Phone advice from a helpline e.g., Healthline ("Phone advice from a helpline (e.g., Healthline)") null#Care from a GP clinic including the clinic nurse, a doctor, or a phone call with a person at the GP clinic. ("Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).") null#Visit to a hospital emergency department ("Visit to a hospital emergency department") null#Māori Health Provider ("Māori Health Provider") null#Rongoā clinic ("Rongoā clinic") null#Whānau Ora navigator ("Whānau Ora navigator") null#Pharmacy ("Pharmacy") null#Other ("Other") Answer options for p07-q01-OverallExperience null#Very poor ("Very poor") null#Poor ("Poor") null#Average ("Average") null#Good ("Good") null#Excellent ("Excellent")
%vaccineReceived = 'COVID-19 and flu vaccines at the same time' or %vaccineReceived = 'Only flu vaccine' or %vaccineReceived = 'Only COVID-19 vaccine'
%resource.item.where(linkId='p02-Screening').item.where(linkId='p02-q02-SideEffects').answer.valueCoding.display = 'Yes' or %resource.item.where(linkId='p02-Screening').item.where(linkId='p02-q02-SideEffects').answer.valueCoding.display = 'Can\'t remember'
Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey.
Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 3 days.
This is the first of two surveys about your experience with receiving your vaccine. This survey will take approximately five minutes to complete. You will be asked about any reactions you had after your vaccination(s). If you did not have any there is also a section at the end for you to comment on any other parts of your vaccination experience. Your responses are important and will help contribute to the safety monitoring of vaccines in New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccinations: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’
Kia ora This is the first of two surveys about your experience with receiving your recent vaccination(s). This survey will take approximately five minutes to complete. You will be asked about any reactions you had after your vaccination(s). If you did not have any, there is also a section at the end for you to comment on any other parts of your vaccination experience. Your responses are important and will help contribute to the safety monitoring of vaccines in Aotearoa New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccinations: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’ If you need any help completing your survey you can call 0800 855 066 for assistance.
Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago
COVID-19 and flu vaccines at the same time
We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination?
%validVaccine and %experiencedSideEffects
Where did you/they go to receive your/their vaccination?
Were you/they pregnant/Hapu at the time of your/their vaccination?
Did you/they experience any of the following after vaccination? (choose all that apply)
How long after vaccination did anaphylaxis occur?
How long after vaccination did syncope occur?
How long after vaccination did the seizure/ convulsions occur?
Please choose all the reactions that you/they experienced, and if yes describe, on a scale from Minor, Mild, Moderate, Serious, to Severe. For your rating take into account levels of pain, how long symptoms lasted and impact on daily life.
Please choose all the reactions that you/they experienced. If yes, describe the reaction on a scale from minor, mild, moderate, serious, to severe. For your rating take into account levels of pain, how long symptoms lasted and impact on daily life
Injection site reaction (pain, redness, swelling, or itching at or near the injection site)
Where abouts did you experience swelling?
Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite)
Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing)
Did you/they experience any symptoms that were not listed above?
Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities?
Did any of the symptoms cause you/them to seek advice or care from a healthcare professional?
Please choose the type of advice or care you/they sought. Please choose all that apply
Phone advice from a helpline e.g., Healthline
Phone advice from a helpline (e.g., Healthline)
Care from a GP clinic including the clinic nurse, a doctor, or a phone call with a person at the GP clinic.
Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).
Visit to a hospital emergency department
How would you/they rate the overall experience at the vaccination site? For your rating take into account informed consent process, staff helpfulness, vaccination site cleanliness etc.
How would you/they rate the overall experience at the vaccination site? For your rating take into account informed consent process, staff helpfulness, vaccination site cleanliness, etc.
Do you/they have any comments about your/their vaccine experience?
Thank you for completing the Day 3 post vaccine survey, your answers have been submitted. You will receive your next survey 42 days after your vaccination. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential.
Thank you for completing the Day 3 post vaccine survey, your answers have been submitted. You will receive your next survey 42 days after your vaccination. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential. Ngā mihi Health New Zealand