Generated Narrative: QuestionnaireResponse ActiveMonitoringDay3SurveyQuestionnaireResponse version: 1; Last updated: 2024-04-21 22:07:18+0000 LinkID Text Definition Answer ActiveMonitoringDay3SurveyQuestionnaireResponse Questionnaire:Post Vaccine Symptom Check day 3 survey #xD; p01-Intro 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’ Immunization/452fb7d0-8d3d-4534-a147-25560206edc2 #xD; p02-Screening Screening #xD; p02-q01-VaccineType Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago [not stated] Only flu vaccine: Only flu vaccine #xD; p02-q02-SideEffects We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination? [not stated] Yes: Yes #xD; p02-q03-SideEffectsScreening #xD; p02-q03.1-WhoReceived Who received the vaccine? [not stated] Myself: Myself #xD; p02-q03.2-WhereReceived Where did you/they go to receive your/their vaccination? [not stated] Community vaccination centre: Community vaccination centre #xD; p02-q03.3-Pregnant Were you/they pregnant/Hapu at the time of your/their vaccination? false #xD; p03-EarlyOnsetReactions Early onset reactions #xD; p03-q01-SelectedSideEffects Did you/they experience any of the following after vaccination? (choose all that apply) [not stated] None of the above: None of the above #xD; p04-Reactions Reactions #xD; p04-q01-ReactionsIntro 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. #xD; p04-q02-InjectionSiteDisorder Injection site reaction (pain, redness, swelling, or itching at or near the injection site) false #xD; p04-q04-Fever Fever (a temperature of 38°C or higher) false #xD; p04-q06-Swelling Swelling of glands (i.e., lymph nodes) false #xD; p04-q09-Chills Chills, shivering, or cold sweats false #xD; p04-q11-Headaches Headaches false #xD; p04-q13-Rash Rash (not at the injection site) false #xD; p04-q15-AchesPains Aches and pains false #xD; p04-q17-DigestiveDisorder Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite) false #xD; p04-q19-Fatigue Fatigue or tiredness false #xD; p04-q21-ChestSymptoms Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing) false #xD; p04-q23-DifficultyBreathing Difficulty breathing false #xD; p04-q25-Dizziness Dizziness or feeling lightheaded false #xD; p04-q27-OtherSymptoms Did you/they experience any symptoms that were not listed above? false #xD; p05-DailyImpact Impact on daily activities #xD; p05-q01-MissedWork Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities? true #xD; p05-q02-MissedWorkDetail How many days did you miss? [not stated] Less than 1 day: Less than 1 day #xD; p06-CareSought Medical advice/care sought #xD; p06-q01-SymptomRelief Did any of the symptoms cause you/them to seek advice or care from a healthcare professional? true #xD; p06-q02-SymptomReliefDetail Please choose the type of advice or care you/they sought. Please choose all that apply #xD; p07-VaccinationExperience Vaccination experience #xD; p07-q01-OverallExperience 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. [not stated] Average: Average #xD; p07-q02-Comments Do you/they have any comments about your/their vaccine experience? true #xD; p07-q03-CommentsDetail Please explain ASsA #xD; p08-Thanks 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. #xD; Documentation for this format
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’
Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago
We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination?
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)
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.
Injection site reaction (pain, redness, swelling, or itching at or near the injection site)
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)
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.