Research on COVID-19 Vaccine reactions.
Nigerian Covid Response Alliance is conducting a research on COVID-19 Vaccine reactions. Thanks for sparing 5 minutes of your time to help complete this form. Confidentiality will be ensured.
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1. Email address
Optional
2. Age *
3. Sex: *
4. Occupation *
5. Are you suffering from any of these medical conditions? *
Required
6. Have you been vaccinated? *
7. Which of the vaccine brands were you given? *
8. How many doses of the vaccine have you received? *
9. Which of these adverse effect did you experience? (Tick as apply) *
Required
10. After which dose(s)? *
11. If yes, did you report these adverse effects? *
12. If yes, who did you report to? *
13. Do you know anyone who has experienced adverse reactions following COVID 19 vaccination? *
14. Which of these adverse effects do you know to have been reported by people who took the vaccine? (Tick as apply) *
Required
15. Why did you receive the vaccine? (Tick as apply) *
Required
 16. Have you been infected or reinfected with COVID 19 despite being vaccinated? *
17. Do you know any fully vaccinated person who got infected after vaccination? *
18. Do you regret taking the vaccine? *
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