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COMPLETE SURVEY ON C*0*V*1*D*I*9 INJECTIONS -
NOVA SCOTIA RESIDENTS ONLY PLEASE

NOVA SCOTIANS: Record Your Side Effects/Adverse Reactions.

We would like to provide the people in Canada who have had the COVID-19 vaccine(s)/boosters the opportunity to complete the following 10 question survey on Adverse Events Following Immunization (AEFI).

If you do not see an adverse reaction that you experienced please identify if it was serious or non-serious in Question 5.


Thank you.




1.Please identify your province or territory.
2.The Nova Scotia Health Authority is made up of four geographic management zones. Which one do you live in?
3.Which COVID-19 vaccine(s) did you get?
4.Did you experience any adverse events/reactions to the COVID-19 vaccine and if "Yes" - how many doses did you have when you experienced the reaction.
5.If yes, please identify what reaction(s) that you experienced.
6.Did you experience any of the following Adverse Events of Special Interest below? (AESI)

These are pre-specified medically significant events that have the potential to be causally associated with a vaccine product.
7.Please choose what age group you are in or the age group you are filling out this survey for.
8.If you experienced an adverse event please check the boxes below that pertain to your experience.
9.If you experienced an adverse event/reaction to the COVI-19 vaccine, did you notify your health care provider and did he or she file a report.
10.Why did you decide to get the COVID-19 vaccine?