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

Question Title

* 2. The Nova Scotia Health Authority is made up of four geographic management zones. Which one do you live in?

Central Zone (Halifax area, Eastern Shore and West Hants)

Eastern Zone (Cape Breton, Guysborough and Antigonish areas)

Northern Zone (Colchester-East Hants, Cumberland and Pictou areas)

Western Zone (Annapolis Valley, South Shore and South West)

Question Title

* 3. Which COVID-19 vaccine(s) did you get?

Pfizer-BioNTech (Comirnaty)

Moderna (SpikeVax COVID-19)

AstraZeneca (Vaxzevria)

Janssen (Johnson & Johnson)

Two different vaccinations

Booster

Question Title

* 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.

No. I did not have an adverse reaction.

Yes I did - and it was after the first dose.

Yes I did - and it was after the second dose.

Yes I did - and it was after the booster.

Question Title

* 5. If yes, please identify what reaction(s) that you experienced.

Paraesthesia (tingling or prickling)

Vaccination site pain

Headache Pruritus (itching)

Dyspnoea (laboured breathing)

Fatigue

Nausea

Vaccination site erythema (redness)

Urticaria (hives)

Dizziness

Fever ≥ 38°C

Hypoaesthesia (numbness)

Vaccination site swelling

Erythema (redness)

Chest pain

Pain

Vaccination site warmth

Chest discomfort

Chills

Arthralgia (joint pain)

Vomiting

Diarrhea

Myocarditis/pericarditis

Pain in extremity

Rash

Throat tightness

Adenopathy/lymphadenopathy (swollen lymph nodes)

Myalgia (muscle pain)

Dysphagia (difficulty swallowing)

Asthenia (weakness)

Vaccination site pruritus (itching)

Malaise (discomfort)

Tachycardia (fast heartbeat)

Vaccination site reaction

Bell's Palsy/facial paralysis

Rash generalized (non-allergic)

Cough

Hypersensitivity

Vaccination site cellulitis

Abdominal pain

Feeling hot

Swelling face

Swollen tongue

Vaccination site rash

Flushing

Lip swelling

Dysphonia (hoarse voice)

Oropharyngeal pain (throat pain)

Vaccination site induration (hardness)

Dermatitis allergic

If the adverse event that you experienced is not listed above please identify if it was a:
Serious Adverse Event Following Immunization: the at has resulted in AT LEAST one of the following: Hospitalization or prolongation of existing hospitalization; Death or permanent disability/incapacity.

Non-serious AEFI: An adverse event following immunization that does not meet the criteria for a serious AEFI (as described above) and meets the criteria below: A reaction that did not require hospitalization or prolongation of existing hospitalization; a reaction that did not result in death or permanent disability/incapacity.

Question Title

* 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.

Guillain-Barré Syndrome - Auto-immune disease

Thrombocytopenia (low blood platelets) - Auto-immune disease

Cardiac arrest - Cardiovascular system

Cardiac failure - Cardiovascular system

Myocardial infarction (heart attack) - Cardiovascular system

Myocarditis1/Pericarditis (inflammation of the heart muscle and lining around the heart) - Cardiovascular system

Cerebral venous (sinus) thrombosis - Circulatory system

Cerebral thrombosis - Circulatory system

Cutaneous vasculitis - Circulatory system

Deep vein thrombosis - Circulatory system

Embolism - Circulatory system

Haemorrhage (bleeding) - Circulatory system

Pulmonary embolism - Circulatory system

Thrombosis (blood clot) - Circulatory system

Thrombosis with thrombocytopenia syndrome1 (blood clot with low platelets) Circulatory system

Acute kidney injury - Hepato-gastrointestinal and renal system

Glomerulonephritis (kidney inflammation) and nephrotic syndrome (kidney disorder) - Hepato-gastrointestinal and renal system

Liver injury - Hepato-gastrointestinal and renal system

Bell's Palsy1/facial paralysis - Nerves and central nervous system

Cerebrovascular accident (stroke) - Nerves and central nervous system

Transverse myelitis (inflammation of spinal cord) - Nerves and central nervous system

Anaphylaxis

COVID-19

Multisystem inflammatory syndrome

Fetal growth restriction - Pregnancy outcomes

Spontaneous abortion - Pregnancy outcomes

Acute respiratory distress syndrome - Respiratory system

Chilblains - Skin and mucous membrane, bone and joints system

Erythema multiforme (immune skin reaction) - Skin and mucous membrane, bone and joints system

Capillary leak syndrome

Question Title

* 7. Please choose what age group you are in or the age group you are filling out this survey for.

Birth to 4 years old.

5-11

12-19

20-29

30-39

40-49

50-59

60-69

70-79

80-89

90+

Question Title

* 8. If you experienced an adverse event please check the boxes below that pertain to your experience.

I was able to manage it on my own.

I visited my family doctor.

I needed to call an ambulance.

I went to outpatients/emergency.

I was hospitalized.

I was hospitalized in the ICU.

I was referred to a specialist.

Question Title

* 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.

No. I did not notify my health care provider.

Yes. I notified my health care provider but a report was not done.

Yes. I notified my health care provider and a report was done.

I don't know.

Question Title

* 10. Why did you decide to get the COVID-19 vaccine?

To protect myself and others from COVID-19.

Because the Premier and Dr. Strang said it was safe and effective.

To travel.

Because of my job.

To play and watch sports.

I wanted my freedoms and for things to go back to normal.

Other.

COMPLETE SURVEY ON C0V1DI9 INJECTIONS -
NOVA SCOTIA RESIDENTS ONLY PLEASE

NOVA SCOTIANS: Record Your Side Effects/Adverse Reactions.

Question Title

* 1. Please identify your province or territory.

Question Title

* 2. The Nova Scotia Health Authority is made up of four geographic management zones. Which one do you live in?

Question Title

* 3. Which COVID-19 vaccine(s) did you get?

Question Title

* 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.

Question Title

* 5. If yes, please identify what reaction(s) that you experienced.

Question Title

* 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.

Question Title

* 7. Please choose what age group you are in or the age group you are filling out this survey for.

Question Title

* 8. If you experienced an adverse event please check the boxes below that pertain to your experience.

Question Title

* 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.

Question Title

* 10. Why did you decide to get the COVID-19 vaccine?

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

NOVA SCOTIANS: Record Your Side Effects/Adverse Reactions.

Question Title

* 1. Please identify your province or territory.

Question Title

* 2. The Nova Scotia Health Authority is made up of four geographic management zones. Which one do you live in?

Question Title

* 3. Which COVID-19 vaccine(s) did you get?

Question Title

* 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.

Question Title

* 5. If yes, please identify what reaction(s) that you experienced.

Question Title

* 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.

Question Title

* 7. Please choose what age group you are in or the age group you are filling out this survey for.

Question Title

* 8. If you experienced an adverse event please check the boxes below that pertain to your experience.

Question Title

* 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.

Question Title

* 10. Why did you decide to get the COVID-19 vaccine?

COMPLETE SURVEY ON C0V1DI9 INJECTIONS -
NOVA SCOTIA RESIDENTS ONLY PLEASE

* 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.