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Information gathered from this survey will help us better understand how patients and survivors of severe adverse hypersensitivity drug reactions are reacting to the COVID-19 vaccines. 

Although responses may be shared with the public, personal identifying information will be kept confidential.

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* 1. Patient Information

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* 2. Please confirm that you have taken the COVID-19 vaccine before completing this survey.

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* 5. What is your age?

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* 6. Please describe your gender.

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* 7. Please describe your ethnicity.

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* 8. Was your severe adverse drug reaction diagnosed by a physician?

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* 9. What year were you diagnosed with or suspected of having a severe adverse drug reaction?

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* 10. Which drug reaction did you have?

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* 11. Was a known medication associated with your adverse reaction?

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* 12. Which medication is believed to have caused your adverse reaction?

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* 13. If not a medication, what was thought to be the cause of your adverse reaction?

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* 14. Which vaccine did you receive?

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* 15. How would you describe your reaction to the 1st dose of vaccine?

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* 16. Did you experience any of the following symptoms after being vaccinated with the 1st dose?

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* 17. How would you describe your reaction to the 2nd dose of vaccine?

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* 18. Did you experience any of the following symptoms after being vaccinated with the 2nd dose?

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* 19. What else would you like to share about your experience with the COVID-19 vaccine?

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