| covid19_new |
|
radio |
SELECT THIS FIELD if you are entering data for a COVID-19 participant where data has been collected via the new short CRF |
1, Data in new COVID-19 short CRF |
| version_9_7 |
|
radio |
Data entered for CRF version 9.7 or later? |
1, Yes |
| ni_site |
|
radio |
Northern Irish data? |
1, Yes |
| dsstdat |
|
text (date_dmy) |
Date of enrolment |
|
| sitename |
|
text |
Site name |
|
| corona_ieorres |
CLINICAL INCLUSION CRITERIA |
yesno |
Suspected or proven infection with pathogen of Public Health Interest |
1, Yes ; 0, No |
| coriona_ieorres2 |
|
yesno |
Proven or high likelihood of infection with pathogen of Public Health Interest |
1, Yes ; 0, No |
| coriona_ieorres3 |
|
yesno |
Proven infection with pathogen of Public Health Interest N.B. For acute covid-19, please only collect data from proven (laboratory test-positive) people. |
1, Yes ; 0, No |
| fever |
Experience of the following symptoms during this illness episode (one or more required for inclusion) |
yesno |
A history of self-reported feverishness or measured fever of ≥ 38°C |
1, Yes ; 0, No |
| cough |
|
yesno |
Cough |
1, Yes ; 0, No |
| dyspnoe |
|
yesno |
Dyspnoea (shortness of breath) OR Tachypnoea |
1, Yes ; 0, No |
| ari |
|
yesno |
Clinical suspicion of ARI despite not meeting above criteria |
1, Yes ; 0, No |
| inflammatory_mss |
|
yesno |
Meets case definition for inflammatory multi-system syndrome (MIS-C/MIS-A) |
1, Yes ; 0, No |
| noncorona_expphi |
|
yesno |
High suspicion of exposure of Public Health Interest - this does not relate to covid-19 exposuren |
1, Yes ; 0, No |
| resprate |
|
descriptive |
respiratory rate ≥50 breaths/min for < 1 year; ≥40 breaths/min for 1-4 years; ≥30 breaths/min for 5-12 years; ≥20 breaths/min for ≥13 years |
|
| symptoms_epi_travel |
EPIDEMIOLOGICAL FACTORS - In the 14 days before onset of illness had any of the following: |
radio |
History of travel to area with documented cases of nCoV infection |
1, Yes ; 2, No ; 3, Unknown |
| symptoms_epi_physical |
|
radio |
Close contact with confirmed/probable case of nCoV infection while asymp. |
1, Yes ; 2, No ; 3, Unknown |
| symptoms_epi_healthfac |
|
radio |
Presence in healthcare facility where nCoV infections have been managed |
1, Yes ; 2, No ; 3, Unknown |
| symptoms_epi_lab |
|
radio |
Presence in laboratory handling suspected or confirmed nCoV samples |
1, Yes ; 2, No ; 3, Unknown |
| symptoms_epi_pathogen |
|
radio |
Otherwise unexplained respiratory illness in context of outbreak/incident |
1, Yes ; 2, No ; 3, Unknown |
| symptoms_epi_animal |
|
radio |
Contact with animals in countries where nCoV is known to be a result of zoonosis |
1, Yes ; 2, No ; 3, Unknown |
| contact |
|
descriptive |
Close contact' is defined as:- Health care associated exposure, including providing directcare for patients, e.g. health care worker, direct exposure tobody fluids or specimens including aerosols, working withhealth care workers infected with the pathogen of public healthinterest, visiting patients or staying in the same closeenvironment of relevant case.- Working together in close proximity or sharing the sameclassroom environment with a relevant case- Traveling together with in any kind of conveyance with arelevant case- Living in the same household as a relevant case |
|
| inclusion_criteria_complete |
Form Status |
dropdown |
Inclusion criteria section completed? |
0, Incomplete ; 1, Unverified ; 2, Complete |