asymptomatic |
ONSET and ADMISSION |
radio |
Asymptomatic? |
1, Asymptomatic |
cestdat |
|
text (date_dmy) |
Onset date of first/earliest symptom |
|
hostdat |
|
text (date_dmy) |
Admission date at facility |
|
hosttim |
|
text |
Admission time at facility |
|
readm_cov19 |
|
radio |
Is patient being readmitted with COVID-19? (Please only addre-admission episodes for COVID patients remaining or newpositive COVID test- Please assign new subject ID) |
1, Yes ; 0, No ; 3, N/K |
prev_subjid |
|
text |
Previous participant ID if known |
|
prev_subjid_nk |
|
radio |
Previous participant ID not known |
1, N/K |
readminreas |
|
text |
Reason for readmission if known |
|
readminreasnk |
|
radio |
Reason for readmission not known |
1, N/K |
susp_reinf |
|
radio |
Suspected reinfection with COVID-19? Defined as proven (PCR/antibody test) or highly probable (clinical definition met more than 21 days prior to proven COVID-19 infection) |
1, Yes ; 0, No ; 3, N/K |
surgefacil |
|
radio |
Is a NIGHTINGALE or other SURGE facility? |
1, Yes ; 0, No ; 3, N/K |
hooccur |
|
radio |
Transfer from other facility? |
1, Yes-other facility is a study site ; 2, Yes-other facility is not a study site ; 3, No ; 4, N/A |
siteid_transfer |
|
text |
If transfer, name of transfer facility if known |
|
siteid_transfernk |
|
radio |
If transfer, name of transfer facility not known |
1, N/K |
hostdat_transfer |
|
text (date_dmy) |
If transfer, admission date at previous facillity |
|
hostdat_transfernk |
|
radio |
If transfer, admission date at previous facillity not known |
1, N/K |
subjidcat_trasnfer |
|
radio |
If transfer, comparison of subjid at transfer facility |
1, Same as above ; 2, Different ; 3, N/A |
subjid_transfer |
|
text |
If subjidcat_transfer == different, previous participant number |
|
travel_erterm |
|
radio |
Travel in 14 days prior to first symptom onset |
1, Yes ; 2, No ; 3, N/A |
supper_trcntry |
|
dropdown |
If travel, state country location |
4, Afghanistan ; 5, Albania ; 6, Algeria ; 7, Andorra ; 8, Angola ; 9, Antigua and Barbuda ; 10, Argentina ; 11, Armenia ; 12, Aruba ; 13, Australia ; 14, Austria ; 15, Azerbaijan ; 1, Bahamas (The) ; 16, Bahrain ; 17, Bangladesh ; 18, Barbados ; 19, Belarus ; 20, Belgium ; 21, Belize ; 22, Benin ; 23, Bhutan ; 24, Bolivia ; 25, Bosnia and Herzegovina ; 26, Botswana ; 27, Brazil ; 28, Brunei ; 29, Bulgaria ; 30, Burkina Faso ; 31, Burma ; 32, Burundi ; 33, Cambodia ; 34, Cameroon ; 35, Canada ; 36, Cabo Verde ; 37, Central African Republic ; 38, Chad ; 39, Chile ; 40, China ; 41, Colombia ; 42, Comoros ; 2, Congo (Republic of the) ; 43, Costa Rica ; 44, Cote d'Ivoire ; 45, Croatia ; 46, Cuba ; 47, Curacao ; 48, Cyprus ; 49, Czechia ; 50, Denmark ; 51, Djibouti ; 52, Dominica ; 53, Dominican Republic ; 54, Ecuador ; 55, Egypt ; 56, El Salvador ; 57, Equatorial Guinea ; 58, Eritrea ; 59, Estonia ; 60, Ethiopia ; 61, Fiji ; 62, Finland ; 63, France ; 64, Gabon ; 3, Gambia (The) ; 65, Georgia ; 66, Germany ; 67, Ghana ; 68, Greece ; 69, Grenada ; 70, Guatemala ; 71, Guinea ; 72, Guinea-Bissau ; 73, Guyana ; 74, Haiti ; 75, Holy See ; 76, Honduras ; 77, Hong Kong ; 78, Hungary ; 79, Iceland ; 80, India ; 81, Indonesia ; 82, Iran ; 83, Iraq ; 84, Ireland ; 85, Israel ; 86, Italy ; 87, Jamaica ; 88, Japan ; 89, Jordan ; 90, Kazakhstan ; 91, Kenya ; 92, Kiribati ; 202, Korea (South) ; 93, Kosovo ; 94, Kuwait ; 95, Kyrgyzstan ; 96, Laos ; 97, Latvia ; 98, Lebanon ; 99, Lesotho ; 100, Liberia ; 101, Libya ; 102, Liechtenstein ; 103, Lithuania ; 104, Luxembourg ; 105, Macau ; 106, Macedonia ; 107, Madagascar ; 108, Malawi ; 109, Malaysia ; 110, Maldives ; 111, Mali ; 112, Malta ; 113, Marshall Islands ; 114, Mauritania ; 115, Mauritius ; 116, Mexico ; 117, Micronesia ; 118, Moldova ; 119, Monaco ; 120, Mongolia ; 121, Montenegro ; 122, Morocco ; 123, Mozambique ; 124, Namibia ; 125, Nauru ; 126, Nepal ; 127, Netherlands ; 128, New Zealand ; 129, Nicaragua ; 130, Niger ; 131, Nigeria ; 132, North Korea ; 133, Norway ; 134, Oman ; 135, Pakistan ; 136, Palau ; 137, Palestinian Territories ; 138, Panama ; 139, Papua New Guinea ; 140, Paraguay ; 141, Peru ; 142, Philippines ; 143, Poland ; 144, Portugal ; 145, Qatar ; 146, Romania ; 147, Russia ; 148, Rwanda ; 149, Saint Kitts and Nevis ; 150, Saint Lucia ; 151, Saint Vincent and the Grenadines ; 152, Samoa ; 153, San Marino ; 154, Sao Tome and Principe ; 155, Saudi Arabia ; 156, Senegal ; 157, Serbia ; 158, Seychelles ; 159, Sierra Leone ; 160, Singapore ; 161, Sint Maarten ; 162, Slovakia ; 163, Slovenia ; 164, Solomon Islands ; 165, Somalia ; 166, South Africa ; 167, South Korea ; 168, South Sudan ; 169, Spain ; 170, Sri Lanka ; 171, Sudan ; 172, Suriname ; 173, Swaziland ; 174, Sweden ; 175, Switzerland ; 176, Syria ; 177, Taiwan ; 178, Tajikistan ; 179, Tanzania ; 180, Thailand ; 181, Timor-Leste ; 182, Togo ; 183, Tonga ; 184, Trinidad and Tobago ; 185, Tunisia ; 186, Turkey ; 187, Turkmenistan ; 188, Tuvalu ; 189, Uganda ; 190, Ukraine ; 191, United Arab Emirates ; 192, United Kingdom ; 201, United States ; 193, Uruguay ; 194, Uzbekistan ; 195, Vanuatu ; 196, Venezuela ; 197, Vietnam ; 198, Yemen ; 199, Zambia ; 200, Zimbabwe |
supper_trcity |
|
text |
If travel, state city/geographic area |
|
erendat |
|
text (date_dmy) |
If travel, return date |
|
travel_erterm_2 |
|
radio |
Travelled to another country in the 14 days prior to first symptom onset? |
1, Yes ; 2, No ; 3, N/A |
supper_trcntry_2 |
|
dropdown |
Travel to another country 14 days prior to first symptom onset |
4, Afghanistan ; 5, Albania ; 6, Algeria ; 7, Andorra ; 8, Angola ; 9, Antigua and Barbuda ; 10, Argentina ; 11, Armenia ; 12, Aruba ; 13, Australia ; 14, Austria ; 15, Azerbaijan ; 1, Bahamas (The) ; 16, Bahrain ; 17, Bangladesh ; 18, Barbados ; 19, Belarus ; 20, Belgium ; 21, Belize ; 22, Benin ; 23, Bhutan ; 24, Bolivia ; 25, Bosnia and Herzegovina ; 26, Botswana ; 27, Brazil ; 28, Brunei ; 29, Bulgaria ; 30, Burkina Faso ; 31, Burma ; 32, Burundi ; 33, Cambodia ; 34, Cameroon ; 35, Canada ; 36, Cabo Verde ; 37, Central African Republic ; 38, Chad ; 39, Chile ; 40, China ; 41, Colombia ; 42, Comoros ; 2, Congo (Republic of the) ; 43, Costa Rica ; 44, Cote d'Ivoire ; 45, Croatia ; 46, Cuba ; 47, Curacao ; 48, Cyprus ; 49, Czechia ; 50, Denmark ; 51, Djibouti ; 52, Dominica ; 53, Dominican Republic ; 54, Ecuador ; 55, Egypt ; 56, El Salvador ; 57, Equatorial Guinea ; 58, Eritrea ; 59, Estonia ; 60, Ethiopia ; 61, Fiji ; 62, Finland ; 63, France ; 64, Gabon ; 3, Gambia (The) ; 65, Georgia ; 66, Germany ; 67, Ghana ; 68, Greece ; 69, Grenada ; 70, Guatemala ; 71, Guinea ; 72, Guinea-Bissau ; 73, Guyana ; 74, Haiti ; 75, Holy See ; 76, Honduras ; 77, Hong Kong ; 78, Hungary ; 79, Iceland ; 80, India ; 81, Indonesia ; 82, Iran ; 83, Iraq ; 84, Ireland ; 85, Israel ; 86, Italy ; 87, Jamaica ; 88, Japan ; 89, Jordan ; 90, Kazakhstan ; 91, Kenya ; 92, Kiribati ; 202, Korea (South) ; 93, Kosovo ; 94, Kuwait ; 95, Kyrgyzstan ; 96, Laos ; 97, Latvia ; 98, Lebanon ; 99, Lesotho ; 100, Liberia ; 101, Libya ; 102, Liechtenstein ; 103, Lithuania ; 104, Luxembourg ; 105, Macau ; 106, Macedonia ; 107, Madagascar ; 108, Malawi ; 109, Malaysia ; 110, Maldives ; 111, Mali ; 112, Malta ; 113, Marshall Islands ; 114, Mauritania ; 115, Mauritius ; 116, Mexico ; 117, Micronesia ; 118, Moldova ; 119, Monaco ; 120, Mongolia ; 121, Montenegro ; 122, Morocco ; 123, Mozambique ; 124, Namibia ; 125, Nauru ; 126, Nepal ; 127, Netherlands ; 128, New Zealand ; 129, Nicaragua ; 130, Niger ; 131, Nigeria ; 132, North Korea ; 133, Norway ; 134, Oman ; 135, Pakistan ; 136, Palau ; 137, Palestinian Territories ; 138, Panama ; 139, Papua New Guinea ; 140, Paraguay ; 141, Peru ; 142, Philippines ; 143, Poland ; 144, Portugal ; 145, Qatar ; 146, Romania ; 147, Russia ; 148, Rwanda ; 149, Saint Kitts and Nevis ; 150, Saint Lucia ; 151, Saint Vincent and the Grenadines ; 152, Samoa ; 153, San Marino ; 154, Sao Tome and Principe ; 155, Saudi Arabia ; 156, Senegal ; 157, Serbia ; 158, Seychelles ; 159, Sierra Leone ; 160, Singapore ; 161, Sint Maarten ; 162, Slovakia ; 163, Slovenia ; 164, Solomon Islands ; 165, Somalia ; 166, South Africa ; 167, South Korea ; 168, South Sudan ; 169, Spain ; 170, Sri Lanka ; 171, Sudan ; 172, Suriname ; 173, Swaziland ; 174, Sweden ; 175, Switzerland ; 176, Syria ; 177, Taiwan ; 178, Tajikistan ; 179, Tanzania ; 180, Thailand ; 181, Timor-Leste ; 182, Togo ; 183, Tonga ; 184, Trinidad and Tobago ; 185, Tunisia ; 186, Turkey ; 187, Turkmenistan ; 188, Tuvalu ; 189, Uganda ; 190, Ukraine ; 191, United Arab Emirates ; 192, United Kingdom ; 201, United States ; 193, Uruguay ; 194, Uzbekistan ; 195, Vanuatu ; 196, Venezuela ; 197, Vietnam ; 198, Yemen ; 199, Zambia ; 200, Zimbabwe |
supper_trcity_2 |
|
text |
If travel, state city/geographic area |
|
erendat_2 |
|
text (date_dmy) |
If travel, return date |
|
animal_eryn |
|
radio |
Contact with animals, raw meat or insect bites 14 days prior to first symptom onset |
1, Yes ; 2, No ; 3, Unknown ; 4, N/A |
animal_erterm |
|
text |
If yes |
|
animal_erdat |
|
text (date_dmy) |
If YES, specify the animal/insect date of exposure |
|
animal_eryn_2 |
|
radio |
Contact with other animals, raw meat or insect bites 14 days prior to first symptom onset |
1, Yes ; 2, No ; 3, Unknown ; 4, N/A |
animal_erterm_2 |
|
text |
If YES, specify the animal/insect |
|
animal_erdat_2 |
|
text (date_dmy) |
If YES, specify the animal/insect date of exposure |
|
onset_and_admission_complete |
Form Status |
dropdown |
Onset and admission section completed? |
0, Incomplete ; 1, Unverified ; 2, Complete |