Protocol - Long COVID - Symptoms Due to COVID-19 - Pediatric

1. If you have had symptoms of COVID-19, how much do you agree with the following statement?

2. How do you feel right now?
[ ] I feel as healthy as normal
[ ] I am not feeling quite right

3. Do you have a fever?
[ ] Yes
[ ] No

4. Do you feel chills or shivers (feel too cold)?
[ ] Yes
[ ] No

5. If you are able to measure it, what is your temperature?
________

6. Do you have a persistent cough (coughing a lot for more than an hour, or 3 or more coughing episodes in 24 hours)?
[ ] Yes
[ ] No

7. Are you experiencing unusual fatigue/tiredness?
[ ] No
[ ] Mild fatigue
[ ] Severe fatigue - I struggle to get out of bed

8. Are you experiencing problems with your sleep, including getting to sleep, waking in the night or waking early?
[ ] Yes
[ ] No

 8a. If yes, please describe
 ______________________

9. Are you experiencing unusual shortness of breath?
[ ] No
[ ] Yes, mild symptoms - slight shortness of breath during ordinary activity
[ ] Yes, significant symptoms - breathing is comfortable only at rest
[ ] Yes, severe symptoms - breathing is difficult even at rest

10. What are your current symptoms? (Please tick all that apply)
[ ] loss of smell/taste
[ ] unusually hoarse voice
[ ] unusual chest pain or tightness in your chest
[ ] unusual abdominal pain
[ ] diarrhoea
[ ] headache
[ ] confusion, disorientation or drowsiness
[ ] unusual eye-soreness or discomfort (e.g. light sensitivity, excessive tears, or pink/red eye)
[ ] skipping meals
[ ] dizziness or light-headedness
[ ] sore throat
[ ] unusual strong muscle pains
[ ] earache or ringing in your ears (tinnitus)
[ ] raised, red, itchy welts on the skin or sudden swelling of the face or lips
[ ] red/purple sores or blisters on your feet, including your toes
[ ] no symptoms
[ ] other

 10a. Are there other important symptoms you want to share with us?
 ____________

11. Since the start of your COVID-19 symptoms, have you had a period longer than one week with none of the above symptoms at all (where you were back to how you were pre-COVID)
[ ] Yes (I have had a period of one week or more since my test with none of the above symptoms)
[ ] No (My symptoms have been continuous since Covid test)
[ ] Not applicable