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 | RANDS | Which of the following symptoms have you had at any point in time since March 1, 2020? [CHECK ALL THAT APPLY] | 2020 |
| RANDS | Which of the following occurred as a result of your symptoms? [CHECK ALL THAT APPLY] | 2020 |
| RANDS | In the two weeks before you had symptoms, did you: [MARK ALL THAT APPLY] | 2020 |
| PRAMS | Do you have Chronic Pain, which is pain lasting more than 12 weeks or 3 months? | 2019 |
| VA | Did (s)he vomit? | 2019 |
| VA | To clarify: Did (s)he vomit in the week preceding the death? | 2019 |
| VA | Did (s)he have mental confusion? | 2019 |
| VA | Did (s)he have sores or ulcers anywhere on the body? | 2019 |
| VA | Did (s)he have an ulcer (pit) on the foot? | 2019 |
| VA | Did (s)he have any lumps? | 2019 |
| VA | Did (s)he have difficulty swallowing? | 2019 |
| VA | Did (s)he have pain upon swallowing? | 2019 |
| VA | Did her menstrual period stop naturally because of menopause or removal of uterus? | 2019 |
| Not Applicable | Adult or Direct: "Did you feel sick to your stomach or did you vomit? /Proxy: "Did your child complain of feeling sick to his or her stomach?" | 2016 |
| Not Applicable | Adult or Direct: “Were you knocked out, blackened out, or did you lose consciousness, even briefly? /Proxy: “Was your child knocked out, blacked out, or did you child lose consciousness, even briefly?" | 2016 |
| Not Applicable | Adult or Direct: "Did you have a headache?" / Proxy: “Did your child complain of a headache?” | 2016 |
| Not Applicable | Did this occur: immediately after the injury, in the hours or days after the injury, or both immediately and in the hours or days after the injury? | 2016 |
| Not Applicable | Adult: "Was there ever a time when you were dizzy, uncoordinated, had poor balance, were stumbling around, or moved more slowly than usual?” / PROXY: “Did your child appear or complain of dizziness, appear to move in a clumsy manner, or have balance problems?”/ DIRECT: “Was there a time when you were dizzy, moved in a clumsy manner, or had balance problems?” | 2016 |
| Not Applicable | Adult or Direct: "Did you have blurred vision or changes in your vision?” / PROXY: Did your child have or complain about visual problems such as blurry or double vision?” | 2016 |
| Not Applicable | Did [you/your child] have trouble concentrating? | 2016 |
| Not Applicable | Adult: "Did you have difficulty thinking clearly, remember, or learning new things?” / PROXY: “Did your child become confused with directions or tasks or answer questions more slowly than usual?” DIRECT: “Did you become confused with directions or tasks, or answer questions more slowly than usual?” | 2016 |
| Not Applicable | Adult or Direct: "Were you sensitive to light or noise?” / PROXY: “Was your child sensitive to light or noise?” | 2016 |
| Not Applicable | Adult or Direct: "Did you experience a change in mood or personality such as irritability, changes in emotional responses, or feeling more bothered by things?” / PROXY “Did your child act more or less emotional than usual, more irritable, or more bothered by things?” | 2016 |
| Not Applicable | Adult: "Did you have trouble with sleep? Such as, did you have trouble falling asleep, were you more drowsy than usual, did you get tired easily or more frequently than usual, or did you sleep noticeably more or less than usual?” / PROXY: “Did your child appear drowsy, sleep more than usual, or appear more tired or fatigued?” / DIRECT: “Did you feel drowsy, sleep more than usual or feel more tired or fatigued?” | 2016 |
| Not Applicable | [Are you/ Is your child] still experiencing any of the injury-related symptoms that we’ve talked about? | 2016 |