Health New Zealand Te Whatu Ora Shared Care FHIR API
0.4.5 - release

Health New Zealand Te Whatu Ora Shared Care FHIR API - Local Development build (v0.4.5) built by the FHIR (HL7® FHIR® Standard) Build Tools. See the Directory of published versions

## Questionnaire: Post Vaccine Symptom Check day 3 survey

Official URL: https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey | Version: 0.2.2
Draft as of 2023-08-23 | Computable Name: ActiveMonitoringDay3Survey
Other Identifiers: ActiveMonitoringDay3Survey (use: official, period: 7/19/23 --> (ongoing)), Questionnaire-ActiveMonitoring-Day3SurveyQuestionnaire (use: temp, period: (?) --> 7/19/23)
Usage:Workflow Setting:

Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey.

Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 3 days.

Structure

LinkID | Text | Cardinality | Type | Description & Constraints
--- | --- | --- | --- | ---
ActiveMonitoringDay3Survey | Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey. |  | Questionnaire | https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey#0.2.2
p01-Intro | page 01. This is the first of two surveys about your experience with receiving your vaccine. This survey will take approximately five minutes to complete. You will be asked about any reactions you had after your vaccination(s). If you did not have any there is also a section at the end for you to comment on any other parts of your vaccination experience. Your responses are important and will help contribute to the safety monitoring of vaccines in New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards. Please remember this is a survey only, your answers will not result in a medical response to your situation. If you have any concerns about your health after your vaccination, call Healthline at 0800 611 116 or speak to your healthcare professional. If you experience any of the following symptoms, you should seek medical help urgently and tell them about your vaccinations: tightness, heaviness, discomfort, pressure or pain in your chest or neck difficulty breathing or catching your breath feeling faint, dizzy, or light-headed fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’ | 0..1 | display |
p02-Screening | page 02. Screening | 0..1 | group |
p02-q01-VaccineType | page 02 question 1. Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago | 1..1 | choice | Options: 5 options
p02-q02-SideEffects | page 02 question 2. We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination? | 1..1 | choice | Options: 3 options
p02-q03-SideEffectsScreening | page 02 question 3. null | 0..1 | group |
p02-q03.1-WhoReceived | page 02 question 3.1. Who received the vaccine? | 1..1 | choice | Options: 2 options
p02-q03.2-WhereReceived | page 02 question 3.2. Where did you/they go to receive your/their vaccination? | 1..1 | choice | Options: 6 options
p02-q03.3-Pregnant | page 02 question 3.3. Were you/they pregnant/Hapu at the time of your/their vaccination? | 1..1 | boolean |
p03-EarlyOnsetReactions | page 03. Early onset reactions | 0..1 | group |
p03-q01-SelectedSideEffects | page 03 question 1. Did you/they experience any of the following after vaccination? (choose all that apply) | 1..* | choice | Options: 5 options
p03-q02-AnaphylaxisDelay | page 03 question 2. How long after vaccination did anaphylaxis occur? | 1..1 | choice | Enable When: p03-q01-SelectedSideEffects = Options: 5 options
p03-q03-SyncopeDelay | page 03 question 3. How long after vaccination did syncope occur? | 1..1 | choice | Enable When: p03-q01-SelectedSideEffects = Options: 5 options
p03-q04-SeizureDelay | page 03 question 4. How long after vaccination did the seizure/ convulsions occur? | 1..1 | choice | Enable When: p03-q01-SelectedSideEffects = Options: 5 options
p03-q05-SeizureComorbidity | page 03 question 5. Did seizure/ convulsions occur with: | 1..1 | choice | Enable When: p03-q01-SelectedSideEffects = Options: 4 options
p04-Reactions | page 04. Reactions | 0..1 | group |
p04-q01-ReactionsIntro | page 04 question 1. Please choose all the reactions that you/they experienced, and if yes describe, on a scale from Minor, Mild, Moderate, Serious, to Severe. For your rating take into account levels of pain, how long symptoms lasted and impact on daily life. | 0..1 | display |
p04-q02-InjectionSiteDisorder | page 04 question 2. Injection site reaction (pain, redness, swelling, or itching at or near the injection site) | 1..1 | boolean |
p04-q03-InjectionSiteSeverity | page 04 question 3. Injection site reaction severity | 1..1 | choice | Enable When: p04-q02-InjectionSiteDisorder = Options: 5 options
p04-q04-Fever | page 04 question 4. Fever (a temperature of 38°C or higher) | 1..1 | boolean |
p04-q05-FeverSeverity | page 04 question 5. Temperature/fever severity | 1..1 | choice | Enable When: p04-q04-Fever = Options: 5 options
p04-q06-Swelling | page 04 question 6. Swelling of glands (i.e., lymph nodes) | 1..1 | boolean |
p04-q07-SwellingLocation | page 04 question 7. Where abouts did you experience swelling? | 1..1 | choice | Enable When: p04-q06-Swelling = Options: 3 options
p04-q08-SwellingSeverity | page 04 question 8. Swelling of glands severity | 1..1 | choice | Enable When: p04-q06-Swelling = Options: 5 options
p04-q09-Chills | page 04 question 9. Chills, shivering, or cold sweats | 1..1 | boolean |
p04-q10-ChillsSeverity | page 04 question 10. Chills/shivering/cold sweats severity | 1..1 | choice | Enable When: p04-q09-Chills = Options: 5 options
p04-q11-Headaches | page 04 question 11. Headaches | 1..1 | boolean |
p04-q12-HeadachesSeverity | page 04 question 12. Headache severity | 1..1 | choice | Enable When: p04-q11-Headaches = Options: 5 options
p04-q13-Rash | page 04 question 13. Rash (not at the injection site) | 1..1 | boolean |
p04-q14-RashSeverity | page 04 question 14. Rash severity | 1..1 | choice | Enable When: p04-q13-Rash = Options: 5 options
p04-q15-AchesPains | page 04 question 15. Aches and pains | 1..1 | boolean |
p04-q16-AchesPainsSeverity | page 04 question 16. Aches and pains severity | 1..1 | choice | Enable When: p04-q15-AchesPains = Options: 5 options
p04-q17-DigestiveDisorder | page 04 question 17. Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite) | 1..1 | boolean |
p04-q18-DigestiveDisorderSeverity | page 04 question 18. Stomach symptoms severity | 1..1 | choice | Enable When: p04-q17-DigestiveDisorder = Options: 5 options
p04-q19-Fatigue | page 04 question 19. Fatigue or tiredness | 1..1 | boolean |
p04-q20-FatigueSeverity | page 04 question 20. Fatigue or tiredness severity | 1..1 | choice | Enable When: p04-q19-Fatigue = Options: 5 options
p04-q21-ChestSymptoms | page 04 question 21. Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing) | 1..1 | boolean |
p04-q22-ChestSymptomsSeverity | page 04 question 22. Chest symptoms severity | 1..1 | choice | Enable When: p04-q21-ChestSymptoms = Options: 5 options
p04-q23-DifficultyBreathing | page 04 question 23. Difficulty breathing | 1..1 | boolean |
p04-q24-DifficultyBreathingSeverity | page 04 question 24. Difficulty breathing severity | 1..1 | choice | Enable When: p04-q23-DifficultyBreathing = Options: 5 options
p04-q25-Dizziness | page 04 question 25. Dizziness or feeling lightheaded | 1..1 | boolean |
p04-q26-DizzinessSeverity | page 04 question 26. Dizziness or lightheaded severity | 1..1 | choice | Enable When: p04-q25-Dizziness = Options: 5 options
p04-q27-OtherSymptoms | page 04 question 27. Did you/they experience any symptoms that were not listed above? | 1..1 | boolean |
p04-q28-OtherSymptomsDetail | page 04 question 28. Please explain | 1..1 | string | Enable When: p04-q27-OtherSymptoms =
p05-DailyImpact | page 05. Impact on daily activities | 0..1 | group |
p05-q01-MissedWork | page 05 question 1. Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities? | 1..1 | boolean |
p05-q02-MissedWorkDetail | page 05 question 2. How many days did you miss? | 1..1 | choice | Enable When: p05-q01-MissedWork = Options: 4 options
p06-CareSought | page 06. Medical advice/care sought | 0..1 | group |
p06-q01-SymptomRelief | page 06 question 1. Did any of the symptoms cause you/them to seek advice or care from a healthcare professional? | 1..1 | boolean |
p06-q02-SymptomReliefDetail | page 06 question 2. Please choose the type of advice or care you/they sought. Please choose all that apply | 1..* | choice | Enable When: p06-q01-SymptomRelief = Options: 8 options
p07-VaccinationExperience | page 07. Vaccination experience | 0..1 | group |
p07-q01-OverallExperience | page 07 question 1. How would you/they rate the overall experience at the vaccination site? For your rating take into account informed consent process, staff helpfulness, vaccination site cleanliness etc. | 1..1 | choice | Options: 5 options
p07-q02-Comments | page 07 question 2. Do you/they have any comments about your/their vaccine experience? | 1..1 | boolean |
p07-q03-CommentsDetail | page 07 question 3. Please explain | 1..1 | text | Enable When: p07-q02-Comments =
p08-Thanks | page 08. Thank you for completing the Day 3 post vaccine survey, your answers have been submitted. You will receive your next survey 42 days after your vaccination. The data collected by these surveys will be made available online on the Health NZ website. Survey data provided online are not identifiable and individual responses are confidential. | 0..1 | display |
Documentation for this format

Options Sets

Answer options for p02-q01-VaccineType

- null#COVID-19 and flu vaccines at the same time ("COVID-19 and flu vaccines at the same time")
- null#Only flu vaccine ("Only flu vaccine")
- null#Only COVID-19 vaccine ("Only COVID-19 vaccine")
- null#Other vaccine ("Other vaccine")
- null#Was not vaccinated or do not recall ("Was not vaccinated or do not recall")

Answer options for p02-q02-SideEffects

- null#Yes ("Yes")
- null#No ("No")
- null#Can't remember ("Can't remember")

Answer options for p02-q03.1-WhoReceived

- null#Myself ("Myself")
- null#My dependent/whānau member ("My dependent/whānau member")

Answer options for p02-q03.2-WhereReceived

- null#Community vaccination centre ("Community vaccination centre")
- null#General practice ("General practice")
- null#Pharmacy ("Pharmacy")
- null#Mobile vaccination unit ("Mobile vaccination unit")
- null#Hospital or emergency room ("Hospital or emergency room")
- null#Other ("Other")

Answer options for p03-q01-SelectedSideEffects

- null#Anaphylaxis ("Anaphylaxis")
- null#Syncope (fainting) ("Syncope (fainting)")
- null#Seizure/ convulsion ("Seizure/ convulsion")
- null#I don't know/ unsure ("I don't know/ unsure")
- null#None of the above ("None of the above")

Answer options for p03-q02-AnaphylaxisDelay

- null#0-5 minutes ("0-5 minutes")
- null#6-10 minutes ("6-10 minutes")
- null#11-15 minutes ("11-15 minutes")
- null#16-20 minutes ("16-20 minutes")
- null#21+ minutes ("21+ minutes")

Answer options for p03-q03-SyncopeDelay

- null#0-5 minutes
- null#6-10 minutes ("6-10 minutes")
- null#11-15 minutes ("11-15 minutes")
- null#16-20 minutes ("16-20 minutes")
- null#21+ minutes ("21+ minutes")

Answer options for p03-q04-SeizureDelay

- null#0-5 minutes
- null#6-10 minutes ("6-10 minutes")
- null#11-15 minutes ("11-15 minutes")
- null#16-20 minutes ("16-20 minutes")
- null#21+ minutes ("21+ minutes")

Answer options for p03-q05-SeizureComorbidity

- null#Syncope (fainting) ("Syncope (fainting)")
- null#Fever ("Fever")
- null#Other ("Other")
- null#I don't know ("I don't know")

Answer options for p04-q03-InjectionSiteSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q05-FeverSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q07-SwellingLocation

- null#Same arm as vaccination ("Same arm as vaccination")
- null#Opposite arm to vaccination ("Opposite arm to vaccination")
- null#Other ("Other")

Answer options for p04-q08-SwellingSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q10-ChillsSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q12-HeadachesSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q14-RashSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q16-AchesPainsSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q18-DigestiveDisorderSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q20-FatigueSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q22-ChestSymptomsSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q24-DifficultyBreathingSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p04-q26-DizzinessSeverity

- null#Minor ("Minor")
- null#Mild ("Mild")
- null#Moderate ("Moderate")
- null#Serious ("Serious")
- null#Severe ("Severe")

Answer options for p05-q02-MissedWorkDetail

- null#Less than 1 day ("Less than 1 day")
- null#1 day ("1 day")
- null#2 days ("2 days")
- null#3 or more days ("3 or more days")

Answer options for p06-q02-SymptomReliefDetail

- null#Phone advice from a helpline e.g., Healthline ("Phone advice from a helpline (e.g., Healthline)")
- null#Care from a GP clinic including the clinic nurse, a doctor, or a phone call with a person at the GP clinic. ("Care from a GP clinic (including the clinic nurse, a doctor, or a phone call with a person at the GP clinic).")
- null#Visit to a hospital emergency department ("Visit to a hospital emergency department")
- null#Māori Health Provider ("Māori Health Provider")
- null#Rongoā clinic ("Rongoā clinic")
- null#Whānau Ora navigator ("Whānau Ora navigator")
- null#Pharmacy ("Pharmacy")
- null#Other ("Other")

Answer options for p07-q01-OverallExperience

- null#Very poor ("Very poor")
- null#Poor ("Poor")
- null#Average ("Average")
- null#Good ("Good")
- null#Excellent ("Excellent")