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

Now I want you to think about symptoms you may have experienced after your initial illness. Have/had you experienced any new or continuing COVID-19 symptoms?

*Select all that apply

[ ] Discomfort, tightness, or pressure in chest

[ ] New or worsening cough

[ ] Shortness of breath

[ ] Lack of energy or general tired feeling

[ ] Muscle weakness

[ ] Loss of appetite, like you just haven't been hungry

[ ] Feeling sick to your stomach or vomiting

[ ] Diarrhea

[ ] Muscle aches

[ ] Joint aches

[ ] Headache

[ ] Seizure

[ ] Dizziness

[ ] Having hallucinations, altered consciousness

[ ] Loss of ability to smell

[ ] Altered smell

[ ] Loss of ability to taste

[ ] Altered taste

[ ] Pain in teeth

[ ] Hair loss (alopecia)

[ ] Heavy limbs

[ ] Tremors

[ ] Rapid heart rate

[ ] Slow heart rate

[ ] Chills/Repeated shaking with chills

[ ] Difficulty sleeping

[ ] Insomnia (difficulty falling and staying asleep)

[ ] Hypersomnia (excessive sleepiness or drowsiness)

[ ] Disturbed sleep (nightmares, night sweats, etc.)

[ ] Foggy brain

[ ] Feeling down or depressed

[ ] Feeling anxious

[ ] Always feeling hot or cold (temperature dysregulation)

[ ] Feeling dizzy or lightheaded when standing up after sitting (orthostatic hypotension)

[ ] Eye problems

[ ] Prickling, burning, or numb sensation (neuropathy)

[ ] Ringing or buzzing in ears (tinnitus)

[ ] Skin problems

[ ] Other symptom #1 (specify)

[ ] Other symptom #2 (specify)

[ ] Other symptom #3 (specify)

[ ] Other symptom #4 (specify)

[ ] Other symptom #5 (specify)

[ ] Any additional symptoms (specify)

[ ] I have not experienced any new or continuing symptoms