Te Whatu Ora Shared Care FHIR API
0.3.9 - release New Zealand flag

Te Whatu Ora Shared Care FHIR API, published by Te Whatu Ora. This guide is not an authorized publication; it is the continuous build for version 0.3.9 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/tewhatuora/cinc-fhir-ig/ and changes regularly. See the Directory of published versions

: COVID19 Vaccination Side Effects Questionnaire - XML Representation

Draft as of 2023-07-19

Raw xml | Download



<Questionnaire xmlns="http://hl7.org/fhir">
  <id value="COVIDVaccinationSurveyQuestionnaire"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><b>Structure</b><table border="1" cellpadding="0" cellspacing="0" style="border: 1px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top;"><tr style="border: 2px #F0F0F0 solid; font-size: 11px; font-family: verdana; vertical-align: top"><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The linkID for the item">LinkID</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Text for the item">Text</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Minimum and Maximum # of times the item can appear in the instance">Cardinality</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="The type of the item">Type</a></th><th style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Additional information about the item">Description &amp; Constraints</a><span style="float: right"><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,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" alt="doco" style="background-color: inherit"/></a></span></th></tr><tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck1.png)" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon_q_root.gif" alt="." style="background-color: white; background-color: inherit" title="QuestionnaireRoot" class="hierarchy"/> COVIDVaccinationSurveyQuestionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Te Whatu Ora post COVID-19 vaccination survey.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Questionnaire</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDVaccinationSurveyQuestionnaire#0.3.9</td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck10.png)" id="item.p01" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Display" class="hierarchy"/> p01</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 1. Thanks for taking part in our survey to understand the side effects you experienced after your Pfizer COVID-19 vaccination.  Please note this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional.  This survey is optional and will take approximately 5 minutes to complete. Your responses will help us to monitor the safety of the Pfizer COVID-19 vaccine in Aotearoa New Zealand. For more information about this survey, visit http://medsafe.govt.nz/covid-safety-reporting/.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p02" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: white; background-color: inherit" title="Group" class="hierarchy"/> p02</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2. Side Effects</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q01-SideEffects" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> p02-q01-SideEffects</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 1. Select all the side effects you experienced after your recent COVID-19 vaccination</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p02-q01-SideEffects">11 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q02-SideEffects.Rash" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="Boolean" class="hierarchy"/> p02-q02-SideEffects.Rash</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 2. Rash not near injection site</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q02-1-SideEffects.Rash.WhenStarted" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> p02-q02-1-SideEffects.Rash.WhenStarted</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 2.1. When did the rash appear?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p02-q02-SideEffects.Rash">p02-q02-SideEffects.Rash</a> = true</span><br/>Options: <a href="#opt-item.p02-q02-1-SideEffects.Rash.WhenStarted">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q02-2-SideEffects.Rash.HowLong" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> p02-q02-2-SideEffects.Rash.HowLong</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 2.2. How long did the rash last?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p02-q02-SideEffects.Rash">p02-q02-SideEffects.Rash</a> = true</span><br/>Options: <a href="#opt-item.p02-q02-2-SideEffects.Rash.HowLong">3 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p02-q03-SideEffects.Other" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Boolean" class="hierarchy"/> p02-q03-SideEffects.Other</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 3. Other or not listed side effect?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p02-q03-1-SideEffects.Other.Description" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-text.png" alt="." style="background-color: white; background-color: inherit" title="Text" class="hierarchy"/> p02-q03-1-SideEffects.Other.Description</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 2 question 3.1. What other side effects did you experience?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text">text</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p02-q03-SideEffects.Other">p02-q03-SideEffects.Other</a> = true</span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p03" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> p03</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3. Symptom Relief</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q01-SymptomRelief.Medicines" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="Boolean" class="hierarchy"/> p03-q01-SymptomRelief.Medicines</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3 question 1. Did you take any medicines to ease your symptoms for example paracetamol or ibuprofen?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q01-1-Medicines.ReducedSymptoms" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Boolean" class="hierarchy"/> p03-q01-1-Medicines.ReducedSymptoms</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3 question 1.1. Did the medicines help ease your symptoms?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q01-SymptomRelief.Medicines">p03-q01-SymptomRelief.Medicines</a> = true</span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q02-Medicines.SawDoctor" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="Boolean" class="hierarchy"/> p03-q02-Medicines.SawDoctor</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3 question 2. Did you see a healthcare provider for your symptoms?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p03-q03-MissedActivities" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Boolean" class="hierarchy"/> p03-q03-MissedActivities</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3 question 3. Did your symptoms cause you to miss any normal daily or normal daily activities? For example, work, school, exercise or other activities.</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p03-q03-1-MissedActivities.Period" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: white; background-color: inherit" title="Coding" class="hierarchy"/> p03-q03-1-MissedActivities.Period</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 3 question 3.1. How many days did you miss?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p03-q03-MissedActivities">p03-q03-MissedActivities</a> = true</span><br/>Options: <a href="#opt-item.p03-q03-1-MissedActivities.Period">4 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck11.png)" id="item.p04" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-group.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Group" class="hierarchy"/> p04</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 4. Health Conditions</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-group">group</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p04-q01-Pregnant" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="Boolean" class="hierarchy"/> p04-q01-Pregnant</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 4 question 1. Are you pregnant or have you given birth in the last 6 weeks?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p04-q02-LongTermConditions" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-coding.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Coding" class="hierarchy"/> p04-q02-LongTermConditions</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 4 question 2. Do you have any of the following conditions?</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..*</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-choice">choice</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Options: <a href="#opt-item.p04-q02-LongTermConditions">11 options</a></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck110.png)" id="item.p04-q02-1-LongTermConditions.Other" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-boolean.png" alt="." style="background-color: white; background-color: inherit" title="Boolean" class="hierarchy"/> p04-q02-1-LongTermConditions.Other</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 4 question 2.1. Other or not listed long term condition?</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">1..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-boolean">boolean</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: #F7F7F7"><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck100.png)" id="item.p04-q02-2-LongTermConditions.Other.Description" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vline.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-text.png" alt="." style="background-color: #F7F7F7; background-color: inherit" title="Text" class="hierarchy"/> p04-q02-2-LongTermConditions.Other.Description</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 4 question 2.2. Please list any other long term condition(s) you have</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-text">text</a></td><td style="vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">Enable When: <span><a href="#item.p04-q02-1-LongTermConditions.Other">p04-q02-1-LongTermConditions.Other</a> = true</span></td></tr>
<tr style="border: 1px #F0F0F0 solid; padding:0px; vertical-align: top; background-color: white"><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px; white-space: nowrap; background-image: url(tbl_bck00.png)" id="item.p05" class="hierarchy"><img src="tbl_spacer.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="tbl_vjoin_end.png" alt="." style="background-color: inherit" class="hierarchy"/><img src="icon-q-display.png" alt="." style="background-color: white; background-color: inherit" title="Display" class="hierarchy"/> p05</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">page 5. Thank you for taking part in this survey. The information you provide is confidential and is protected by the Privacy Act 2020 and by the safeguards we have put in place.  Remember this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional.   Results from the survey will be published on the Medsafe website at http://medsafe.govt.nz/covid-safety-reporting/as the survey progresses.</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy">0..1</td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"><a href="http://hl7.org/fhir/R4/codesystem-item-type.html#item-type-display">display</a></td><td style="vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px" class="hierarchy"/></tr>
<tr><td colspan="5" class="hierarchy"><br/><a href="http://hl7.org/fhir/R4/formats.html#table" title="Legend for this format"><img src="data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAABAAAAAQCAYAAAAf8/9hAAAABmJLR0QA/wD/AP+gvaeTAAAACXBIWXMAAAsTAAALEwEAmpwYAAAAB3RJTUUH3goXBCwdPqAP0wAAAldJREFUOMuNk0tIlFEYhp9z/vE2jHkhxXA0zJCMitrUQlq4lnSltEqCFhFG2MJFhIvIFpkEWaTQqjaWZRkp0g26URZkTpbaaOJkDqk10szoODP//7XIMUe0elcfnPd9zsfLOYplGrpRwZaqTtw3K7PtGem7Q6FoidbGgqHVy/HRb669R+56zx7eRV1L31JGxYbBtjKK93cxeqfyQHbehkZbUkK20goELEuIzEd+dHS+qz/Y8PTSif0FnGkbiwcAjHaU1+QWOptFiyCLp/LnKptpqIuXHx6rbR26kJcBX3yLgBfnd7CxwJmflpP2wUg0HIAoUUpZBmKzELGWcN8nAr6Gpu7tLU/CkwAaoKTWRSQyt89Q8w6J+oVQkKnBoblH7V0PPvUOvDYXfopE/SJmALsxnVm6LbkotrUtNowMeIrVrBcBpaMmdS0j9df7abpSuy7HWehwJdt1lhVwi/J58U5beXGAF6c3UXLycw1wdFklArBn87xdh0ZsZtArghBdAA3+OEDVubG4UEzP6x1FOWneHh2VDAHBAt80IbdXDcesNoCvs3E5AFyNSU5nbrDPZpcUEQQTFZiEVx+51fxMhhyJEAgvlriadIJZZksRuwBYMOPBbO3hePVVqgEJhFeUuFLhIPkRP6BQLIBrmMenujm/3g4zc398awIe90Zb5A1vREALqneMcYgP/xVQWlG+Ncu5vgwwlaUNx+3799rfe96u9K0JSDXcOzOTJg4B6IgmXfsygc7/Bvg9g9E58/cDVmGIBOP/zT8Bz1zqWqpbXIsd0O9hajXfL6u4BaOS6SeWAAAAAElFTkSuQmCC" alt="doco" style="background-color: inherit"/> Documentation for this format</a></td></tr></table><hr/><p><b>Options Sets</b></p><a name="opt-item.p02-q01-SideEffects"> </a><p><b>Answer options for p02-q01-SideEffects </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#95376002 (&quot;Pain, redness, swelling, itching at or near the injection site&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#386661006 (&quot;Fever&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#25064002 (&quot;Headache&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#68962001 (&quot;Muscle pain&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#57676002 (&quot;Joint pain&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#274640006 (&quot;Chills and fever&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#422587007 (&quot;Nausea&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#422400008 (&quot;Vomiting&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#62315008 (&quot;Diarrhoea&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#271681002 (&quot;Stomach pain&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#84229001 (&quot;Fatigue&quot;)</li></ul><a name="opt-item.p02-q02-1-SideEffects.Rash.WhenStarted"> </a><p><b>Answer options for p02-q02-1-SideEffects.Rash.WhenStarted </b></p><ul><li style="font-size: 11px">null#null (&quot;Within 1 hour after vaccination&quot;)</li><li style="font-size: 11px">null#null (&quot;Within a day after vaccination&quot;)</li><li style="font-size: 11px">null#null (&quot;More than a day after vaccination&quot;)</li></ul><a name="opt-item.p02-q02-2-SideEffects.Rash.HowLong"> </a><p><b>Answer options for p02-q02-2-SideEffects.Rash.HowLong </b></p><ul><li style="font-size: 11px">null#null (&quot;Less than 30 minutes&quot;)</li><li style="font-size: 11px">null#null (&quot;30 minutes to 24 hours&quot;)</li><li style="font-size: 11px">null#null (&quot;More than 24 hours&quot;)</li></ul><a name="opt-item.p03-q03-1-MissedActivities.Period"> </a><p><b>Answer options for p03-q03-1-MissedActivities.Period </b></p><ul><li style="font-size: 11px">null#null (&quot;Less than 1 day&quot;)</li><li style="font-size: 11px">null#null (&quot;1 day&quot;)</li><li style="font-size: 11px">null#null (&quot;2 days&quot;)</li><li style="font-size: 11px">null#null (&quot;3 days or more&quot;)</li></ul><a name="opt-item.p04-q02-LongTermConditions"> </a><p><b>Answer options for p04-q02-LongTermConditions </b></p><ul><li style="font-size: 11px">http://snomed.info/sct#4301008 (&quot;Autoimmune conditions (eg. arthritis)&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#32709003 (&quot;Alcohol or other drug addictions&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#195967001 (&quot;Asthma&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#363346000 (&quot;Cancer&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#82423001 (&quot;Chronic pain&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#13645005 (&quot;Chronic obstructive pulmonary disease&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#73211009 (&quot;Diabetes mellitus&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#770924008 (&quot;Acute Gout (disorder)&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#56265001 (&quot;Heart disease&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#74732009 (&quot;Mental health condition&quot;)</li><li style="font-size: 11px">http://snomed.info/sct#414916001 (&quot;Obesity&quot;)</li></ul></div>
  </text>
  <url
       value="https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/COVIDVaccinationSurveyQuestionnaire"/>
  <identifier>
    <use value="official"/>
    <value value="COVIDVaccinationSurveyQuestionnaire"/>
    <period>
      <start value="2023-07-19"/>
    </period>
  </identifier>
  <identifier>
    <use value="temp"/>
    <value value="Questionnaire-COVID-VaccinationSurveyQuestionnaire"/>
    <period>
      <end value="2023-07-19"/>
    </period>
  </identifier>
  <version value="0.3.9"/>
  <name value="COVIDVaccinationSurveyQuestionnaire"/>
  <title value="COVID19 Vaccination Side Effects Questionnaire"/>
  <status value="draft"/>
  <experimental value="false"/>
  <subjectType value="Patient"/>
  <date value="2023-07-19"/>
  <publisher value="Te Whatu Ora"/>
  <contact>
    <name value="Te Whatu Ora"/>
    <telecom>
      <system value="url"/>
      <value value="https://www.tewhatuora.govt.nz/"/>
    </telecom>
  </contact>
  <contact>
    <name value="David Grainger"/>
    <telecom>
      <system value="email"/>
      <value value="david.grainger@middleware.co.nz"/>
      <use value="work"/>
    </telecom>
  </contact>
  <description value="Te Whatu Ora post COVID-19 vaccination survey."/>
  <useContext>
    <code>
      <system
              value="http://terminology.hl7.org/CodeSystem/usage-context-type"/>
      <code value="workflow"/>
      <display value="Workflow Setting"/>
    </code>
    <valueCodeableConcept>
      <text value="Vaccination Side Effect Questionnaire"/>
    </valueCodeableConcept>
  </useContext>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="NZ"/>
      <display value="New Zealand"/>
    </coding>
  </jurisdiction>
  <purpose
           value="Survey of side effects experienced after COVID-19 vaccination"/>
  <code>
    <system value="http://snomed.info/sct"/>
    <code value="293104008"/>
    <display value="Vaccine adverse reaction"/>
  </code>
  <item>
    <linkId value="p01"/>
    <prefix value="page 1"/>
    <text
          value="Thanks for taking part in our survey to understand the side effects you experienced after your Pfizer COVID-19 vaccination.  Please note this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional.  This survey is optional and will take approximately 5 minutes to complete. Your responses will help us to monitor the safety of the Pfizer COVID-19 vaccine in Aotearoa New Zealand. For more information about this survey, visit http://medsafe.govt.nz/covid-safety-reporting/."/>
    <type value="display"/>
  </item>
  <item>
    <linkId value="p02"/>
    <prefix value="page 2"/>
    <text value="Side Effects"/>
    <type value="group"/>
    <item>
      <linkId value="p02-q01-SideEffects"/>
      <prefix value="page 2 question 1"/>
      <text
            value="Select all the side effects you experienced after your recent COVID-19 vaccination"/>
      <type value="choice"/>
      <required value="false"/>
      <repeats value="true"/>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="95376002"/>
          <display
                   value="Pain, redness, swelling, itching at or near the injection site"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="386661006"/>
          <display value="Fever"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="25064002"/>
          <display value="Headache"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="68962001"/>
          <display value="Muscle pain"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="57676002"/>
          <display value="Joint pain"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="274640006"/>
          <display value="Chills and fever"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="422587007"/>
          <display value="Nausea"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="422400008"/>
          <display value="Vomiting"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="62315008"/>
          <display value="Diarrhoea"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="271681002"/>
          <display value="Stomach pain"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="84229001"/>
          <display value="Fatigue"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p02-q02-SideEffects.Rash"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="271807003"/>
        <display value="Rash"/>
      </code>
      <prefix value="page 2 question 2"/>
      <text value="Rash not near injection site"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p02-q02-1-SideEffects.Rash.WhenStarted"/>
      <prefix value="page 2 question 2.1"/>
      <text value="When did the rash appear?"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p02-q02-SideEffects.Rash"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
      <answerOption>
        <valueCoding>
          <display value="Within 1 hour after vaccination"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="Within a day after vaccination"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="More than a day after vaccination"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p02-q02-2-SideEffects.Rash.HowLong"/>
      <prefix value="page 2 question 2.2"/>
      <text value="How long did the rash last?"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p02-q02-SideEffects.Rash"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
      <answerOption>
        <valueCoding>
          <display value="Less than 30 minutes"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="30 minutes to 24 hours"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="More than 24 hours"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p02-q03-SideEffects.Other"/>
      <prefix value="page 2 question 3"/>
      <text value="Other or not listed side effect?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p02-q03-1-SideEffects.Other.Description"/>
      <prefix value="page 2 question 3.1"/>
      <text value="What other side effects did you experience?"/>
      <type value="text"/>
      <enableWhen>
        <question value="p02-q03-SideEffects.Other"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="false"/>
    </item>
  </item>
  <item>
    <linkId value="p03"/>
    <prefix value="page 3"/>
    <text value="Symptom Relief"/>
    <type value="group"/>
    <item>
      <linkId value="p03-q01-SymptomRelief.Medicines"/>
      <prefix value="page 3 question 1"/>
      <text
            value="Did you take any medicines to ease your symptoms for example paracetamol or ibuprofen?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p03-q01-1-Medicines.ReducedSymptoms"/>
      <prefix value="page 3 question 1.1"/>
      <text value="Did the medicines help ease your symptoms?"/>
      <type value="boolean"/>
      <enableWhen>
        <question value="p03-q01-SymptomRelief.Medicines"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p03-q02-Medicines.SawDoctor"/>
      <prefix value="page 3 question 2"/>
      <text value="Did you see a healthcare provider for your symptoms?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p03-q03-MissedActivities"/>
      <prefix value="page 3 question 3"/>
      <text
            value="Did your symptoms cause you to miss any normal daily or normal daily activities? For example, work, school, exercise or other activities."/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p03-q03-1-MissedActivities.Period"/>
      <prefix value="page 3 question 3.1"/>
      <text value="How many days did you miss?"/>
      <type value="choice"/>
      <enableWhen>
        <question value="p03-q03-MissedActivities"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="true"/>
      <repeats value="false"/>
      <answerOption>
        <valueCoding>
          <display value="Less than 1 day"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="1 day"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="2 days"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <display value="3 days or more"/>
        </valueCoding>
      </answerOption>
    </item>
  </item>
  <item>
    <linkId value="p04"/>
    <prefix value="page 4"/>
    <text value="Health Conditions"/>
    <type value="group"/>
    <item>
      <linkId value="p04-q01-Pregnant"/>
      <code>
        <system value="http://snomed.info/sct"/>
        <code value="77386006"/>
        <display value="Pregnancy"/>
      </code>
      <prefix value="page 4 question 1"/>
      <text
            value="Are you pregnant or have you given birth in the last 6 weeks?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p04-q02-LongTermConditions"/>
      <prefix value="page 4 question 2"/>
      <text value="Do you have any of the following conditions?"/>
      <type value="choice"/>
      <required value="false"/>
      <repeats value="true"/>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="4301008"/>
          <display value="Autoimmune conditions (eg. arthritis)"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="32709003"/>
          <display value="Alcohol or other drug addictions"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="195967001"/>
          <display value="Asthma"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="363346000"/>
          <display value="Cancer"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="82423001"/>
          <display value="Chronic pain"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="13645005"/>
          <display value="Chronic obstructive pulmonary disease"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="73211009"/>
          <display value="Diabetes mellitus"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="770924008"/>
          <display value="Acute Gout (disorder)"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="56265001"/>
          <display value="Heart disease"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="74732009"/>
          <display value="Mental health condition"/>
        </valueCoding>
      </answerOption>
      <answerOption>
        <valueCoding>
          <system value="http://snomed.info/sct"/>
          <code value="414916001"/>
          <display value="Obesity"/>
        </valueCoding>
      </answerOption>
    </item>
    <item>
      <linkId value="p04-q02-1-LongTermConditions.Other"/>
      <prefix value="page 4 question 2.1"/>
      <text value="Other or not listed long term condition?"/>
      <type value="boolean"/>
      <required value="true"/>
    </item>
    <item>
      <linkId value="p04-q02-2-LongTermConditions.Other.Description"/>
      <prefix value="page 4 question 2.2"/>
      <text value="Please list any other long term condition(s) you have"/>
      <type value="text"/>
      <enableWhen>
        <question value="p04-q02-1-LongTermConditions.Other"/>
        <operator value="="/>
        <answerBoolean value="true"/>
      </enableWhen>
      <enableBehavior value="all"/>
      <required value="false"/>
    </item>
  </item>
  <item>
    <linkId value="p05"/>
    <prefix value="page 5"/>
    <text
          value="Thank you for taking part in this survey. The information you provide is confidential and is protected by the Privacy Act 2020 and by the safeguards we have put in place.  Remember this is a survey only and your answers will not result in a medical response to your situation. If you have concerns about your health since your vaccination, particularly if you have had chest pain, racing heartbeat, or trouble breathing, please seek medical attention. You may ring the Healthline at 0800 358 5453 or speak to your healthcare professional.   Results from the survey will be published on the Medsafe website at http://medsafe.govt.nz/covid-safety-reporting/as the survey progresses."/>
    <type value="display"/>
  </item>
</Questionnaire>