Long COVID

Specific symptoms experienced Severity and progression of symptoms over time Any symptom improvement or new symptoms

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Reports Fatigue Muscle or body aches Joint pain Headache Difficulty sleeping Chest pain Shortness of breath Difficulty with concentration (“brain fog”) Difficulty with memory

Reports No Fatigue No Muscle or body aches No Joint pain No Headache No Difficulty sleeping No Chest pain No Shortness of breath No Difficulty with concentration (“brain fog”) No Difficulty with memory

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Reports Fast-beating or pounding heart (heart palpitations) Loss of smell Loss of taste Dizziness Balance problems Feeling unwell after physical activity (post-exertional malaise) Feeling unwell after mental activity Depression Anxiety

Reports No Fast-beating or pounding heart (heart palpitations) No Loss of smell No Loss of taste No Dizziness No Balance problems No Feeling unwell after physical activity (post-exertional malaise) No Feeling unwell after mental activity No Depression No Anxiety

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Red Flag Symptoms

Reports Sudden onset of chest pain Sudden onset of shortness of breath Persistent fever New confusion Inability to wake or stay awake Bluish lips or face Sudden loss of ability to move a limb

Reports No Sudden onset of chest pain No Sudden onset of shortness of breath No Persistent fever No New confusion No Inability to wake or stay awake No Bluish lips or face No Sudden loss of ability to move a limb

Report negative symptoms?

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Has a history of Severe acute respiratory distress syndrome (ARDS) during the acute phase of COVID-19 Hospitalization for COVID-19 Admission to an intensive care unit (ICU) for COVID-19 Mechanical ventilation during the acute phase of COVID-19 ECMO during the acute phase of COVID-19

Has no history of Severe acute respiratory distress syndrome (ARDS) during the acute phase of COVID-19 Hospitalization for COVID-19 Admission to an intensive care unit (ICU) for COVID-19 Mechanical ventilation during the acute phase of COVID-19 ECMO during the acute phase of COVID-19

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Has a history of Cardiovascular disease Pulmonary disease Kidney disease Liver disease Diabetes Severe obesity Smoking Chronic obstructive pulmonary disease (COPD) Asthma Autoimmune conditions Immunocompromised state

Has no history of Cardiovascular disease Pulmonary disease Kidney disease Liver disease Diabetes Severe obesity Smoking Chronic obstructive pulmonary disease (COPD) Asthma Autoimmune conditions Immunocompromised state

Report negative symptoms?

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List of medications currently used, including over-the-counter drugs and supplements Any treatments or medications tried for long COVID and their effects Impact on daily activities and quality of life Psychological impact (anxiety, depression, etc.) Social impact (relationships, work, etc.)

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Any other relevant details



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