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Resource Questionnaire/FHIR Server from package tewhatuora.sharedcare#current (515 ms)

Package cinc.fhir.ig
Type Questionnaire
Id Id
FHIR Version R4
Source https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire-ActiveMonitoringDay3Survey.html
Url https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey
Version 0.2.2
Status draft
Date 2023-08-23T22:13:19+00:00
Name ActiveMonitoringDay3Survey
Title Post Vaccine Symptom Check day 3 survey
Experimental False
Realm nz
Authority national
Description Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey.
Purpose Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 3 days.

Resources that use this resource

No resources found

Resources that this resource uses

No resources found

Narrative

Note: links and images are rebased to the (stated) source

Generated Narrative: Questionnaire ActiveMonitoringDay3Survey

Structure
LinkIDTextCardinalityTypeDescription & Constraintsdoco
.. ActiveMonitoringDay3SurveyTe Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey.Questionnairehttps://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey#0.2.2
... p01-Intropage 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..1display
... p02-Screeningpage 02. Screening0..1group
.... p02-q01-VaccineTypepage 02 question 1. Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago1..1choiceOptions: 5 options
.... p02-q02-SideEffectspage 02 question 2. We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination?1..1choiceOptions: 3 options
.... p02-q03-SideEffectsScreeningpage 02 question 3. null0..1group
..... p02-q03.1-WhoReceivedpage 02 question 3.1. Who received the vaccine?1..1choiceOptions: 2 options
..... p02-q03.2-WhereReceivedpage 02 question 3.2. Where did you/they go to receive your/their vaccination?1..1choiceOptions: 6 options
..... p02-q03.3-Pregnantpage 02 question 3.3. Were you/they pregnant/Hapu at the time of your/their vaccination?1..1boolean
... p03-EarlyOnsetReactionspage 03. Early onset reactions0..1group
.... p03-q01-SelectedSideEffectspage 03 question 1. Did you/they experience any of the following after vaccination? (choose all that apply)1..*choiceOptions: 5 options
.... p03-q02-AnaphylaxisDelaypage 03 question 2. How long after vaccination did anaphylaxis occur?1..1choiceEnable When: p03-q01-SelectedSideEffects =
Options: 5 options
.... p03-q03-SyncopeDelaypage 03 question 3. How long after vaccination did syncope occur?1..1choiceEnable When: p03-q01-SelectedSideEffects =
Options: 5 options
.... p03-q04-SeizureDelaypage 03 question 4. How long after vaccination did the seizure/ convulsions occur?1..1choiceEnable When: p03-q01-SelectedSideEffects =
Options: 5 options
.... p03-q05-SeizureComorbiditypage 03 question 5. Did seizure/ convulsions occur with:1..1choiceEnable When: p03-q01-SelectedSideEffects =
Options: 4 options
... p04-Reactionspage 04. Reactions0..1group
.... p04-q01-ReactionsIntropage 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..1display
.... p04-q02-InjectionSiteDisorderpage 04 question 2. Injection site reaction (pain, redness, swelling, or itching at or near the injection site)1..1boolean
.... p04-q03-InjectionSiteSeveritypage 04 question 3. Injection site reaction severity1..1choiceEnable When: p04-q02-InjectionSiteDisorder =
Options: 5 options
.... p04-q04-Feverpage 04 question 4. Fever (a temperature of 38°C or higher)1..1boolean
.... p04-q05-FeverSeveritypage 04 question 5. Temperature/fever severity1..1choiceEnable When: p04-q04-Fever =
Options: 5 options
.... p04-q06-Swellingpage 04 question 6. Swelling of glands (i.e., lymph nodes)1..1boolean
.... p04-q07-SwellingLocationpage 04 question 7. Where abouts did you experience swelling?1..1choiceEnable When: p04-q06-Swelling =
Options: 3 options
.... p04-q08-SwellingSeveritypage 04 question 8. Swelling of glands severity1..1choiceEnable When: p04-q06-Swelling =
Options: 5 options
.... p04-q09-Chillspage 04 question 9. Chills, shivering, or cold sweats1..1boolean
.... p04-q10-ChillsSeveritypage 04 question 10. Chills/shivering/cold sweats severity1..1choiceEnable When: p04-q09-Chills =
Options: 5 options
.... p04-q11-Headachespage 04 question 11. Headaches1..1boolean
.... p04-q12-HeadachesSeveritypage 04 question 12. Headache severity1..1choiceEnable When: p04-q11-Headaches =
Options: 5 options
.... p04-q13-Rashpage 04 question 13. Rash (not at the injection site)1..1boolean
.... p04-q14-RashSeveritypage 04 question 14. Rash severity1..1choiceEnable When: p04-q13-Rash =
Options: 5 options
.... p04-q15-AchesPainspage 04 question 15. Aches and pains1..1boolean
.... p04-q16-AchesPainsSeveritypage 04 question 16. Aches and pains severity1..1choiceEnable When: p04-q15-AchesPains =
Options: 5 options
.... p04-q17-DigestiveDisorderpage 04 question 17. Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite)1..1boolean
.... p04-q18-DigestiveDisorderSeveritypage 04 question 18. Stomach symptoms severity1..1choiceEnable When: p04-q17-DigestiveDisorder =
Options: 5 options
.... p04-q19-Fatiguepage 04 question 19. Fatigue or tiredness1..1boolean
.... p04-q20-FatigueSeveritypage 04 question 20. Fatigue or tiredness severity1..1choiceEnable When: p04-q19-Fatigue =
Options: 5 options
.... p04-q21-ChestSymptomspage 04 question 21. Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing)1..1boolean
.... p04-q22-ChestSymptomsSeveritypage 04 question 22. Chest symptoms severity1..1choiceEnable When: p04-q21-ChestSymptoms =
Options: 5 options
.... p04-q23-DifficultyBreathingpage 04 question 23. Difficulty breathing1..1boolean
.... p04-q24-DifficultyBreathingSeveritypage 04 question 24. Difficulty breathing severity1..1choiceEnable When: p04-q23-DifficultyBreathing =
Options: 5 options
.... p04-q25-Dizzinesspage 04 question 25. Dizziness or feeling lightheaded1..1boolean
.... p04-q26-DizzinessSeveritypage 04 question 26. Dizziness or lightheaded severity1..1choiceEnable When: p04-q25-Dizziness =
Options: 5 options
.... p04-q27-OtherSymptomspage 04 question 27. Did you/they experience any symptoms that were not listed above?1..1boolean
.... p04-q28-OtherSymptomsDetailpage 04 question 28. Please explain1..1stringEnable When: p04-q27-OtherSymptoms =
... p05-DailyImpactpage 05. Impact on daily activities0..1group
.... p05-q01-MissedWorkpage 05 question 1. Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities?1..1boolean
.... p05-q02-MissedWorkDetailpage 05 question 2. How many days did you miss?1..1choiceEnable When: p05-q01-MissedWork =
Options: 4 options
... p06-CareSoughtpage 06. Medical advice/care sought0..1group
.... p06-q01-SymptomReliefpage 06 question 1. Did any of the symptoms cause you/them to seek advice or care from a healthcare professional?1..1boolean
.... p06-q02-SymptomReliefDetailpage 06 question 2. Please choose the type of advice or care you/they sought. Please choose all that apply1..*choiceEnable When: p06-q01-SymptomRelief =
Options: 8 options
... p07-VaccinationExperiencepage 07. Vaccination experience0..1group
.... p07-q01-OverallExperiencepage 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..1choiceOptions: 5 options
.... p07-q02-Commentspage 07 question 2. Do you/they have any comments about your/their vaccine experience?1..1boolean
.... p07-q03-CommentsDetailpage 07 question 3. Please explain1..1textEnable When: p07-q02-Comments =
... p08-Thankspage 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..1display

doco Documentation for this format

Options Sets

Answer options for p02-q01-VaccineType

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

Answer options for p02-q02-SideEffects

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

Answer options for p02-q03.1-WhoReceived

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

Answer options for p02-q03.2-WhereReceived

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

Answer options for p03-q01-SelectedSideEffects

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

Answer options for p03-q02-AnaphylaxisDelay

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

Answer options for p03-q03-SyncopeDelay

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

Answer options for p03-q04-SeizureDelay

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

Answer options for p03-q05-SeizureComorbidity

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

Answer options for p04-q03-InjectionSiteSeverity

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

Answer options for p04-q05-FeverSeverity

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

Answer options for p04-q07-SwellingLocation

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

Answer options for p04-q08-SwellingSeverity

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

Answer options for p04-q10-ChillsSeverity

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

Answer options for p04-q12-HeadachesSeverity

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

Answer options for p04-q14-RashSeverity

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

Answer options for p04-q16-AchesPainsSeverity

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

Answer options for p04-q18-DigestiveDisorderSeverity

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

Answer options for p04-q20-FatigueSeverity

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

Answer options for p04-q22-ChestSymptomsSeverity

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

Answer options for p04-q24-DifficultyBreathingSeverity

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

Answer options for p04-q26-DizzinessSeverity

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

Answer options for p05-q02-MissedWorkDetail

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

Answer options for p06-q02-SymptomReliefDetail

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

Answer options for p07-q01-OverallExperience

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

Source

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  "resourceType" : "Questionnaire",
  "id" : "ActiveMonitoringDay3Survey",
  "text" : {
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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\"/> ActiveMonitoringDay3Survey</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 3-day post Influenza/Covid-19 booster 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/ActiveMonitoringDay3Survey#0.2.2</td></tr>\r\n<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-Intro\" 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-Intro</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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’</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>\r\n<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-Screening\" 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-Screening</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02. Screening</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>\r\n<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-VaccineType\" 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-VaccineType</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02 question 1. Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago</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\">Options: <a href=\"#opt-item.p02-q01-VaccineType\">5 options</a></td></tr>\r\n<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\" 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-SideEffects</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02 question 2. We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination?</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\">Options: <a href=\"#opt-item.p02-q02-SideEffects\">3 options</a></td></tr>\r\n<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_bck101.png)\" id=\"item.p02-q03-SideEffectsScreening\" 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-group.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"group\" class=\"hierarchy\"/> p02-q03-SideEffectsScreening</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02 question 3. null</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>\r\n<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_bck1010.png)\" id=\"item.p02-q03.1-WhoReceived\" 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_blank.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-q03.1-WhoReceived</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02 question 3.1. Who received the vaccine?</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\">Options: <a href=\"#opt-item.p02-q03.1-WhoReceived\">2 options</a></td></tr>\r\n<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_bck1010.png)\" id=\"item.p02-q03.2-WhereReceived\" 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_blank.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-q03.2-WhereReceived</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 02 question 3.2. Where did you/they go to receive your/their vaccination?</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\">Options: <a href=\"#opt-item.p02-q03.2-WhereReceived\">6 options</a></td></tr>\r\n<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_bck1000.png)\" id=\"item.p02-q03.3-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_blank.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-boolean.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"boolean\" class=\"hierarchy\"/> p02-q03.3-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 02 question 3.3. Were you/they pregnant/Hapu at the time of your/their vaccination?</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>\r\n<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-EarlyOnsetReactions\" 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-EarlyOnsetReactions</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03. Early onset reactions</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>\r\n<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-SelectedSideEffects\" 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\"/> p03-q01-SelectedSideEffects</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03 question 1. Did you/they experience any of the following after vaccination? (choose all that apply)</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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\">Options: <a href=\"#opt-item.p03-q01-SelectedSideEffects\">5 options</a></td></tr>\r\n<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-q02-AnaphylaxisDelay\" 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\"/> p03-q02-AnaphylaxisDelay</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03 question 2. How long after vaccination did anaphylaxis occur?</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.p03-q01-SelectedSideEffects\">p03-q01-SelectedSideEffects</a> = </span><br/>Options: <a href=\"#opt-item.p03-q02-AnaphylaxisDelay\">5 options</a></td></tr>\r\n<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-q03-SyncopeDelay\" 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\"/> p03-q03-SyncopeDelay</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03 question 3. How long after vaccination did syncope occur?</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-q01-SelectedSideEffects\">p03-q01-SelectedSideEffects</a> = </span><br/>Options: <a href=\"#opt-item.p03-q03-SyncopeDelay\">5 options</a></td></tr>\r\n<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-q04-SeizureDelay\" 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\"/> p03-q04-SeizureDelay</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03 question 4. How long after vaccination did the seizure/ convulsions occur?</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.p03-q01-SelectedSideEffects\">p03-q01-SelectedSideEffects</a> = </span><br/>Options: <a href=\"#opt-item.p03-q04-SeizureDelay\">5 options</a></td></tr>\r\n<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-q05-SeizureComorbidity\" 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-q05-SeizureComorbidity</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 03 question 5. Did seizure/ convulsions occur with:</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-q01-SelectedSideEffects\">p03-q01-SelectedSideEffects</a> = </span><br/>Options: <a href=\"#opt-item.p03-q05-SeizureComorbidity\">4 options</a></td></tr>\r\n<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-Reactions\" 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-Reactions</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04. Reactions</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>\r\n<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-ReactionsIntro\" 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-display.png\" alt=\".\" style=\"background-color: white; background-color: inherit\" title=\"display\" class=\"hierarchy\"/> p04-q01-ReactionsIntro</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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.</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>\r\n<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-InjectionSiteDisorder\" 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\"/> p04-q02-InjectionSiteDisorder</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 2. Injection site reaction (pain, redness, swelling, or itching at or near the injection site)</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>\r\n<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-q03-InjectionSiteSeverity\" 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\"/> p04-q03-InjectionSiteSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 3. Injection site reaction severity</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.p04-q02-InjectionSiteDisorder\">p04-q02-InjectionSiteDisorder</a> = </span><br/>Options: <a href=\"#opt-item.p04-q03-InjectionSiteSeverity\">5 options</a></td></tr>\r\n<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-q04-Fever\" 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\"/> p04-q04-Fever</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 4. Fever (a temperature of 38°C or higher)</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>\r\n<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-q05-FeverSeverity\" 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\"/> p04-q05-FeverSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 5. Temperature/fever severity</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.p04-q04-Fever\">p04-q04-Fever</a> = </span><br/>Options: <a href=\"#opt-item.p04-q05-FeverSeverity\">5 options</a></td></tr>\r\n<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-q06-Swelling\" 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\"/> p04-q06-Swelling</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 6. Swelling of glands (i.e., lymph nodes)</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>\r\n<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-q07-SwellingLocation\" 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\"/> p04-q07-SwellingLocation</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 7. Where abouts did you experience swelling?</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.p04-q06-Swelling\">p04-q06-Swelling</a> = </span><br/>Options: <a href=\"#opt-item.p04-q07-SwellingLocation\">3 options</a></td></tr>\r\n<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-q08-SwellingSeverity\" 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-q08-SwellingSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 8. Swelling of glands severity</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.p04-q06-Swelling\">p04-q06-Swelling</a> = </span><br/>Options: <a href=\"#opt-item.p04-q08-SwellingSeverity\">5 options</a></td></tr>\r\n<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-q09-Chills\" 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-q09-Chills</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 9. Chills, shivering, or cold sweats</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>\r\n<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-q10-ChillsSeverity\" 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-q10-ChillsSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 10. Chills/shivering/cold sweats severity</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.p04-q09-Chills\">p04-q09-Chills</a> = </span><br/>Options: <a href=\"#opt-item.p04-q10-ChillsSeverity\">5 options</a></td></tr>\r\n<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-q11-Headaches\" 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-q11-Headaches</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 11. Headaches</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>\r\n<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-q12-HeadachesSeverity\" 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-q12-HeadachesSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 12. Headache severity</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.p04-q11-Headaches\">p04-q11-Headaches</a> = </span><br/>Options: <a href=\"#opt-item.p04-q12-HeadachesSeverity\">5 options</a></td></tr>\r\n<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-q13-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\"/> p04-q13-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 04 question 13. Rash (not at the 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>\r\n<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-q14-RashSeverity\" 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-q14-RashSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 14. Rash severity</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.p04-q13-Rash\">p04-q13-Rash</a> = </span><br/>Options: <a href=\"#opt-item.p04-q14-RashSeverity\">5 options</a></td></tr>\r\n<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-q15-AchesPains\" 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-q15-AchesPains</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 15. Aches and pains</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>\r\n<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-q16-AchesPainsSeverity\" 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-q16-AchesPainsSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 16. Aches and pains severity</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.p04-q15-AchesPains\">p04-q15-AchesPains</a> = </span><br/>Options: <a href=\"#opt-item.p04-q16-AchesPainsSeverity\">5 options</a></td></tr>\r\n<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-q17-DigestiveDisorder\" 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-q17-DigestiveDisorder</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 17. Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite)</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>\r\n<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-q18-DigestiveDisorderSeverity\" 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-q18-DigestiveDisorderSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 18. Stomach symptoms severity</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.p04-q17-DigestiveDisorder\">p04-q17-DigestiveDisorder</a> = </span><br/>Options: <a href=\"#opt-item.p04-q18-DigestiveDisorderSeverity\">5 options</a></td></tr>\r\n<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-q19-Fatigue\" 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-q19-Fatigue</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 19. Fatigue or tiredness</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>\r\n<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-q20-FatigueSeverity\" 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-q20-FatigueSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 20. Fatigue or tiredness severity</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.p04-q19-Fatigue\">p04-q19-Fatigue</a> = </span><br/>Options: <a href=\"#opt-item.p04-q20-FatigueSeverity\">5 options</a></td></tr>\r\n<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-q21-ChestSymptoms\" 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-q21-ChestSymptoms</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 21. Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing)</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>\r\n<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-q22-ChestSymptomsSeverity\" 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-q22-ChestSymptomsSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 22. Chest symptoms severity</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.p04-q21-ChestSymptoms\">p04-q21-ChestSymptoms</a> = </span><br/>Options: <a href=\"#opt-item.p04-q22-ChestSymptomsSeverity\">5 options</a></td></tr>\r\n<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-q23-DifficultyBreathing\" 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-q23-DifficultyBreathing</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 23. Difficulty breathing</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>\r\n<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-q24-DifficultyBreathingSeverity\" 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-q24-DifficultyBreathingSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 24. Difficulty breathing severity</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.p04-q23-DifficultyBreathing\">p04-q23-DifficultyBreathing</a> = </span><br/>Options: <a href=\"#opt-item.p04-q24-DifficultyBreathingSeverity\">5 options</a></td></tr>\r\n<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-q25-Dizziness\" 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-q25-Dizziness</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 25. Dizziness or feeling lightheaded</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>\r\n<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-q26-DizzinessSeverity\" 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-q26-DizzinessSeverity</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 26. Dizziness or lightheaded severity</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.p04-q25-Dizziness\">p04-q25-Dizziness</a> = </span><br/>Options: <a href=\"#opt-item.p04-q26-DizzinessSeverity\">5 options</a></td></tr>\r\n<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-q27-OtherSymptoms\" 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-q27-OtherSymptoms</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 27. Did you/they experience any symptoms that were not listed above?</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>\r\n<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-q28-OtherSymptomsDetail\" 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-string.png\" alt=\".\" style=\"background-color: #F7F7F7; background-color: inherit\" title=\"string\" class=\"hierarchy\"/> p04-q28-OtherSymptomsDetail</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 04 question 28. Please explain</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-string\">string</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-q27-OtherSymptoms\">p04-q27-OtherSymptoms</a> = </span></td></tr>\r\n<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.p05-DailyImpact\" 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\"/> p05-DailyImpact</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 05. Impact on daily activities</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>\r\n<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.p05-q01-MissedWork\" 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\"/> p05-q01-MissedWork</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 05 question 1. Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily 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>\r\n<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.p05-q02-MissedWorkDetail\" 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\"/> p05-q02-MissedWorkDetail</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 05 question 2. 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.p05-q01-MissedWork\">p05-q01-MissedWork</a> = </span><br/>Options: <a href=\"#opt-item.p05-q02-MissedWorkDetail\">4 options</a></td></tr>\r\n<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.p06-CareSought\" 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\"/> p06-CareSought</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 06. Medical advice/care sought</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>\r\n<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.p06-q01-SymptomRelief\" 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\"/> p06-q01-SymptomRelief</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 06 question 1. Did any of the symptoms cause you/them to seek advice or care from a healthcare professional?</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>\r\n<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.p06-q02-SymptomReliefDetail\" 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: #F7F7F7; background-color: inherit\" title=\"coding\" class=\"hierarchy\"/> p06-q02-SymptomReliefDetail</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 06 question 2. Please choose the type of advice or care you/they sought. Please choose all that apply</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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.p06-q01-SymptomRelief\">p06-q01-SymptomRelief</a> = </span><br/>Options: <a href=\"#opt-item.p06-q02-SymptomReliefDetail\">8 options</a></td></tr>\r\n<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.p07-VaccinationExperience\" 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\"/> p07-VaccinationExperience</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 07. Vaccination 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-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>\r\n<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.p07-q01-OverallExperience\" 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\"/> p07-q01-OverallExperience</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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.</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\">Options: <a href=\"#opt-item.p07-q01-OverallExperience\">5 options</a></td></tr>\r\n<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.p07-q02-Comments\" 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\"/> p07-q02-Comments</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 07 question 2. Do you/they have any comments about your/their vaccine experience?</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>\r\n<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.p07-q03-CommentsDetail\" 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\"/> p07-q03-CommentsDetail</td><td style=\"vertical-align: top; text-align : left; background-color: #F7F7F7; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">page 07 question 3. Please explain</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-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.p07-q02-Comments\">p07-q02-Comments</a> = </span></td></tr>\r\n<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.p08-Thanks\" 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\"/> p08-Thanks</td><td style=\"vertical-align: top; text-align : left; background-color: white; border: 1px #F0F0F0 solid; padding:0px 4px 0px 4px\" class=\"hierarchy\">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.</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>\r\n<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,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\" 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-VaccineType\"> </a><p><b>Answer options for p02-q01-VaccineType </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;COVID-19 and flu vaccines at the same time&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Only flu vaccine&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Only COVID-19 vaccine&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other vaccine&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Was not vaccinated or do not recall&quot;)</li></ul><a name=\"opt-item.p02-q02-SideEffects\"> </a><p><b>Answer options for p02-q02-SideEffects </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Yes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;No&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Can't remember&quot;)</li></ul><a name=\"opt-item.p02-q03.1-WhoReceived\"> </a><p><b>Answer options for p02-q03.1-WhoReceived </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Myself&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;My dependent/whānau member&quot;)</li></ul><a name=\"opt-item.p02-q03.2-WhereReceived\"> </a><p><b>Answer options for p02-q03.2-WhereReceived </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Community vaccination centre&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;General practice&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Pharmacy&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mobile vaccination unit&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Hospital or emergency room&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p03-q01-SelectedSideEffects\"> </a><p><b>Answer options for p03-q01-SelectedSideEffects </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Anaphylaxis&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Syncope (fainting)&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Seizure/ convulsion&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;I don't know/ unsure&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;None of the above&quot;)</li></ul><a name=\"opt-item.p03-q02-AnaphylaxisDelay\"> </a><p><b>Answer options for p03-q02-AnaphylaxisDelay </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;0-5 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;6-10 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;11-15 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;16-20 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;21+ minutes&quot;)</li></ul><a name=\"opt-item.p03-q03-SyncopeDelay\"> </a><p><b>Answer options for p03-q03-SyncopeDelay </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;0-5 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;6-10 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;11-15 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;16-20 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;21+ minutes&quot;)</li></ul><a name=\"opt-item.p03-q04-SeizureDelay\"> </a><p><b>Answer options for p03-q04-SeizureDelay </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;0-5 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;6-10 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;11-15 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;16-20 minutes&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;21+ minutes&quot;)</li></ul><a name=\"opt-item.p03-q05-SeizureComorbidity\"> </a><p><b>Answer options for p03-q05-SeizureComorbidity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Syncope (fainting)&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Fever&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;I don't know&quot;)</li></ul><a name=\"opt-item.p04-q03-InjectionSiteSeverity\"> </a><p><b>Answer options for p04-q03-InjectionSiteSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q05-FeverSeverity\"> </a><p><b>Answer options for p04-q05-FeverSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q07-SwellingLocation\"> </a><p><b>Answer options for p04-q07-SwellingLocation </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Same arm as vaccination&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Opposite arm to vaccination&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p04-q08-SwellingSeverity\"> </a><p><b>Answer options for p04-q08-SwellingSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q10-ChillsSeverity\"> </a><p><b>Answer options for p04-q10-ChillsSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q12-HeadachesSeverity\"> </a><p><b>Answer options for p04-q12-HeadachesSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q14-RashSeverity\"> </a><p><b>Answer options for p04-q14-RashSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q16-AchesPainsSeverity\"> </a><p><b>Answer options for p04-q16-AchesPainsSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q18-DigestiveDisorderSeverity\"> </a><p><b>Answer options for p04-q18-DigestiveDisorderSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q20-FatigueSeverity\"> </a><p><b>Answer options for p04-q20-FatigueSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q22-ChestSymptomsSeverity\"> </a><p><b>Answer options for p04-q22-ChestSymptomsSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q24-DifficultyBreathingSeverity\"> </a><p><b>Answer options for p04-q24-DifficultyBreathingSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p04-q26-DizzinessSeverity\"> </a><p><b>Answer options for p04-q26-DizzinessSeverity </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Minor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Mild&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Moderate&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Serious&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Severe&quot;)</li></ul><a name=\"opt-item.p05-q02-MissedWorkDetail\"> </a><p><b>Answer options for p05-q02-MissedWorkDetail </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 or more days&quot;)</li></ul><a name=\"opt-item.p06-q02-SymptomReliefDetail\"> </a><p><b>Answer options for p06-q02-SymptomReliefDetail </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Phone advice from a helpline (e.g.,  Healthline)&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Care from a GP clinic (including the clinic  nurse, a doctor, or a phone call with a  person at the GP clinic).&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Visit to a hospital emergency department&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Māori Health Provider&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Rongoā clinic&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Whānau Ora navigator&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Pharmacy&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Other&quot;)</li></ul><a name=\"opt-item.p07-q01-OverallExperience\"> </a><p><b>Answer options for p07-q01-OverallExperience </b></p><ul><li style=\"font-size: 11px\">null#null (&quot;Very poor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Poor&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Average&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Good&quot;)</li><li style=\"font-size: 11px\">null#null (&quot;Excellent&quot;)</li></ul></div>"
  },
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/variable",
      "valueExpression" : {
        "name" : "vaccineReceived",
        "language" : "text/fhirpath",
        "expression" : "%resource.item.where(linkId='p02-Screening').item.first().answer.valueCoding.display"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/variable",
      "valueExpression" : {
        "name" : "validVaccine",
        "language" : "text/fhirpath",
        "expression" : "%vaccineReceived = 'COVID-19 and flu vaccines at the same time' or %vaccineReceived = 'Only flu vaccine' or %vaccineReceived = 'Only COVID-19 vaccine'"
      }
    },
    {
      "url" : "http://hl7.org/fhir/StructureDefinition/variable",
      "valueExpression" : {
        "name" : "experiencedSideEffects",
        "language" : "text/fhirpath",
        "expression" : "%resource.item.where(linkId='p02-Screening').item.where(linkId='p02-q02-SideEffects').answer.valueCoding.display = 'Yes' or %resource.item.where(linkId='p02-Screening').item.where(linkId='p02-q02-SideEffects').answer.valueCoding.display = 'Can\\'t remember'"
      }
    }
  ],
  "url" : "https://build.fhir.org/ig/tewhatuora/cinc-fhir-ig/Questionnaire/ActiveMonitoringDay3Survey",
  "identifier" : [
    {
      "use" : "official",
      "value" : "ActiveMonitoringDay3Survey",
      "period" : {
        "start" : "2023-07-19"
      }
    },
    {
      "use" : "temp",
      "value" : "Questionnaire-ActiveMonitoring-Day3SurveyQuestionnaire",
      "period" : {
        "end" : "2023-07-19"
      }
    }
  ],
  "version" : "0.2.2",
  "name" : "ActiveMonitoringDay3Survey",
  "title" : "Post Vaccine Symptom Check day 3 survey",
  "status" : "draft",
  "subjectType" : [
    "Patient"
  ],
  "date" : "2023-08-23T22:13:19+00:00",
  "publisher" : "Te Whatu Ora",
  "contact" : [
    {
      "name" : "Te Whatu Ora",
      "telecom" : [
        {
          "system" : "url",
          "value" : "https://www.tewhatuora.govt.nz/"
        }
      ]
    },
    {
      "name" : "David Grainger",
      "telecom" : [
        {
          "system" : "email",
          "value" : "david.grainger@middleware.co.nz",
          "use" : "work"
        }
      ]
    }
  ],
  "description" : "Te Whatu Ora 3-day post Influenza/Covid-19 booster vaccination survey.",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "workflow",
        "display" : "Workflow Setting"
      },
      "valueCodeableConcept" : {
        "text" : "Vaccination Side Effect Questionnaire"
      }
    }
  ],
  "jurisdiction" : [
    {
      "coding" : [
        {
          "system" : "urn:iso:std:iso:3166",
          "code" : "NZ",
          "display" : "New Zealand"
        }
      ]
    }
  ],
  "purpose" : "Survey of side effects and overall experience of Influenza/COVID-19 Booster vaccination after 3 days.",
  "code" : [
    {
      "system" : "http://snomed.info/sct",
      "code" : "293104008",
      "display" : "Vaccine adverse reaction"
    }
  ],
  "item" : [
    {
      "linkId" : "p01-Intro",
      "prefix" : "page 01",
      "text" : "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’",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "<p>Kia ora</p><p>This is the first of two surveys about your experience with receiving your recent vaccination(s). 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 Aotearoa New Zealand. The information you provide is confidential and is protected by the Privacy Act 2020 and data security safeguards.</p><p>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.<p>If you experience any of the following symptoms, <u>you should seek medical help urgently</u> and tell them about your vaccinations: <ul><li>tightness, heaviness, discomfort, pressure or pain in your chest or neck</li><li>difficulty breathing or catching your breath</li><li>feeling faint, dizzy, or light-headed</li><li>fluttering, racing, or pounding heart, or feeling like it’s ‘skipping beats’</li></ul></p><p>If you need any help completing your survey you can call 0800 855 066 for assistance.</p>"
          }
        ]
      },
      "type" : "display"
    },
    {
      "linkId" : "p02-Screening",
      "prefix" : "page 02",
      "text" : "Screening",
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ],
                "text" : "Drop down"
              }
            }
          ],
          "linkId" : "p02-q01-VaccineType",
          "prefix" : "page 02 question 1",
          "text" : "Please confirm the vaccine(s) that you or your dependent (e.g., child) received 3 days ago",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "COVID-19 and flu vaccines at the same time"
              }
            },
            {
              "valueCoding" : {
                "display" : "Only flu vaccine"
              }
            },
            {
              "valueCoding" : {
                "display" : "Only COVID-19 vaccine"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other vaccine"
              }
            },
            {
              "valueCoding" : {
                "display" : "Was not vaccinated or do not recall"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
              "valueExpression" : {
                "language" : "text/fhirpath",
                "expression" : "%validVaccine"
              }
            }
          ],
          "linkId" : "p02-q02-SideEffects",
          "prefix" : "page 02 question 2",
          "text" : "We would like to confirm your answer to the invitation text message. Did you experience any side effects after vaccination?",
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Yes"
              }
            },
            {
              "valueCoding" : {
                "display" : "No"
              }
            },
            {
              "valueCoding" : {
                "display" : "Can't remember"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
              "valueExpression" : {
                "language" : "text/fhirpath",
                "expression" : "%validVaccine and %experiencedSideEffects"
              }
            }
          ],
          "linkId" : "p02-q03-SideEffectsScreening",
          "prefix" : "page 02 question 3",
          "type" : "group",
          "item" : [
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "p02-q03.1-WhoReceived",
              "prefix" : "page 02 question 3.1",
              "text" : "Who received the vaccine?",
              "type" : "choice",
              "required" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "display" : "Myself"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "My dependent/whānau member"
                  }
                }
              ]
            },
            {
              "extension" : [
                {
                  "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
                  "valueCodeableConcept" : {
                    "coding" : [
                      {
                        "system" : "http://hl7.org/fhir/questionnaire-item-control",
                        "code" : "drop-down",
                        "display" : "Drop down"
                      }
                    ]
                  }
                }
              ],
              "linkId" : "p02-q03.2-WhereReceived",
              "prefix" : "page 02 question 3.2",
              "text" : "Where did you/they go to receive your/their vaccination?",
              "type" : "choice",
              "required" : true,
              "answerOption" : [
                {
                  "valueCoding" : {
                    "display" : "Community vaccination centre"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "General practice"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "Pharmacy"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "Mobile vaccination unit"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "Hospital or emergency room"
                  }
                },
                {
                  "valueCoding" : {
                    "display" : "Other"
                  }
                }
              ]
            },
            {
              "linkId" : "p02-q03.3-Pregnant",
              "prefix" : "page 02 question 3.3",
              "text" : "Were you/they pregnant/Hapu at the time of your/their vaccination?",
              "type" : "boolean",
              "required" : true
            }
          ]
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
          "valueExpression" : {
            "language" : "text/fhirpath",
            "expression" : "%validVaccine and %experiencedSideEffects"
          }
        }
      ],
      "linkId" : "p03-EarlyOnsetReactions",
      "prefix" : "page 03",
      "text" : "Early onset reactions",
      "type" : "group",
      "item" : [
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "check-box",
                    "display" : "Check-box"
                  }
                ]
              }
            }
          ],
          "linkId" : "p03-q01-SelectedSideEffects",
          "prefix" : "page 03 question 1",
          "text" : "Did you/they experience any of the following after vaccination? (choose all that apply)",
          "type" : "choice",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Anaphylaxis"
              }
            },
            {
              "valueCoding" : {
                "display" : "Syncope (fainting)"
              }
            },
            {
              "valueCoding" : {
                "display" : "Seizure/ convulsion"
              }
            },
            {
              "valueCoding" : {
                "display" : "I don't know/ unsure"
              }
            },
            {
              "valueCoding" : {
                "display" : "None of the above"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p03-q02-AnaphylaxisDelay",
          "prefix" : "page 03 question 2",
          "text" : "How long after vaccination did anaphylaxis occur?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-SelectedSideEffects",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Anaphylaxis"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "0-5 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "6-10 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "11-15 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "16-20 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "21+ minutes"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p03-q03-SyncopeDelay",
          "prefix" : "page 03 question 3",
          "text" : "How long after vaccination did syncope occur?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-SelectedSideEffects",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Syncope (fainting)"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "0-5 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "6-10 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "11-15 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "16-20 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "21+ minutes"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p03-q04-SeizureDelay",
          "prefix" : "page 03 question 4",
          "text" : "How long after vaccination did the seizure/ convulsions occur?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-SelectedSideEffects",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Seizure/ convulsion"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "0-5 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "6-10 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "11-15 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "16-20 minutes"
              }
            },
            {
              "valueCoding" : {
                "display" : "21+ minutes"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p03-q05-SeizureComorbidity",
          "prefix" : "page 03 question 5",
          "text" : "Did seizure/ convulsions occur with:",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p03-q01-SelectedSideEffects",
              "operator" : "=",
              "answerCoding" : {
                "display" : "Seizure/ convulsion"
              }
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Syncope (fainting)"
              }
            },
            {
              "valueCoding" : {
                "display" : "Fever"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            },
            {
              "valueCoding" : {
                "display" : "I don't know"
              }
            }
          ]
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
          "valueExpression" : {
            "language" : "text/fhirpath",
            "expression" : "%validVaccine and %experiencedSideEffects"
          }
        }
      ],
      "linkId" : "p04-Reactions",
      "prefix" : "page 04",
      "text" : "Reactions",
      "type" : "group",
      "item" : [
        {
          "linkId" : "p04-q01-ReactionsIntro",
          "prefix" : "page 04 question 1",
          "text" : "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.",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<p>Please choose all the reactions that you/they experienced. If yes, describe the reaction on a scale from minor, mild, moderate, serious, to severe.</p><p>For your rating take into account levels of pain, how long symptoms lasted and impact on daily life</p>"
              }
            ]
          },
          "type" : "display"
        },
        {
          "linkId" : "p04-q02-InjectionSiteDisorder",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "95376002",
              "display" : "Injection site disorder"
            }
          ],
          "prefix" : "page 04 question 2",
          "text" : "Injection site reaction (pain, redness, swelling, or itching at or near the injection site)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q03-InjectionSiteSeverity",
          "prefix" : "page 04 question 3",
          "text" : "Injection site reaction severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q02-InjectionSiteDisorder",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q04-Fever",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "386661006",
              "display" : "Fever or high temperature"
            }
          ],
          "prefix" : "page 04 question 4",
          "text" : "Fever (a temperature of 38°C or higher)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q05-FeverSeverity",
          "prefix" : "page 04 question 5",
          "text" : "Temperature/fever severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q04-Fever",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q06-Swelling",
          "prefix" : "page 04 question 6",
          "text" : "Swelling of glands (i.e., lymph nodes)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q07-SwellingLocation",
          "prefix" : "page 04 question 7",
          "text" : "Where abouts did you experience swelling?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q06-Swelling",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Same arm as vaccination"
              }
            },
            {
              "valueCoding" : {
                "display" : "Opposite arm to vaccination"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q08-SwellingSeverity",
          "prefix" : "page 04 question 8",
          "text" : "Swelling of glands severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q06-Swelling",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q09-Chills",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "274640006",
              "display" : "Chills, shivering or feeling cold"
            }
          ],
          "prefix" : "page 04 question 9",
          "text" : "Chills, shivering, or cold sweats",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q10-ChillsSeverity",
          "prefix" : "page 04 question 10",
          "text" : "Chills/shivering/cold sweats severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q09-Chills",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q11-Headaches",
          "prefix" : "page 04 question 11",
          "text" : "Headaches",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q12-HeadachesSeverity",
          "prefix" : "page 04 question 12",
          "text" : "Headache severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q11-Headaches",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q13-Rash",
          "prefix" : "page 04 question 13",
          "text" : "Rash (not at the injection site)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q14-RashSeverity",
          "prefix" : "page 04 question 14",
          "text" : "Rash severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q13-Rash",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q15-AchesPains",
          "prefix" : "page 04 question 15",
          "text" : "Aches and pains",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q16-AchesPainsSeverity",
          "prefix" : "page 04 question 16",
          "text" : "Aches and pains severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q15-AchesPains",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q17-DigestiveDisorder",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "53619000",
              "display" : "Disorder of digestive system"
            }
          ],
          "prefix" : "page 04 question 17",
          "text" : "Stomach symptoms (nausea, vomiting, diarrhoea, abdominal pain or loss of appetite)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q18-DigestiveDisorderSeverity",
          "prefix" : "page 04 question 18",
          "text" : "Stomach symptoms severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q17-DigestiveDisorder",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q19-Fatigue",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "84229001",
              "display" : "Fatigue"
            }
          ],
          "prefix" : "page 04 question 19",
          "text" : "Fatigue or tiredness",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q20-FatigueSeverity",
          "prefix" : "page 04 question 20",
          "text" : "Fatigue or tiredness severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q19-Fatigue",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q21-ChestSymptoms",
          "prefix" : "page 04 question 21",
          "text" : "Chest symptoms (chest pain/heaviness/tightness or heart palpitations/pounding/racing)",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q22-ChestSymptomsSeverity",
          "prefix" : "page 04 question 22",
          "text" : "Chest symptoms severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q21-ChestSymptoms",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q23-DifficultyBreathing",
          "code" : [
            {
              "system" : "http://snomed.info/sct",
              "code" : "230145002",
              "display" : "Difficulty breathing"
            }
          ],
          "prefix" : "page 04 question 23",
          "text" : "Difficulty breathing",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q24-DifficultyBreathingSeverity",
          "prefix" : "page 04 question 24",
          "text" : "Difficulty breathing severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q23-DifficultyBreathing",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q25-Dizziness",
          "prefix" : "page 04 question 25",
          "text" : "Dizziness or feeling lightheaded",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p04-q26-DizzinessSeverity",
          "prefix" : "page 04 question 26",
          "text" : "Dizziness or lightheaded severity",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p04-q25-Dizziness",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Minor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Mild"
              }
            },
            {
              "valueCoding" : {
                "display" : "Moderate"
              }
            },
            {
              "valueCoding" : {
                "display" : "Serious"
              }
            },
            {
              "valueCoding" : {
                "display" : "Severe"
              }
            }
          ]
        },
        {
          "linkId" : "p04-q27-OtherSymptoms",
          "prefix" : "page 04 question 27",
          "text" : "Did you/they experience any symptoms that were not listed above?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p04-q28-OtherSymptomsDetail",
          "prefix" : "page 04 question 28",
          "text" : "Please explain",
          "type" : "string",
          "enableWhen" : [
            {
              "question" : "p04-q27-OtherSymptoms",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
          "valueExpression" : {
            "language" : "text/fhirpath",
            "expression" : "%validVaccine and %experiencedSideEffects"
          }
        }
      ],
      "linkId" : "p05-DailyImpact",
      "prefix" : "page 05",
      "text" : "Impact on daily activities",
      "type" : "group",
      "item" : [
        {
          "linkId" : "p05-q01-MissedWork",
          "prefix" : "page 05 question 1",
          "text" : "Did any of the symptoms that you/they reported cause you/them to miss work, study, or normal daily activities?",
          "type" : "boolean",
          "required" : true
        },
        {
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://hl7.org/fhir/questionnaire-item-control",
                    "code" : "drop-down",
                    "display" : "Drop down"
                  }
                ]
              }
            }
          ],
          "linkId" : "p05-q02-MissedWorkDetail",
          "prefix" : "page 05 question 2",
          "text" : "How many days did you miss?",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p05-q01-MissedWork",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Less than 1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "1 day"
              }
            },
            {
              "valueCoding" : {
                "display" : "2 days"
              }
            },
            {
              "valueCoding" : {
                "display" : "3 or more days"
              }
            }
          ]
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
          "valueExpression" : {
            "language" : "text/fhirpath",
            "expression" : "%validVaccine and %experiencedSideEffects"
          }
        }
      ],
      "linkId" : "p06-CareSought",
      "prefix" : "page 06",
      "text" : "Medical advice/care sought",
      "type" : "group",
      "item" : [
        {
          "linkId" : "p06-q01-SymptomRelief",
          "prefix" : "page 06 question 1",
          "text" : "Did any of the symptoms cause you/them to seek advice or care from a healthcare professional?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p06-q02-SymptomReliefDetail",
          "prefix" : "page 06 question 2",
          "text" : "Please choose the type of advice or care you/they sought. Please choose all that apply",
          "type" : "choice",
          "enableWhen" : [
            {
              "question" : "p06-q01-SymptomRelief",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true,
          "repeats" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Phone advice from a helpline (e.g.,  Healthline)"
              }
            },
            {
              "valueCoding" : {
                "display" : "Care from a GP clinic (including the clinic  nurse, a doctor, or a phone call with a  person at the GP clinic)."
              }
            },
            {
              "valueCoding" : {
                "display" : "Visit to a hospital emergency department"
              }
            },
            {
              "valueCoding" : {
                "display" : "Māori Health Provider"
              }
            },
            {
              "valueCoding" : {
                "display" : "Rongoā clinic"
              }
            },
            {
              "valueCoding" : {
                "display" : "Whānau Ora navigator"
              }
            },
            {
              "valueCoding" : {
                "display" : "Pharmacy"
              }
            },
            {
              "valueCoding" : {
                "display" : "Other"
              }
            }
          ]
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/uv/sdc/StructureDefinition/sdc-questionnaire-enableWhenExpression",
          "valueExpression" : {
            "language" : "text/fhirpath",
            "expression" : "%validVaccine"
          }
        }
      ],
      "linkId" : "p07-VaccinationExperience",
      "prefix" : "page 07",
      "text" : "Vaccination experience",
      "type" : "group",
      "item" : [
        {
          "linkId" : "p07-q01-OverallExperience",
          "prefix" : "page 07 question 1",
          "text" : "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.",
          "_text" : {
            "extension" : [
              {
                "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
                "valueString" : "<p>How would you/they rate the overall experience at the vaccination site?</p><p>For your rating take into account informed consent process, staff helpfulness, vaccination site cleanliness, etc.</p>"
              }
            ]
          },
          "type" : "choice",
          "required" : true,
          "answerOption" : [
            {
              "valueCoding" : {
                "display" : "Very poor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Poor"
              }
            },
            {
              "valueCoding" : {
                "display" : "Average"
              }
            },
            {
              "valueCoding" : {
                "display" : "Good"
              }
            },
            {
              "valueCoding" : {
                "display" : "Excellent"
              }
            }
          ]
        },
        {
          "linkId" : "p07-q02-Comments",
          "prefix" : "page 07 question 2",
          "text" : "Do you/they have any comments about your/their vaccine experience?",
          "type" : "boolean",
          "required" : true
        },
        {
          "linkId" : "p07-q03-CommentsDetail",
          "prefix" : "page 07 question 3",
          "text" : "Please explain",
          "type" : "text",
          "enableWhen" : [
            {
              "question" : "p07-q02-Comments",
              "operator" : "=",
              "answerBoolean" : true
            }
          ],
          "enableBehavior" : "all",
          "required" : true
        }
      ]
    },
    {
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/StructureDefinition/questionnaire-itemControl",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "code" : "post-submit"
              }
            ]
          }
        }
      ],
      "linkId" : "p08-Thanks",
      "prefix" : "page 08",
      "text" : "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.",
      "_text" : {
        "extension" : [
          {
            "url" : "http://hl7.org/fhir/StructureDefinition/rendering-xhtml",
            "valueString" : "<p>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.</p><p>Ngā mihi</p><p>Health New Zealand</p>"
          }
        ]
      },
      "type" : "display"
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.