[NCEZID] Traveler-based Genomic Surveillance Questionnaire (24BT)

Mass Gathering

1. Have you attended any events in Australia/New Zealand associated with the 2023 FIFA Women’s World Cup?

   1. Yes

   2. No

   3. Prefer not to answer

2. Have you attended any events in France associated with the 2024 Olympic Games?

   1. Yes

   2. No

   3. Prefer not to answer

3. Did you perform Hajj in Saudi Arabia?

   1. Yes

   2. No

   3. Prefer not to answer

4. Did you perform Umrah in Saudi Arabia?

   1. Yes

   2. No

   3. Prefer not to answer

5. Did you attend any other large events (>10,000 people) during your travel?

   1. Yes

   2. No

   3. Prefer not to answer

   4. If YES, what was the event and the country?

Other

1. Did you take a COVID-19 test in the 2 days before your flight? (Single select)

   1. Yes, antigen test

   2. Yes, PCR or other molecular test

   3. Yes, not sure what type

   4. No

   5. Prefer not to answer

2. Have you received a flu vaccine in the last 12 months?

   1. Yes

   2. No

   3. Don’t Know

3. If yes, what was the date of your last flu vaccine?

   1. Month, Year

   2. Don’t remember

4. Have you ever received an RSV vaccine?

   1. Yes

   2. No

   3. Don’t Know

5. If yes, what was the date of your last RSV vaccine?

   1. Month, Year

   2. Don’t remember

6. Please check any symptoms you have experienced in the past 2 days. Check all that apply, check ‘none of the above’ if you have not experienced any of the symptoms listed.

   1. Cough, shortness of breath, or difficulty breathing

   2. Congestion or sore throat

   3. Fever or chills

   4. Nausea, vomiting, or diarrhea

   5. New loss of taste or smell

   6. None of the above