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First Dose
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Have you received any dose of a COVID-19 vaccine?
Have you received any dose of a COVID-19 vaccine?
No
Have you received any dose of a COVID-19 vaccine?
Yes
What was the date that you received the dose?
What was the vaccine type?
Updated Pfizer (12+ yrs/años)
Updated Moderna (12+ yrs/años)
UPDATED Pfizer (5-11 yrs/años)
UPDATED Moderna (6-11 yrs/años)
Updated Pfizer (6 mos-4 yrs/6 meses-4 años) Dose 1 & 2
Updated Pfizer (6 mos-4 yrs/6 meses-4 años) Dose 3
Updated Moderna (6 mos-5 yrs/6 meses-5 años) Series
UPDATED DOSE Pfizer (6 mos-4 yrs/6 meses-4 años)
UPDATED DOSE Moderna (6 mos-5 yrs/6 meses-5 años)
Novavax
OTHER/Otra/Khác/Summad Kale
If you received the first of a two-part vaccine somewhere else, we need you to answer some registration questions before scheduling the second dose with us. Click “Next” to get started.
What Other COVID-19 Vaccine brand did you receive?
AstraZeneca-Oxford (Covishield, Vaxzevria)
Johnson & Johnson (J&J)
Moderna
Moderna Booster/Refuerzo
Other/Don't remember
Pfizer
Pfizer (12+ yrs/años) Booster/Refuerzo
Pfizer (6 mos-4 yrs/6 meses-4 años) Monovalent Dose 3 Series
Sinopharm
Sinovac
Sputnik V
Health Related Questions
Have you previously experienced a severe allergic reaction to any COVID vaccine?
Have you previously experienced a severe allergic reaction to any COVID vaccine?
No
Have you previously experienced a severe allergic reaction to any COVID vaccine?
Yes
Have you had a severe allergic reaction to ANYTHING - including food, medication, previous vaccines or anything else?
Have you had a severe allergic reaction to ANYTHING - including food, medication, previous vaccines or anything else?
No
Have you had a severe allergic reaction to ANYTHING - including food, medication, previous vaccines or anything else?
Yes
Do you have any conditions that cause you to be immune compromised (have a weakened immune system), including taking immune suppressing medications?
Do you have any conditions that cause you to be immune compromised (have a weakened immune system), including taking immune suppressing medications?
No
Do you have any conditions that cause you to be immune compromised (have a weakened immune system), including taking immune suppressing medications?
Yes