Are you 16 years old? * Yes No Able and willing to attend the study site for up to 6 visits over one year? (see map below) ? * Yes No Are you registered with a GP Practice in the UK? * Yes No Have you previously received a vaccine for COVID-19? * Yes No If yes, how many doses? * 1 2 Did you receive the Pfizer vaccine? * Yes No What date did you receive the Pfizer vaccine? * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20232024 Have you been advised to have two doses of COVID-19 vaccine? (This could either be because of a health condition you have, or because someone you live with has impaired immunity.) * Yes No Have you previously taken part in a clinical study involving a vaccine? * Yes No Please give details of any studies you have previously participated in that have involved a vaccine (if possible: the disease studied; the vaccine given; who organised the study?) * Are you currently participating in any COVID-19 serological survey studies and/or prophylactic drug trials? * Yes No Do you take any routine medication? * Yes No Please give details of any medication you are currently taking * Have you ever had a severe allergic reaction? * Yes No Have you had antibody infusions and/or any blood products (such as a blood transfusion) in the last 3 months? * Yes No Do you have any bleeding disorders? * Yes No Do you have a history of congenital heart disease? * Yes No Do you have a history of cancer? * Yes No Has your spleen been removed? ? * Yes No Do you have any problems with your immune system? * Yes No Please specify * Do you take any immunosuppressant medication? * Yes No Please specify what medication you are taking. * How long have you been taking this medication? * Are you under the care of a psychiatrist? * Yes No Do you have any other serious long-term illnesses requiring hospital follow-up * Yes No Please specify * Have you received any vaccinations in the past 7 days, or do you have any planned vaccinations coming up? * Yes No Do you have elective surgery (requiring general anaesthetic or overnight hospital admission) planned? * Yes No Are you pregnant, or breast feeding, or planning to become pregnant in the next 6 months? * Yes No If sexually active, are you willing to use contraception and avoid getting pregnant for the duration of the study? (Urinary pregnancy tests will be required in the study for all girls aged 11 and over.) * Yes No NA How did you hear about us? SELECT ONE * Facebook Instagram Twitter Word of mouth Poster Email Circular Online Search Daily info Other Please Specify * Thank you for your interest in our study. Based on your responses, you may be eligible to participate. Please complete the questions below. We will contact you by phone. Thank you for your interest in our study. Based on your responses, you might be eligible to participate. Please complete the questions below. We will contact you by phone if you are eligible, or if we have any more questions. Are you happy to provide details of your medical history? * Yes No Please provide details of any past or current medical problems * Do you wish for your parents (or guardian) to know about your participation in this study? If so, please provide their details below * Yes No Parent Name * Parent Address * Parent contact number * I agree for the Oxford Vaccine Group to record my personal information and information about my medical history. I agree to be contacted by the Manchester University NHS Foundation Trust for the purposes of this trial. * Yes No I consent for Manchester University NHS Foundation Trust to contact my General Practitioner and to obtain details of my medical history from them.. * Yes No Thank you for your interest in our study. Based on your responses, you are not eligible to take part in this study. What is your first name? * What is your last name? * What is your date of birth? * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 What is your gender? * What is your e-mail address? * What is your phone number? * What is your address? * What is your postcode? * What are your GP Practice details? * What is your NHS number (if known). You can find out your NHS number by clicking on this website link and filling in your details: https://www.nhs.uk/nhs-services/online-services/find-nhs-number/ * Math question * 5 + 3 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
