Is your child aged between 12 and 15 years? * Yes No Are you and your child able and willing to attend the study site for up to 6 visits over one year? * Yes No Is your child registered with a GP Practice in the UK? * Yes No Has your child previously received a vaccine for COVID-19? * Yes No If yes, how many doses? * 1 2 Did your child receive the Pfizer vaccine? * Yes No What date did your child receive the Pfizer vaccine? * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year20242025 Has your child been advised to have two doses of COVID-19 vaccine? (This could either be because of a health condition they have, or because someone they live with has impaired immunity.) * Yes No Has your child previously taken part in a clinical study involving a vaccine? * Yes No Please give details of any studies your child has previously participated in that have involved a vaccine (if possible: the disease studied; the vaccine given; who organised the study?) * Is your child currently participating in any COVID-19 serological survey studies and/or prophylactic drug trials? * Yes No Does your child take any routine medication? * Yes No Please give details of any medication you are currently taking * Has your child ever had a severe allergic reaction? * Yes No Has your child had antibody infusions and/or any blood products (such as a blood transfusion) in the last 3 months? * Yes No Does your child have any bleeding disorders? * Yes No Does your child have a history of congenital heart disease? * Yes No Does your child have a history of cancer? * Yes No Has your child’s spleen been removed? * Yes No Does your child have any problems with their immune system? * Yes No Please specify * Does your child take any immunosuppressant medication? * Yes No Please specify what medication they are taking. * How long has your child been taking this medication? * Is your child under the care of a psychiatrist? * Yes No Does your child have any other serious long-term illnesses requiring hospital follow-up? * Yes No Please specify * Has your child received any vaccinations in the past 7 days, or do they have any planned vaccinations coming up? * Yes No Does your child have elective surgery (requiring general anaesthetic or overnight hospital admission) planned? * Yes No Is your child pregnant, or breast feeding, or planning to become pregnant in the next 6 months? * Yes No If sexually active, is your child 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. A second part to this questionnaire will follow shortly Thank you for your interest in our study. Based on your responses, your child might be eligible to participate. Please complete the questions below. We will contact you by phone if your child is eligible, or if we have any more questions. Are you happy to provide details of your child’s medical history? * Yes No Please provide details of any past or current medical problems of your child * Do you consent for us to contact your GP with any further questions we may have about your child’s medical history? * Yes No I agree for the Oxford Vaccine Group to record our personal information and information about my child’s medical history. I agree to be contacted by the Alder Hey Children's Hospital NHS Foundation Trust for the purposes of this trial. * Yes No I consent for Alder Hey Children's Hospital NHS Foundation Trust to contact my child’s General Practitioner and to obtain details of my child’s medical history from them. * Yes No Thank you for your interest in our study. Based on your responses, your child is not eligible to take part in this study. What is your child’s first name? * What is your child’s last name? * What is your child’s date of birth? * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 What is your child’s gender? * What is your first name? * What is your e-mail address? * What is your phone number? * What is your address? * What is your postcode? * What are your child’s GP Practice details? * What is your childs 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 * 1 + 1 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
