COVID-19 Symptom Impact Survey

Please take this survey if you tested positive for COVID-19, if you have/had a suspected case of COVID-19, or if you believe you have/had COVID-19.

We know that many people who experienced COVID-19 symptoms weren’t able to get tested, and that some people with COVID-19 symptoms received a false negative on their test.

The best way we can learn about this disease is through your experiences. Your responses will remain completely anonymous and will do a huge service to us and others as we continue to learn about this disease. If you’re able, please fill out the survey to the end. We truly appreciate and value your insights.

Thank you!

INDIANA UNIVERSITY STUDY INFORMATION SHEET FOR RESEARCH

COVID-19 Symptom Impact Survey

About this research
You are being asked to participate in a research study. Scientists do research to answer important questions which might help change or improve the way we do things in the future.

This form will give you information about the study to help you decide whether you want to participate. Please read this form, and ask any questions you have, before agreeing to be in the study.

Taking part in this study is voluntary.
You may choose not to take part or may leave the study at any time. Leaving the study will not result in any penalty or loss of benefits to which you are entitled. Your decision whether or not to participate in this study will not affect your current or future relations with Survivor Corps or Indiana University.

This research is intended for individual 18 years of age or older. If you are under age 18, do not complete the survey.

Why is this study being done?
The purpose of this study is to understand what symptoms people with COVID-19 are experiencing, how severe those symptoms are, what factors like age, race, and health impact which symptoms they experience, as well as people's experiences seeking treatment for COVID-19 symptoms.

You may participate in this study if you have tested positive for COVID-19, have/had a suspected case of COVID-19, or believe you have/had COVID-19 based on your symptoms and/or exposure to others who have COVID-19.

The study is being conducted by Dr. Natalie Lambert in the School of Medicine at Indiana University School of Medicine.

What will happen during the study?
If you agree to be in the study, you will take a survey where you share information about:

• Your background and overall health prior to getting COVID-19
• The COVID-19 symptoms you have experienced, along with how long they lasted, how severe they are/were, and how they have impacted your life
• Your experiences seeking medical care for COVID-19

They survey should take no more than 15-20 minutes to complete.

What are the risks and benefits of taking part in this study?
The risks of participating in this research are minimal but could include you feeling uncomfortable recalling difficult experiences related to having COVID-19.

We don't expect you to receive any benefit from taking part in this study other than an ability to share your COVID-19 experiences, but we hope to learn things which will help scientists and policy makers in the future.

How will my information be protected?
We will not collect your name, address, or other directly identifiable information. However, all research includes at least a small risk of loss of confidentiality. Efforts will be made to keep your personal information confidential. We cannot guarantee absolute confidentiality. Your personal information may be disclosed if required by law. Your identity will be held in confidence in reports in which the study may be published and databases in which results may be stored.

Organizations that may inspect and/or copy your research records for quality assurance and data analysis include groups such as the study investigator and his/her research associates, the Indiana University Institutional Review Board or its designees, and any state or federal agencies who may need to access your research records (as allowed by law).

Will I be paid for participation?
You will not be paid for participating in this study.

Who should I call with questions or problems?
For questions about the study, contact the researcher Dr. Natalie Lambert at nalamb@iu.edu .

For questions about your rights as a research participant or to discuss problems, complaints or concerns about a research study, or to obtain information, or offer input, please contact the IU Human Subjects Office at 800-696-2949 or at irb@iu.edu.

To begin the survey, please click BEGIN SURVEY and then click Next Page below.

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BEGIN SURVEY

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You have selected an option that triggers this survey to end right now.

To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.