COVID-19 rapid test survey

Welcome to your immunDETEC SARS-CoV 2 Rapid Test survey

If you get a tag number please type in here:

Which user type you are?

medical doctor

Nurse

Pharmacist

Laboratory Staff

others (please specify)

User type to specify:

Which test device are you using?

Not listed test device Please fill in here...

Please insert the LOT number of your test.

In which country is the tested person right now?

What is the nationality of the tested person?

What is the age of the tested person [in years]?

What is the gender of the tested person ?

male

female

inter

What is the weight of the tested person [in kg]?

What is the height of the tested person [in cm]?

Do the tested person smoke regularly?

seldom (1-3 times a week)

normal (1-3 times a day)

no smoker

Why are you using the COVID-19 test device?

Please select the symptoms the tested person have?

Coughing high temperature (at least 38°C) Sore throat Sneezing and runny nose temporary loss of smell none others

What symtomps the tested person have which are not mentioned above?

When did the first symptoms occur?

What is the clincal diagnosis in relation to COVID-19?

COVID-19 positive (+)

COVID-19 negative (-)

No sufficient data

No clinical diagnosis

When was the clinical examination carried out?

Have the tested person been tested by PCR?

yes

In case the tested person got PCR testresult, when was your PCR test done?

What was the PCR result?

SARS-CoV2 positiv (+)

SARS-CoV2 negative (-)

Whats about the health conditions of the tested person - what kind of conditions the tested person have?

Chronic kidney disease, as defined by your doctor

Chronic liver disease, as defined by your doctor

Compromised immune system, including undergoing cancer treatment such as chemotherapy or radiation, having received an organ or bone marrow transplant, or taking high doses of corticosteroids or other immunosuppressant medications, and HIV or AIDS

Current or recent pregnancy in the last two weeks

Endocrine disorders, such as diabetes

Metabolic disorders

Heart disease

Lung disease, including asthma

Neurological and neurologic and neurodevelopment conditions

Was the packaging intact?

yes

Did you read the instructions for use? or Did you get an instruction or introduction?

yes

Were the instructions at the packaging insert easy to unserstand? or
Were the introduction you got easy to understand?

yes

too long

too short

too complicated

Were the packaging and the items complete?

yes

lancets missing

pipettes missing

Alcohol wrap pad missing

test device missing

packaging insert missing

buffer missing

not relevant

Did you use the test device according the instructions on the Manual? Did you use the test according the introduction you get?

yes

Was this the first time performing a COVID-19 test for the tested person?

yes

How many COVID-19 rapid tests did the tested person perform previously?

When did you perfrom the test?

What is the test result?

IgM / IgG negative (-/-)

IgM positive / IgG negative (+/-)

IgM negative / IgG positive (-/+)

IgM / IgG positive (+/+)

Invalid

other result as i used a different test - answer below...

other test result as an other test device was used:

Picture of you test result

Is there any further important information you would like to share?

In case you want to contact us, please leave your message here:

COVID-19 rapid test survey

Welcome to the sanPharmacy immunDETEC SARS-CoV 2 Rapid Test survey

Thank You for your time.