Mass Gathering
Have you attended any events in Australia/New Zealand associated with the 2023 FIFA Women’s World Cup?
Yes
No
Prefer not to answer
Have you attended any events in France associated with the 2024 Olympic Games?
Yes
No
Prefer not to answer
Did you perform Hajj in Saudi Arabia?
Yes
No
Prefer not to answer
Did you perform Umrah in Saudi Arabia?
Yes
No
Prefer not to answer
Did you attend any other large events (>10,000 people) during your travel?
Yes
No
Prefer not to answer
If YES, what was the event and the country?
Other
Did you take a COVID-19 test in the 2 days before your flight? (Single select)
Yes, antigen test
Yes, PCR or other molecular test
Yes, not sure what type
No
Prefer not to answer
Have you received a flu vaccine in the last 12 months?
Yes
No
Don’t Know
If yes, what was the date of your last flu vaccine?
Month, Year
Don’t remember
Have you ever received an RSV vaccine?
Yes
No
Don’t Know
If yes, what was the date of your last RSV vaccine?
Month, Year
Don’t remember
Please check any symptoms you have experienced in the past 2 days. Check all that apply, check ‘none of the above’ if you have not experienced any of the symptoms listed.
Cough, shortness of breath, or difficulty breathing
Congestion or sore throat
Fever or chills
Nausea, vomiting, or diarrhea
New loss of taste or smell
None of the above
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | Smith, Teresa (CDC/DDID/NCEZID/DGMQ) |
File Modified | 0000-00-00 |
File Created | 2024-08-18 |