| Part | Sector | Questions covered in survey | ||||
| Part I | Demographic information | Age Groups | 0 - 19 years old | |||
| 20 - 39 years old | ||||||
| 40 - 69 years old | ||||||
| 70 - 89 years old | ||||||
| Above 90 years | ||||||
| Gender | Male | |||||
| Female | ||||||
| Part II | Relevant medical history | Do you have a Liver disease? | ||||
| Are you hypertensive? | ||||||
| Are you Diabetic? | ||||||
| Are you pregnant? (Females) | ||||||
| Do you have any Cardiac problem or disease? | ||||||
| Do you suffer from any Respiratory disease or problem? | ||||||
| Did you have cancer? | ||||||
| Do you have any type of Hepatitis? (Hepatitis B or C) | ||||||
| Are you immunocompromised or having any sort of autoimmune disease? | ||||||
| Do you have any other medical problem or disease (not mentioned)? | ||||||
| Do you have an accompanied Disease? | ||||||
| Part III | Infection date | Since two-months | ||||
| Since three-months | ||||||
| Since four-months | ||||||
| Since five-months | ||||||
| Since six-months | ||||||
| More than six months | ||||||
| Part IV | After-infection symptoms | Are you affected by the following conditions? | Asymptomatic | |||
| Stomachache | ||||||
| Lung problems | ||||||
| Fatigue | ||||||
| Fever | ||||||
| Depression | ||||||
| Sore Throat | ||||||
| Cough | ||||||
| Chronic Sinusitis | ||||||
| New Loss of sense of taste and smelling | ||||||
| Diarrhea | ||||||
| Headaches | ||||||
| Other symptoms | ||||||
| Hair lost | ||||||
| Diabetes | ||||||
| Urinary tract infections | ||||||
| Part V | Post-cure symptoms | Do you still have these symptoms? | Asymptomatic | |||
| Hair lost | ||||||
| Hyperglycemia | ||||||
| Recurrent urinary tract infections | ||||||
| Gastrointestinal problems | ||||||
| Lung problems | ||||||
| Fever | ||||||
| Cough | ||||||
| Fatigue | ||||||
| Depression | ||||||
| Headaches | ||||||
| Nasal infections | ||||||
| Lost of sense of taste and smelling | ||||||
| Other symptoms | ||||||
| Part VI | Disease severity | During onset of active infection, it was | Sever (I needed admission to ICU) | |||
| Moderate (I needed Oxygen) | ||||||
| Mild (I needed drugs only) | ||||||
| Very mild (I didn’t had drugs) | ||||||
| Without symptoms | ||||||
| Part VII | Vaccination | Didn’t reserved a vaccine | ||||
| I did get the vaccine | Type | Astra Zeneca | ||||
| Pfizer | ||||||
| Moderna | ||||||
| Sinopharm BIBP | ||||||
| Sputnik V | ||||||
| Other type | ||||||
| Part VIII | Treatment | I had reserved treatment in hospital | ||||
| Vitamins and minerals such as Vitamin C, Iron, Zinc and analgesic | ||||||
| Vitamins as well as Antibiotics | ||||||
| Vitamins, Antibiotics, Anticoagulants and Hydrocortisone | ||||||
| Oxygen, Vitamins, Antibiotics, Anticoagulants and Hydrocortisone | ||||||
| Home remedies and herbs | ||||||
| I didn’t had any type of Therapy | ||||||
| I had other different protocol | ||||||