MEDsan COVID-19 rapid test survey – English

GDPR consent *

I consent to the storage of the survey entries entered here so that my survey information can participate in the anonymous evaluation. Personal data are not saved or processed here. *

Did you get a tag number for the test?

yes
no

Insert your tag number:

In case you got a tag number or similar, please insert above.

Please indicate your profession: *

Medical doctor
Nurse
Pharmacist
Laboratory Staff
Others (please specify)

Please specify your profession: *

Please specify your profession. This information helps us to understand the specific application groups and we are able to develop more convenient prodcts.

Which device are you using? *

Choose your product if it´s not a MEDsan COVID-19 rapid test.

If your device is not listed above, please enter the name of your test device here:

Please enter the name and/or brand of your device.

Please enter your device LOT or BATCH number:

This number is usually printed on the pouch of the test kit.

In which country was the test conducted? *

Choos your location

What is the nationality of the tested person? *

Choos your nationality

How old is the tested person (in years)? *

What is the gender of the tested person? *

Female
Male
Inter

What is the weight of the tested person (in kg)? *

Enter the weight in full kg please.

What is the hight of the tested person (in cm)? *

Insert the hight in full cm please.

Does the tested person smoke regularily? *

1-3 times a week
1-3 times a day
More than 1-3 times per hour
Non smoker

Why are you using the COVID-19 test device? *

Contact with a positive person
Return from risk area
Occupational saftey requirements
On medical advice
Released from Quaranten/Shut down
Personal interest

Please select the symptoms of the tested person? *

Coughing
High temperature (at least 38°C)
Sore throat
Sneezing and runny nose
Temporary loss of smell
None
Blue colored skin
Others (please specify)

If the sympthoms of the tested person are not listed above please enter here: *

Which other symptoms does the tested person have?

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

COVID-19 positive (+)
COVID-19 negative (-)
No sufficient data
No clinical diagnosis

Was the person in additon tested by PCR, ELISA or gene sequencing? *

RT-PCR
ELISA Test
Gene sequencing
Non of the listed methods

What was the result of the additional test?

COVID-19 positive (+)
COVID-19 positive (-)
Other result (please specify)

Please specify the PCR, ELISA or sequenzing results:

Please enter additional information on the PCR, ELISA or sequenzing results.

Does the tested person have any preexisting health conditions? *

Specify health conditions not mentioned above:

Please specify health conditions in case you think they have impact on COVID-19.

Was the packaging/safety seal intact? *

Yes
No

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

Yes
No

Were the instructions on the packaging insert easy to unserstand or was the introduction given easy to understand? *

Yes
Too long
Too short
Too complicated

Was the packaging and the items of the test kit complete? *

Yes
No

Which item was missing?

Test Kit(s)
Lancet(s)
Pipette(s) / Dropper(s)
Alcohol prep pad(s)
Buffer solution(s)
Packaging insert(s)

Did you use the test device according to the instructions on the manual? Did you use the test kit according to the introduction you got? *

Yes
No

Was the tested person previously tested by rapid test?

Please insert how often a rapid test was made for the tested person before this one.

What is the rapid test result? *

IgM / IgG negative (-/-)
IgM positive / IgG negative (+/-)
IgM / IgG positive (+/+)
IgM negative / IgG positive (-/+)
Invalid
Other result (please specify)

Please specify your COVID-19 Rapid Test result:

In case your device shows results you can´t choose from the list above you can enter the result in here.

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

MEDsan COVID-19 rapid test survey – English

Welcome to the MEDsan COVID-19 rapid test survey