Survey Questionnaire for the Research of Vitamin C in Flu and Covid-19

Whether you take Vitamin C or not, your participation will greatly help our research. During this global crisis of COVID-19 (SARS-Cov-2) pandemic, it is reported that vitamin C (VC) has been used in the prevention and treatmment in China and elsewhere. There are several government sanctioned VC clinical trials in China underway. The Shanghai Medical Association and the Shanghai government have included VC as part of their recommendations for COVID-19 treatment. This Questionnaire is designed to learn facts about your usage of VC and if it has helped you in any way or form, or not. We‘d like to hear from you. This is a not-for-profit research project initiated by a group of concerned scientists, doctors and citizens. You need to be 18 years or older to participate in this survey. Your answers are anonymous. The demographic data is de-identified and will only be used for data analysis.
1. What is your age?* 【多选题】
18-30 years
31-50 years
51 years or older
2. What is your gender?* 【多选题】
Female
Male
I prefer not to answer
3. What country/region do you live in?
4. How do you describe your race or ethnicity?* 【多选题】
Chinese
Asian (other than Chinese)
Caucasian/white
African/black
Other
I prefer not to answer
5. Do you currently take Vitamin C of any form?* 【多选题】
Yes
No (go to Q15)
6. What form of Vitamin C do you take? 【多选题】
Tablet
Powder
Lisoposomal Vitamin C
Intravenous Injection
Other
7. How long have you been taking Vitamin C? 【多选题】
Less than a week
A week to a month
More than a month but less than a year
More than a year
8. If you have been taking VC for more than a year, please describe how many years.
9. How often have you been taking Vitamin C? 【多选题】
Once or several times a day
Once or several times a week
Other
10. If you chose “other”, please describe.
11. What is your average dose for each time you take VC? 【多选题】
Less than 500 mg
500 mg to 1,000 mg
More than 1,000 mg but less than 10,000 mg
More than 10,000 mg
12. What are you taking Vitamin C for? Please describe briefly.
13. Do you have any side effects from taking Vitamin C? Please describe briefly.
14. Does Vitamin C help your health in any way or form? Please describe briefly.
15. Do you currently take other dietary supplements?* 【多选题】
No
Yes
16. Have you gotten flu vaccine since August 2019?* 【多选题】
Yes
No
17. Have you gotten cold or flu symptoms since August 2019?* 【多选题】
Yes
No
18. Have you been tested for the Covid-19 (SARS-Cov-2) virus?* 【多选题】
No (go to Q21)
Yes. The result is negative (-). (Go to Q21).
Yes. The result is positive (+).
Yes. The result is pending.
19. If you tested for Covid-19, how severe are your symptoms? 【多选题】
Severe
Moderate
Mild
Barely noticeable.
20. Have/had you been hospitalized because of the SARS-Cov-2 (Covid-19) infection? 【多选题】
Yes
No
21. Has any of your family members or the ones you have direct contact with been tested postive for SARS-Cov-2 (Covid-19)?* 【多选题】
Yes
No
22. If any of your family members or the ones you have direct contact with been tested positive, how many of them?
23. Do you have any chronic or underlying health conditions
24. If you allow us to contact you for further information, should it be necessary, please provide us with your email or other contact info.
Please click the blue bar that says ”提交“ to SUBMIT. (This survey was designed in a Chinese APP).
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