Questionnaire
1) Did you bring your vaccination certificate to the hospital today?
□ Yes
□ No
□ I do not have a vaccination certificate at all
□ Yes, but I have another one / older vaccination certificate that I did not bring with me.
2) Do you think that you received all vaccinations recommended for people of your age and your health status?
□ Yes
□ No
□ I do not know
3) Are you sceptical about vaccinations in general?
□ Yes
□ No
□ I do not know
If yes, why?
□ I am afraid of side effects
□ I am confused about the information about vaccinations in the media
□ I would need more information
□ Vaccinations are only used by pharmaceutical companies, and doctors only perform vaccinations to make money
□ I don’t feel threatened by the diseases which are prevented by vaccinations
□ My immune system can handle the pathogens on its own
□ Other:__________________________
4) Have you ever felt any side effects after vaccination?
□ Yes
□ No
If yes, what kind of side effects?
□ fever
□ headache and limb pain
□ muscle pain
□ nausea
□ tiredness
□ redness, swelling or pain on the injection point
□ Other:__________________________
5) Would you get vaccinated if we recommend it to you in the discharge letter?
□ Yes
□ No
□ I do not know
6) Did somebody check your vaccination status after receiving the diagnosis lung cancer but before therapy started?
□ Yes
□ No
□ I do not know
□ I received no chemotherapy at all
If yes, which physician checked your vaccination status?
□ General practitioner
□ Specialist for pulmonary care
□ Cardiologist
□ Endocrinologist
□ Nephrologist
□ Angiologist
□ Rheumatologist
□ Neurologist
□ Oncologist
□ Gynaecologist
□ Gastroenterologist
□ Other:__________________________
7) Have you visited your general practitioner since the diagnosis lung cancer and has he or she checked your vaccination certificate?
□ Yes, I visited my general practitioner and he or she checked the vaccination certificate.
□ Yes, I visited my general practitioner but he or she did not check the vaccination certificate.
□ Yes, I visited my general practitioner and he or she asked for my vaccination certificate, but I left it at home.
□ No, I have not been to my general practitioner since the diagnosis lung cancer.
8) Have you visited a specialist of pulmonary care since the diagnosis lung cancer and has he or she checked your vaccination certificate?
□ Yes, I was at a specialist of pulmonary care and he checked the vaccination certificate.
□ Yes, I was at a specialist of pulmonary care but he did not check the vaccination certificate.
□ Yes, I was at a specialist of pulmonary care and he or she asked for my vaccination certificate but I left it at home.
□ No, I have not been at a specialist of pulmonary care since the diagnosis lung cancer.
9) Has any other medical specialist checked your vaccination certificate since the diagnosis lung cancer?
□ Yes
□ No
□ Yes, but I left my vaccination certificate at home
10) Did you visit your general practitioner in the last 12 months and has he or she checked your vaccination certificate?
□ Yes, I visited my general practitioner and he or she checked the vaccination certificate.
□ Yes, I visited my general practitioner but he or she did not check the vaccination certificate.
□ Yes, I visited my general practitioner and he or she asked for my vaccination certificate but I left it at home.
□ No, I have not been to my general practitioner in the last 12 months.
11) Did you visit your general practitioner in the last 36 months (=3 years) and has he or she checked your vaccination certificate?
□ Yes, I visited my general practitioner and he or she checked the vaccination certificate.
□ Yes, I visited my general practitioner but he or she did not check the vaccination certificate.
□ Yes, I visited my general practitioner and he or she asked for my vaccination certificate but I left it at home.
□ No, I have not been to my general practitioner in the last 36 months (=3 years).
12) Are you still working?
□ Yes
□ No
If no, since when?
□ Before the diagnosis lung cancer
□ Since the diagnosis lung cancer
□ Since therapy has started or later
Which profession do you have?__________________________________________
Are you working as a professional first-aider?
□ Yes
□ No
□ I do not know
Are you working
□ in an institution with many other people (e.g. sales person, office work with a lot of customer contact, etc.)?
□ as a day nanny, baby sitter of a newborn (<4 weeks old)?
□ in a function using welding and isolating metals?
13) Have you had chickenpox (in your childhood)?
□ Yes
□ No
□ I do not know
14) Have you had measles (in your childhood)?
□ Yes
□ No
□ I do not know
15) Have you had mumps (in your childhood)?
□ Yes
□ No
□ I do not know
16) There are vaccination recommendations for special risk groups. Do you belong to any of them?
Animals and nature
□ direct contact to poultry or wild birds
□ contact to bats
□ contact to ticks (e.g. in leisure time outdoors, garden work, etc.)
□ farmer
□ hunter
Resident in special facilities
□ resident in an accommodation of asylm seekers or refugees
□ resident in a nursing home
□ resident in a psychiatric facility
□ resident in an accommodation for people with abnormal behavior or cerebral paresis
Contact to pregnant women, children and newborns
□ planned pregnancy of the partner/daughter/close contact person
□ pregnancy of a close contact person with delivery in the next 4 weeks
□ planned activity as day nanny / baby sitter of a newborn
□ contact to newborns (<4 weeks old)
□ contact to children (<1 year old)
Risk contact in private setting
□ contact to immunosupressed persons
□ persons with dialysis in your own household
□ close contact to a person with chronic hepatitis B
□ close contact to a person who has not had chickenpox and was not vaccinated against it, with a severe neurodermatitis, planned immunosuppression or planned organ transplantation
Sexual preferences
□ Men who have sex with men
□ Sex with often changing partners
Other:
□ active drug consumption (Intravenous)
□ prison inhabitation since diagnosis lung cancer
□ other:______________________________________________________
Are you working voluntarily?
□ Yes
□ in health care, including associated jobs (including laboratories, cleaning person)
□ in a shelter or home for people seeking asylum
□ in a health care kitchen
□ in day care or children’s home or something similar
□ in a training facility for young adults
□ in a prison / penal system
□ Other:__________________________
□ No
17) Have you been vaccinated against seasonal influenza?
□ Yes
□ I would like to get vaccinated, but there is no vaccine left.
□ No, but I would like to get vaccinated
□ No, I do not want to get vaccinated this year
18) Are you willing to get vaccinated against SARS Cov2?
□ Yes, I have already been vaccinated
□ Yes, of course
□ Yes, if it is recommended
□ No, I would like to wait
□ No
If No, why?
□ I don’t feel threatened by coronavirus
□ I am afraid of side effects
□ The vaccine has not been sufficiently tested
19) Any comments?
_______________________________________________________
Thank you!