Clinically Suspected SARS-CoV-2 Reinfection among COVID-19 Cases

The purpose of this query is to facilitate case description. Please complete as much as feasible. If preferable, you may describe the case in its entirety using the final text box at the end of this query.


          Clinician's Information:
    Your name:
    Your email address:
    Your state of practice:   
    Patient's Demographic Information :
  1. Age group in years:   18-44    45-54    55-64    >=65
  2. Sex:   Male      Female

    3. COVID-19 Initial Presentation:
  3. Date of illness onset (approximate):   [MM/DD/YY]

  4. Symptoms (please separate each symptom by a comma):  

  5. Lab-confirmed SARS-CoV-2 infection?   Yes      No

  6. Illness severity:
    Mild to moderate (mild symptoms up to mild pneumonia)
    Severe (dyspnea, hypoxia, or >50% lung involvement on imaging)
    Critical (respiratory failure, shock, or multiorgan system dysfunction)

  7. Evidence of recovery:   [Select all that apply]
    Two consecutive negative RT-PCR results
    Resolution of symptoms, describe: 
    Radiographic evidence of recovery, describe: 

  8. Date isolation ended (approximate):   [MM/DD/YY]

  9. Comments about 1st course of illness:

    10. COVID-19 Recurrence:
  10. Date of illness onset (approximate):   [MM/DD/YY]

  11. Symptoms (please separate each symptom by a comma):  

  12. Lab-confirmed SARS-CoV-2 infection?   Yes      No

  13. Illness severity:
    Mild to moderate (mild symptoms up to mild pneumonia)
    Severe (dyspnea, hypoxia, or >50% lung involvement on imaging)
    Critical (respiratory failure, shock, or multiorgan system dysfunction)

  14. Evidence of recovery:   [Select all that apply]
    Two consecutive negative RT-PCR results
    Resolution of symptoms, describe: 
    Radiographic evidence of recovery, describe: 

  15. Date isolation ended (approximate):   [MM/DD/YY]

  16. Comments about 2nd course of illness:

    17. SARS-CoV-2 Testing History:
      Date  
    [MM/DD/YY]    		 Specimen Type Test Type Result (For PCR, cycle
    threshold value, if known
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    Please provide additional comments about this suspected case:


    May we contact you if more information is necessary to understand your case and if additional steps are needed?   Yes      No

    Both the CDC IRB and the University of Iowa IRB have determined that this project meets the requirements of public health surveillance (not research) as defined in 45 CFR 46.102(l)(2). No further review is required.