COVID-19 Infection Record Please enable JavaScript in your browser to complete this form.Date Please Enter the Date That You First Realized That You Were Ill; whether You Knew You Had COVID-19 or not.Initial SymptomsTemperatureNasal CongestionSore ThroatBreathing DifficultyChest PainNauseaDiarrheaVomiting-Upset StomachHeadacheBleeding CuticlesPneumoniaAbnormal TasteAbnormal SmellFatigueBody-Joint PainPlease Select ALL that apply to your initial infection.Did You Suspect a COVID19 Infection?YesNoDid You Seek Medical Assistance--Visit Your Physician?YesNoWere You Hospitalized?YesNoIf Hospitalized, Were You Admitted to:Hospital BedICUCCUIsolationWere You Placed on a Ventilator?YesNoHow Many Days Were You Hospitalized?Did You Receive Any of the Following Therapies:OxygenAntibioticsSteroidsPlateletsChloroquineIvermectinRemdisivirVaccineUpon Discharge Were You:Fully RecoveredPartially RecoveredOn OxygenChest PainPalpitationsArrhythmiasCoughExtreme FatigueBed RiddenTo Nursing HomeSubmit