Table 6.

Medical history and physical examination data about a probable or confirmed case of COVID-19

Main class	Sub class	Data element
Signs and symptoms at the time of admission	General signs and symptoms	Fever, chills, tiredness, muscle aches, headache, loss of smell or taste, eye congestion, dry mouth, other(s), please specify
	Respiratory signs and symptoms	Dry cough, sneezing, runny nose, dyspnea/tachypnea, constant pain or pressure in chest, nasal congestion, exudative pharyngitis, mucus or phlegm, hemoptysis, other(s), please specify
	Digestive signs and symptoms	Diarrhea, nausea or vomiting, loss of appetite, abdominal pain, constipation, other(s), please specify
	Nervous signs and symptoms	Fatigue, decreased consciousness, Glasgow coma scale/score (GCS), functional limb weakness, other(s), please specify
	Cardiovascular signs and symptoms	Orthopnea, ischemia, angina‏‏, arrhythmias, other(s), please specify
	Others signs and symptoms	Rash on skin, discoloration of fingers or toes, other(s), please specify
Review of systems at the time of admission	Vital signs	Pulse rate, respiratory rate, blood pressure, temperature, level of consciousness
	Thorax	Heart murmurs, wheezing, stridor, pleural friction rub, ventricular gallop, atrial gallop, other(s), please specify
	Abdomen	Tenderness, organomegaly, other(s), please specify
	Limbs	Edema, weak pulse, other(s), please specify
	Height and weight	Height, weight, BMI > 30
	Other	Others signs and symptoms, please specify, additional comment
Underlying conditions and comorbidity	Cardiovascular diseases	Hypertension, heart failure, arrhythmia, ischemic heart disease, other(s), please specify
	Endocrine and metabolic diseases	Type 1 diabetes mellitus, Type 2 diabetes mellitus, unspecified diabetes mellitus If yes, Had the patient’s diabetes be controlled? Metabolic syndrome, other(s), please specify
	Malignant neoplasms	Morphology, primary site, secondary site If yes, Does the patient receive chemotherapy? If yes, Does the patient receive radiotherapy? Additional comment
	Respiratory diseases	Chronic obstructive pulmonary disease (COPD), bronchiectasis, interstitial lung disease (ILD), asthma, other(s), please specify
	Immunodeficiency	HIV/AIDS, congenital immunodeficiency disorders, other(s), please specify
		The patient is being treated with corticosteroids or immunosuppressant medications If yes, Name of medications used, medications dosage
	Chronic neurological or neuromuscular diseases	Cerebral palsy, paraplegia, hemiplegia, multiple sclerosis (MS), old cerebrovascular accident (CVA),other(s), please specify
	Renal diseases	Chronic kidney disease, end stage renal disease (ESRD), other(s), please specify
	Liver diseases	Liver failure, liver cirrhosis, hepatitis (A, B, C), other(s), please specify
	Other important underlying conditions and comorbidity,	Prematurity (infant), mental retardation, other important underlying conditions and comorbidity, please specify
	Pregnancy, childbirth and the puerperium	Pregnancy, gestational age
		Childbirth in the last 6 weeks
	Menopause	Menopause, menopause age
	Smoking, drugs abuse and alcohol	Cigarettes, hookahs, alcohol, drug’s abuse, additional comment
	Medications history	Name of drug, drug dosage, additional comment
Previous history of COVID-19	History of COVID-19	Had a previous history of COVID-19, illness onset date, disease severity status (mild, moderate and severe), additional comment
	History of COVID-19 vaccination	History of COVID-19 vaccination, number of vaccine doses received, date of administration