Today's date:* must provide value
Today M-D-Y
Please confirm that you have entered today's date correctly above.
Your email address:* must provide value
How did you hear about the VIVID study? Quest Diagnostics
Social media
Family and friends
Other
Specify how you heard about the VIVID study:
What country do you currently reside in?* must provide value
United States of America
Other
ELIGIBILITY: Inclusion, lives in USA
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0 = ELIGIBLE, 1 = INELIGIBLE
What is your age in years?* must provide value
ELIGIBILITY: Inclusion, current age is >= 18
Update 2021-02-16 : Decreased minimum age from 30 to 18
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0 = ELIGIBLE, 1 = INELIGIBLE
Have you been tested for the coronavirus (COVID-19, SARS-CoV-2)?* must provide value
Yes
No
Not sure
ELIGIBILITY: Exclusion, never been COVID tested
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0 = ELIGIBLE, 1 = INELIGIBLE
Have you had at least one COVID-19 test with a POSITIVE result?* must provide value
Yes
No
Not sure
ELIGIBILITY: Inclusion, ever tested positive for coronavirus
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0 = ELIGIBLE, 1 = INELIGIBLE
Please answer the following questions about the most recent POSITIVE test result you received: On what date did you take the test?* must provide value
Today M-D-Y
ELIGIBILITY: Inclusion, positive COVID test within past 7 days
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0 = ELIGIBLE, 1 = INELIGIBLE
What type of test did you take? Nasal or throat swab
Saliva test
Blood test
Not sure
ELIGIBILITY: Inclusion, test type is throat/nasal swab or saliva test
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0 = ELIGIBLE, 1 = INELIGIBLE
On what date did you receive the positive result?
Today M-D-Y
Please check dates listed above for the date of your most recent positive test and the date you received the result.
Where was the test performed? Mark all that apply. Hospital - Emergency Department
Hospital - Inpatient
Outpatient Clinic
Urgent Care
Quest
Drive-Through
Other
The next questions ask about your symptoms in the last 14 days: The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Did you experience NEW onset of the following symptoms in the last 14 days? (Excluding chronic or recurrent conditions. Check all that apply)* must provide value
Fever or chills
Cough
Shortness of breath or difficulty breathing
Unusual chest pain or tightness in your chest
Muscle or body aches
New loss of smell or taste
Sore throat
Congestion or runny nose
Nausea or vomiting
Diarrhea
Unusual fatigue
Headache
NONE OF THE ABOVE
Fever and chills: Fever or chills: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since fever or chills STARTED
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Fever or chills: Is this symptom ongoing?* must provide value
Yes
No
Fever or chills: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since fever or chills STOPPED
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Fever or chills: What is/was the severity of this symptom? Mild or Moderate
Severe
Cough: Cough: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since cough STARTED
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Cough: Is this symptom ongoing?* must provide value
Yes
No
Cough: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since cough STOPPED
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Cough: What is/was the severity of this symptom? Mild or Moderate
Severe
Shortness of breath or difficulty breathing: Shortness of breath or difficulty breathing: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since shortness of breath or difficulty breathing STARTED
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Shortness of breath or difficulty breathing : Is this symptom ongoing?* must provide value
Yes
No
Shortness of breath or difficulty breathing: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since shortness of breath or difficulty breathing STOPPED
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Shortness of breath or difficulty breathing: What is/was the severity of this symptom? Mild or Moderate
Severe
Unusual chest pain or tightness in your chest: Unusual chest pain or tightness in your chest: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since unusual chest pain or tightness in your chest STARTED
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Unusual chest pain or tightness in your chest: Is this symptom ongoing?* must provide value
Yes
No
Unusual chest pain or tightness in chest: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since unusual chest pain or tightness in your chest STOPPED
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Unusual chest pain or tightness in chest: What is/was the severity of this symptom? Mild or Moderate
Severe
Muscle or body aches: Muscle or body aches: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since the muscle or body aches STARTED
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Muscle or body aches: Is this symptom ongoing?* must provide value
Yes
No
Muscle or body aches: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since the muscle or body aches STOPPED
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Muscle or body aches: What is/was the severity of this symptom? Mild or Moderate
Severe
New loss of smell or taste: New loss of smell or taste: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since the new loss of smell or taste STARTED
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New loss of smell or taste: Is this symptom ongoing?* must provide value
Yes
No
New loss of smell of taste: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since the new loss of smell or taste STOPPED
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New loss of smell or taste: What is/was the severity of this symptom? Mild or Moderate
Severe
Sore throat: Sore throat: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since sore throat STARTED
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Sore throat: Is this symptom ongoing?* must provide value
Yes
No
Sore throat: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since sore throat STOPPED
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Sore throat: What is/was the severity of this symptom? Mild or Moderate
Severe
Congestion or runny nose: Congestion or runny nose: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since congestion or runny nose STARTED
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Congestion or runny nose: Is this symptom ongoing?* must provide value
Yes
No
Congestion or runny nose: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since congestion or runny nose STOPPED
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Congestion or runny nose: What is/was the severity of this symptom? Mild or Moderate
Severe
Nausea or vomiting: Nausea or vomiting: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since nausea or vomiting STARTED
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Nausea or vomiting: Is this symptom ongoing?* must provide value
Yes
No
Nausea or vomiting: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since nausea or vomiting STOPPED
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Nausea or vomiting: What is/was the severity of this symptom? Mild or Moderate
Severe
Diarrhea: Diarrhea: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since diarrhea STARTED
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Diarrhea: Is this symptom ongoing?* must provide value
Yes
No
Diarrhea: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since diarrhea STOPPED
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Diarrhea: What is/was the severity of this symptom? Mild or Moderate
Severe
Unusual fatigue: Unusual fatigue: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since unusual fatigue STARTED
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Unusual fatigue: Is this symptom ongoing?* must provide value
Yes
No
Unusual fatigue: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since unusual fatigue STOPPED
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Unusual fatigue: What is/was the severity of this symptom? Mild or Moderate
Severe
Headache: Headache: On what date did this symptom start?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since headache STARTED
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Headache: Is this symptom ongoing?* must provide value
Yes
No
Headache: What date did this symptom stop?* must provide value
Today M-D-Y
ELIGIBILITY: Number of days since headache STOPPED
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Headache: What is/was the severity of this symptom? Mild or Moderate
Severe
Did you participate in a COVID-19 vaccine trial?* must provide value
Yes
No
ELIGIBILITY: Exclusion, participated in a vaccine trial
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you participating in another COVID-19 trial where you are receiving any treatment?* must provide value
Yes
No
ELIGIBILITY: Exclusion, participating in ongoing COVID-19 trial
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0 = ELIGIBLE, 1 = INELIGIBLE
Please complete the following information about you: Sex Male
Female
Other
Weight* must provide value
Enter weight in pounds (lbs)
Height (feet)* must provide value
3 4 5 6 7
Height (inches)* must provide value
0 1 2 3 4 5 6 7 8 9 10 11
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Race (select all that apply) American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian/Other Pacific Islander
White
Race (Asian) specify:* must provide value
South Asian Indian
Other
Ethnicity Hispanic or Latino
Not Hispanic or Latino
Unknown
Please answer the following questions about yourself: The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Do you have any of the following medical conditions? (Mark all that apply)* must provide value
Diabetes
Hypertension
Chronic obstructive pulmonary disease (COPD) or emphysema
History of heart attack
History of heart failure
History of coronary bypass surgery or coronary angioplasty or stent
History of stroke
Diagnosis of sleep apnea
History of kidney stone
Kidney failure or dialysis
Severe liver disease or cirrhosis
Diagnosis of hypercalcemia (high blood calcium level)
Parathyroid disease
Sarcoid or sarcoidosis
Active tuberculosis
Advanced cancer
Hospitalization due to COVID-19 infection
NONE OF THE ABOVE
ELIGIBILITY: Exclusion, has a serious medical condition (1+ of last 8 checkboxes)
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you currently receiving treatment for diabetes? * must provide value
Yes
No
Are you currently receiving treatment for hypertension? * must provide value
Yes
No
Are you using a CPAP device? * must provide value
Yes
No
Have you smoked at least 100 cigarettes in your lifetime?* must provide value
Yes, I have smoked 100 or more cigarettes in my lifetime
No, I have never smoked or smoked less than 100 cigarettes in my lifetime.
If Yes to above, what is your current smoking status?* must provide value
Current smoker, every day
Current smoker, some days
Past smoker (having smoked at least 100 cigarettes in my lifetime but no longer smoking now)
Are you pregnant?* must provide value
Yes
No
ELIGIBILITY: Exclusion, pregnant
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0 = ELIGIBLE, 1 = INELIGIBLE
Please answer the following regarding your medical history:Â Have you ever been diagnosed with cancer? * must provide value
Yes
No
If Yes, are you currently undergoing radiation, chemotherapy, or immunotherapy?* must provide value
Yes
No
ELIGIBILITY: Exclusion, currently undergoing cancer treatment
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you currently taking calcium supplements more than 1,200 mg per day?* must provide value
Yes
No
ELIGIBILITY: Exclusion, taking calcium supplements > 1,200 mg per day
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you currently taking medications for seizures or epilepsy? Examples: Carbamazepine (Carbatrol, Tegretol), Phenytoin (Dilantin, Phenytek),Valproic acid (Depakene), Oxcarbazepine (Oxtellar, Trileptal), Phenobarbital, Topiramate (Topamax)* must provide value
Yes
No
ELIGIBILITY: Exclusion, taking medications for seizures or epilepsy
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you currently taking the medication digoxin?* must provide value
Yes
No
ELIGIBILITY: Exclusion, taking digoxin
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0 = ELIGIBLE, 1 = INELIGIBLE
Please answer the following questions regarding your vitamin D intake: NOT including your diet, in the past two weeks, on average, how much TOTAL vitamin D do you take each day from nutritional supplements such as single tablets of vitamin D, multi-vitamins, calcium supplements (Calcium+D) or drugs that may include vitamin D (Example: Fosamax+D)? Referring to package labels, please add up ALL your non-diet sources of vitamin D.* must provide value
None
400 IU or less per day
401-1000 IU per day
Greater than 1000 IU per day
ELIGIBILITY: Exclusion, daily Vitamin D intake (>1000 IU)
Changed 1/22/2021 from >400 IU to >1000 IU.
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you currently undergoing prescription vitamin D treatments? (Calcitriol [Rocaltrol, Calcitrol, Vectical], Paricalcitol [Zemplar], or Calcijex)* must provide value
Yes
No
ELIGIBILITY: Exclusion, undergoing prescription vitamin D treatments
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0 = ELIGIBLE, 1 = INELIGIBLE
Would you be willing to provide a blood sample by mail on your own (e.g. with a finger prick) to gather important information related to the COVID-19 infection and for a Vitamin D blood level?* must provide value
Yes
No
ELIGIBILITY: Inclusion, willing to provide blood sample
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0 = ELIGIBLE, 1 = INELIGIBLE
Are you able to receive an overnight express mail shipment of study pills at your current address?* must provide value
Yes
No
ELIGIBILITY: Inclusion, able to receive shipments at current address
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0 = ELIGIBLE, 1 = INELIGIBLE
Please answer the following questions regarding your living arrangement Where do you CURRENTLY live?* must provide value
Independent home or other housing (Example: apartment, condominium) in the general community
Senior/retirement housing
Assisted living facility
Rehabilitation facility or skilled nursing facility
Nursing home
ELIGIBILITY: Current living arrangements
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0 = ELIGIBLE, 1 = INELIGIBLE
With whom do you live? (Mark all that apply.)* must provide value
Alone
With spouse or partner
With other family members
With non-relatives
How many adults (18 years or older), including yourself, are living in the same household?* must provide value
1
2
3
4
5
6 or more
How many children (under 18) are living in your household? None
1
2
3
4 or more
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
What protective measures are you currently taking at home? (Mark all that apply)* must provide value
I am using a separate bedroom
I am using a separate bathroom
I eat separately, away from others
I do not share personal items (dishes, cups/glasses, silverware, towels, bedding, or electronics) with others
I wear face covering whenever around others in the household
I wash hands often
None of the above
The option " " can only be selected by itself. Selecting this option will clear your previous selections for this checkbox field. Are you sure?
Can you identify ONE person in your household who will stay with you for the next two weeks, has NOT tested positive for COVID-19 and fits any of the following descriptions? (Mark all that apply)* must provide value
Spends 2 hours or more per day with you in a single room, often within 6 feet
Has meals with you at least 5 times in the past week
Stays with you for at least 6 days in the past week
Plans on staying with you for the next two weeks or longer
No, I am not living with anybody who fits any of the above descriptions
The person you identified is considered a close household contact and may be eligible to participate in the study. We will provide you with a link for you to pass to the person as they might be interested in participating in the study.
To your knowledge, have you EVER been exposed to another person with confirmed or suspected COVID-19? Yes, confirmed COVID-19 case(s)
Yes, suspected COVID-19 case(s) only
Yes, both confirmed and suspected COVID-19 case(s)
No, not that I know of
How long ago did the most recent exposure take place?
Within 3 days
4-7 days ago
8-14 days ago
More than 2 weeks ago
I do not remember
Were any of these cases a member of your household? Yes
No
What is the highest level of education you have completed? 8th grade or below
9th to 11th grade
Graduated from high school
1 year of college
2 years of college
3 years of college
Graduated from college
Completed graduate school
What is your approximate average annual household income? $0-$24,999
$25,000 - $49,999
$50,000 - $74,999
$75,000 and up
HIDDEN IN PRODUCTION Internal Logic for Eligibility ELIGIBILITY: Inclusion, had at least one symptom (among all 12) that started in last 4 days
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0 = ELIGIBLE, 1 = INELIGIBLE
ELIGIBILITY: Inclusion, had at least one symptom (among all 12) that started in last 5 days
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0 = ELIGIBLE, 1 = INELIGIBLE
ELIGIBILITY: Exclusion, had symptom (among first 7) start >4 days ago and is still ongoing
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0 = ELIGIBLE, 1 = INELIGIBLE
ELIGIBILITY: Exclusion, had symptom (among first 7) start >5 days ago and is still ongoing
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0 = ELIGIBLE, 1 = INELIGIBLE
ELIGIBILITY: Sum of comorbidities and risk factors (CRF)
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ELIGIBILITY: Eligible on age + comorbidities / risk factors (>=2 CRF for ages 30-49; >=1 for ages 50-59; >=0 for ages 60+)
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0 = ELIGIBLE, 1 = INELIGIBLE
Sum of eligibility criteria (0 = ELIGIBLE, 1+ = INELIGIBLE)
Change 1/22/2021 - Remove symptom (______ , ______ ) and comorbidity/risk-factor criteria (______ ).
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0 = ELIGIBLE, 1+ = INELIGIBLE
ELIGIBLE FOR STUDY
NOT ELIGIBLE FOR STUDY
Please answer the following questions about yourself: Date of birth * must provide value
M-D-Y
First name* must provide value
Last name* must provide value
Phone number * must provide value
Street address* must provide value
City* must provide value
State* must provide value
AL, Alabama AK, Alaska AZ, Arizona AR, Arkansas CA, California CO, Colorado CT, Connecticut DE, Delaware DC, District of Columbia FL, Florida GA, Georgia HI, Hawaii ID, Idaho IL, Illinois IN, Indiana IA, Iowa KS, Kansas KY, Kentucky LA, Louisiana ME, Maine MD, Maryland MA, Massachusetts MI, Michigan MN, Minnesota MS, Mississippi MO, Missouri MT, Montana NE, Nebraska NV, Nevada NH, New Hampshire NJ, New Jersey NM, New Mexico NY, New York NC, North Carolina ND, North Dakota OH, Ohio OK, Oklahoma OR, Oregon PA, Pennsylvania RI, Rhode Island SC, South Carolina SD, South Dakota TN, Tennessee TX, Texas UT, Utah VT, Vermont VA, Virginia WA, Washington WV, West Virginia WI, Wisconsin WY, Wyoming
ZIP code* must provide value
Please provide the contact information of a person who is authorized to confirm whether you have been hospitalized (This will only be used when we cannot reach you):
Contact name:
Contact phone number:
Contact email address:
By clicking "Submit", I confirm that:
I understand that I will need to take the study pills every day for 28 days I understand that I will need to provide 2 fingerstick blood samples: 1 on the day I receive the study supplies before I start taking the study pills and 1 between Days 25 and 28 of pill-taking I understand that I will need to complete 1 brief survey in a few days, weekly surveys during the first 4 weeks of the study and 1 additional survey at week 8. Randomization strata: Age criteria 1: < 60 2: 60+
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Randomization strata: Race/ethnicity 1: White, Non-Hispanic 2: Black or African American 3: Other/Unknown
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Randomization strata: Sex 1: Male 2: Female 3: Other/Unknown
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Randomization strata: Final stratum (1-18)
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INTERNAL: Consent version
* must provide value
v1 - VIVID Consent 12.18.20 CLEAN RTR
v2 - VIVID Consent 1.19.21 CLEAN
v3 - VIVID Consent 2.12.21 CLEAN 18 years approved
v4 - VIVID Consent 3.1.21 CLEAN
Submit
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