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Dermatology Covid-19, Monkeypox, and Emerging Infections Registry

Thank you for agreeing to take part in this important effort to understand dermatologic manifestations of COVID-19 or Monkeypox. This survey is for all health care professionals taking care of COVID-19 or Monkeypox patients. You can use this registry to report i) COVID-19 skin reactions and/or COVID-19 vaccine reactions, ii) Monkeypox cases, and/or iii) Monkeypox/smallpox vaccine reactions.

The case report form should take about 5-7 minutes to complete. Patient identifiers such as name or date of birth will not be collected. All de-identified information will be kept strictly confidential and will only be shared with researchers compiling information. Data will be stored on a secure Redcap server at Massachusetts General Hospital (Partners Healthcare).

The success of this collaborative effort depends on active participation by our international healthcare community to obtain accurate and reliable information. This registry is for healthcare professionals from all countries. We ask that you share this site with your colleagues and encourage them to report any cases of COVID-19 or Monkeypox related dermatoses and/or vaccine reactions. Even if you have already submitted your case to a journal, please enter a summary of the case here so we can get an accurate understanding of the range of dermatologic manifestations from COVID-19 or Monkeypox.

This form has been reviewed by the Massachusetts General Hospital (Partners Healthcare) institutional review board.

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First name (given name) of reporter

* must provide value

Last name (family name) of reporter

* must provide value

Email address of reporter (institution email preferred)

* must provide value

Professional title of reporter

* must provide value

Dermatologist

Other Physician

Podiatrist

Physician Assistant

Nurse Practitioner

Nurse

Other

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Other professional title:

* must provide value

Hospital or clinic name

* must provide value

Hospital or clinic country

* must provide value

Other country:

* must provide value

Hospital or clinic state

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What is the patient's age in years?

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Patient's country of residence

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Other:

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Patient's U.S. state of residence

* must provide value

What was the patient's assigned sex at birth?

* must provide value

Female

Male

Unknown

Other

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Other assigned sex:

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Patient's race/ethnicity

* must provide value

White

Black - African

Afro - Caribbean

African American

American Indian / Alaska Native

Asian American

Asian-Chinese

South Asian (India, Pakistan, Sri Lanka, Nepal, Bhutan, Bangladesh)

Asian-other (Korea, China, north of Huai River)

Japanese

Hispanic or Latino

Native Hawaiian / Pacific Islander

Unknown

Other

Other race/ethnicity:

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Is the patient hispanic/latino?

* must provide value

Yes

Don't know

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What type of case are you reporting?

* must provide value

COVID skin manifestation or COVID vaccine reaction

Monkeypox case or monkeypox vaccine reaction

Both

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.