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hK45q2WNcBwx8iTCGAsCH9RQTyC8AEKWS2oC2ESCYjmfdCEeDCnxSmi9Q9oagHE3fwwQ33t9j5ZYsYrJT

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, Mpox, and Drug-resistant dermatophytes. This survey is for all health care professionals taking care of a) COVID-19 or Monkeypox patients that develop dermatologic manifestations, b) dermatology patients with an existing condition that then develop COVID-19 or Monkeypox, c) dermatologic reactions to a COVID-19 or Monkeypox vaccine, or d) suspected or confirmed drug-resistant Tinea.

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, Mpox, or drug-resistant Tinea-related dermatoses. 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, Mpox, or drug-resistant Tinea.

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

Microbiologist/Mycologist

Pharmacist

Public Health

Other

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Other professional title:

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Hospital or clinic name

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Hospital or clinic country

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Other country:

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Hospital or clinic state

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What is the patient's age in years?

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Patient's Nationality:

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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

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What was the patient's assigned sex at birth?

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Female

Male

Unknown

Other

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Other assigned sex:

* must provide value

Patient's race/ethnicity

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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?

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Yes

Don't know

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What type of case are you reporting?

* must provide value

COVID-19 case

Monkeypox case

A case with both COVID-19 and Monkeypox

A case with suspected or confirmed drug-resistant Tinea

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