Do you have any of the following coditions - Diabetes, respiratory (breathing) problems, heart disease, neurological illness, liver or kidney problems, blood disorders [e.g. sickle cell disease, clotting or bleeding issues] Optional
Do you have allergies? e.g. food, medication or latex Optional
Have you, or a first degree relative (parents, brother, sister, or child), ever experienced any mental health issues, even mild anxiety, or depression? Optional
Do you have, or have you had, a condition that could impair your immune system? e.g. HIV/AIDS, blood cancer Optional
In the last 12 months, have you taken any medication or had treatment that could impair your immune system? e.g. chemotherapy, radiotherapy, high dose steroids Optional
Are you receiving regular treatment or follow up with your GP/hospital specialist? Optional
Do you have any disability or mobility problems? Optional
Do you, or a first degree relative (parents, brother, sister or child), have epilepsy or seizures? Optional
Have you, or anyone in your family, ever had a severe reaction to a vaccine or malaria medication? Optional
Are you or your partner pregnant or planning a pregnancy? Optional
Are you breast feeding? (if applicable) Optional
