| Question | Answers | Source | Source Link | Dates Used | |
|---|---|---|---|---|---|
| 1 | Do you have a child between the ages of 5 and 18? | • Yes • No | NA | 01/31/2022-02/11/2022 05/09/2022-05/24/2022 07/08/2022-07/15/2022 | |
| 2 | Has your child age 5 or older received the COVID-19 vaccine? | • Yes • No | NA | 01/31/2022-02/11/2022 05/09/2022-05/24/2022 07/08/2022-07/15/2022 | |
| 3 | Why has your child age 5 or older not yet received the COVID-19 vaccine? | • I have not been able to get an appointment for my child • I can’t get to a vaccination site due to where I live, time off from work, etc. • I am planning to “wait and see” if the vaccine is safe and effective before my child is vaccinated • I do not believe the vaccine is safe/effective • Other, please specify __________________________ | NA | 12/07/2021-12/21/2021 01/31/2022-02/11/2022 05/09/2022-05/24/2022 07/08/2022-07/15/2022 | |
| 4 | How likely are you to get the COVID-19 vaccine for your child age 5-12? | • Very likely • Somewhat likely • Not very likely • Not at all likely • N/A | NA | 01/31/2022-02/11/2022 05/09/2022-05/24/2022 07/08/2022-07/15/2022 | |
| 5 | How likely are you to get the COVID-19 vaccine for your child age 5-12? | • Already received • Very likely • Somewhat likely • Not very likely • Not at all likely | NA | 12/07/2021-12/21/2021 | |
| 6 | When would you vaccinate (for COVID-19) your child between the ages of 5-12 years? Select the best answer. | • In a few weeks, I am planning to "wait and see" if the vaccine is safe and effective before my child is vaccinated • In a few months, I am planning to "wait and see" if the vaccine is safe and effective before my child is vaccinated • If my child begins to attend a center, program or school • I am unlikely to ever have my child receive the vaccine • Other, please specify | NA | 01/31/2022-02/11/2022 05/09/2022-05/24/2022 07/08/2022-07/15/2022 | |
| 7 | Do you have a child that is 5 years old or younger? | • Yes • No | NA | 07/08/2022-07/15/2022 | |
| 8 | Now that the FDA has approved the COVID-19 vaccine for children under the age of 5, do you plan to vaccinate your child/ren under age 5? | • My child already got the first dose • Yes • No | NA | 07/08/2022-07/15/2022 | |
| 9 | Once it becomes available, how likely are you to get the COVID-19 vaccine for your child(ren) under the age of 5? | • Very likely • Somewhat likely • Not very likely • Not at all likely | NA | 01/31/2022-02/11/2022 05/09/2022-05/24/2022 | |
| 10 | Why do you plan not to vaccinate your child/ren under age 5? | • I have not been able to get an appointment • I don't know how to get an appointment to get my child vaccinated • I can't get to a vaccination site due to where I live, time off from work, etc. • I am planning to "wait and see" the vaccine is safe and effective • I do not believe the vaccine is safe/effective • Other, please specify | NA | 07/08/2022-07/15/2022 |