The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

NextGen Booster Vaccine Study Interest Form

Returning?

A A A

Thank you for your interest in Next Generation SARS-CoV-2 Booster vaccine clinical trial.

Filling out this survey means that you agree to be contacted about your interest in NextGen vaccines.

This survey will collect information such as your name, age, contact information, demographics, and current COVID-19 vaccination status. Although this information will be kept confidential and only the study team at the VRC will have access to the information, there is a small risk of loss of privacy. We will make every effort to make sure that does not happen.

Completing this survey does not mean that you are agreeing to be part of a study; it just means that if you qualify for the NextGen vaccine study, we will reach out to you to see if you would like to participate. By completing this survey, you are giving your consent for the VRC to collect your information.

If you have any questions, please contact a member of the VRC at 713-798-4912 or email

VRC-NextGen@bcm.edu.

You have selected an option that triggers this survey to end right now.

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.