Real Immunity Influenzinum CV30 Survey

Thank you for helping us collect information about our Influenzinum CV30 product.

• You’re receiving this since you purchased Real Immunity’s Influenzinum CV30. We would love to know how you did during the last few months if you took the product. As a thank you for filling out the survey, you will receive a 25% discount to the “9 Remedies for Influenza” online course on the "thank you" page following the survey. Please submit your survey by Sept 30th so we can crunch the numbers and report back the results to you! Thank you!
• Did you or a family member take the Real Immunity influenzinum CV30 between January 2020 and August 2020?*
  • Yes
  • No
• For each family member who took Influenzinum CV30 please answer the following questions. FAMILY MEMBER #1 Enter Age of recipient:*
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities*
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?*
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?*
  YesNoDid not test
• FAMILY MEMBER #2 Enter Age of recipient:
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?
  YesNoDid not test
• FAMILY MEMBER #3 Enter Age of recipient:
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?
  YesNoDid not test
• FAMILY MEMBER #4 Enter Age of recipient:
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?
  YesNoDid not test
• FAMILY MEMBER #5 Enter Age of recipient:
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?
  YesNoDid not test
• FAMILY MEMBER #6 Enter Age of recipient:
  0-10 yrs11-18 yrs19-29 yrs30-49 yrs50-64 yrs65 or older
• After taking Real Immunity influenzinumCV 30, please indicate the intensity of any flu-like symptoms experienced between January and August 2020 in each of the symptoms listed below. If you did not experience a particular symptom select “0” for that symptom. On a scale of 0-5 (5= most severe) how severe were your symptoms?
• Fever:
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Nasal Congestion
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Headache
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Body Aches
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Shortness of breath
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• Fatigue that prevents daily activities
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
• In general how long did symptoms last?
  • 0 days, (no symptoms)
  • 1-3 days
  • 4-7 days
  • 8-10 days
  • more than 10 days
• Did you have a Covid positive test?
  YesNoDid not test

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