BASIC INFORMATION & ONSET

Thank you in advance for your time and commitment to sharing your stories and experiences with PANDAS Network.

It is our hope that the anonymous data gathered in this survey will help our community of clinicians, researchers and families to improve the outcomes for our children. This is a mere sampling of what is to come. Our vision is to create an extensive PANDAS/PANS Registry that will provide data to help move the needle toward better treatment and an eventual cure for all of our children.

As you complete the 29-question survey, each response is focused on ONE child. If you have more than one child effected by PANDAS/PANS, you should take the survey a second time with specifics for that child.

We look forward to sharing the results of this survey on March 9 and 10, 2018, at the Common Threads 2018 Conference at Columbia University in New York City.

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* 1. What is the sex of your child with PANDAS/PANS?

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* 2. In what city did your child live during ONSET?

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* 3. In what YEAR was your child born?

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* 4. What is the birth MONTH of your child?

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* 5. What is the current age of your child with PANDAS/PANS?

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* 6. What WAS the age of your child at PANDAS/PANS onset?

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* 7. In hindsight, did your child display any subtle or early manifestations of symptoms within 6 months of the ACUTE ONSET of PANDAS/PANS symptoms?

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* 8. At ONSET, what were the primary symptoms that your child exhibited? (Select ALL that apply)

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* 9. During the time of onset, or within 3 months of onset, was your CHILD effected by the following: (Check ALL that apply)

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* 10. During the time of onset, or within 3 months of onset, was any member of your immediate family, effected by the following: (Check ALL that apply)

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* 11. What, if any, co-morbid (simultaneous) health issues existed PRIOR TO ONSET? (Select ALL that apply)

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* 12. Symptom Severity:  At ONSET how would you describe the severity-- on a scale of 0 to 5-- of your child's symptoms? 

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* 13. Symptom Severity:  CURRENTLY, how would you describe the severity-- on a scale of 0 to 5-- of your child's symptoms? 

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* 14. I would describe my child as:

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* 15. TRUE OR FALSE: My Child's symptoms resolved / completely remitted POST PUBERTY.