Guidelines on Format

Column
Category
Unique Person ID
PWD
Indigenous Member
Last Name
First Name
Middle Name
Suffix
Contact Number
Current Residence - Region
Current Residence - Province
Current Residence - Municipality/City
Current Residence - Barangay
Sex
Birth Date
Deferral
Reason for Deferral
Vaccination Date
Vaccine Manufacturer Name
Batch Number
Lot Number
Bakuna Center CBCR ID
Vaccinator Name
1st Dose
2nd Dose
Adverse Event
Adverse Event Condition
INSTRUCTIONS:
1. To input or paste your Vaccine Administration System (VAS) Data, please go to VAS Template tab.
2. Hover on the header columns to see recommended answers or choices.
3. Go to CHOICES, REGION_PROVINCE_CODE, CITY_CODE TAB for answer reference.
4. Go to Deferral Codes tab and Adverse Events tab to check for Reasons for Codes and Descriptions
5. Check the SAMPLE tab to review sample input.

Template Updates:
1. Cell Data Validations removed.
2. 27 Columns only.

Format
Must be in "Category (Priority Group)" List in CHOICES tab
Government ID
Y or N
Must be in "Indigenous Member" List in CHOICES tab
Alphanumeric except special characters < > : " / \ | ? *
Alphanumeric except special characters < > : " / \ | ? *
Alphanumeric except special characters < > : " / \ | ? *
Alphanumeric except special characters < > : " / \ | ? *
8 or 11 digits
Must be in "Region" List in the CHOICES tab
Must be in "Province" List in the PROVINCE_CODE tab and use PROVINCE column
Must be in "MuniCity" List in the MUNICITY_CODE and use the MUNICITY column
Free Text
M or F
MM/DD/YYYY; cannot be later than vaccination date
Y or N
Cannot be BLANK if Deferral is Y; Must be in "Reason for Deferral" List in CHOICES tab; If many, separate with comma (,)
MM/DD/YYYY
Must be in "Vaccine Manufacturer Name" List in CHOICES tab
Must have value
Must have value
CBCXXXXX
Last Name, First Name of Vaccinator
Y if 1st dose, N if 2nd dose
N if 1st dose, Y if 2nd dose
Y or N
Cannot be BLANK if Adverse Event is Y; Must be in "Adverse Event Condition" List in CHOICES tab; If many, separate with comma (,)
CATEGORY UNIQUE_PERSON_ID PWD Indigenous Member LAST_NAME
A3 10020009118 Y Abelling/Aberling Martin
FIRST_NAME MIDDLE_NAME SUFFIX CONTACT_NO
Coco X III 09981134123
REGION PROVINCE
NATIONAL CAPITAL REGION (NCR) 137400000NCR, Second Distri
MUNI_CITY BARANGAY SEX BIRTHDATE DEFERRAL REASON_FOR_DEFERRAL
137404000Quezon CUmaga M 6/1/1984 N
VACCINATION_DATE VACCINE_MANUFACTURER_NAME BATCH_NUMBER LOT_NO
5/1/2021 Sinovac 100100 100500
BAKUNA_CENTER_CBCR_ID VACCINATOR_NAME 1ST_DOSE 2ND_DOSE Adverse Event
CBC000000000002739 Bondoc, Anderson N Y N
Adverse Event Condition
CATEGORY UNIQUE_PERSON_ID PWD Indigenous Member LAST_NAME
A2 19-3238 N No ALVENDIA
A2 19-2978 N No DE CASTRO
A2 17-3820 N No ALIPIO
A2 18-1311 N No SOLEE
A2 19-3280 N No FAJARDO
A2 21-9603 N No GARCIA
A2 21-9428 N No UBANDO
A2 A02-00-062820 N No AQUINO
A2 8896 N No LUMAHAN
A2 14-998 N No DE VERA
A2 20-0649 N No GREGORIO
A2 19-0116 N No VALERIO
A2 18-780 N No CASTRO
A2 24015 N No DELOS SANTOS
A2 17-5144 N No BALOLONG
A2 19-3484 N No LOPEZ
A2 7712 N No MORANTE
A2 25-834 N No CENTINO
A2 16-1937 N No CASILANG
A2 10814 N No LANDINGIN
A2 17-6653 N No DE VERA
A2 18-3029 N No GONZALES
A2 21-8751 N No MARIÑAS
A2 16-2167 N No DAROY
A2 20331 N No CRUZ
A2 17-4710 N No LAZARO
A2 21-9092 N No ESTRADA
A2 1927 N No TIONG
A2 A02-97-054778 N No CALLANTA
A2 20087 N No CALIMLIM
A2 15571 N No UBANDO
A2 18-3055 N No CATABAY
A2 6118 N No ESTRADA
A2 20-0311 N No DELA CRUZ
A2 00001 N No PETALVER
A2 2800 N No FERNANDEZ
A2 20-0210 N No ONG
A2 20-1345 N No CALAGUIN
A2 15531 N No TINGSON
A2 19-21111 N No PINERO
A2 17-4501 N No PINERO
A2 6708 N No ARMAS
A2 22038 N No CABANUT
A2 6907244 N No FLANNAGAN
A2 19-0354 N No GUARDIANA
A2 05-0500185934 N No NAVARRO
A2 18-2089 N No RAGUDO
A2 18-2389 N No BUSTO
A2 19-2043 N No BAÑEZ
A2 55-18300104818 N No PADILLA
A2 10145 N No MARAMBA
A2 20-0432 N No AMADO
A2 17-6806 N No ABLING
A2 21-9388 N No PARAMIO
A2 26600 N No AGAS
A2 21-9611 N No GONZALES
A2 19-3090 N No ESCAÑO
A2 20-1740 N No MARIGA
A2 19907 N No SIBIT
A2 19-2897 N No TIONG
A2 21-8644 N No TOMISTA
A2 17-5447 N No ANTINEO
A2 26533 N No DE VERA
A2 21-8873 N No BEROÑA
A2 24365 N No COQUIA
A2 13902 N No LALAS
A2 19-628 N No SANTILLAN
A2 20-1433 N No VILORIA
A2 N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
N No
FIRST_NAME MIDDLE_NAME SUFFIX CONTACT_NO
GLORIA GABITO 09125025079
JULITA DE VERA 09125002751
ROSALDO DE VERA 09275206261
MERLIN TORINO 09505998751
ALEXANDER JUBE 09124580473
JOVENCIO TURLA 09165893940
ALFREDO ARANDIA 09296460551
HADJI BUSTO 09123455333
DODINA NONES 09232418085
CECILIA CAYABYAB 09638588029
CREDO VILLAR 09666435586
ALFREDO BAROLO 09509040673
BARBARA CALLANTA 09515011361
MAGDALENA PASCUAL 09196583897
LINA BATO 09458006001
LEONIDA FERNANDEZ 09879718696
LILIA SAMSON 09469653873
PROCESA CABOTEJA 09073090861
HIPOLITA JOVEN 09997443782
CLAUDIA ORAZA 09617415522
MUSTIOLA AQUINO 09189182262
VIRGINIA GOMEZ 09124580473
DEMETRIA VIDAL 09106293960
ANGELES EDADES 09233776407
LUIS LABARINTO 09317779935
JUANA CLAUNA 09616272418
CLARITA BASBAS 09776954090
AGUSTINA MARAMBA 09984867869
FELOMINO DULAY 09479356400
AIDA CEREZO 09334189351
LUCIANO ARANDIA 09153964523
JOVITA CAYABYAB 09102070175
ZENAIDA MUYRONG 09312181352
RAMIREZ ZARATE 09196170145
FLORIDA MENDOZA 09993874254
JUANITA CALIMLIM 09333649093
ESMERALDA GAPANG 09260644917
MARLENE GABICA 09109914579
TERESITA DACOT 09124580473
ARCADIA ARZADON 09109090033
GILBERT ARANDIA 09124580473
RUPERTA CAGUIOA 09194535581
BETTY MACASPE 09391328215
JOSEPH MARTIN 09275502330
VIRGINIA ARZADON 09121192020
MARLON CAINGAL 09558202278
PILAR GEMINO 09092726906
MARLENE FERNANDEZ 09205931204
CATALINA CRUZ 09679814672
MERCEDES DELA PEÑA 09109902813
LORETA MANAOIS 09469668803
ROSAURO AMIGABLE 09204126309
ALBERTO SAGER 09468222849
VIRGINIA DE GUZMAN 09222543264
ERLINDA TANDOC 09319800413
CONDE FABIA 09092764932
RODOLFO FERRER 09686777410
VIRGINIA BAUTISTA 09952012086
SOLIDAD SOLIS 09166606918
ANTONIO VILLAREAL 09984867869
ANITA CLAVERIA 09954097283
ARACELI TORIO 09951440657
AURORA TIBAGACAY 09165378285
BELLA FLOR CAYABYAB 09480657138
TERESITA QUESJADA 09175087412
LUCIA MALICDEM 09223776077
PHILIP DE VERA 09283962986
BENIGNO ARISANG JR 09271901964
REGION PROVINCE
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
REGION I (ILOCOS REGION) 015500000Pangasinan
MUNI_CITY BARANGAY SEX BIRTHDATE
015518000City of Dagupan LASIP CHICO F 4/8/1959
015518000City of Dagupan MAYOMBO F 11/6/1958
015518000City of Dagupan LUCAO M 1/16/1957
015518000City of Dagupan MAYOMBO F 12/23/1944
015518000City of Dagupan BONUAN GUESET M 4/14/1958
015518000City of Dagupan TEBENG M 3/27/1951
015518000City of Dagupan SAN GABRIEL BONUAN BOQUIG M 5/20/1961
015518000City of Dagupan BONUAN BLUE BEACH M 2/4/1980
015518000City of Dagupan PANTAL CENTRO F 4/24/1940
015518000City of Dagupan TAPUAC F 4/8/1949
015518000City of Dagupan BRGY I M 1/17/1960
015518000City of Dagupan POGO CHICO M 7/23/1958
015518000City of Dagupan POGO CHICO F 3/12/1951
015518000City of Dagupan CAREENAN F 7/31/1951
015518000City of Dagupan BONUAN GUESET F 6/27/1957
015518000City of Dagupan PUELAY CAREENAN F 12/9/1959
015518000City of Dagupan MALUED F 6/9/1947
015518000City of Dagupan MAYOMBO F 2/7/1953
015518000City of Dagupan BONUAN BOQUIG F 4/7/1956
015518000City of Dagupan BONUAN SABANGAN F 4/7/1956
015518000City of Dagupan GALVAN ST. F 3/7/1956
015518000City of Dagupan CARANGLAAN F 9/20/1953
015518000City of Dagupan CARANGLAAN F 4/6/1958
015518000City of Dagupan BOLOSAN F 2/8/1956
015518000City of Dagupan AMADO TAPUAC M 6/21/1945
015518000City of Dagupan BONUAN BOQUIG F 1/21/1957
015518000City of Dagupan BONUAN GUESET F 9/4/1961
015518000City of Dagupan BONUAN BOQUIG F 5/5/1935
015518000City of Dagupan CARANGLAAN M 10/5/1960
015518000City of Dagupan MAYOMBO F 1/23/1954
015518000City of Dagupan BONUAN BOQUIG M 7/1/1952
015518000City of Dagupan PANTAL CENTRO F 2/10/1958
015518000City of Dagupan PANTAL F 6/1/1941
015518000City of Dagupan RIVERA ST. M 2/2/1960
015518000City of Dagupan TAPUAC F 6/1/1935
015518000City of Dagupan MALUED F 3/3/1945
015518000City of Dagupan MAYOMBO F 2/11/1951
015518000City of Dagupan MALUED F 8/26/1960
015518000City of Dagupan MAYOMBO F 3/12/1949
015518000City of Dagupan POBLACION WEST F 3/23/1959
015518000City of Dagupan POBLACION OESTE M 1/1/1957
015518000City of Dagupan MALUED F 4/17/1948
015518000City of Dagupan POGO CHICO F 10/6/1953
015518000City of Dagupan LUCAO M 5/14/1952
015518000City of Dagupan BONUAN GUESET F 8/6/1951
015545000Urbiztondo URBIZTONDO PANGASINAN M 5/1/1961
015518000City of Dagupan MANGIN DISTRICT F 10/24/1941
015518000City of Dagupan POGO CHICO F 7/22/1958
015518000City of Dagupan TAPUAC F 12/13/1940
015518000City of Dagupan MAYOMBO F 5/13/1955
015518000City of Dagupan BACAYAO NORTE F 5/24/1946
015518000City of Dagupan RIVERA ST. M 11/25/1955
015518000City of Dagupan TEBENG M 11/20/1957
015518000City of Dagupan CARANGLAAN F 11/12/1955
015518000City of Dagupan MALUED F 4/28/1955
015518000City of Dagupan BACAYAO NORTE M 4/15/1957
015518000City of Dagupan TAPUAC M 12/15/1953
015518000City of Dagupan BONUAN BOQUIG F 5/11/1960
015518000City of Dagupan BONUAN BINLOC F 9/27/1951
015518000City of Dagupan BONUAN BOQUIG M 11/18/1931
015518000City of Dagupan MALUED F 6/23/1958
015518000City of Dagupan ARELLANO BANI F 7/29/1957
015518000City of Dagupan BONUAN BINLOC F 11/3/1955
015518000City of Dagupan BONUAN BOQUIG F 3/24/1961
015518000City of Dagupan ARELLANO BANI F 6/26/1940
015518000City of Dagupan BONUAN GUESET F 4/7/1951
015518000City of Dagupan BONUAN LOMBOY M 12/12/1957
015518000City of Dagupan BONUAN BINLOC M 8/16/1960
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
015518000City of Dagupan
DEFERRAL REASON_FOR_DEFERRAL VACCINATION_DATE
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE 5/8/2021
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
VACCINE_MANUFACTURER_NAME BATCH_NUMBER LOT_NO
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
J&J 213C21A 213C21A
213C21A 213C21A
BAKUNA_CENTER_CBCR_ID VACCINATOR_NAME 1ST_DOSE 2ND_DOSE
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 AQUINO, GINALYN N Y
CBC00307 AQUINO, GINALYN N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 AQUINO, GINALYN N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 PETALVER, NORA N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 AQUINO, GINALYN N Y
CBC00307 AQUINO, GINALYN N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 OKOL, MYLONA SUZZETTE N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
CBC00307 N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
N Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Adverse Event Adverse Event Condition
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
N NONE
Category (Priority Group) Priority Group DESCRIPTION
A1 Workers in Frontline Health Services
A1.8 Outbound OFWS
A1.9 Family Members of Healthcare Workers
A2 All Senior Citizens
A3 Persons with Comorbidities
A4 Frontline personnel in essential sectors, including uniformed personnel
A5 Indigent Population
ROP Rest of the population
PWD INDIGENOUS MEMBER
Y No
N Abelling/Aberling
Aeta
Aeta/Ayta
Aeta/Ayta-Sambal
Aeta/Ayta-Ambala
Aeta/Ayta-Abelling/Abellen
Aeta/Ayta-Mag-indi
Aeta/Ayta-Mang-ansti
Aeta/Ayta-Magbukun
Agta
Agta-Labin
Agta-Dupanigan
Agta Isigiran
Agta-Cimaron
Agta-Tabangnon
Agta-Taboy
Agta-Abay
Agta-Dumagat
Agutaynen
Alangan Mangyan
Alta
Applai
Applai-Kachakran/Kadaclan
Aromanen-Manobo/Eromanen-Manobo
Aromanen-Manobo/Eromanen-Manobo Dibabeen
Aromanen-Manobo/Eromanen-Manobo Direrayaan
Aromanen-Manobo/Eromanen-Manobo Ilianen
Aromanen-Manobo/Eromanen-Manobo Isoroken
Aromanen-Manobo/Eromanen-Manobo Kirenteken
Aromanen-Manobo/Eromanen-Manobo Lahitanen
Aromanen-Manobo/Eromanen-Manobo Livunganen
Aromanen-Manobo/Eromanen-Manobo Mulitaan
Aromanen-Manobo/Eromanen-Manobo Pulengien
Aromanen-Manobo/Eromanen-Manobo Kulmanen
Ata
Ata-Manobo
Ati
Ayangan
Ayangan-Henanga
Ayta
Badjao
Bago
Bagobo Lkata
Bagobo Tagabawa
Bajau
Balangao
Balangao - Lias
Baliwon
Baliwon - Gaddang
Baliwon - Miligan
Baliwon - I-sadanga
Baliwon - Fiallig/Fialika
Bangon Mangyan
Bantoanon
Banwaon
Batak
B'laan/Blaan
Bontok
Bontok-Majukayong
Bugkalot/Ilongot
Buhid Mangyan
Bukidnon
Bukidnon - Akeanon
Bukidnon - Pan-anayon
Bukidnon - Halowodnon
Bukidnon - Magahat
Bukidnon - Ituman
Bukidnon - Iraynon
Bukidnon - Tagoloanon
Cagayanen
Calinga
Cuyonen/Cuyunon
Diangan
Dibabawon
Dumagat
Dumagat - Remontado
Dumagat - Kabolowen
Dumagat - Tagebolus
Dumagat - Edimala
Eskaya
Gaddang
Gubatnon-Ratagnon Mangyan
Hanunuo Mangyan
Higaonon/Higa-onon
Higaonon - Tagoloanon
Ibanag
Ibatan
Ibaloy
Ibukid
Ifugao
Imalawa
Iraya Mangyan
Isinai
Isnag
Isneg
Isneg/Isnag
Itawes
Itneg
Itneg/Tinguian
Itneg/Tinguian - Adasen
Itneg/Tinguian - Balatok
Itneg/Tinguian - Banao
Itneg/Tinguian - Belwang
Itneg/Tinguian - Binongan
Itneg/Tinguian - Gubang
Itneg/Tinguian - Inlaud
Itneg/Tinguian - Mabaka
Itneg/Tinguian - Maeng
Itneg/Tinguian - Masadiit
Itneg/Tinguian - Muyadan
Ivatan
Iwak
Kabihug
Kabihug - Manide
Kagan/Kalagan
Kalanguya
Kalanguya - Yattuka
Kalanguya-Ikalahan
Kalinga
Kalinga - Lubo
Kalinga - Mangali
Kalinga - Taloctoc
Kalinga - Pangol
Kalinga - Gaang
Kalinga - Dacalan
Kalinga - Guilayon
Kalinga - Nanong
Kalinga - Dallac
Kalinga - Biga
Kalinga - Tobog
Kalinga - Gaddang
Kalinga - Culminga
Kalinga - Malbong
Kalinga - Minanga
Kalinga - Dao-Angan
Kalinga - Banao
Kalinga - Salegseg
Kalinga - Gubang
Kalinga - Mabaca
Kalinga - Poswoy
Kalinga - Ab-abaan
Kalinga - Buaya
Kalinga - Balatoc
Kalinga - Dangtalan
Kalinga - Cagaluan
Kalinga - Balinciagao
Kalinga - Ableg/Dalupa
Kalinga - Limos
Kalinga - Pinukpuk
Kalinga - Magaogao
Kalinga - Aciga
Kalinga - Ballayangan
Kalinga - Ammacian
Kalinga - Dugpa
Kalinga - Uma
Kalinga - Luluagan
Kalinga - Mabongtot
Kalinga - Tanglag
Kalinga - Tulgao
Kalinga - Dananao
Kalinga - Tongrayan
Kalinga - Bangad
Kalinga - Basao
Kalinga - Guina-Ang
Kalinga - Sumadel
Kalinga - Butbut
Kamiguin
Kankanaey
Kankanaey - Hak'ki
Karao
Karulano
Kolibugan
Lambanguian
Malaueg
Mamanwa
Mandaya
Mangguangan
Mangyan
Mansaka
Manobo
Manobo - Pulanguinon
Manobo - Dunggoanon
Manobo - Kirenteken
Manobo - Aromanon
Manobo-Blit
Manobo-Blit - Tasaday
Manobo-Dulangan
Manobo-Dulangan - Lambangian
Ubo Monuvu/Manobo-Ubo/Ubo Manobo/Ubo Manuvu/Ubo Menuvu
Matigsalog
Molbog
Obu-Manuvu
Palawan-o
Palawan-o - Tao't Bato
Palawan-o - Ken-ey
Pan-ayanon
Panay Bukidnon
Parananum
Sama
Sama Badjao
Sama Bangingi
Sama Delaut
Sibuyan Mangyan-Tagabukid
Subanen/Subanon - Kolibugan
Tagakaulo
Tagbanua
Tagbanua-Calamian
Tagbanua Tandulanen
Tadyawan Mangyan
Talaandig
T'boli/Tboli
Tau-buid Mangyan
T'duray/Teduray
Tigwahanon
Tinananen
Tingguian
Tuwali
Tuwali - Kele-i
Umayamnon
Yakan
Yapayao
Yogad
 REGION PROVINCE
AUTONOMOUS REGION IN MUSLIM MINDANAO (ARMM) Please refer to REGION_PROVINCE_CODE Tab
CORDILLERA ADMINISTRATIVE REGION (CAR)
NATIONAL CAPITAL REGION (NCR)
REGION I (ILOCOS REGION)
REGION II (CAGAYAN VALLEY)
REGION III (CENTRAL LUZON)
REGION IV-A (CALABARZON)
REGION IV-B (MIMAROPA)
REGION V (BICOL REGION)
REGION VI (WESTERN VISAYAS)
REGION VII (CENTRAL VISAYAS)
REGION VIII (EASTERN VISAYAS)
REGION IX (ZAMBOANGA PENINSULA)
REGION X (NORTHERN MINDANAO)
REGION XI (DAVAO REGION)
REGION XII (SOCCSKSARGEN)
REGION XIII (CARAGA)

Manobo Dibabeen
Manobo Direrayaan
Manobo Ilianen
Manobo Isoroken
Manobo Kirenteken
Manobo Lahitanen
Manobo Livunganen
Manobo Mulitaan
Manobo Pulengien
Manobo Kulmanen
Manobo/Ubo Manuvu/Ubo Menuvu
MUNICITY SEX Deferral
Please refer to MUNICITY_CODE Tab M Y
F N
Reason for Deferral Vaccine Brand
NONE Sinovac
DC01_Age Requirement AstraZeneca
DC02_1st Dose Other Brand Pfizer
DC03_Allergy to Vaccine component Moderna
DC04_Severe Allergy to 1st Dose Sputnik V/Gamaleya
DC05_Allergy/Asthma, No monitor Novavax
DC06_History of Anaphylaxis Johnson and Johnson
DC07_Bleeding disorders/Taking anti-coagulants
DC08_Symptomatic for COVID-19 Infection
DC09_High SBP, DBP, Organ Damage
DC10_Covid-19 Exposure
DC11_Ongoing Covid-19 Treatment
DC12_Attach, Admissions, Meds Change
DC13_Other Vaccine/s within 2 weeks
DC14_Plasma or Antibodies
DC15_Pregnant or Breastfeeding
DC16_No Med Clearance for Comorbidity
Vaccine Manufacturer Name 1st Dose 2nd Dose Adverse Event
Sinovac Y Y Y
AZ N N N
Pfizer
Moderna
Gamaleya
Novavax
J&J
Adverse Event Condition
NONE
AE01_General Symptoms
AE02_Cardiac Symptoms
AE03_Ear Symptoms
AE04_Endocrine Symptoms
AE05_Examinations
AE06_Eye Symptoms
AE07_Gastrointestinal Symptoms
AE08_Hepatobiliary Symptoms
AE09_Immune System Symptoms
AE10_Infections
AE11_Nutrition-Related Symptoms
AE12_Musculoskeletal Symptoms
AE13_Neurological Symptoms
AE14_Perinatal Conditions
AE15_Procedural Symptoms
AE16_Psychiatric Symptoms
AE17_Renal and Urinary Symptoms
AE18_Reproductive Symptoms
AE19_Respiratory Symptoms
AE20_Skin Symptoms
AE21_Lymphatic System Symptoms
AE22_Vascular Symptoms
CODE NAME PROVINCE
012800000 Ilocos Norte 012800000Ilocos Norte
012900000 Ilocos Sur 012900000Ilocos Sur
013300000 La Union 013300000La Union
015500000 Pangasinan 015500000Pangasinan
020900000 Batanes 020900000Batanes
021500000 Cagayan 021500000Cagayan
023100000 Isabela 023100000Isabela
025000000 Nueva Vizcaya 025000000Nueva Vizcaya
025700000 Quirino 025700000Quirino
030800000 Bataan 030800000Bataan
031400000 Bulacan 031400000Bulacan
034900000 Nueva Ecija 034900000Nueva Ecija
035400000 Pampanga 035400000Pampanga
036900000 Tarlac 036900000Tarlac
037100000 Zambales 037100000Zambales
037700000 Aurora 037700000Aurora
041000000 Batangas 041000000Batangas
042100000 Cavite 042100000Cavite
043400000 Laguna 043400000Laguna
045600000 Quezon 045600000Quezon
045800000 Rizal 045800000Rizal
174000000 Marinduque 174000000Marinduque
175100000 Occidental Mindoro 175100000Occidental Mindoro
175200000 Oriental Mindoro 175200000Oriental Mindoro
175300000 Palawan 175300000Palawan
175900000 Romblon 175900000Romblon
050500000 Albay 050500000Albay
051600000 Camarines Norte 051600000Camarines Norte
051700000 Camarines Sur 051700000Camarines Sur
052000000 Catanduanes 052000000Catanduanes
054100000 Masbate 054100000Masbate
056200000 Sorsogon 056200000Sorsogon
060400000 Aklan 060400000Aklan
060600000 Antique 060600000Antique
061900000 Capiz 061900000Capiz
063000000 Iloilo 063000000Iloilo
064500000 Negros Occidental 064500000Negros Occidental
067900000 Guimaras 067900000Guimaras
071200000 Bohol 071200000Bohol
072200000 Cebu 072200000Cebu
074600000 Negros Oriental 074600000Negros Oriental
076100000 Siquijor 076100000Siquijor
082600000 Eastern Samar 082600000Eastern Samar
083700000 Leyte 083700000Leyte
084800000 Northern Samar 084800000Northern Samar
086000000 Samar 086000000Samar
086400000 Southern Leyte 086400000Southern Leyte
087800000 Biliran 087800000Biliran
097200000 Zamboanga del Norte 097200000Zamboanga del Norte
097300000 Zamboanga del Sur 097300000Zamboanga del Sur
098300000 Zamboanga Sibugay 098300000Zamboanga Sibugay
101300000 Bukidnon 101300000Bukidnon
101800000 Camiguin 101800000Camiguin
103500000 Lanao del Norte 103500000Lanao del Norte
104200000 Misamis Occidental 104200000Misamis Occidental
104300000 Misamis Oriental 104300000Misamis Oriental
112300000 Davao del Norte 112300000Davao del Norte
112400000 Davao del Sur 112400000Davao del Sur
112500000 Davao Oriental 112500000Davao Oriental
118200000 Davao de Oro 118200000Davao de Oro
118600000 Davao Occidental 118600000Davao Occidental
124700000 Cotabato 124700000Cotabato
126300000 South Cotabato 126300000South Cotabato
126500000 Sultan Kudarat 126500000Sultan Kudarat
128000000 Sarangani 128000000Sarangani
140100000 Abra 140100000Abra
141100000 Benguet 141100000Benguet
142700000 Ifugao 142700000Ifugao
143200000 Kalinga 143200000Kalinga
144400000 Mountain Province 144400000Mountain Province
148100000 Apayao 148100000Apayao
150700000 Basilan 150700000Basilan
153600000 Lanao del Sur 153600000Lanao del Sur
153800000 Maguindanao 153800000Maguindanao
156600000 Sulu 156600000Sulu
157000000 Tawi-Tawi 157000000Tawi-Tawi
160200000 Agusan del Norte 160200000Agusan del Norte
160300000 Agusan del Sur 160300000Agusan del Sur
166700000 Surigao del Norte 166700000Surigao del Norte
166800000 Surigao del Sur 166800000Surigao del Sur
168500000 Dinagat Islands 168500000Dinagat Islands
133900000 NCR, City of Manila, First District (Not a Province) 133900000NCR, City of Manila, First District (Not a Prov
137400000 NCR, Second District (Not a Province) 137400000NCR, Second District (Not a Province)
137500000 NCR, Third District (Not a Province) 137500000NCR, Third District (Not a Province)
137600000 NCR, Fourth District (Not a Province) 137600000NCR, Fourth District (Not a Province)
 Manila, First District (Not a Province)
d District (Not a Province)
District (Not a Province)
h District (Not a Province)
CODE DESCRIPTION MUNICITY
015545000 Urbiztondo 015545000Urbiztondo
 Reason for Deferral Code Astrazeneca
1 DC01_Age Requirement Below 18 years old?

2 DC02_1st Dose Other Brand

Has an allergy to polysorbate or any

other components of the Astrazeneca
vaccine (L-Histidine, L-Histidine
3 DC03_Allergy to Vaccine component hydrochloride monohydrate,
magnesium chloride hexahydrate,
polysorbate 80, ethanol, sucrose,
sodium chloride, disodium edetate
dihydrate, water for injections)?

Has severe allergic reaction after the

4 DC04_Severe Allergy to 1st Dose
1st dose of the ASTRAZENECA vaccine

5.1 Allergy to food, egg, medicines,

and/or with asthma?
DC05_Allergy/Asthma, No monitor If with allergy or asthma, will
5.2 monitoring the patient for 30 mins be
a problem

6 DC06_History of Anaphylaxis

Has history of bleeding disorders or

7.1
currently taking anti-coagulants
DC07_Bleeding disorders/Taking
anti-coagulants If with bleeding history or currently
taking anti coagulants, is there a
7.2
problem securing a gauge 23-25
syringe for injection

Manifests any one of the following

DC08_Symptomatic for COVID-19
8 Infection
symptoms (fever/chills, headache,
cough, colds, sore throat, myalgia,
fatigue, weakness, loss of smell/taste,
diarrhea, shortness of
breath/difficulty in breathing, rashes,
nausea/vomiting, other symptoms of
existing comorbidity)
 Currently with SBP>=180 and/or
9 DC09_High SBP, DBP, Organ Damage dBP>=120, with signs and symptoms
of organ damage

Has history of exposure to a

10 DC10_Covid-19 Exposure confirmed or suspected COVID-19
case in the past 14 days

If previously diagnosed with COVID-

11 DC11_Ongoing Covid-19 Treatment 19, is still undergoing recovery or
treatment

Has had attacks, admissions, or

DC12_Attach, Admissions, Meds
12 changes in medication for the past 3
Change
months

Has received any vaccine in the past

DC13_Other Vaccine/s within 2
13 weeks 14 days or plans to receive another
vaccine 14 days following vaccination

Has received convalescent plasma or

14 DC14_Plasma or Antibodies monoclonal antibodies for COVID-19
in the past 90 days

15.1 Pregnant
DC15_Pregnant or Breastfeeding
If pregnant, are you in the 1st
15.2
trimester

Has any of the following diseases or

health condition
(HIV,Cancer/Malignancy and is
currently undergoing chemotherapy,
radiotherapy, immunotherapy, or
16.1
other treatment, Underwent
Transplant, Under Steroid
Medication/Treatment, Bed ridden,
DC16_No Med Clearance for terminal illness, less than 6 months
Comorbidity prognosis, Autoimmune disease)

If with any of the abovementioned

condition, is there any objection to
16.2
vaccination from presented medical
clearance prior to vaccination day

For Better Visual, Check word file

Sinovac Gamaleya
Below 18 years old? Below 18 years old?
Has previously been vaccinated with
another COVID-19 vaccine that is not
Gamaleya (Sputnik V Gam-COVID-
Vac)

Has allergy to polysorbate or any

other components (Tris
(hydroxymethyl), aminomethane,
sodium chloride, sucrose, magnesium
chloride hexahydrate, sodium EDTA,
ethanol) of the Sputnik V vaccine?

Has severe allergic reaction after the

1st dose of the SINOVAC vaccine

Allergy to food, egg, medicines, Has allergy to food, egg, medicines,

and/or with asthma? and/or asthma?
If with allergy or asthma, will If with allergy or asthma, will
monitoring the patient for 30 mins be monitoring the patient for 30 mins be
a problem a problem
Has history of any anaphylaxis or
severe allergic reactions

Has history of bleeding disorders or Has history of bleeding disorders or

currently taking anti-coagulants currently taking anti-coagulants

If with bleeding history or currently If with bleeding history or currently

taking anti coagulants, is there a taking anti coagulants, is there a
problem securing a gauge 23-25 problem securing a gauge 23-25
syringe for injection syringe for injection

Manifests any one of the following

symptoms (fever/chills, headache,
Manifests any one of the following cough/colds, sore throat,
symptoms (fever/chills, headache, myalgia/weakness, fatigue, loss of
cough, colds, sore throat, myalgia, smell/taste, diarrhea, jaundice,
fatigue, weakness, loss of smell/taste, shortness of breath/difficulty in
diarrhea, shortness of breathing, chest pain, rashes,
breath/difficulty in breathing, rashes, nausea/vomiting, new onset
nausea/vomiting, other symptoms of neurologic deficits, uncontrolled
existing comorbidity) epilepsy, other symptoms of existing
comorbidity or active disease
process)
Currently with SBP>180 and/or Currently with SBP>180 and/or
DBP>120, with signs and symptoms of DBP>120, with signs and symptoms of
organ damage organ damage

Has history of exposure to a Has history of exposure to a

confirmed or suspected COVID-19 confirmed or suspected COVID-19 in
case in the past 2 weeks (14 days) the past 14 days

If previously diagnosed with COVID- If previously diagnosed with COVID-

19, is still undergoing recovery or 19, is still undergoing recovery or
treatment treatment

Has had attacks, admissions, or Has had attacks, admissions, or

changes in medication for the past 3 changes in medication for the past 3
months months

Has received any vaccine in the past Has received any vaccine in the past
14 days or plans to receive another 14 days or plans to receive another
vaccine 14 days following vaccination vaccine 14 days following vaccination

Has received convalescent plasma or Has received convalescent plasma or

monoclonal antibodies for COVID-19 monoclonal antibodies for COVID-19
in the past 90 days in the past 90 days
Are you pregnant and/or
Are you pregnant
breastfeeding
If pregnant, are you in the 1st
trimester

Has any of the following diseases or
health condition
(HIV,Cancer/Malignancy and is
currently undergoing chemotherapy,
radiotherapy, immunotherapy, or
other treatment, Underwent
Transplant, Under Steroid
Medication/Treatment, Bed ridden,
terminal illness, less than 6 months
prognosis, Autoimmune disease)
Has any of the following diseases or
health condition
(HIV,Cancer/Malignancy and is
currently undergoing chemotherapy,
radiotherapy, immunotherapy, or
other treatment, Underwent
Transplant, Under Steroid
Medication/Treatment, Bed ridden,
terminal illness, less than 6 months
prognosis, Autoimmune disease)

If with any of the abovementioned If with any of the abovementioned

condition, is there any objection to condition, is there any objection to
vaccination from presented medical vaccination from presented medical
clearance prior to vaccination day clearance prior to vaccination day
Pfizer *For Better Visual, Check word file
Below 16 years old?

Has allergy to PEG or polysorbate

Has severe allergic reaction after the

1st dose of the PFIZER vaccine

Allergy to food, egg, medicines,

and/or with asthma?
If with allergy or asthma, will
monitoring the patient for 30 mins be
a problem

Has history of bleeding disorders or

currently taking anti-coagulants

If with bleeding history or currently

taking anti coagulants, is there a
problem securing a gauge 23-25
syringe for injection

Manifests any one of the following

symptoms (fever/chills, headache,
cough, colds, sore throat, myalgia,
fatigue, weakness, loss of smell/taste,
diarrhea, shortness of
breath/difficulty in breathing, rashes,
nausea/vomiting, other symptoms of
existing comorbidity)
Currently with SBP>=180 and/or
dBP>=120, with signs and symptoms
of organ damage

Has history of exposure to a

confirmed or suspected COVID-19
case in the past 14 days

If previously diagnosed with COVID-

19, is still undergoing recovery or
treatment

Has had attacks, admissions, or

changes in medication for the past 3
months

Has received any vaccine in the past

14 days or plans to receive another
vaccine 14 days following vaccination

Has received convalescent plasma or

monoclonal antibodies for COVID-19
in the past 90 days

Are you pregnant

If pregnant, are you in the 1st

trimester

Has any of the following diseases or

health condition
(HIV,Cancer/Malignancy and is
currently undergoing chemotherapy,
radiotherapy, immunotherapy, or
other treatment, Underwent
Transplant, Under Steroid
Medication/Treatment, Bed ridden,
terminal illness, less than 6 months
prognosis, Autoimmune disease)

If with any of the abovementioned

condition, is there any objection to
vaccination from presented medical
clearance prior to vaccination day
 Code Adverse Event

AE01_General Symptoms General Symptoms and Reactions in the Administration Site

AE02_Cardiac Symptoms Cardiac Symptoms

AE03_Ear Symptoms Ear Symptoms

AE04_Endocrine Symptoms Endocrine Symptoms

AE05_Examinations Examinations

AE06_Eye Symptoms Eye Symptoms

AE07_Gastrointestinal Symptoms Gastrointestinal Symptoms

AE08_Hepatobiliary Symptoms Hepatobiliary Symptoms

AE09_Immune System Symptoms Immune System Symptoms
AE10_Infections Infections
AE11_Nutrition-Related Symptoms Metabolism and Nutrition-Related Symptoms

AE12_Musculoskeletal Symptoms Musculoskeletal Symptoms

AE13_Neurological Symptoms Neurological Symptoms

AE14_Perinatal Conditions Pregnancy, Puerperium, and Perinatal Conditions

AE15_Procedural Symptoms Procedural Symptoms

AE16_Psychiatric Symptoms Psychiatric Symptoms

AE17_Renal and Urinary Symptoms Renal and Urinary Symptoms

AE18_Reproductive Symptoms Reproductive Symptoms

AE19_Respiratory Symptoms Respiratory Symptoms

AE20_Skin Symptoms Skin Symptoms

AE21_Lymphatic System Symptoms Symptoms in Blood and Lymphatic System

AE22_Vascular Symptoms Vascular Symptoms
Inactivated Vaccine Non-replicating Viral Vector Vaccine
Sinovac AstraZeneca and Gamaleya
Pain and Reaction in the Injection Site Pain and Reaction in the Injection Site
Chills Chills
Discomfort Discomfort
Palpitations Palpitations
Bradycardia Bradycardia
Ear Swelling Ear Swelling
Vertigo Vertigo
Adrenal Insufficiency Adrenal Insufficiency
Goiter Goiter
Increased Blood Pressure Increased Blood Pressure
Increased Heart Rate Increased Heart Rate
Eye Itchiness Eye Itchiness
Blurred Vision Blurred Vision
Abdominal Pain Abdominal Pain
Diarrhea Diarrhea
Nausea Nausea
Vomiting Vomiting
Jaundice Jaundice
Allergic Reactions Allergic Reactions
Cold Symptoms Cold Symptoms
Decreased Appetite Decreased Appetite
Back Pain Back Pain
Joint Pain Joint Pain
Pain in Extremities Pain in Extremities
Dizziness Dizziness
Headache Headache
Syncope Syncope
Abortion
Procedural Hypertension Procedural Hypertension
Vaccination Adverse Reaction Vaccination Adverse Reaction
Feeling Anxious Feeling Anxious
Urine coloring yellow Urine coloring yellow
Urine frequency Urine frequency
Vaginal Bleeding Vaginal Bleeding
Vaginal Spotting Vaginal Spotting
Cough Cough
Nasal Congestion Nasal Congestion
Throat Irritation Throat Irritation
Cold Sweat Cold Sweat
Rash Rash
Redness Redness
Pain in the lymph nodes Pain in the lymph nodes
Flushes Flushes
Low Blood Pressure Low Blood Pressure
mRNA vaccine
Pfizer and Moderna
Pain and Reaction in the Injection Site
Chills
Discomfort
Palpitations
Bradycardia
Ear Swelling
Vertigo

Increased Blood Pressure

Increased Heart Rate

Abdominal Pain
Diarrhea
Nausea
Vomiting

Cold Symptoms

Back Pain
Joint Pain
Pain in Extremities
Dizziness
Headache
Syncope

Cough
Nasal Congestion
Throat Irritation
Cold Sweat
Rash
Redness
Flushes
Low Blood Pressure