Professional Documents
Culture Documents
PV46700
PV46700
PV46700
PV46700
PV46700
PV46700
PV46700
PV46700
08/16/2021 ASTRAZENECA PV46700
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
ZORAIDA TOLIA, RM
Z
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Category_I PhilHealth_ Middle_Na sid e: Current_Residence:
Category PWD ID Last_Name First_Name Suffix Contact_No. id Sex
D ID me en M Barangay
en
ce: un
_01_A1_Heal05_A1.5: Government Owned Community GANION AMELODIN ANGKEL NA 9106397656 Soc
ce _12 _12_124708006_CENTRAL MALA02_Male
Pro ici
_03_A3_Adult_with_Comorbidity LEE MESALINA :_ _12 _12_124708008_ESTADO
Soc 01_Female
vin pa
R
_02_A2_Senior_Citizens MILLAN NIELA A ce lit _124708013_KIBUDOC
eg
_02_A2_Senio 09_A2.2: All Other Senior Citizens MATULLANO ELVIRA BESO SO_12 y/
_12_124708015_KILADA
io
COLONIA SAMUEL 9103002538 Soc Cit
_02_A2_Senio 09_A2.2: All Other Senior Citizens n _12 _12_124708017_LAMPAYAN M
y
02_Senior_Citizen BILOG ROSALINA ESTUESTA Soc_12 _12_124708019_LINAO
02_Senior_Citizen ESTUESTA CRISTINA CORNELIO 90070677256 Soc_12 _12_124708019_LINAO
02_Senior_Citizen 1.7175E+11 ORDINARIO HORTENCIA Soc_12 _12_124708019_LINAO
SECRETARY 17-20095145N/A ZAMORA MARIBEL CANO N/A 9657067890 _12 _12_124708019_LINAO FEMALE
BPAT 04_Other_ID 17-20036057N/A MADIS VEVENCIO SAGASAG JR 9187202341 Soc_12 _12_124708020_LOWER MALAM 02_Male
_02_A2_Senior09_A2.2: All Other Senior Citizens MAGBANUA ANASTACIA MAHINAY 9107915611 Soc_124_12_124708025_MANUBUAN 01_Female
02_Senior_Ci04_Other_ID ### TEOFILA AL-AG Soc_12 _12_124708027_MARBEL 01_Female
_02_A2_Senio 09_A2.2: All Other Senior Citizens AMBROCIO ERLINDA DE GUZMAN Soc_12 _12_124708027_MARBEL 01_Female
_03_A3_Adult_with_Comorbidity LLANTO EMIE ENCARNACION Soc_12 _12_124708027_MARBEL 01_Female
_02_A2_Senio 09_A2.2: All Other Senior Citizens SAMSON YOLANDA PRESTO Soc_12 _12_124708027_MARBEL 01_Female
HRH 01_PRC_num17-02520182N/A AMIGO MARIAN PEROCHO 9474410556 Soc_12 _12_124708034_POBLACION 01_Female
02_Senior_Ci02_OSCA_number BALDONADO MARILYN GALAN 09239233344 Soc_12 _12_124708034_POBLACION F
_02_A2_Senio 09_A2.2: All Other Senior Citizens CRESPO VIOLETA SARMIENTO Soc_12 _12_124708034_POBLACION F
03_A3: Adult with Comorbidity DANDAN ROSE LAARNI PUNZALAN 9431282904 Soc_12 _12_124708034_POBLACION F
_03_A3_Adult_with_Comorbidity GALANG MARA SHAIRA ANGELES 09284373714 Soc_12 _12_124708034_POBLACION
_02_A2_Senior09_A2.2: All Other Senior Citizens JAVIER GODOFREDO GODOFRED NA 99556010859 Soc_124_12 _124708034_POBLACION 02_Male
_02_A2_Senio 09_A2.2: All Other Senior Citizens SUNICO LEAH BESANA _124708034_POBLACION
_01_A1_Healt 06_A1.6: Stand-alone Clinics and DiagnTEJANO JOHN CARLO LOPECILLO Soc_124_12_124708034_POBLACION
02_Senior_CiSENIOR CITIZEN UMALI CONCEPCION ESCALANA 9075203936 Soc_12 _12_124708034_POBLACION M
_02_A2_Senior_Citizens MEDINA MANUEL Soc_124_12_124708035_SALVACION
_02_A2_Senior_Citizens PALALIMPA MARIO E Soc_12 _12_124708007_DALAPITAN
Pregnancy_s
Birthdate_m tatus Drug_Allerg Food_Allerg Insect_Aller Latex_Allerg Mold_Allerg Pollen_Aller With_Comor Hypertensio
Civil_Status Profession Pet_Allergy?
m/dd/yyyy_ y? y? gy? y? y? gy? bidity? n
02/09/1967 BARANGAY CAPTAIN
2/6/1966 02_Not_Pregn01_Yes 01_Yes 02_No 02_No 02_No 02_No 02_No 02_None 02_No
NOT PREGNA02_No 02_No 02_No 02_No 02_No 02_No 02_No 01_Yes 01_Yes
07/27/1938 NOT PREGNA02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No
02/11/1956
4/9/1949
7/10/1951
1/6/1937 NOT PREGNA02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No
04/26/1973 MARRIED SECRETARY
2/6/1967 02_Married BPAT
06/01/1950 NO NO YES NO NO NO NO NO NO NO
7/2/1959 03_Widow/Widower
04/09/1959
4/6/1984 02_Not_Pregn02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_None 02_No
02/22/1945
6/7/1985 02_Married 06_Nurse
12/25/1955 MARRIED
2/8/1970
02/19/1955 NO
5/7/1993 UTILITY
12/8/1956 NA NOT PREGNA02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No
5/21/1959 NONE NO NO NO NO NO NO NO NO NO
3/2/1955
Date_of_first
Patient_was _positive_re Vaccine
Classificatio Willing
Heart_Disea Kidney_Dise Diabetes_Me Bronchial_A Immunodefic _diagnosed_ sult_/_speci Date of Manufact
Cancer Others n_of_COVID to_be_Vacci 28
se ase llitus sthma iency_Status with_COVID men_collecti Vaccination urer
_19 nated?
_19 on_mm/dd/y Name
5/14/2021 Sinovac 6/11/2021
yyy_
02_No 02_No 02_No 01_Yes 02_No 02_No 02_No 02_No 02_No 5/26/2021 SINOVAC 6/23/2021
02_NO 02_No 02_No 02_No 02_No 02_No 02_No 02_No 4/23/2021 Sinovac 5/21/2021
02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No None N/A 02_No 5/28/2021 SINOVAC 6/25/2021
5/27/2021 SINOVAC 6/24/2021
5/27/2021 SINOVAC 6/24/2021
02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No None N/A 02_No 5/28/2021 SINOVAC 6/25/2021
02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No 4/15/2021 Sinovac 5/13/2021
YES YES 6/11/2021 SINOVAC 7/9/2021
02_No 02_No 02_No 02_No 02_No 02_No 02_No 02_No None N/A 02_No 5/27/2021 SINOVAC 6/24/2021
NO NO NO NO NO NO NO NO 4/23/2021 Sinovac 5/21/2021
32
6/15/2021
6/27/2021
5/25/2021
6/29/2021
6/28/2021
6/28/2021
6/29/2021
7/6/2021
7/19/2021
5/17/2021
7/13/2021
7/19/2021
6/28/2021
7/19/2021
6/28/2021
5/25/2021
ABIAN WARLITO LABUGUEN SR. 9101442619
GAYAK ALJEHAD S 9755004510
BUSAYONG FLORIE PAMPLONA 9101187662
CAMANO RAYMUND QUIME 909614972
MAIDO LORETO CATUBO
ALOQUIN CHRISTOPHER CANTERO 9355023886
LATIDO RANDY JAMOLES 9465644255
CARI JISMAR CADANGIN
CADANGIN JESSIE CAMBEL
OROLA ARMENIO GENOLOS
ESCUDERO VICTOR BONCALES 9958842680
TAGAMOLILA MARIO TABUGA
JAWOD JOSE RANELO REGALADO 9466470470
GONGGA FAISAL ZAITOC N/A 09360277744
DELA CRUZ JOEY MAGBANUA N/A 09355763341
NOBLE CAROLINE QUIRINO N/A 9466470470.00
CAHEMTONG JHONNY N 9076802138
MATAYA SALAHUDIN USMAN 9361183040
PAQUITA VERONICA BACUTA 9515749819
GAZO AGRIPINO BALDE JR 938448333
CAMPOLLO ANGELITA PANUGALINOG 9105350431
IPONG TARHATA ANGKEL NA 9557982730
USMAN IMELDA SILONGAN NA 9534014377
ANGKEL WARDA GUIAMPUTO NA 9554861091
SOMERA WILFREDO JAQUIAS JR 9302744080
CABENIAN ENGELBERT ASI 9503341172
BILOG LEONARDO CRISTOBAL JR 9973000871
BILOG REMEGIA TAMBOGON 9979000871
BIONGAN DELIA PALMERO 9197551244
RAQUEL ERNESTO ALIDA JR 9475694221
GELLEGANI DIVINA GRACE BELDIA 9307337321
BANDOJA REY CONDINO 9075256803
DOONG ABITA L. 9277379733
SOLAIMAN MANSOR WAHAB 9058042500
FUENTES EDISON MANLAYA NA 9468861818
SEGUNDERA ANALYN SEDON 9511985513
ROMAY IMELDA MANUEL 93082245783
JANAPON GRACE MAGSINO
JANAPON REY ABUC
LLOBRERA ROMEO ALEJANDRO 9679608598
DELA CRUZ WARLITO C 9755168973
SALVARION LUDY CODERIAS 9679608598
BALMONTE MELECIO CAPILLAN SR
POSADAS RODRIGO OBRA 9679608598
CUANAN JUVY ESCUDERO 9679608598
ABIAN CONSTANCIO LABUGUEN 9679608598
SAWAY ROMEO ONOTAN 9679608598
MAYUGA PERRY CAUNGA 9301581818
CRISPOLON ALADIN ALPERTO N/A 09464024740
SOBREVILLA LUDY JABAN 9612207651
WACAY EMELLODY JOYCE 9500817527
PALACIO MONALISA CASTILLON 96538025531
DELOS SANTOS BILLY L 9066364720
ALGAR LYNDON EVANGENIO 9363388505
DALISAY ESTELA JAVIER 9356878621
BORCILLO JULIETA VALDEZ
UGAY LARRY LAGMAY 9120532436
TUMBAO NORHANA JOSE 9153707771
AQUINO AIZA BENIDO 9511996125
SALES FLORENDA ESTEBE 9487323306
CATALO KENNETH ISAAC GARCIA 9514509136
MARTIZANO ANTONIO DELSOCORO JR 9700748217
FERNANDO CHERMELITA S. 9356500421
ROQUERO RHONNA MAE ENATE 9464023303
SALVADOR ROGER ABRIQUE 9468214831
REUSORA ALEXANDER MOLINA 9652035144
LAGASAN NASRULLA MAMALAPAT 9352728443
ANGELES SITTIE GUIMLA 9558737035
DIMAAGOS OMAR IMBONG 9976358445
ANDALING EBRAHIM BALARANAN 9975420077
PLON ZOREN NANIMBONG 9058392955
AMBEL MAMA MARALIGO 9531249957
DUMLAO LYXER KENT 9568161930
QUIRINO CLEMENTE LUPERA JR. 9090050946
NOBLE MARCELINO BAUTISTA 9466470470
SALMORIN BENNY BELLO 9071007421
SALMORIN DANNY BELLO 9516561368.00
CORDERO GIL OLAO JR.
JARAVATA RAIZA NELLAS 9355259050
PASTOLERO RAYMUNDO GANI NA 09382433740
PABLO RAQUEL DE TOMAS NA 09103358138
ANTIPOLO MERCEDITA PAMULAGAN NA 09558754436
ASUNCION RAMON PREDES JR 09485752129
LANOSIN RUBEN ESPIRITU NA 09187702654
SANTILLAN SANDRO LUZADA NA 09630700199
PASCUA ANALIZA TANODTANOD NA 09638213740
BUENA JAY RONEL VIADO NA 09104257239
DOCTOLERO MARLO DUCLAYAN NA 09631472939
AKAS MAIMONA KANAPIA 90683036616
GUADALUPE MARIA JOHANNIE VIV ESCOMES 9304918401
DESACA DANNIE FACTAO JR 9097413302
TUSCANO MODESTO PALEN
LEE MARILOU VILLAS NA 9514790211
PIORNATO JOZACAR MACAIRAN 9336824505
PIORNATO MINDA B 9432934752
PIORNATO GLAIZA MAE YBAÑES 9336824505
PELIGROS LENIE NOVESTEROS NA 9465031921
PIORNATO ZENAIDA BISCARRA 9099568509
FLORES KERSTIN ORDANEZA None 09050816955
PELIGROS ARNOLD AMPER NA 9501862492
PELIGROS EMILY AMPER 9501862492
ENAD MARILOU IGLESIA 95321099369
JULOYA ANNALIE ENGALLADO 9317387585
TAYO RODEL ESTOMATO 9485699250
ROLDAN BERNARD FERNANDEZ 9534099369
MUJERES OLIVER 9121876603
JAQUIAS ROVELYN CARDILLA 9513891330
MONTERONA ALLAN A 9638119699
PALOMO JAIME OROLA 9076802138
PERALTA DOMINADOR E 9076802138
PATALINO RONITO OROLA 9076802138
ODONES RUDILIZA QUINONES 9564069817
NOTARIO DOMINADOR GASMIN JR 9360700092
NOTARIO HERMINIGILDA CABRERA 9554881185
CABES MARCOS BERMUDO
ALABADO ELDRED ESTANQUE 9101506710
ALABADO RENE AMAHIDO
REPOSAR ELMERITO GAPOL
CALANAO GERSON DORONILA 90514182353
OTON ROGELIO GARBILIO 9631040697
TEJERO LUZ BARBOSA NA 9974974015.00
ALCALDE JOFREY SAAVEDRA NA 9569750258.00
TUZON FERNANDO QUINTINITA NA 9679124123.00
IPONG NASROLA MINALANG 9531295782
MARIANO ELVIRA REPAREJO 9519406739
BELANDRES LOURDES D
BELDIA DONA BELLA BARRACA 9618313663
CAJELO MARINA A 9308216789
REYES YIEL MURAD 9474262664
CABAÑAS RAMON C
TOQUERO JUDITH ANCHETA 9366993760
BEÑALES JOEMAR F 9771667221
ESCOSIA PETER JOSHUA T 9518190721
GADIA LADY LEE 9158388597
MASCARIÑAS VANESSA MORENO 9386870110
BILOG JOMAR TUZON 9755087689
TOLEDO JEFFERSON MARIANO 9101104340
TOLEDO JUNRIEL C 9101104340
MARANION LEAH PIORNATO 09124299405
ECO JUMAR NORICO 9531285420
LANOSIN MELLIE GICOS 09102975586
ALOD MARIAFE CAMPANO 09553364836
SELOVERES ELSA QUEMADO 09365934748
ANTONIO GERTRUDES QUEMADO 09076287028
BAUZON PAUL LANA 09661990148
GONZALES JOBELLE BUENTIPO
GUMANIT VENUS PEREZ
GUANZON DONNA MAE BLANCIA 9651444433
SEGUMBAN CASSANDRA CELINE
J. 9289739329
NATIVIDAD AVELINO PAGADUAN SR
Civi
Birthdate_mm/d l_St
Sex* Occupation*
d/yyyy_* atu
s
F 02/18/1976 BHW
M 04/14/1979 BPAT
02_Ma12/10/1964 BPAT
F 06/20/1977 BARANGAY KAGAWAD
MALE08/09/1969
02/06/1997 MUNICIPAL
M 06/04/1975 NONE
MALE06/11/1972 BPAT
MALE07/10/1966 BPAT
FEMA10/14/1962
M 02/24/1965 GOV'T EMPLOYEE
_124708013_KIBUDOC 01/25/1971 BPAT
CENTRAL MALAMOTE M 11/21/1998 STUDENT
_124708004_BANGBANG 01_F 10/22/1974 BHS-BANGBANG
_124708039_TAGURANAO MALE05/01/1974 BPAT
_124708039_TAGURANAO MALE11/18/1984 BPAT
_124708039_TAGURANAO MALE08/08/1976 BPAT
_124708039_TAGURANAO MALE05/28/1982 BPAT
_124708039_TAGURANAO MALE07/17/1974 BPAT
_124708039_TAGURANAO MALE08/17/1961 BPAT
TAGURANAO M 10/18/1982
_124708013_KIBUDOC 02_Ma07/24/1962 19_Others_
_124708030_NEW BUGASONG MALE10/24/1963 BPAT
_124708030_NEW BUGASONG MALE10/17/1965
_124708014_KIDAMA M 04/05/1972 BPAT
_124708014_KIDAMA M 07/11/1968 BPAT
_124708030_NEW BUGASONG F DECEMBER 10, 1981 BHW
_124708036_SANTA MARIA M 12/12/1979 NONE
CENTRAL MALAMOTE M 03/26/1982
POBLACION F 6/16/1974
_124708001_NEW ALIMODIAN 02_Ma08/27/1969 BPAT
_124708004_BANGBANG 01_F09/16/1968
_124708006_CENTRAL MALAMOT01_F10/16/1980 BNS
_124708006_CENTRAL MALAMOT01_F07/25/1963 16_Barangay_Health_Worker
_124708006_CENTRAL MALAMOT01_F08/07/1997 BARANGAY KAGAWAD
_124708006_CENTRAL MALAMOT02_Ma04/03/1968
_124708007_DALAPITAN 02_Ma05/16/1983 AIRCON TECHNICIAN
_124708007_DALAPITAN M 12/02/1968
_124708007_DALAPITAN F 12/26/1970
_124708007_DALAPITAN F 05/04/1962
_124708007_DALAPITAN 02_Ma03/26/1974
_124708007_DALAPITAN 01_F09/21/1986
_124708007_DALAPITAN 02_Ma
02/11/1968
_124708008_ESTADO 01_F05/02/1964 BHS
_124708009_ILIAN MALE12/21/1994 BPAT
_124708012_KIBIA 02_Ma
07/31/1980 19_Others_
_124708012_KIBIA 01_F01/10/1981 19_Others_
_124708012_KIBIA 01_F10/19/1967 19_Others_
_124708012_KIBIA 01_F11/04/1970 19_Others_
_124708012_KIBIA 02_Ma
08/17/1978 19_Others_
_124708013_KIBUDOC M 05/15/1973 BPAT
_124708013_KIBUDOC M 7/18/1971 BPAT
_124708013_KIBUDOC M 05/05/1975 BPAT
_124708013_KIBUDOC M 10/19/1970 BPAT
_124708013_KIBUDOC M 10/21/1965 BPAT
_124708013_KIBUDOC 07/21/1984 TREASURER
_124708013_KIBUDOC M 12/15/1965 BPAT
_124708013_KIBUDOC M 10/05/1983 BPAT
_124708014_KIDAMA 02_Ma
6/3/1974 BPAT
_124708014_KIDAMA M 04/20/1978 BPAT
_124708015_KILADA F 12/24/1962
_124708017_LAMPAYAN 01_Female 19_Others_
_124708017_LAMPAYAN 01_Female 19_Others_
_124708019_LINAO M 12/31/1960
_124708019_LINAO M 04/08/1975
_124708019_LINAO F 07/07/1968
_124708019_LINAO F 05/09/1978 BHS
_124708020_LOWER MALAMOTE 02_Ma
07/20/1972
_124708025_MANUBUAN 09/06/1988 BHW
_124708025_MANUBUAN 06/29/1990 BHW
_124708025_MANUBUAN 01_F05/03/1989
_124708026_MANUPAL 02_Ma
05/24/1987 BPAT
_124708026_MANUPAL 02_Ma
12/08/1965
_124708026_MANUPAL 01_F11/28/1985
_124708026_MANUPAL 01_F05/09/2001
_124708026_MANUPAL 02_Ma
09/13/1997 19_Others_
_124708027_MARBEL 02_Male BPAT
_124708027_MARBEL 02_Ma
07/14/1946 BPAT
_124708027_MARBEL 01_F11/09/1971 DAY CARE WORKER
_124708027_MARBEL 02_Ma
03/09/1984 BPAT
_124708027_MARBEL 02_Ma
07/13/1976 19_Others_
_124708027_MARBEL 02_Ma
03/21/1976 19_Others_
_124708027_MARBEL 02_Ma
02/24/1990 BPAT
_124708027_MARBEL M 08/17/1998 BHS
_124708030_NEW BUGASONG M 02/16/1996 BLGU
_124708030_NEW BUGASONG MAL 04/16/1977 BPAT
E
_124708030_NEW BUGASONG MALE06/22/1975 BPAT
_124708030_NEW BUGASONG M 06/22/1975 BARANGAY KAGAWAD
_124708030_NEW BUGASONG MALE12/10/1968 BPAT
_124708034_POBLACION 01_F12/30/1992 CLERK-HOSPITAL
_124708034_POBLACION MALE01/07/1975 BARANGAY DRIVER
_124708034_POBLACION FEMA04/08/1963 BNS
_124708034_POBLACION 01_F12/14/1974 BNS
_124708034_POBLACION MALE04/29/1989 BARANGAY TANOD
_124708034_POBLACION MALE06/10/1967 BARANGAY TANOD
_124708034_POBLACION MALE05/24/1984 BARANGAY TANOD
_124708034_POBLACION FEMA02/11/1981 BARANGAY TANOD
_124708034_POBLACION MALE03/02/1972 BARANGAY TANOD
_124708034_POBLACION MALE08/26/1981 BARANGAY TANOD
_124708034_POBLACION F 12/19/1982 BPAT
_124708034_POBLACION F 4/14/2000 STUDENT
_124708034_POBLACION M 10/10/2000 STUDENT
_124708034_POBLACION M 06/22/1967
_124708034_POBLACION F 10/20/1978
_124708034_POBLACION F 07/15/1983
_124708034_POBLACION F 09/02/1978
_124708034_POBLACION F 12/08/1998
_124708034_POBLACION F 08/10/1971
_124708034_POBLACION F 01/07/1978
_124708034_POBLACION 01_F 11/12/1996 TEACHER
_124708034_POBLACION M 07/10/1964
_124708034_POBLACION F 07/19/1976
_124708034_POBLACION F 11/29/1970
_124708034_POBLACION F 12/26/2008
_124708034_POBLACION 02_Ma 06/22/1970
_124708034_POBLACION M 10/27/1961
_124708036_SANTA MARIA M 07-24-1975 NONE
_124708036_SANTA MARIA 8/23/1985 BHW
_124708036_SANTA MARIA M 06/11/1970 BPAT
_124708036_SANTA MARIA M 09-22-1965 NONE
_124708036_SANTA MARIA M 06/11/1967 BPAT
_124708036_SANTA MARIA M 10/07/1968 BPAT
_124708036_SANTA MARIA F 3/5/1997 01_SiSTUDENTS
_124708036_SANTA MARIA M 11/21/1979
_124708036_SANTA MARIA 10/26/1983 TEACHER
_124708039_TAGURANAO MALE09/13/1970 BPAT
_124708039_TAGURANAO MALE04/04/1970 BPAT
_124708039_TAGURANAO MALE02/16/1968 BPAT
_124708039_TAGURANAO MALE02/24/1970 BPAT
_124708039_TAGURANAO MALE07/26/1966 BPAT
_124708039_TAGURANAO MALE06/01/1968 BPAT
_124708041_NEW ABRA 01_F07/08/1978 16_Barangay_Health_Worker
_124708041_NEW ABRA 02_Ma
06/05/1997 16_Barangay_Health_Worker
_124708041_NEW ABRA 02_Ma
10/01/1976 16_Barangay_Health_Worker
CENTRAL MALAMOTE M 9/2/1996
CENTRAL MALAMOTE 09/21/1970
DALAPITAN F 9/21/1961 BHS
DALAPITAN F 02/15/1980
DALAPITAN F 03/03/1962
DALAPITAN 04/07/1978
KIBIA M 9/5/1961 BRGY. KAGAWAD
KIBUDOC F 11/21/1987
KIDAMA M 06/04/1990
KILADA M 12/07/2001
MARBEL 6/3/1991 MARKETING EXECUTIVE
POBLACION 2/4/2000 STUDENTS
POBLACION M 11/23/1996
POBLACION M 8/31/1996
POBLACION M 6/30/1988
POBLACION 06/25/1965
POBLACION M 01/18/1988
POBLACION F 09/13/1965
POBLACION F 10/06/1985
POBLACION F 11/20/1964
POBLACION F 06/16/1966
POBLACION M 06/29/1965
POBLACION M 09/28/1986
POBLACION F 09/01/3061
POBLACION F 9/22/1997 OFFICE STAFF
TAGURANAO F 02/26/2003
KIBUDOC M 1/24/1961
Allergy to vaccines Pregnancy_status
or components of Drug_Allergy? Food_Allergy?
vaccines
KAGAWAD
y_Health_Worker
KAGAWAD
KAGAWAD
y_Health_Worker
y_Health_Worker
y_Health_Worker
Insect_Allergy? Latex_Allergy? Mold_Allergy? Pet_Allergy?
Pollen_Allergy? With_Comorbidity? Hypertension Heart_Disease
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Immunodeficiency_S
Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
tatus
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
Date_of_first_positiv
Patient_was_diagnos e_result_/_specimen
Cancer Others
ed_with_COVID_19 _collection_mm/dd/y
yyy_
YES
Classification_of_CO Willing
CONSENT Reason for Refusal
VID_19 to_be_Vaccinated?
Has no severe
Has no allergy to
Age more than Has no allergies to allergic reaction after
food, egg, medicines,
16 years old? PEG or polysorbate? the 1st dose of the
and no asthma?
vaccine?
Does not manifest
any of the following
symptoms:
* If with allergy or Fever/chills,
Has no history of * if with bleeding
asthma, will the Headache, Cough,
bleeding disorders or history, is a gauge 23
vaccinator able to Colds, Sore throat,
currently taking anti- - 25 syringe available
monitor the patient Myalgia, Fatigue,
coagulants? for injection?
for 30 minutes? Weakness, Loss of
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has no history of
* If manifesting any exposure to a Has not been
Has not received any
of the mentioned confirmed or previously treated for
vaccine in the past 2
symptom/s, specify suspected COVID-19 COVID-19 in the past
weeks?
all that apply case in the past 2 90 days?
weeks?
Does not have any of
the following: HIV,
Has not received Cancer/ Malignancy,
convalescent plasma Underwent
or monoclonal * if pregnant, 2nd or Transplant, Under
Not Pregnant?
antibodies for 3rd Trimester? Steroid Medication/
COVID-19 in the past Treatment, Bed
90 days? Ridden, terminal
illness, less than 6
months prognosis
* If with mentioned
condition, has
* If with mentioned
presented medical Deferral Date of Vaccination
condition/s, specify.
clearance prior to
vaccination day?
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
8/2/2021
Vaccine
Batch Number Lot Number Vaccinator Name
Manufacturer Name
MIDWIFE
NURSE
NURSE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
NURSE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
NURSE
NURSE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
NURSE
NURSE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
NURSE
NURSE
MIDWIFE
NURSE
NURSE
MIDWIFE
MIDWIFE
Last_Name* First_Name* Middle_Name* Suffix Contact_No.*
YES YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES
YES YES
YES
YES
YES
YES
YES
YES
YES
Immunodeficiency_S
Diabetes_Mellitus Bronchial_Asthma Cancer
tatus
YES
YES
Date_of_first_positiv
Patient_was_diagnos e_result_/_specimen Classification_of_CO
Others
ed_with_COVID_19 _collection_mm/dd/y VID_19
yyy_
Willing Age more than
CONSENT Reason for Refusal
to_be_Vaccinated? 16 years old?
* If with allergy or
Has no severe
Has no allergy to asthma, will the
Has no allergies to allergic reaction after
food, egg, medicines, vaccinator able to
PEG or polysorbate? the 1st dose of the
and no asthma? monitor the patient
vaccine?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Fever/chills,
Has no history of * if with bleeding * If manifesting any
Headache, Cough,
bleeding disorders or history, is a gauge 23 of the mentioned
Colds, Sore throat,
currently taking anti- - 25 syringe available symptom/s, specify
Myalgia, Fatigue,
coagulants? for injection? all that apply
Weakness, Loss of
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has no history of Has not received
exposure to a Has not been convalescent plasma
Has not received any
confirmed or previously treated for or monoclonal
vaccine in the past 2
suspected COVID-19 COVID-19 in the past antibodies for
weeks?
case in the past 2 90 days? COVID-19 in the past
weeks? 90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
Underwent
* if pregnant, 2nd or Transplant, Under * If with mentioned
Not Pregnant?
3rd Trimester? Steroid Medication/ condition/s, specify.
Treatment, Bed
Ridden, terminal
illness, less than 6
months prognosis
* If with mentioned
condition, has
Vaccine
presented medical Deferral Date of Vaccination
Manufacturer Name
clearance prior to
vaccination day?
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
8/3/2021 Sinovac
Profession of
Batch Number Lot Number Vaccinator Name
Vaccinator
KAGAWAD
KAGAWAD
Insect_Allergy? Latex_Allergy? Mold_Allergy? Pet_Allergy?
Pollen_Allergy? With_Comorbidity? Hypertension Heart_Disease
Immunodeficiency_S
Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
tatus
Date_of_first_positiv
Patient_was_diagnos e_result_/_specimen
Cancer Others
ed_with_COVID_19 _collection_mm/dd/y
yyy_
Classification_of_CO Willing
CONSENT Reason for Refusal
VID_19 to_be_Vaccinated?
Has no severe
Has no allergy to
Age more than Has no allergies to allergic reaction after
food, egg, medicines,
16 years old? PEG or polysorbate? the 1st dose of the
and no asthma?
vaccine?
Does not manifest
any of the following
symptoms:
* If with allergy or Fever/chills,
Has no history of * if with bleeding
asthma, will the Headache, Cough,
bleeding disorders or history, is a gauge 23
vaccinator able to Colds, Sore throat,
currently taking anti- - 25 syringe available
monitor the patient Myalgia, Fatigue,
coagulants? for injection?
for 30 minutes? Weakness, Loss of
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has no history of
* If manifesting any exposure to a Has not been
Has not received any
of the mentioned confirmed or previously treated for
vaccine in the past 2
symptom/s, specify suspected COVID-19 COVID-19 in the past
weeks?
all that apply case in the past 2 90 days?
weeks?
Does not have any of
the following: HIV,
Has not received Cancer/ Malignancy,
convalescent plasma Underwent
or monoclonal * if pregnant, 2nd or Transplant, Under
Not Pregnant?
antibodies for 3rd Trimester? Steroid Medication/
COVID-19 in the past Treatment, Bed
90 days? Ridden, terminal
illness, less than 6
months prognosis
* If with mentioned
condition, has
* If with mentioned
presented medical Deferral Date of Vaccination
condition/s, specify.
clearance prior to
vaccination day?
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
8/4/2021
Vaccine
Batch Number Lot Number Vaccinator Name
Manufacturer Name
ESE V CARUMBA-MORENO, RN
ESE V CARUMBA-MORENO, RN
NURSE
NURSE
ESE V CARUMBA-MORENO, RN
ESE V CARUMBA-MORENO, RN
ESE V CARUMBA-MORENO, RN
ESE V CARUMBA-MORENO, RN
ESE V CARUMBA-MORENO, RN
Suffi
Last_Name* First_Name* Middle_Name*
x
_124708004_BANGBANG F 11/09/1972
9059690434 _124708006_CENTRAL MALAMO02_Ma03/20/1979
9100210342 _124708034_POBLACION F 02/14/1967
9069595363 POBLACION 08/01/1996
9052677344 POBLACION M 07/14/2001
9510463080 _124708010_KABULACAN M 05/06/1976
9070855494 _124708038_TACULEN M 04-28-1999
9318139292 MANUBUAN 11/04/1968
9467344275 POBLACION 12/02/1996
9553863389 _124708028_MINAMAING F 03/31/1996
9171189807 MANUBUAN F 10/08/1991
9389618127 MANUBUAN F 11/05/1974
9452506046 MANUBUAN F 08/17/1978
9500256546 POBLACION 02_Ma11/28/1991
POBLACION Male 08/24/1981
9485821210 _124708001_NEW ALIMODIAN M 08/27/86
9059690434 _124708006_CENTRAL MALAMO02_Ma05/01/1986
9518075296 _124708006_CENTRAL MALAMO01_F07/29/2002
9462635264 _124708007_DALAPITAN 01_F08/27/1976
9108611261 _124708007_DALAPITAN FEMA04/25/1971
9639471438 _124708007_DALAPITAN MALE05/02/1984
9966058800 _124708007_DALAPITAN 01_F03/31/1977
9505185465 _124708007_DALAPITAN 02_Ma09/09/1982
9107766703 _124708007_DALAPITAN 02_Ma11/23/2000
9187885590 _124708007_DALAPITAN F 3/17/77
9106847425 _124708007_DALAPITAN M 12/14/83
9479990526 _124708012_KIBIA 01_Fe05/26/1986
9616870571 _124708012_KIBIA F 11/4/1988
9508048504 _124708012_KIBIA M 08/20/1978
9128280187 _124708013_KIBUDOC M 4/15/73
9094582829 _124708015_KILADA 01-F 07/30/1964
9120285356 _124708015_KILADA FEMA10/28/1969
9306936632 _124708015_KILADA 02-M11/21/1963
9465718525 _124708015_KILADA 02-M3/1319/76
9553958893 _124708015_KILADA F 06/16/1973
9755160306 _124708015_KILADA FEMA12/06/1969
9382743879 _124708015_KILADA M 1/20/78
9161180924 _124708015_KILADA M 02/22/1973
9475676987 _124708015_KILADA M 8/21/65
9752334942 _124708019_LINAO FEMA03/06/1976
9752877270 _124708019_LINAO M 06/09/1982
_124708025_MANUBUAN 01_F12/27/1968
9679703051 _124708027_MARBEL 01_F05/11/1981
9066574127 _124708027_MARBEL 02_Male
9752812511 _124708027_MARBEL 02_Male
9058915660 _124708027_MARBEL 02_Ma08/23/76
9460076040 _124708030_NEW BUGASONG 06/15/1997
9187504200 _124708031_NEW PANDAN F 08/08/1965
9771670693 _124708034_POBLACION M 11/02/1962
9100416333 _124708034_POBLACION M 03/02/1967
9297608025 _124708034_POBLACION M 9/25/66
9096320511 _124708034_POBLACION M 12/16/69
9307776030 _124708034_POBLACION M 12/12/1982
9510891554 _124708034_POBLACION M 06/05/1980
_124708034_POBLACION M 08/07/1992
9307784740 _124708034_POBLACION F 11/02/994
_124708037_SARAYAN 02_Ma6/20/1965
9505668678 _124708038_TACULEN F 9/16/93
BANGBANG 02_Ma03/25/1962
9071972230 BANGBANG 02_Ma01/21/1971
9476231298 DALAPITAN 01_Fe 10/04/1972
9632369161 DALAPITAN M 11/26/1962
9483114383 DALAPITAN F 10/27/1976
9505909031 MANUBUAN F 07/24/1986
9501469554 MANUBUAN M 05/25/1965
9297696110 MANUBUAN 02_Ma 04/25/1970
9151645317 MANUBUAN 01_Fe 08/16/2001
9502640641 MANUBUAN 01_Fe07/17/1968
9989902912 POBLACION 12/29/1984
9670041131 POBLACION M 05/18/1993
9489117259 POBLACION M 06/11/1998
9515745932 POBLACION M 07/19/1990
9498522815 F 10/18/62
9755335087 M 3/16/69
Allergy to vaccines Pregnancy_status
Occupation* or components of Drug_Allergy?
vaccines
BPAT
BPAT
BPAT
BPAT
RHU MATALAM
BPAT
BPAT
BPAT
MIDWAY
BPAT
NONE
BPAT
BHW
BPAT
BPAT
BPAT
MEDTECH STUDENT
BPAT
BNS
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
PAGAYON SUSAN
TAMBOGON IMELDA RUIZ
SARMIENTO MARIO E.
UNOTAN ALVIN TAPA
MAMANGAN JOHN USMAN
ROA JUDITH MATEO
LABAYEN LOVELY MAY NACIS
BLAYA HERMENIA BICCAY
ABEDIN ARBEN KALUNSING
QUIRANTE KARL ARDIENTE
PACYAO RICHARD GOMEZ SR
QUIRICON BENJIE MOJANA N/A
ETANG ANALYN OTTI N/A
FERNANDEZ JOSE ARNEL SUMUGAT N/A
LAPIDES RAMIL CATAYA
CLARITO JIMMY ANDIANO
BENITO ROGER CATANUS N/A
TAGUDAR REYMUN CABAÑAS N/A
MORALLAS ROBERTO CAMPOS
GESULGA NORMAN A
BUTON MARVIN DAPAG N/A
CASTILLON JANICE TORIAGA
MATALAM ALGHABID QADEER
ENTING ABDULATIF TAHIR
NAWAWI NASRUDIN SALAPUDIN
DALPENG ABDUL RACMAN CASAN
BENEDICTO ROMEO RENACIA JR
RAMOS ROBERT ALEGRIA
PADAGAS RICARDO Q.
TUYAN ALMA JARABATA NA
PELEGROS DIANNE HERMIE B
BALDONADO JASPHER B
JUNTILANO ROSEMALYN
BANEZ VIVIEN DELA TORRE
SEBLARIO THERESA D.
ADIL TOMY MOMA
BAUTISTA ROSALIA MAGLASANG
FROFUNGA JONATHAN I.
VALDEZ ROMEL BADUA SR
PADILLA BENITA FERRER
VASQUEZ DANILO M.
VALDEZ KIMBERLY M.
FEOLOG REY G.
FEOLOG DEIONESIA TOMINES
VALDEZ ROMEL C. JR
VASQUEZ LEONIDA E.
ABELLO MARIA RUIZ
JULAO MARITESS DURAN
RAMIREZ JAYSON DELA FUENTE
QUIMOT JUDGIE ESPEDES
ALCAMPOR MARGIE ESPANOLA
NOTARIO BERLYN INTONG
LAPEŇA ERNESTO V. JR
OBRA MIRLA POSADAR
EPISTOLA WILFREDO DELA CRUZ
MORBO EFREN LAURISTA
OBRA ANGELITA D.
DUMLAO LYRIE CASTOR
DUMLAO ROBERTO BILOG
FUENTES FRELYN S. N/A
FUENTES MARILOU DECHOSA
PARAGSA PROSPERO AZUCENA JR
CERVANTES MARIETTA CANJA
BARCEBAL CARMENCITA
MAGONCIA SHERLY J.
AMBAY LORIE BALLARTA
CAMAY JANETTE CERVANTES
AMBAY JOSUE TALIDONG JR
CAMARIÑAS DOMINGO E.
BISCARRA RONNIE TURQUEZA
CASIBANG SUSAN E.
LANOSIN FREDDIE ESPIRITU
LAGUARDIA GRACE
Current_Residence:
Contact_No.* Sex*
Barangay*
F
MALE
MALE
02_Male
02_Male
01_Female
9555036700 MINAMAING
9971680394 KILADA
9653122503 _124708031_NEW PANDAN
9058011701 _124708009_ILIAN MALE
9091729473 POBLACION
9503277649 _124708035_SALVACION F
9076554070 _124708035_SALVACION F
9458240373 MARBEL
9363034877 _124708027_MARBEL 02_Male
9274912099 LAMPAYAN
9093418391 _124708035_SALVACION MALE
9150714665 _124708018_LATAGAN 02_Male
9058113408 _124708018_LATAGAN 01_Female
9608512035 _124708018_LATAGAN 02_Male
9515042801 _124708001_NEW ALIMODIAN M
9575042001 _124708001_NEW ALIMODIAN
9050827220 _124708018_LATAGAN 02_Male
9124428164 _124708018_LATAGAN 02_Male
9121961223 _124708035_SALVACION MALE
9508048501 POBLACION
9658922223 _124708018_LATAGAN 02_Male
9102843379 _124708026_MANUPAL 01_Female
9352277825 WEST PATADON M
9973795383 _124708033_PATADON WEST 02_Male
9534018960 _124708033_PATADON WEST 02_Male
9069563707 _124708033_PATADON WEST 02_Male
9500095366 TACULEN M
9463085067 TACULEN
9558745761 LINAO M
9105299219 POBLACION 01_Female
9666618001 POBLACION
9630700198 POBLACION
9317906978 NEW PANDAN F
9431327406 _124708034_POBLACION
9197634535 _124708031_NEW PANDAN F
9091729473 CENTRAL MALAMOTE
9973477194 POBLACION
9363366328 KIBIA
9751559102 LINAO
99670257048 KIBUDOC F
9101740043 LINAO
9068901542 LINAO
9304980677 SANTA MARIA
9517911073 SANTA MARIA
9052223123 LINAO
9977387471 LATAGAN F
9631844043 MARBEL
9195050375 SALVACION
9120502918 MINAMAING
9468777881 NEW ALIMODIAN M
9097705885 BATO
_124708036_SANTA MARIA F
9129713854 _124708027_MARBEL
KIBUDOC
9073183474 _124708036_SANTA MARIA M
9096542654 _124708017_LAMPAYAN
KIBUDOC F
KIBUDOC
KIBUDOC
9468861818 _124708012_KIBIA
9485609730 KIBIA F
9456653553 CENTRAL MALAMOTE
9510205253 POBLACION
9518036781 POBLACION
9101200603 KIBUDOC
9505692701 DALAPITAN
9461260208 POBLACION
9120167454 _124708007_DALAPITAN 02_Male
9534308138 LINAO
MARBEL M
9534017401 MARBEL F
9104638053 POBLACION M
9759709534 KIBIA F
Civi
Allergy to vaccines Pregnancy_status
Birthdate_mm/dd/yy l_St
Occupation* or components of
yy_* atu
vaccines
s
12/14/1991
05/11/1986 BARANGAY BOOKKEEPER
06/09/1995 M BARANGAY TANOD
09/29/1988 M BARANGAY TANOD
09/03/1980 M BPAT
12/27/1979 BPAT
02/04/1992 KGD?
5/26/1951
08/07/1973
03/06/1968
09/29/1976
6/19/1959
10/18/1971
12/08/1974
02/24/1975 BPAT
1/12/1963 BPAT
04/20/1976 BARANGAY KAGAWAD
05/11/1986 SECRETARY
9/8/1991 STUDENT
09/28/1990 BPAT
10/2/1998 SK KGD
02/20/1979 BPAT
02/08/1985 BPAT
09/06/1977 BARANGAY KAGAWAD
11/26/1967 BPAT
12/15/1976 BPAT
8/20/1977 BPAT
03/09/1971 BPAT
06/10/1991 BPAT
02/13/1984 BPAT
8/24/1968 M BPAT
05/03/1978 M BPAT
07/31/1986 F DAYCARE WORKER
8/24/1946 KGD?
01/06/1986 BPAT
12/10/1974 DRIVER
05/18/1980 BPAT
12/26/1977 BPAT
8/13/1987 BPAT
12/24/1961
11/15/1960
06/12/1996
01/05/1999
12/24/1977
06/04/1963
10/15/1964
08/15/1974
01/17/1962
09/15/1972
10/04/1996
07/30/1966
12/17/1974
02/22/1996
10/11/1976
6/11/1967
12/31/1995
03/16/1983
08/20/1967
10/18/1983
6/5/1991
12/05/1983
05/29/1983
06/20/1966
07/10/1970
11/25/1968
10/19/1968
07/10/1969
08/03/1967
06/06/1966
11/09/1963
8/20/1985
10/21/1979
9/17/1986
4/24/1974
11/04/1983
05/12/1981
01/19/1970
6/10/1980
05/30/1987
04/03/1969
1/15/1972
5/27/1965
1/9/1978
2/18/1962
Drug_Allergy? Food_Allergy? Insect_Allergy? Latex_Allergy?
Mold_Allergy? Pet_Allergy? Pollen_Allergy? With_Comorbidity?
Hypertension Heart_Disease Kidney_Disease Diabetes_Mellitus
Immunodeficiency_S
Bronchial_Asthma Cancer Others
tatus
Date_of_first_positiv
Patient_was_diagnos e_result_/_specimen Classification_of_CO Willing
ed_with_COVID_19 _collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Age more than Has no allergies to
CONSENT Reason for Refusal
16 years old? PEG or polysorbate?
* If with allergy or
Has no severe Has no history of
Has no allergy to asthma, will the
allergic reaction after bleeding disorders or
food, egg, medicines, vaccinator able to
the 1st dose of the currently taking anti-
and no asthma? monitor the patient
vaccine? coagulants?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* if with bleeding * If manifesting any exposure to a
Headache, Cough,
history, is a gauge 23 of the mentioned confirmed or
Colds, Sore throat,
- 25 syringe available symptom/s, specify suspected COVID-19
Myalgia, Fatigue,
for injection? all that apply case in the past 2
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
Has not been convalescent plasma
Has not received any
previously treated for or monoclonal
vaccine in the past 2 Not Pregnant?
COVID-19 in the past antibodies for
weeks?
90 days? COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
* if pregnant, 2nd or Transplant, Under * If with mentioned
presented medical
3rd Trimester? Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Deferral Date of Vaccination Batch Number
Manufacturer Name
BARANGAY KAGAWAD
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
MEDICAL STUDENT
BPAT
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
STUDENT
DAYCARE WORKER
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
MEDTECH STUDENT
BHW
SK
BPAT
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BPAT
BARANGAY KAGAWAD
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
ZORAIDA TOLIA, RM
ARCELYN QUINTO, RM
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
ARCELYN QUINTO, RM
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
LERRY ESTELLOSO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
MARY JEAN ROLDAN, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
LERRY ESTELLOSO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
MARY JEAN ROLDAN, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
ARCELYN QUINTO, RM
ARCELYN QUINTO, RM
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
MARY JEAN ROLDAN, RM
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
LERRY ESTELLOSO, RM
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
ROMER NICOLAS, RN
LERRY ESTELLOSO, RM
LERRY ESTELLOSO, RM
ARCELYN QUINTO, RM
ARCELYN QUINTO, RM
ROMER NICOLAS, RN
MARY JEAN ROLDAN, RM
Phi
Sub- PW
Priority lHe
Priority D Last_Name* First_Name* Middle_Name*
Group* alth
Group* ID
_ID
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_02_A2_Senior_Citizens
_03_A3_Adult_with_Comorbidity
_03_A3_Adult_with_Comorbidity
_01_A1_H05_A1.5: Government Owned Community Based Primary Care Facilities
_02_A2_Senior_Citizens YALDA AURORA YAGONG
_03_A3_Adult_with_ComorbidiYAGONG VIRGILIO S
_03_A3_Adult_with_ComorbidiMOJANA CRISTINA PALMA
_03_A3_Adult_with_ComorbidiBOLANO JELYN ESTEVA
_03_A3_Adult_with_ComorbidiHORBEDALLA HAIDE COMBONG
_03_A3_Adult_with_ComorbidiANDRES GENEDINA BALBES
_03_A3_Adult_with_ComorbiPAULINO ROSITA SANIO
_03_A3_Adult_with_ComorbiMENDIOLA ELNIE O.
_03_A3_Adult_with_ComorbiZABALA HAMMER REY SUMAGAYSAY
_03_A3_Adult_with_ComorbidiCABUYAO NORA BATUA
_03_A3_Adult_with_ComorbiVERONA JANREY TUZON
_03_A3_Adult_with_ComorbiVILLARIN DANNYBOY CATALBAS
_01_A1_Health_Care_WorkeTUMPAR ARNEL
_03_A3_Adult_with_ComorbidiSANCHEZ FELIX R
_03_A3_Adult_with_ComorbidiMERCADO MARIETA JOVONILLO
_03_A3_Adult_with_ComorbiENCARNADO RENE DEEYOY
_03_A3_Adult_with_ComorbidiBELOTINDOS BELINDA
03_A3: Adult with ComorbidiBAGUAMAMA MAIRO LANGKOT
_03_A3_Adult_with_ComorbiLUBON ANESITA
_03_A3_Adult_with_ComorbidiRODUTA MERGIE
_03_A3_Adult_with_ComorbiSINCO OFELIA JAMOLES
_03_A3_Adult_with_ComorbiCARINO DANIEL UCEP
_03_A3_Adult_with_ComorbiSALES ALLAN MADIO
_03_A3_Ad 708-018-282 LAGUNDAY GERLIE NAZARENO
_03_A3_Adult_with_ComorbiASILDEQUE RUBY DIONESIO
_03_A3_Adult_with_ComorbiLLAVADO ROMEO NAZARENO
_03_A3_Adult_with_ComorbiDAPUN ARGIE N
_03_A3_Adult_with_ComorbiNUESCA EVELYN DE PEDRO
_03_A3_Adult_with_ComorbiPAJARO MARICEL MICATOR
_03_A3_Ad_03_A3 JAVIEN SELVA ETABAG
_03_A3_Ad_03_A3 JAVIEN MELBERT I
_01_A1_H05_A1.5: Governme AMAN BENCITO DIAZ
_02_A2_Se09_A2.2: All Other OLIVEROS MARIANO MARQUEZ
_03_A3_Adult_with_ComorbiPERLA LORNA SEGUMBAN
_03_A3_Adult_with_ComorbiCAMANDAGAN CARLIE DANILA
_03_A3_Adult_with_ComorbiRAMOS FEBRALYN JUVY V.
_03_A3_Adult_with_ComorbiMASOLA KRISTINE V.
_03_A3_Adult_with_ComorbidiOMANDAM ENRICO SUNICO
_03_A3_Adult_with_ComorbidiIPONG MAGUID CABUYAO
_03_A3_Adult_with_ComorbidiSEBAYAN JOEL CAPECIO
_03_A3_Adult_with_ComorbidiABALOS CATHERINE D.
_03_A3_Adult_with_ComorbiTERNIO ROSE ANN
_03_A3_Adult_with_ComorbiEBITA RYL MAY ABALOS
_03_A3_Adult_with_ComorbidiVALDEVIESO RICA
_03_A3_Adult_with_ComorbidiIRLANDEZ MARY ROSE
_03_A3_Adult_with_ComorbidiREAL RUBYLYN
_03_A3_Adult_with_ComorbidiMALLORCA FELIMON SISON
_03_A3_Adult_with_ComorbidiVALDEVIESO TONY
_03_A3_Adult_with_ComorbidiREAL ALLEN CUARES
_03_A3_Adult_with_ComorbiCABANILLA MANUEL C.
_03_A3_Adult_with_ComorbiMAGNO JAMES M.
_03_A3_Adult_with_ComorbiCANQUE VICENTE CAGANILLA
_03_A3_Adult_with_ComorbiDELA TORRE JAN JANAPON
_03_A3_Adult_with_ComorbiYRA REMY MORALES
_03_A3_Adult_with_ComorbiCANQUE EROL CAPINDO
_03_A3_Adult_with_ComorbiMAGNO JOSEPH M.
_03_A3_Adult_with_ComorbiENCARNACION ALFONSO CARINO
_03_A3_Adult_with_ComorbiGATCHALIAN MARK BARNEDO
_03_A3_Adult_with_ComorbiSIOBAL MARLON VERSOLA
_03_A3_Adult_with_ComorbiSIOBAL JANRY VERSOLA
_03_A3_Adult_with_ComorbidiCABILBIGAN MARILOU CABAYA
_03_A3_Adult_with_ComorbidiCABANAS JOWENA CABAYA
_03_A3_Adult_with_ComorbidiSIASOL ARNEL MOJANA
_03_A3_Adult_with_ComorbiBIGAYO RENANTE VILLASOR
_03_A3_Adult_with_ComorbidiFORONDA IZA MAE RACETES
_03_A3_Adult_with_ComorbidiGACAL JOAN ANDRES
_01_A1_Health_Care_WorkeEVANGELIO JUDELYN BACUS
_03_A3_Adult_with_ComorbidiCANLOG LUZVIMINDA T.
_03_A3_Adult_with_ComorbidiCADUNGON ROWENA TAPULGO
_03_A3_Adult_with_ComorbidiSANCHEZ JUNALYN BUENTIPO
_03_A3_Adult_with_ComorbidiSINCO JAZREL JAMOLES
_03_A3_Adult_with_ComorbidiLEE HENRY SERGUINA
_03_A3_Adult_with_ComorbidiJAVILLONAR IAN JAY BUENAVISTA
_03_A3_Adult_with_ComorbidiCANLOG LEONILO V.
_03_A3_Adult_with_ComorbidiJAVILLONAR SHEILAH FAITH BUENAVISTA
_03_A3_Adult_with_ComorbiGATCHALIAN JAYSON BARMEDO
_03_A3_Adult_with_ComorbiGATCHALIAN SANNY PABLO
_03_A3_Adult_with_ComorbiBALDOS MARINO BALILI
_03_A3_Adult_with_ComorbiGATCHALIAN JERRY PABLO
_03_A3_Adult_with_ComorbiSAMILLANO LUZ BELLA ORBE
_03_A3_Adult_with_ComorbiGATCHALIAN ERIC RABARA
_03_A3_Adult_with_ComorbiRAFAEL ALBERTO
_03_A3_Adult_with_ComorbiRAFAEL MARILYN TAGAYUNA
_03_A3_Adult_with_ComorbiCUMLA JIMUEL BLANCIA
_03_A3_Adult_with_ComorbiTUSCANO ELLEN RAGUS
_03_A3_Adult_with_ComorbiUY JOHN BERT TACANG
_03_A3_Adult_with_ComorbidiCADING LILIBETH SASUMAN
_03_A3_Adult_with_ComorbidiANTONIO LIEZEL S
_03_A3_Adult_with_ComorbiALCALDE REMIE LYNN PECAOCO
_03_A3_Adult_with_RAYUMA VALDEZ CELSO SAMULDE
_02_A2_Senior_Citizens CATIQUESTA WILFREDO BILOG
_03_A3_Adult_with_ComorbiPANIAGUA CRIS AMLON
_01_A1_Health_Care_WorkeCANDIDIER RENELYN CALAWIGAN
A3 CALLO JOVELINA
_03_A3_Adult_with_ComorbiFERNANDEZ IRVIN NINO
Civi
Suffi Current_Residence: Birthdate_mm/ l_St
Contact_No.* Sex*
x Barangay* dd/yyyy_* atu
s
01_F 10/07/1976
01_F 01/14/1974
F 07/10/1973
F 10/21/1967
F 12/03/1981
F 08/02/1970
F 3/20/1963
M 08/01/1980
M 11/27/1960
M 12/31/1971
F 3/3/1963
M 08-19-1982
ESTADO F 7/9/1961
JR 9125033492 ESTADO M 03/17/1969
9679608329 LATAGAN F 07/05/1975
9803233442 LATAGAN F 02/07/1980
9619970267 LATAGAN F 05/16/1974
9968120308 LATAGAN F 1/28/1964
LATAGAN F 11/12/1967
9418230449 POBLACION F 03/05/1983
9564082952 POBLACION M 04/05/1992
9153757755 CENTRAL MALAMOTE F 5/3/1971
9513620502 CENTRAL MALAMOTE M 10/01/1996
0906-610-0884 ESTADO 02_Ma1/15/1972
ESTADO M 9/6/1987
ESTADO M 03/31/1968
9754951382 ESTADO F 01/09/1968
KABULACAN M 04/04/1983
9489290500 LINAO F 1-/18/1980
9091729473 _124708006_CENTRAL M M 12/06/1970
9366034006 _124708008_ESTADO 01_F 10/03/1974
9361814681 _124708013_KIBUDOC F 12/08/1967
9174077564 _124708019_LINAO F 12/03/1975
9103079226 _124708025_MANUBUAN02_Ma 05/22/1962
9487323306 _124708025_MANUBUAN02_Ma 9/18/1985
9223018340 _124708026_MANUPAL 01_Fe 03/28/1982 01_Single
9500271745 _124708028_MINAMAIF 05/11/1988
9559730114 _124708028_MINAMAIM 07/30/1965
9463493845 _124708028_MINAMAIF 11/22/1969
9520880405 _124708028_MINAMAIF 07/15/1979
9104734677 _124708028_MINAMAIF 01/21/1983
09107024542 _124708034_POBLACIF 10/22/1974
09107024542 _124708034_POBLACIM 01/20/1967
JR 9486388044 _124708036_SANTA MM 11-21-1985
_124708038_TACULENMALE05/18/1954
9061706548 ARAKAN F 03/08/1986
9464437711 ARAKAN F 05/05/1978
9305899750 ARAKAN F 02/18/1995
9061188996 ARAKAN F 12/20/1995
9953381145 BANGBANG M 08/22/2002
9756818894 CENTRAL MALAMOTE M 03/15/1979
9122064289 CENTRAL MALAMOTE M 2/13/1981
9121701172 CENTRAL MALAMOTE F 2/19/1986
9638237061 DALAPITAN F 12/15/1994
9230849482 DALAPITAN F 05/08/1987
KABULACAN F 08/31/1989
9481710775 KABULACAN F 01/21/1977
9055654418 KABULACAN F 10/17/1975
JR KABULACAN M 05/14/1972
KABULACAN 03/25/1983
KABULACAN M 08/23/1974
9396348881 KABULACAN M 09/11/1972
9777804790 KABULACAN M 4/25/2001
9534311383 KABULACAN M 4/17/1975
KABULACAN M 02/05/1966
9069711667 KABULACAN M 11/23/1978
9187241522 KABULACAN M 07/14/1987
9104569651 KABULACAN M 9/22/1995
9977806025 KIBUDOC M 01/05/1972
9488820034 KIDAPAWAN M 04/19/1998
9487873457 KILADA M 03/19/1981
9970968142 KILADA M 01/19/1989
9109937296 LATAGAN F 06/04/1970
LATAGAN F 07/02/1977
9107987211 LATAGAN M 10/09/1990
9070148284 LATAGAN M 04/19/1988
9774624266 LINAO F 04/01/1981
9355742230 LINAO F 07/26/1978
9061706256 LINAO FEMA 5/5/1997
9057104241 LINAO F 06/06/1970
LINAO F 01/17/1977
9168211597 LINAO F 6/13/1983
9756104560 LINAO M 4/28/2001
9070463848 LINAO M 1/19/1978
9237457103 MANUBUAN M 08/05/1994
9057104241 MANUBUAN M 06/20/1965
9512559652 MANUBUAN F 11/22/2000
9488200324 MARBEL M 12/15/1992
MARBEL M 06/26/1924
9076126679 MARBEL M 01/14/1972
MARBEL M 12/05/1976
9096984413 NEW BUGASONG F 10/16/1972
NEW PANDAN M 01/05/1988
JR 9304946424 POBLACION M 11/18/1976
9185952937 POBLACION F 7/16/1970
9301160833 POBLACION M 02/03/1986
9155720110 POBLACION F 04/30/1980
9175820494 POBLACION M 11/03/1991
9519463279 POBLACION FEMA 3/9/1983
09100484135 POBLACION F 01/29/1980
9197527110 POBLACION F 08/24/1986
9090093434 POBLACION M 03/21/1971
SANTA MARIA M 3/17/1961
9509741626 TAMPED F 12/25/1999
9975435165 MINAMAING F 11/1/1992
9700925098 MANUBUAN F 1/22/1984
9317320360 KIBUDOC M 06/04/1990
Allergy to vaccines Pregnancy_status
Occupation* or components of Drug_Allergy?
vaccines
BPAT
BRGY DRIVER
01_Single
BPAT
STUDENT
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106047
08/16/2021 SINOVAC
08/16/2021 SINOVAC J202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106047
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106033
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC J202106037
08/16/2021 SINOVAC L202106047
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106037
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106032
08/16/2021 SINOVAC L202106033
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106033
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106047
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106033
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC
08/16/2021 SINOVAC L202106047
08/16/2021 SINOVAC
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
QUARRY
QUARRY
QUARRY
TEACHER
STUDENT
QUARRY
19_Others_
AFP
BPAT
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
DM
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
BPAT
BPAT
UTILITY
BPAT
BPAT
SK KGD
BPAT
BPAT
DAYCARE WORKER
STUDENT
02_Married
TEACHER
BPAT
SK KGD
STUDENT
SK KGD
COTELCO
COTELCO
COTELCO
COTELCO
STUDENT
AFP
EMBALMER
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
COTELCO
MARRIED
AFP
AFP
AFP
AFP
AFP
BHW
19_Others_
19_Others_
TEACHER
STUDENT
19_Others_
BPAT
POBLACION
STUDENT
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
BARANGAY KAGAWAD
01_Single
03_Widower
01_Single
02_Married
UTILITY
TEACHER
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
02_Married
02_Married
BPAT
BPAT
BPAT
AFP
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
8/25/2021 SINOVAC L202107062
J202106037
J202106037
J202106037
J202106037
8/25/2021 SINOVAC L202107062
J202106037
J202106037
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8/25/2021 SINOVAC J202106037
J202106037
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J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
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J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
L202107062
J202106037
J202106037
J202106037
J202106037
J202106037
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J202106037
J202106037
J202106037
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J202106037
J202106037
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L202107062
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Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
06_Nurse
02_Married
SK MEMBER
MARRIED
SINGLE
02_Married
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
8/27/2021 SINOVAC J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
8/27/2021 SINOVAC J202106037
J202106037
J202106037
J202106037
8/27/2021 SINOVAC J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
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J202106037
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J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
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J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
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J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
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Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
PRESIDENT
Insect_Allergy? Latex_Allergy? Mold_Allergy? Pet_Allergy?
Pollen_Allergy? With_Comorbidity? Hypertension Heart_Disease
01_Yes
Immunodeficiency_S
Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
tatus
Date_of_first_positiv
Patient_was_diagnos e_result_/_specimen
Cancer Others
ed_with_COVID_19 _collection_mm/dd/y
yyy_
Classification_of_CO Willing
CONSENT Reason for Refusal
VID_19 to_be_Vaccinated?
Has no severe
Has no allergy to
Age more than Has no allergies to allergic reaction after
food, egg, medicines,
16 years old? PEG or polysorbate? the 1st dose of the
and no asthma?
vaccine?
Does not manifest
any of the following
symptoms:
* If with allergy or Fever/chills,
Has no history of * if with bleeding
asthma, will the Headache, Cough,
bleeding disorders or history, is a gauge 23
vaccinator able to Colds, Sore throat,
currently taking anti- - 25 syringe available
monitor the patient Myalgia, Fatigue,
coagulants? for injection?
for 30 minutes? Weakness, Loss of
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has no history of
* If manifesting any exposure to a Has not been
Has not received any
of the mentioned confirmed or previously treated for
vaccine in the past 2
symptom/s, specify suspected COVID-19 COVID-19 in the past
weeks?
all that apply case in the past 2 90 days?
weeks?
Does not have any of
the following: HIV,
Has not received Cancer/ Malignancy,
convalescent plasma Underwent
or monoclonal * if pregnant, 2nd or Transplant, Under
Not Pregnant?
antibodies for 3rd Trimester? Steroid Medication/
COVID-19 in the past Treatment, Bed
90 days? Ridden, terminal
illness, less than 6
months prognosis
* If with mentioned
condition, has
* If with mentioned
presented medical Deferral Date of Vaccination
condition/s, specify.
clearance prior to
vaccination day?
9/3/2021
9/3/2021
9/3/2021
Vaccine
Batch Number Lot Number Vaccinator Name
Manufacturer Name
NURSE
NURSE
NURSE
NURSE
NURSE
NURSE
NURSE
NURSE
MIDWIFE
MIDWIFE
NURSE
MIDWIFE
Phi
Sub- PW
Priority lHe
Priority D Last_Name* First_Name* Middle_Name*
Group* alth
Group* ID
_ID
_03_A3_Adult_with_ComorbiCABANILLA JUSTINE MAE
_03_A3_Adult_with_ComorbiRECAROS JUVELYN ANDI
_03_A3_Adult_with_ComorbiANTIOLA ANGELOU PIODOS
_03_A3_Adult_with_ComorbiBARBERO FEDERICO T.
_03_A3_Adult_with_ComorbiBARBERO CHERRY MAE M.
_03_A3_Adult_with_ComorbiBISCARRA JOSEPH OPENA
_03_A3_Adult_with_ComorbiBISCARRA JHEMRELL HANGAD
_03_A3_Adult_with_ComorbiBISCARRA FLORELYN LIGASAN
_03_A3_Adult_with_ComorbiDANGUIS REBECCA VALDEZ
_03_A3_Adult_with_ComorbiDAROY ARIAN JANE
_03_A3_Adult_with_ComorbiGANGAN JESIERELL VALDEZ
_03_A3_Adult_with_ComorbiMALASAN ANGELIE BAGOL
_03_A3_Adult_with_ComorbiSUBIATE JAMES BRYAN GELILANG
_03_A3_Adult_with_ComorbiVALDEZ MAERCY BULDA
_03_A3_Adult_with_ComorbiVALDEZ JINKY U
_03_A3_Adult_with_ComorbiAGPALZA DAHREL JAY CUNA
_03_A3_Adult_with_ComorbiBERONILLA MYRAQUEL ZAMORA
_03_A3_Adult_with_ComorbiDEL ROSARIO RODRIGO CREDO
_03_A3_Adult_with_ComorbiFELECIANO ALVIN OGATIA
_03_A3_Adult_with_ComorbiFLORES TEDDIE TERNIO
_03_A3_Adult_with_ComorbiJAQUIAS LOUIE MARK POSADAS
_03_A3_Adult_with_ComorbiPACETE JENEFER SAMILLANO
_03_A3_Adult_with_ComorbiPERALTA CHRISTINE MAE D
_03_A3_Adult_with_ComorbiPLENARIO JONATHAN TARONA
_03_A3_Adult_with_ComorbiANGCOG ALINEL TRABUCO
_03_A3_Adult_with_ComorbiCABALING REGINE GUMABA
_03_A3_Adult_with_ComorbiCRIZALDO CHARLE MAGNE ALAGANO
_03_A3_Adult_with_ComorbiCRIZALDO MAVIE JOY
_03_A3_Adult_with_ComorbiLAURENCE BRYAN LUMANGKIBE
_03_A3_Adult_with_ComorbiMAKANAUNG JANET BUEN
_03_A3_Adult_with_ComorbiMEMBRERE PRINCES JOY CERVERA
_03_A3_Adult_with_ComorbiMEMBRERE RAZHEL MAGPALI
_03_A3_Adult_with_ComorbiPECATE BENJIE VECINA
_03_A3_Adult_with_ComorbiSINADON RINA MAE NOVAL
_03_A3_Adult_with_ComorbiCABALUNA YULALIA MIRABUENO
_03_A3_Adult_with_ComorbiINIEGO ROBERT SUELA
_03_A3_Adult_with_ComorbiMALLORCA BONYFE SUBLA
_03_A3_Adult_with_ComorbiQUIRANTE KRIZZIA KEREN
_03_A3_Adult_with_ComorbidiBAUTISTA MELANIE PARINAS
_03_A3_Adult_with_ComorbidiBAUTISTA GIL BABIENA
_01_A1_Health_Care_WorkeBUENTIPO AIRA ELOISE DAVID
_03_A3_Adult_with_ComorbiGANAS ELVIE JAVISON
_03_A3_Adult_with_ComorbiGANAS LOVELY N.
_03_A3_Adult_with_ComorbiJAWOD EDNA DALISAY
_03_A3_Adult_with_ComorbiJUADIONG CHRISTIAN SUALIBOS
_03_A3_Adult_with_ComorbiTOROBA MIKAELA TRIXIA BUENTIO
_03_A3_Adult_with_ComorbiTUMAODOS MA. ADELBIEN CHEMAPHJ.
_03_A3_Adult_with_ComorbiAGDUMA ANGELO R.
_03_A3_Adult_with_ComorbiGARCIA PINKY ROSE FLORES
_03_A3_Adult_with_ComorbiMADIO ROWEL P.
_03_A3_Adult_with_ComorbiBARCEBAL CHESTER ARZAGA
_03_A3_Adult_with_ComorbiBARCEBAL JESUSITA DAGOHOY
_03_A3_Adult_with_ComorbiBERDIN JOHNRELL ARSENIO
_01_A1_Health_Care_WorkeCASTILLON MARVIRLEN ARZAGA
_03_A3_Adult_with_ComorbiFELASOL IRISH BUSTILLO
_03_A3_Adult_with_ComorbiJAWOD MARIA DAGOHOY
_03_A3_Adult_with_ComorbiMARTIZANO MARY GRACE BARCEBAL
_03_A3_Adult_with_ComorbiOQUENDO ALLAN CASIA
_01_A1_Health_Care_WorkeROQUERO RACHEL C.
_03_A3_Adult_with_ComorbiSAGUT CHENY ROSE JAGONOB
_03_A3_Adult_with_ComorbiSALISE PHILIP BARCEBAL
_03_A3_Adult_with_ComorbiSOLIS DECERANTE ALQUEZA
_03_A3_Adult_with_ComorbiSORELLA GERRY BLANCIA
_03_A3_Adult_with_ComorbiSORELLA MAY ANNE LEONIDAS
_03_A3_Adult_with_ComorbiPASCUAL APRIL MAE BLAYA
_03_A3_Adult_with_ComorbiJORDAN WILMA MANDABONG
_03_A3_Adult_with_ComorbiAHADAIN ELYZER GALORAN
_03_A3_Adult_with_ComorbiAMORIA JOSELITO Y
_03_A3_Adult_with_ComorbiAMORIA ANALIZA MAPANAO
_03_A3_Adult_with_ComorbiBOLANTE NOVA MAE P.
_03_A3_Adult_with_ComorbiCAMADDO ARJELYN ESTOLLOSO
_03_A3_Adult_with_ComorbiFRANCISCO ARIANE ROSE TORRES
_03_A3_Adult_with_ComorbiFRANCISCO MARK ANTHONY
_03_A3_Adult_with_ComorbiGAMIDO ROMEO SUMERA
_03_A3_Adult_with_ComorbiGREGORIO RICKY GAROTE
_03_A3_Adult_with_ComorbiGUBATON CHRISTINE JOYCE RILAN
_03_A3_Adult_with_ComorbiGUIMITARAN JUNREL TOYUGON
_03_A3_Adult_with_ComorbiLANAYON MELANIE FEBRIO
_03_A3_Ad_03_A3 LAWANGEN RUTH BISCARRA
_03_A3_Adult_with_ComorbiMARANION JENIFER NICOLAS
_03_A3_Adult_with_ComorbiMARANION MILTON JAY PIORNATO
_03_A3_Adult_with_ComorbiMARIANON GINETON PIORNATO
_03_A3_Adult_with_ComorbiMENDOZA PEARL JHONE AGASER
_03_A3_Adult_with_ComorbiPACIO JAYNEIL ALLA
_03_A3_Adult_with_ComorbiPEQUIRO FEDERICO B.
_03_A3_Adult_with_ComorbiPIORNATO HANANI MACAIRAN
_03_A3_Adult_with_ComorbiPIORNATO IVY JOY BISCARRA
_03_A3_Adult_with_ComorbiPIORNATO GEDEON MACAIRAD
_03_A3_Adult_with_ComorbiPIORNATO JANICE ABALOS
_03_A3_Adult_with_ComorbiPUEBLO NONA ROSETE
_03_A3_Adult_with_ComorbiPUEBLO RICARDO VALENZUELA
_03_A3_Adult_with_ComorbiRAMOS JINEROSE G.
_03_A3_Adult_with_ComorbiSARMIENTO LALAINE GADIAZA
_03_A3_Adult_with_ComorbiTUA VIVIAN PIORNATO
_03_A3_Adult_with_ComorbiVELARDE EDLAIRE MAE A.
ur Cu
re rre
Cu nt nt
rre _ _R
nt_ R esi
Re es de Civi
Suffi sid id nc Current_Residence: Birthdate_m l_St
Contact_No.* Sex*
x en en e: Barangay* m/dd/yyyy_* atu
ce: ce Mu s
9461220556 _R : nic ARAKAN F 06/29/2001
9092640095 egi Pr ipa ARAKAN F 08/28/2001
on ov lity
9105256589 in /Ci CENTRAL MALAMOTE F 08/25/1996
9518121339 ce ty* CENTRAL MALAMOTE M 01/15/1984
9096154977 * CENTRAL MALAMOTE F 10/16/1987
9977437465 CENTRAL MALAMOTE M 06/22/1962
9461250055 CENTRAL MALAMOTE M 03/11/1986
9488987297 CENTRAL MALAMOTE F 08/06/1975
9956597923 CENTRAL MALAMOTE F 12/02/1978
9307802199 CENTRAL MALAMOTE F 01/30/2002
9700829357 CENTRAL MALAMOTE F 07/09/1985
9389610793 CENTRAL MALAMOTE F 01/18/1997
9300377900 CENTRAL MALAMOTE M 07/25/1997
9104704377 CENTRAL MALAMOTE F 07/12/1987
9466663811 CENTRAL MALAMOTE F 04/29/1976
9384461507 DALAPITAN M 09/29/1996
9516499785 DALAPITAN F 05/26/1966
JR 9485204555 DALAPITAN M 03/10/2002
9465056708 DALAPITAN M 02/03/1994
9501456397 DALAPITAN F 10/24/1987
9518121581 DALAPITAN M 12/05/1993
9388647801 DALAPITAN F 06/26/1988
9104771681 DALAPITAN F 12/25/1990
9489841974 DALAPITAN M 06/19/1989
9365207831 KILADA M 10/15/1986
9351375916 KILADA F 10/12/2001
9073465005 KILADA M 04/06/1992
9557958332 KILADA F 02/19/1991
9071600763 KILADA M 01/07/1978
9093884035 KILADA F 01/28/1992
9058034059 KILADA F 09/03/2000
9121401731 KILADA M 09/30/1976
9510437806 KILADA M 10/01/1984
9050881326 KILADA F 10/11/2002
LAMPAYAN F 12/10/1973
9454912094 LAMPAYAN M 11/07/2001
9058149645 LAMPAYAN F 07/14/2001
9457146224 LAMPAYAN F 09/10/1996
967912947 LINAO F 09/29/1980
SR LINAO M 09/01/1964
9351356584 LINAO F 2/22/2000
9264031674 LINAO F 11/25/1964
926585960 LINAO F 08/14/1995
9163745737 LINAO F 07/07/1964
9386999231 LINAO M 12/28/1996
9553726180 LINAO F 06/16/2002
9658960145 LINAO F 07/07/2001
9950543006 MANUBUAN M 12/24/1986
9484483291 MANUBUAN F 04/10/1983
9484211844 MANUBUAN M 10/23/1986
9684252932 MANUPAL M 01/13/2000
9502230798 MANUPAL F 06/09/1974
9659285300 MANUPAL M 02/24/2001
9093722894 MANUPAL F 11/30/1999
9955301495 MANUPAL 04/01/2001
9097404302 MANUPAL F 03/15/1972
9464023327 MANUPAL F 07/24/2000
9467027527 MANUPAL M 11/12/1980
9489760095 MANUPAL FEMA 12/4/1999
9300327578 MANUPAL F 11/19/1999
9466291473 MANUPAL M 04/27/1989
9502236798 MANUPAL M 02/17/1995
MANUPAL M 10/09/1991
9302892414 MANUPAL F
9754885498 MARBEL F 04/05/1990
9534024158 NEW BUGASONG F 12/31/1987
9666858725 POBLACION F 08/23/2000
9309600398 POBLACION M 12/11/1993
9096974993 POBLACION F 01/31/1996
9513885899 POBLACION F 05/03/1997
None 09756865612 Socc_12_12 POBLACION 01_F 03/16/1999
9662215841 POBLACION F 04/17/1987
POBLACION 02/06/1983
JR 9307076937 POBLACION M 10/30/1976
9489759692 POBLACION M
9666919008 POBLACION F 06/10/1998
9383701792 POBLACION M 06/22/1984
9518259887 POBLACION F 05/23/1999
09103291115 POBLACION 12/04/1974
9630667458 POBLACION F 08/20/1994
9630667458 POBLACION F 05/20/1993
9124299405 POBLACION M 12/08/1990
9451842391 POBLACION F 01/27/2000
9666656220 POBLACION M 01/29/1997
9481624644 POBLACION M 08/24/1964
9483930332 POBLACION M 12/25/1967
9307060808 POBLACION F 01/04/1992
POBLACION M 02/18/1970
9632696149 POBLACION F 01/05/1985
09461643764 Socc_12_12 POBLACION 01_F 07/25/1970
JR 9469344458 POBLACION M 11/09/1966
9569775369 POBLACION F 03/01/1998
9385028014 POBLACION F 10/27/1990
9557961576 POBLACION F 05/06/1974
9666840332 POBLACION F 10/24/1999
Allergy to vaccines Pregnancy_status
Occupation* or components of Drug_Allergy?
vaccines
SK
SK
TEACHER
TEACHER
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
J202106037
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
F 03/03/1984
F 03/22/1988
M 07/26/1992
F 06/29/1962
M 06/20/1998
M 02/05/1976
F 02/09/2001
M 07/31/1999
F 03/11/2001
F 12/12/1994
M 10/05/1968
F 8/10/2002
8/9/1966
F 05/19/1992
01_Fe 5/18/1975
02_Ma 8/17/1977
01_F 11/9/1948
02_Ma 8/31/1981
01_Female 6/24/1973 SALES LADY MAE JOY GROCERY
02_Male 11/24/1974
F 12/25/2001
01_F 1/15/1943
M 09/13/2001
M 10/11/2000
M 04/07/1991
F 06/23/1996
F 10/29/1992
F 01/24/1990
M 01/20/1964
F 03/25/1973
M 02/15/1993
F 10/3/1979
F 03/13/1979
M 05/16/1996
F 10/21/1968
M 09/23/1963
F 10/29/1987
F 11/16/1977
F 1/11/1974
F 08/16/1960
M 09/18/1989
M 11/17/1991
M 12/10/2001
02_Male 7/22/1965
F 11/13/1989
M 06/21/1972
F 06/10/1978
M 07/22/1985
M 08/12/1996
F 07/08/1964
M 01/31/1995
F 02/12/2002
M 02/20/1981
M 05/04/1999
Allergy to vaccines Pregnancy_status
Occupation* or components of Drug_Allergy?
vaccines
19_Others_
SALESLADY
DRIVER
NONE
MARKET VENDOR
19_Others_
DRIVER
DRIVER
MARRIED
ELECTRICIAN
DRIVER
DRIVER
DRIVER
MARRIED
SK CHAIRMAN
SK KAGAWAD
SK KAGAWAD
STUDENT
STUDENT
Store Owner
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
J202106037
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
9/7/2021 SINOVAC L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
J202106037
J202106037
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
9/7/2021 SINOVAC L202107062
L202107062
9/7/2021 SINOVAC L202107062
L202107062
L202107062
9/7/2021 SINOVAC L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
DRIVER
STORE OWNER
SARI-SARI STORE
DRIVER
SARI SARI
MARRIED
BHW
MARRIED
MARRIED
02_Married
02_Married
02_Married
02_Married
TRICYCLE DRIVER
DRIVER
FISH VENDOR
STORE OWNER
TINDERA
DRIVER
DRIVER
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
01_Yes
01_Yes
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
9/10/2021 SINOVAC J202107066 J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202106037
J202106037
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202106037
J202106037
J202107066
J202106037
J202106037
J202106037
J202106037
J202107066
J202106037
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
9/10/2021 SINOVAC J202107066 J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202107066
J202106037
J202106037
J202107066
J202106037
J202107066
J202107066
J202106037
J202106037
J202107066
J202107066
J202107066
J202107066
9/10/2021 SINOVAC J202107066 J202107066
J202107066
J202107066
9/10/2021 J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
J202107066
J202107066
J202106037
J202106037
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
J202106037
J202106037
J202107066
J202107066
J202107066
J202106037
J202106037
J202107066
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
J202107066
J202106037
J202107066
J202107066
J202107066
J202107066
J202106037
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
9/11/2021 AZ A1026
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ZORAIDA S. TOLIA Y N
ARCELYN QUINTO Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
JO ANN THERESE CARUM Y N
ROMER P. NICOLAS Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ZORAIDA S. TOLIA Y N
ZORAIDA S. TOLIA Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ROMER P. NICOLAS Y N
JO ANN THERESE CARUM Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
ARCELYN QUINTO Y N
Su
b-
Pri Phi
PW
Priority ori lHe Suffi
D Last_Name* First_Name* Middle_Name*
Group* ty alth x
ID
Gr _ID
A4.2 ou CUIBAN MARY JANE MAHUSAY
A3 p* BORJA MARIETE ACID
A3 CAPECIO ROMMEL GANABAN
A4.1 LEGASAN ROGER RAMOS
_03_A3_Adult_with_Como
SOMERA WELFREDO
A3 BAGAS CHARLENE JOY TEJERO
A3 JAVISON JAMES ORIBIANA
A3 JAVISON CHERISH J JILL
A3 TOMONAS FRENZ ERN DAYO
A4.1 AGPALO JOEL REY POSADAS
A4.1 BERIC PABLO VIRANO
A3 DASARGO PRECILYN
A4.2 MERCADO NANCY PUGOY
A4 NICOLAS SATURNINA BELMONTE
A4.2 PARONABLE HELEN ABIAN
A4.1 PASARGO ARSENIO L SR.
A4.1 RUIZ JERRY DEUZ
A3 ALIPIO PAUL JOHN
A3 LUTAO KELVIN LEMUEL ALIPO-ON
A4.1 MAMADRA ALLAN SANO
A3 MIPARANUM HONEY ROSE
_03_A3_Adult_with_ComPALACIO LUMINADA
A4.1 PALACIO SIMM DEMAYO JR.
A4.2 ALCIO MELANIE
_03_A3_Adult_with_Como
CABROBIAS CHERRY ENRIQUEZ
_03_A3_Adult_with_Como
CADUNGON JO-ANN GONZALES
A4.2 CAJANDIG ROSALINA A.
A4.1 DELA PENA VICTOR PILINO
A2 ECHEGORIN PRIMITIVO ABELGOS
A4.1 ESPINOSA RENE VALDEZ
A4 ESPINOSA JULYN CARSOLIN
A4 JORQUIA MARITES VASQUEZ
_03_A3_Adult_with_Como
LAGUTING CHERRIE
A4.2 LEE JULIE ANN REDIL
A3 MAGSIPOC CANDIDA E.
A4 REDIL MANUEL TABILID
A4 SABADO FEBELYN
A4.2 SINCIL ANALIE AMBATA
_03_A3_Adult_with_ComVALDEZ MARICEL CAFÉ
A3 EDILLO HONEYLY CONJURADO
_03_A3_Adult_with_Como
MACALIMBOL MONIRA
A3 LIBRADO MARCELITO TOLPO SR.
A4 ASILDEQUE JHONNY PRADO
A4.2 CANGAS GIL REQUIJO
A4.1 DALISAY JOVANIE DELA CRUZ
A4 DALISAY HELEN CANGAS
A4 NUESCA DANILO PASTORES
A3 PADAGAS MARINA LLAVADO
A4.1 PAJARO JAIRUS MAGBANUA
A3 BARAWIDAN ELY VERGAS JR
A3 GAMIDO DORAVEL VERDIDA
A3 RELAMPAGOS ROLLIE JAN S
A3 UMADHAY ELVIS KNETH R.
_03_A3_Adult_with_Como VERGARA LORENA AVELINO
A3 GABALES DARLENE NAVIGAR
A2 GABALES ALFREDO TAMAYO
A4 CADEMIA ELLEN MONTON
A4.1 NONESA FERNANDO AJDAL
_03_A3_Adult_with_ComLOREDO TERESA ANCHETA
A3 MAGSANO ELAIZA MAE BRAGA
A3 PENDUMA JUNAIM L.
ur Cu
re rre
Cu nt nt
rre _ _R
nt_ R esi
Re es de Civi
sid id nc Current_Residence: Birthdate_mm/dd l_St
Contact_No.* Sex*
en en e: Barangay* /yyyy_* atu
ce: ce Mu s
9634000703 _R : nic BATO F 3/5/1983
9351376128 egi Pr ipa CENTRAL MALAMOTE F 10/17/1981
on ov lity
9070908169 in /Ci CENTRAL MALAMOTE M 11/13/1985
9516875975 ce ty* CENTRAL MALAMOTE M 3/29/1972
9551040655 * CENTRAL MALAMOTE M 05/15/1987
9551379718 KABULACAN F 5/13/1993
9355742691 KIBIA M 6/28/1991
9355742691 KIBIA F 9/11/1990
9051478142 KIBIA M 10/23/1999
9514800551 KIBUDOC M 10/5/1972
KIBUDOC M 6/29/1973
955824577 KIBUDOC F 10/16/1972
9270292091 KIBUDOC F 06/11/1962
9564064056 KIBUDOC F 5/18/1973
9124246073 KIBUDOC F 8/26/1963
9554824577 KIBUDOC M 4/23/1965
KIBUDOC M 3/13/1969
9307906502 KILADA M 3/1/1988
9654630391 KILADA M 3/20/1991
9219825722 KILADA M 3/27/1968
9384806239 KILADA F 1/7/1996
9503271685 Socc_12_12 LAMPAYAN F 03/26/1973
9503271685 LAMPAYAN M 1/1/1970
9061706488 LINAO F 10/13/1971
9555936082 LINAO F 09/05/1998
9105582977 LINAO F 12/03/1981
9551386758 LINAO F 6/11/1962
LINAO M 4/23/1967
LINAO M 11/29/1945
9778045408 LINAO M 8/24/1968
9559522453 LINAO F 10/8/1969
9658956356 LINAO F 5/8/1977
9358633000 LINAO F 10/8/1992
9367422755 LINAO F 7/1/1981
LINAO F 7/27/1963
9656983448 LINAO M 3/10/1964
9658877430 LINAO F 2/6/1981
975086487 LINAO F 3/26/1972
9977386177 LINAO F 06/04/1982
9090932618 MANUBUAN F 20-Apr
9978812971 MANUBUAN F 02/18/1968
9354723512 MARBEL M 1/2/1967
9500271745 MINAMAING M 4/7/1978
9951865712 MINAMAING M 2/25/1969
9656196807 MINAMAING M 9/25/1976
9359023890 MINAMAING F 9/6/1971
9510880405 MINAMAING M 4/16/1975
9103223963 MINAMAING F 7/29/1963
MINAMAING M 7/24/1971
9120518342 NEW PANDAN M 7/31/1998
9285913860 POBLACION F 10/20/1976
9173519667 POBLACION M 1/12/1990
9099677341 POBLACION M 5/22/1992
09491605099 Socc_12_12 POBLACION F 04/10/1979
9382356608 SARAYAN F 10/25/1996
9382356602 SARAYAN M 24-Jul
9516844601 STA. MARIA F 9/28/1978
9101841334 STA. MARIA M 2/12/1963
9510205347 Socc_12_12 TACULEN 01_F05/19/1971
9955739063 TACULEN F 12/10/2000
9168664114 WEST PATADON F 8/14/1983
Allergy to vaccines Pregnancy_status
Occupation* or components of Drug_Allergy?
vaccines
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
Profession of
Vaccinator Name 1st Dose 2nd Dose
Vaccinator
driver
driver
driver
driver
driver
BPAT
19_Others_
NURSING STUDENT
BARANGAY TREASURER
SK KAGAWAD
GOV'T EMPLOYEE
NURSING STUDENT
DRIVER
05/04/1981
Food_Allergy? Insect_Allergy? Latex_Allergy? Mold_Allergy?
Pet_Allergy? Pollen_Allergy? With_Comorbidity? Hypertension
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
Date of Vaccination Batch Number Lot Number
Manufacturer Name
01_Yes
01_Yes
Heart_Disease Kidney_Disease Diabetes_Mellitus Bronchial_Asthma
Immunodeficiency_S Patient_was_diagnos
Cancer Others
tatus ed_with_COVID_19
Date_of_first_positiv
e_result_/_specimen Classification_of_CO Willing
CONSENT
_collection_mm/dd/y VID_19 to_be_Vaccinated?
yyy_
Has no severe
Age more than Has no allergies to allergic reaction after
Reason for Refusal
16 years old? PEG or polysorbate? the 1st dose of the
vaccine?
* If with allergy or
Has no history of * if with bleeding
Has no allergy to asthma, will the
bleeding disorders or history, is a gauge 23
food, egg, medicines, vaccinator able to
currently taking anti- - 25 syringe available
and no asthma? monitor the patient
coagulants? for injection?
for 30 minutes?
Does not manifest
any of the following
symptoms:
Has no history of
Fever/chills,
* If manifesting any exposure to a Has not been
Headache, Cough,
of the mentioned confirmed or previously treated for
Colds, Sore throat,
symptom/s, specify suspected COVID-19 COVID-19 in the past
Myalgia, Fatigue,
all that apply case in the past 2 90 days?
Weakness, Loss of
weeks?
smell/taste, Diarrhea,
Shortness of breath/
difficulty in breathing
Has not received
convalescent plasma
Has not received any
or monoclonal * if pregnant, 2nd or
vaccine in the past 2 Not Pregnant?
antibodies for 3rd Trimester?
weeks?
COVID-19 in the past
90 days?
Does not have any of
the following: HIV,
Cancer/ Malignancy,
* If with mentioned
Underwent
condition, has
Transplant, Under * If with mentioned
presented medical Deferral
Steroid Medication/ condition/s, specify.
clearance prior to
Treatment, Bed
vaccination day?
Ridden, terminal
illness, less than 6
months prognosis
Vaccine
FIRST DOSE Date of Vaccination Batch Number
Manufacturer Name
L202107062
L202107062
L202107062
L202107062
J202108081
J202108081
L202107062
L202107062
9/22/2021 SINOVAC J202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
J202106037
L202107062
L202107062
L202107062
L202107062
J202108081
L202107062
L202107062
L202107062
J202108081
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
L202107062
9/22/2021 SINOVAC J202107062
J202108081 J202108081
L202107062
L202107062
J202108081
L202107062
J202108081
L202107062
J202108081
J202108081
J202108081
L202107062
L202107062
J202108081
J202108081
L202107062
L202107062
J202108081
J202108081
J202108081
J202108081
J202108081
J202108081
J202108081
L202107062
L202107062
L202107062
9/22/2021 SINOVAC J202107062 L202107062
J202108081
Profession of
Lot Number Vaccinator Name 2nd Dose
Vaccinator