“Experiences of High Risk Individuals on the COVID 19 Vaccination

in Tacurong City”

Letter to the Respondents

Dear Respondents,

Good day!

The attached questionnaire is a survey instrument for our research on "Experiences of High
Risk Individuals on the Covid-19 Vaccination in Tacurong City".

We humbly ask for your assistance in the process of the conduct of this study by
accomplishing the survey questionnaire. The data collected will remain confidential and will be used
solely for academic purposes.

Thank you very much!

The Researchers
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Survey Questionnaire

Part 1. Respondents Profile

This portion identifies the profile of the respondents. Please fill out the following questions honestly.

Name (Optional): Age:

Address: Gender:

Put a check ( / ) in which category do you belong:

Señior Citizen ( ) Pregnant ( ) 18-59 years old with comorbidities/Illness ( )

What kind of vaccination did you get?

1. Sinovac ( ) 2. Astrazenica ( ) 3. Janssen ( ) 4. Pfizer ( ) 5. Moderna ( )

Part 2: High Risk Individuals Vaccination Related Queries

Direction: Read the questions below and put a check (/) on your chosen answer/response.

1. What is your initial reaction upon learning that there will be a COVID 19 vaccination? Why?
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2. How do you feel during vaccination?

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3. How do you feel after being vaccinated?

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4. Do your experience have adverse effects after being vaccinated? If yes, how did it affect you?
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5. What are the physical, emotional and social changes you experienced after recovering from the
vaccinations?
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RESPONDENTS SIGNATURE