PLEASE COMPLETE ALL THE COLUMNS DETAILS.

INCOMPLETE DETAILS WILL NOT BE INCLUDED

Allergy to
GUARDIAN NAME / 1st Dose 1st Dose 1st Dose 1st Dose 1st Dose 2nd Dose 2nd Dose 2nd Dose 2nd Dose 2nd Dose
CONTACT_N REASON_FOR_DEFERRA VACCINATION_DAT BAKUNA_CENTER_CBCR_I 1ST_DOS vaccines or Employee Vaccinee is fit to Vax Schedule Vax Schedule
CATEGORY COMORBIDITY UNIQUE_PERSON_ID PWD* Indigenous LAST_NAME FIRST_NAME MIDDLE_NAME SUFFIX EMPLOYEE REGION PROVINCE MUNI_CITY BARANGAY SEX BIRTHDATE DEFERRAL VACCINE_MANUFACTURER_NAME BATCH_NUMBER LOT_NO VACCINATOR_NAME 2ND_DOSE Additional Dose Adverse Event Adverse Event Condition Email* Occupation Comorbidity Date of Vaccine Batch/Lot Vaccination Vaccinator Date of Vaccine Batch/Lot Vaccination Vaccinator Company
O L/REFUSAL E D E components of Number* be inoculated Date Time
(PRINCIPAL) Vaccination Manufacturer Number Site Name Vaccination Manufacturer Number Site Name
vaccines*

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

Format
Must be in "Category (Priority Group)" List in CHOICES tab
Free Text
Primary = unique vaccine card # of LGU, Secondary = Government ID, if not applicable put "NONE"
Y or N
Must be in "Indigenous Member" List in CHOICES tab
Alphanumeric except special characters < > " / \ | ? *
Alphanumeric except special characters < > " / \ | ? *
Alphanumeric except special characters < > " / \ | ? * Put "None" if no Middle Name; Middle Initials are rejected
Alphanumeric except special characters < > " / \ | ? *
7, 8, 10 or 11 digits
Last Name, First Name of Guardian
Must be in "Region" List in the CHOICES tab
Must be in "Province" List in the PROVINCE_CODE tab and use PROVINCE column
Must be in "MuniCity" List in the MUNICITY_CODE and use the MUNICITY column
Free Text
M or F
MM/DD/YYYY; cannot be later than vaccination date, must be in date format (no ' or other special characters)
Y or N
Cannot be BLANK if Deferral is Y; Must be in "Reason for Deferral" List in CHOICES tab; If many, separate with semicolon (;)
MM/DD/YYYY; cannot be earlier than March 1, 2021, cannot be later than current date, must be in date format ( no ' or other special c
Must be in "Vaccine Manufacturer Name" List in CHOICES tab, Indicate "None" if not applicable
Must have value, Indicate "None" if not applicable
Must have value, Indicate "None" if not applicable
CBCXXXXX or CBCXXXXXXXXXXXXXXX
Last Name, First Name of Vaccinator; Registrar or Screener name can be indicated instead if vaccinee has deferred during Registration
Y if 1st dose, N if 2nd dose, N if Additional Dose
N if 1st dose, Y if 2nd dose, N if Additional Dose; If Vaccinator Manufacturer Name is J&J, can only be tagged as Y in 2nd Dose
N if 1st dose, N if 2nd dose, Y if Additional Dose
Y or N
Cannot be BLANK if Adverse Event is Y; Must be in "Adverse Event Condition" List in CHOICES tab; If many, separate with semicolon (;)
Category (Priority Group) Priority Group DESCRIPTION
A1 Workers in Frontline Health Services
A1.8 OFW living within 4 months
A1.9 Family members of A1.1 to A1.3, newly hired priority A1
Additional A1 All adult population eligible to be categorized as Priority Group A1
A2 All Senior Citizens
A3 Persons with Comorbidities
Expanded A3 Pregnant with Co-morbidity
Pediatric A3 12-17year old with co-morbidity
A4 Frontline personnel in essential sectors, including uniformed personnel
A5 Indigent Population
ROAP Rest of Adult Population
ROPP Rest of Pediatric Population
PWD INDIGENOUS MEMBER
Y No
N Abelling/Aberling
Aeta
Aeta/Ayta
Aeta/Ayta-Sambal
Aeta/Ayta-Ambala
Aeta/Ayta-Abelling/Abellen
Aeta/Ayta-Mag-indi
Aeta/Ayta-Mang-ansti
Aeta/Ayta-Magbukun
Agta
Agta-Labin
Agta-Dupanigan
Agta Isigiran
Agta-Cimaron
Agta-Tabangnon
Agta-Taboy
Agta-Abay
Agta-Dumagat
Agutaynen
Alangan Mangyan
Alta
Applai
Applai-Kachakran/Kadaclan
Aromanen-Manobo/Eromanen-Manobo
Aromanen-Manobo/Eromanen-Manobo Dibabeen
Aromanen-Manobo/Eromanen-Manobo Direrayaan
Aromanen-Manobo/Eromanen-Manobo Ilianen
Aromanen-Manobo/Eromanen-Manobo Isoroken
Aromanen-Manobo/Eromanen-Manobo Kirenteken
Aromanen-Manobo/Eromanen-Manobo Lahitanen
Aromanen-Manobo/Eromanen-Manobo Livunganen
Aromanen-Manobo/Eromanen-Manobo Mulitaan
Aromanen-Manobo/Eromanen-Manobo Pulengien
Aromanen-Manobo/Eromanen-Manobo Kulmanen
Ata
Ata-Manobo
Ati
Ayangan
Ayangan-Henanga
Ayta
Badjao
Bago
Bagobo Lkata
Bagobo Tagabawa
Bajau
Balangao
Balangao - Lias
Baliwon
Baliwon - Gaddang
Baliwon - Miligan
Baliwon - I-sadanga
Baliwon - Fiallig/Fialika
Bangon Mangyan
Bantoanon
Banwaon
Batak
B'laan/Blaan
Bontok
Bontok-Majukayong
Bugkalot/Ilongot
Buhid Mangyan
Bukidnon
Bukidnon - Akeanon
Bukidnon - Pan-anayon
Bukidnon - Halowodnon
Bukidnon - Magahat
Bukidnon - Ituman
Bukidnon - Iraynon
Bukidnon - Tagoloanon
Cagayanen
Calinga
Cuyonen/Cuyunon
Diangan
Dibabawon
Dumagat
Dumagat - Remontado
Dumagat - Kabolowen
Dumagat - Tagebolus
Dumagat - Edimala
Eskaya
Gaddang
Gubatnon-Ratagnon Mangyan
Hanunuo Mangyan
Higaonon/Higa-onon
Higaonon - Tagoloanon
Ibanag
Ibatan
Ibaloy
Ibukid
Ifugao
Imalawa
Iraya Mangyan
Isinai
Isnag
Isneg
Isneg/Isnag
Itawes
Itneg
Itneg/Tinguian
Itneg/Tinguian - Adasen
Itneg/Tinguian - Balatok
Itneg/Tinguian - Banao
Itneg/Tinguian - Belwang
Itneg/Tinguian - Binongan
Itneg/Tinguian - Gubang
Itneg/Tinguian - Inlaud
Itneg/Tinguian - Mabaka
Itneg/Tinguian - Maeng
Itneg/Tinguian - Masadiit
Itneg/Tinguian - Muyadan
Ivatan
Iwak
Kabihug
Kabihug - Manide
Kagan/Kalagan
Kalanguya
Kalanguya - Yattuka
Kalanguya-Ikalahan
Kalinga
Kalinga - Lubo
Kalinga - Mangali
Kalinga - Taloctoc
Kalinga - Pangol
Kalinga - Gaang
Kalinga - Dacalan
Kalinga - Guilayon
Kalinga - Nanong
Kalinga - Dallac
Kalinga - Biga
Kalinga - Tobog
Kalinga - Gaddang
Kalinga - Culminga
Kalinga - Malbong
Kalinga - Minanga
Kalinga - Dao-Angan
Kalinga - Banao
Kalinga - Salegseg
Kalinga - Gubang
Kalinga - Mabaca
Kalinga - Poswoy
Kalinga - Ab-abaan
Kalinga - Buaya
Kalinga - Balatoc
Kalinga - Dangtalan
Kalinga - Cagaluan
Kalinga - Balinciagao
Kalinga - Ableg/Dalupa
Kalinga - Limos
Kalinga - Pinukpuk
Kalinga - Magaogao
Kalinga - Aciga
Kalinga - Ballayangan
Kalinga - Ammacian
Kalinga - Dugpa
Kalinga - Uma
Kalinga - Luluagan
Kalinga - Mabongtot
Kalinga - Tanglag
Kalinga - Tulgao
Kalinga - Dananao
Kalinga - Tongrayan
Kalinga - Bangad
Kalinga - Basao
Kalinga - Guina-Ang
Kalinga - Sumadel
Kalinga - Butbut
Kamiguin
Kankanaey
Kankanaey - Hak'ki
Karao
Karulano
Kolibugan
Lambanguian
Malaueg
Mamanwa
Mandaya
Mangguangan
Mangyan
Mansaka
Manobo
Manobo - Pulanguinon
Manobo - Dunggoanon
Manobo - Kirenteken
Manobo - Aromanon
Manobo-Blit
Manobo-Blit - Tasaday
Manobo-Dulangan
Manobo-Dulangan - Lambangian
Ubo Monuvu/Manobo-Ubo/Ubo Manobo/Ubo Manuvu/Ubo Menuvu
Matigsalog
Molbog
Obu-Manuvu
Palawan-o
Palawan-o - Tao't Bato
Palawan-o - Ken-ey
Pan-ayanon
Panay Bukidnon
Parananum
Sama
Sama Badjao
Sama Bangingi
Sama Delaut
Sibuyan Mangyan-Tagabukid
Subanen/Subanon - Kolibugan
Tagakaulo
Tagbanua
Tagbanua-Calamian
Tagbanua Tandulanen
Tadyawan Mangyan
Talaandig
T'boli/Tboli
Tau-buid Mangyan
T'duray/Teduray
Tigwahanon
Tinananen
Tingguian
Tuwali
Tuwali - Kele-i
Umayamnon
Yakan
Yapayao
Yogad
REGION PROVINCE
AUTONOMOUS REGION IN MUSLIM MINDANAO (ARMM) Please refer to REGION_PROVINCE_CODE Tab
CORDILLERA ADMINISTRATIVE REGION (CAR)
NATIONAL CAPITAL REGION (NCR)
REGION I (ILOCOS REGION)
REGION II (CAGAYAN VALLEY)
REGION III (CENTRAL LUZON)
REGION IV-A (CALABARZON)
REGION IV-B (MIMAROPA)
REGION V (BICOL REGION)
REGION VI (WESTERN VISAYAS)
REGION VII (CENTRAL VISAYAS)
REGION VIII (EASTERN VISAYAS)
REGION IX (ZAMBOANGA PENINSULA)
REGION X (NORTHERN MINDANAO)
REGION XI (DAVAO REGION)
REGION XII (SOCCSKSARGEN)
REGION XIII (CARAGA)
MUNICITY SEX Deferral
Please refer to MUNICITY_CODE Tab M Y
F N
Reason for Deferral/Refusal Vaccine Brand
NONE Sinovac
DC01_Age Requirement AstraZeneca
DC02_1st Dose Other Brand Pfizer
DC03_Allergy to Vaccine component Moderna
DC04_Severe Allergy to 1st Dose Sputnik V/Gamaleya
DC05_Allergy/Asthma, No monitor Novavax
DC06_History of Anaphylaxis Johnson and Johnson
DC07_Bleeding disorders/Taking anti-coagulants Sinopharm
DC08_Symptomatic for COVID-19 Infection
DC09_High SBP, DBP, Organ Damage
DC10_Covid-19 Exposure
DC11_Ongoing Covid-19 Treatment
DC12_Attach, Admissions, Meds Change
DC13_Other Vaccine/s within 2 weeks
DC14_Plasma or Antibodies
DC15_Pregnant or Breastfeeding
DC16_No Med Clearance for Comorbidity
RC01_Refusal
RC02_Preference for other vaccine brand
Vaccine Manufacturer Name 1st Dose 2nd Dose Additional Dose
Sinovac Y Y Y
AZ N N N
Pfizer
Moderna
Gamaleya
Novavax
J&J
Sinopharm
Adverse Event Adverse Event Condition
Y AE01_General Symptoms
N AE02_Cardiac Symptoms
AE03_Ear Symptoms
AE04_Endocrine Symptoms
AE05_Examinations
AE06_Eye Symptoms
AE07_Gastrointestinal Symptoms
AE08_Hepatobiliary Symptoms
AE09_Immune System Symptoms
AE10_Infections
AE11_Nutrition-Related Symptoms
AE12_Musculoskeletal Symptoms
AE13_Neurological Symptoms
AE14_Perinatal Conditions
AE15_Procedural Symptoms
AE16_Psychiatric Symptoms
AE17_Renal and Urinary Symptoms
AE18_Reproductive Symptoms
AE19_Respiratory Symptoms
AE20_Skin Symptoms
AE21_Lymphatic System Symptoms
AE22_Vascular Symptoms