RU ESU Tally Sheet for COVID-19 vaccination among Pregnant Women (from start to end of COVID-19 Vaccination Program)

*Region: *Number of Vaccination Sites:

CoronaVac AstraZeneca Pfizer Sputnik Moderna Janssen TOTAL*

NUMBER OF VACCINATED NONE

POPULATION*

● 1ST DOSE NONE

● 2ND DOSE NONE

NUMBER OF FEMALES NONE

VACCINATED*

● 1ST DOSE NONE

● 2ND DOSE NONE

NUMBER OF FEMALES OF NONE

REPRODUCTIVE AGE (AGED 15
TO 49 YEARS OLD) VACCINATED

● 1ST DOSE NONE

● 2ND DOSE NONE

NUMBER OF ELIGIBLE NONE

POPULATION* (PREGNANT
DURING VACCINATION
INCLUDING ABORTION POST-
VACCINATION)

● 1ST DOSE NONE

● Number of Maternal Deaths NONE

● Number of Maternal NONE

Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE

 ● Number of Neonatal Deaths NONE

● Number of Microcephaly NONE

CoronaVac AstraZeneca Pfizer Sputnik Moderna Janssen TOTAL*

● Number of Major Congenital NONE

Anomalies

● Number of Infant Deaths NONE

● 2ND DOSE NONE
● Number of Maternal Deaths NONE
● Number of Maternal NONE
Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE
● Number of Neonatal Deaths NONE
● Number of Microcephaly NONE
● Number of Major Congenital NONE
Anomalies

● Number of Infant Deaths NONE

NUMBER OF WOMEN AT THE NONE

1ST TRIMESTER (UP TO 12
WEEKS AND 6 DAYS) OF THEIR
PREGNANCY AT TIME OF
VACCINATION

● 1ST DOSE NONE

● Number of Maternal Deaths NONE
● Number of Maternal NONE
Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

 Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE

CoronaVac AstraZeneca Pfizer Sputnik Moderna Janssen TOTAL*

● Number of Neonatal Deaths NONE

● Number of Microcephaly NONE
● Number of Major Congenital NONE
Anomalies

● Number of Infant Deaths NONE

● 2ND DOSE NONE
● Number of Maternal Deaths NONE
● Number of Maternal NONE
Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE
● Number of Neonatal Deaths NONE
● Number of Microcephaly NONE
● Number of Major Congenital NONE
Anomalies

● Number of Infant Deaths NONE

NUMBER OF WOMEN AT THE NONE

2ND TRIMESTER (13-27 WEEKS
AND 6 DAYS) OF THEIR
PREGNANCY AT TIME OF
VACCINATION

● 1ST DOSE NONE

● Number of Maternal Deaths NONE

● Number of Maternal NONE

Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)
 ● Number of Maternal Thrombotic NONE
Events

● Number of Hypertensive Disorders NONE

of Pregnancy

CoronaVac AstraZeneca Pfizer Sputnik Moderna Janssen TOTAL*

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE

● Number of Neonatal Deaths NONE

● Number of Microcephaly NONE

● Number of Major Congenital NONE

Anomalies

● Number of Infant Deaths NONE

● 2ND DOSE NONE
● Number of Maternal Deaths NONE
● Number of Maternal NONE
Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE
● Number of Neonatal Deaths NONE
● Number of Microcephaly NONE
● Number of Major Congenital NONE
Anomalies

● Number of Infant Deaths NONE

NUMBER OF WOMEN AT THE NONE

3RD TRIMESTER (28 WEEKS
ONWARDS) OF THEIR
PREGNANCY AT TIME OF
VACCINATION
● 1ST DOSE NONE

● Number of Maternal Deaths NONE

CoronaVac AstraZeneca Pfizer Sputnik Moderna Janssen TOTAL*

● Number of Maternal NONE

Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE

● Number of Neonatal Deaths NONE

● Number of Microcephaly NONE

● Number of Major Congenital NONE

Anomalies

● Number of Infant Deaths NONE

● 2ND DOSE NONE

● Number of Maternal Deaths NONE
● Number of Maternal NONE
Hospitalizations (e.g.,threatened
abortion, preterm labor, and causes
other than delivery/labor)

● Number of Maternal Thrombotic NONE

Events

● Number of Hypertensive Disorders NONE

of Pregnancy

● Number of Miscarriage/ NONE

Spontaneous Abortion

● Number of Stillbirths NONE

● Number of Preterm births NONE
● Number of Neonatal Deaths NONE
● Number of Microcephaly NONE
● Number of Major Congenital NONE
 Anomalies

● Number of Infant Deaths NONE

Number of Vaccination Sites Tapped and Coordinated by the RESU NONE

Number of Vaccination Sites for Follow-ups (including sites with pending information, and details for verification) NONE

Assessor’s Name: ROSE ANN PAQUEO Date Accomplished: AUGUST 16,2021