BARANGAY MONTHLY INVENTORY OF VACCINATED POPULATION

REGION:_________________
PROVINCE: ________________
CITY/MUNICIPALITY: __________________
BARANGAY: _________________________

SUMMARY

A. TOTAL NO. OF BARANGAY INHABITANTS

AGED 12 -17 YEARS OLD, ELIGIBLE FOR VACCINATION: Input Brgy Data Here
* Note: Input data for items A and B which may be sourced from
or from the 2020 Census of Population and Housing (2020 CPH

B. TOTAL NO. OF BARANGAY INHABITANTS

AGED 18 YEARS AND ABOVE, ELIGIBLE FOR VACCINATION: Input Brgy Data Here

Formula: C = A + B
C. TOTAL NO. OF BARANGAY INHABITANTS
AGED 12 YEARS AND ABOVE, ELIGIBLE FOR VACCINATION: 0

D. TOTAL NO. OF UNVACCINATED INDIVIDUALS AGED Formula: D = C - (F + L)

12 YEARS AND ABOVE: -10

E. PERCENTAGE OF UNVACCINATED INDIVIDUALS AGED Formula: E = D/C x 100

12 YEARS AND ABOVE: #DIV/0!

F. TOTAL NO. OF PARTIALLY VACCINATED INDIVIDUALS

AGED 12 YEARS AND ABOVE: 3

G. PERCENTAGE OF PARTIALLY VACCINATED INDIVIDUALS Formula: G = F/C x 100

AGED 12 YEARS AND ABOVE: #DIV/0!
H. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS
AGED 12-17 YEARS: 1
I. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS Formula: I= H/A x 100
AGED 12-17 YEARS: #VALUE!
J. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS
AGED 18 YEARS AND ABOVE 6
K. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS Formula: K= J/B x 100
AGED 18 YEARS AND ABOVE: #VALUE!
L. TOTAL NO. OF FULLY VACCINATED INDIVIDUALS Formula: L = H + J
AGED 12 YEARS AND ABOVE: 7
M. PERCENTAGE OF FULLY VACCINATED INDIVIDUALS Formula: M = L/C x 100
AGED 12 YEARS AND ABOVE: #DIV/0!
N. TOTAL NO. OF INDIVIDUALS AGED 18 YEARS AND ABOVE WITH
BOOSTER SHOT: 3
O. PERCENTAGE OF INDIVIDUALS AGED 18 YEARS AND ABOVE Formula: O = N/J x 100
WITH BOOSTER SHOT: 50.00%

AS OF (insert date): ___________________

Prepared by Approved by

Name and Signature of Barangay Secretary/Health Worker Name and Signature of Punong

PRIMARY SERIES OF COVID-19 VACCINE

(Note: 1. If brand is "Janssen, put NA in the column for
Dose"; Put "None" if unvaccinated)

Full Name of Partially or Fully Vaccinated Barangay Inhabitants Date of Vaccination

No. Birthday Age
Aged 12 Y/O and Above

1st Dose 2nd Dose

1 EX: JUAN DELA CRUZ January 4, 1960 62 June 17, 2021 September 19, 2021
 2 EX: JANE DOE November 11, 1978 43 October 20, 2021 NA
3 EX: MARIA SANTOS April 1, 1983 38 May 27, 2021 None
4 EX. JUANA DELA CRUZ October 13, 1999 22 April 19, 2021 June 21, 2021
5 EX. JOHN DOE December 5, 2004 17 October 10, 2021 January 17, 2022
6 EX. MARK SANTOS February 6, 2008 13 November 7, 2021 None
7 EX. ISAY REYES August 20, 1955 66 September 25, 2021 NA
8 EX. ANA REYES May 1, 1954 67 September 25, 2021 NA
9 EX. ISKO SANTIAGO June 24, 2001 20 August 1, 2021 January 6, 2022
10 EX. MARY SANTIAGO September 29, 1968 53 July 18, 2021 None
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50

TOTAL
ch may be sourced from the Registry of Barangay Inhabitants (RBI) which is updated every six months,
and Housing (2020 CPH) of the Philippine Statistics Authority (PSA).
Signature of Punong Barangay

OVID-19 VACCINE
t NA in the column for "2nd BOOSTER DOSE
unvaccinated) Fully
Vaccinated
Partially Fully Vaccinated
18 years old
vaccinated? 12-17 years old?
and above? Individuals 18 years
(Type 1 if Yes ; (Type 1 if Yes ;
(Type 1 if Yes old and above with
0 if No) 0 if No) Date of Vaccination
Brand ; Booster Shot? Brand
(Booster Shot)
0 if No) (Type 1 if Yes;
0 if No; NA if 12-17
Y/O)
Pfizer 0 0 1 1 January 6, 2021 Pfizer
Janssen 0 0 1 0 None
Moderna 1 0 0 0 None
Sinovac 0 0 1 0 None
Sputnik V 0 1 0 NA NA
Sinopharm 1 0 0 NA NA
Janssen 0 0 1 1 January 12, 2021 Janssen
Janssen 0 0 1 1 January 12, 2021 Janssen
Moderna 0 0 1 0 None
Pfizer 1 0 0 0 None
3 1 6 3