Republic of the Philippines

Department of Health
OFFICE OF THE SECRETARY

27 June 2022

DEPARTMENT MEMORANDUM
No. 2022-163
TO: ALL UNDERSECRETARIES AND ASSISTANT SECRETARIES;
DIRECTORS OF BUREAUS, SERVICES AND CENTERS FOR
HEALTH DEVELOPMENT: MINISTER OF HEALTH —

BANGSAMORO AUTONOMOUS REGION IN MUSLIM

MINDANAO: EXECUTI RE RS__O SPECIAL]
HOSPITALS AND NATIONAL NUTRITION COUNCIL: CHIEFS
OF MEDICAL CENTERS, HOSPITALS, SANITARIA AND
INSTITUTES: PRIVATE SECTOR PARTNERS: AND OTHERS
CONCERNED

SUBJECT: Interim erational on the Administration of Additional

Guidelines

Doses of _Pfizer-BioNTech OVID-19 Vaccine _to the

Non-Immunocompromised Pediatric A3 and Rest of the Pediatric
Population ages 12 to 17 Years Old

RATIONALE

Corollary to Department Memorandum 2022-0252 or the “Interim Operational

Guidelines on the Administration of Additional Doses “of Pfizer-BioNTech COVID-19
Vaccine to Immunocompromised Pediatric A3 Population ages 12 to 17 Years Old” and
the issuance of the Philippine Food and Drug Administration (FDA) Emergency Use
Authorization (EUA) allowing the administration of Pfizer BioNTech COVID-19 vaccine
additional/booster doses to individuals 12 years of age and older, the Health Technology
Assessment Council (HTAC) also issued the recommendation approving the
administration of a booster dose of Pfizer BioNTech COVID-19 vaccine to the
non-immunocompromised adolescent population ages 12 to 17 years
months after the second dose of the primary series.
least five (5)at
In view of the foregoing, the National Vaccination Operations Center (NVOC)
hereby issues these guidelines to all concerned agencies, Regional Vaccination
Operations Center (RVOC) or Centers for Health Development (CHDs) or Local
Government Units (LGUs), Provincial Health Offices (PHOs), City Health Offices
(CHOs), Rural Health UNits (RHUs), Implementing Units and Vaccination sites, both

Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila @ Trunk Line 651-7800 local 1113, 1108, 1135 Direct
Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http://www.doh.gov.ph; e-mail: [email protected] ++
 public and private, on the management and administration of Pfizer BioNTech
COVID-19 vaccine booster doses to non-immunocompromised Pediatric A3 and to
the Rest of the Pediatric Population (ROPP).

Il. OBJECTIVES

This Department Memorandum (DM) provides interim operational guidelines on

the management and administration of Pfizer BioNTech COVID-19 vaccine booster
doses to non-immunocompromised Pediatric A3 and to the ROPP.

Il. SCOPE OF APPLICATION

This DM shall be applicable to all concerned agencies of the NVOC, Regional

Vaccination Operations Centers (RVOCs) or Centers for Health Development (CHDs),
Local Vaccination Operations Center (LVOCs) or Local Government Units (LGUs),
Provincial Health Offices (PHOs), City Health Offices (CHOs), Rural Health Units
(RHUs), Implementing Units, and Vaccination Sites, both public and private.

IV. DEFINITION OF TERMS

A. Additional dose - a dose which would be needed as part of an extended primary

series for target populations where the immune response rate following the standard
primary series is deemed insufficient as indicated in the EUA issued by the FDA.
The objective of an additional dose in the primary series is to optimize or enhance
the immune response to establish a sufficient level of effectiveness against the
disease.
.
B. Booster dose - refers to doses administered to a vaccinated population that has
completed a primary vaccination series, when, with time, vaccine effectiveness has
fallen below a rate deemed sufficient in that population, as indicated in the EUA
issued by the FDA.

C. Primary vaccination dose series - refersto the number of

doses as prescribed in the
product-specific EUA provided by the FDA, either a two-dose or a one-dose series.

D. Rest of the Pediatric Population (ROPP)

years old without comorbidities.
- refers to eligible population ages 12-17

GENERAL GUIDELINES

A. The non-immunocompromised adolescent ages 12 to 17 years old or

non-immunocompromised Pediatric A3 and the Rest of the Pediatric Population
2
 (ROPP) shall be recommended to be administered with a booster dose of COVID-19
vaccine using Tozinameran COVID-19 mRNA vaccine (nucleoside-modified)
[Cominarty]Pfizer COVID-19 vaccine based on the EUA issued by the Philippine
FDA. (Copy of the EUA may be assessed at the FDA website:
https:/www.fda.gov.ph/list-of-fda-issued-emergency-use-authorization)

. Vaccination of the non-immunocompromised Pediatric A3 and ROPP shall be

implemented simultaneously with the current eligible priority groups.

. The National COVID-19 Vaccine Deployment and Vaccination Program shall adopt
future EUA or regulatory amendments from the FDA and recommendations from the
HTAC on the provision of the additional/booster doses to the pediatric population.

. Instructions for COVID-19 vaccination providers and administration on storage and

handling, dosing and schedule, administration, contraindications, warnings, adverse
reactions, and use with other vaccines shall follow the product-specific EUA provided
by the FDA and vaccine-specific guidelines issued by the DOH. (Copies of the EUAs
may be accessed at:
https:/www.fda.gov.ph/list-of-fda-issued-emergency-use-authorization/)

. Protocols for the management of Adverse Effects Following Immunization (AEFIs)

and Adverse Events of Special Interest (AESIs) shall follow the provisions of the
approved COVID-19 vaccine EUA of the FDA, succeeding guidelines from the FDA,
and other recognized professional organizations and regulatory bodies, as new
evidence arises. Interim Adverse Events Following Immunization (AEFI) Pathways
may be accessedat: bit.ly/RESBAKUNAFactsheets.

. Vaccination process, including registration, screening, administration, reporting,

AEFI monitoring, and referral, shall follow the provisions in Department of Health
(DOH) Administrative Order No. 2022-0005, titled “Omnibus Guidelines on the
Implementation of the National Deployment and Vaccination Plan (NDVP) for
COVID-19 Vaccines”, Department Circular No. 2021-0483 or the “Interim
Operational Guidelines on the COVID-19 Vaccination of the Rest of the Pediatric
Population Ages 12-17 Years Old,” and Department Memorandum No. 2022-0041
or the “Jnterim Guidelines on the Management and Administration of Tozinameran
COVID-19 mRNA vaccine (nucleoside-modified) {Cominarty] Pfizer COVID-19
Vaccine to Pediatric Population Ages 5-11 Years Old”, Department Memorandum
2022-0252, otherwise known as the “Interim Operational Guidelines on the
Administration of Additional Doses of Pfizer-BioNTech COVID-19 Vaccine to
Immunocompromised Pediatric A3 Population ages 12 to 17 Years Old”, and other
relevant policies issued by the DOH.
VI. IMPLEMENTING GUIDELINES

A. Eligible Groups

1, The eligible pediatric vaccine recipients ages 12-17 years old for the
administration of booster doses are:
a. non-immunocompromised Pediatric A3
b. Rest of the Pediatric Population (ROPP)

B. Vaccine Administration of Additional COVID-19 Vaccine Doses

1. The Pfizer COVID-19 vaccine booster dose to non-immunocompromised

Pediatric A3 and ROPP ages 12-17 years old shall be given at least five (5)
months after the administration of the second dose of the primary dose series.

A heterologous booster vaccination strategy using a different brand of COVID-19

vaccine is allowed.

For the administration of the booster dose, 0.3 ml/dose of Pfizer-BioNTech

COVID-19 vaccine shall be given.

C. Vaccination Rollout

1. The vaccination rollout for the administration of booster doses to

non-immunocompromised Pediatric A3 and ROPP ages 12-17 years old shall be
simultaneously conducted nationwide based on the readiness of the LVOCs,
implementing units and vaccination sites/teams. .
While the implementation of the administration of COVID-19 vaccine booster
doses shall be rolled out simultaneously nationwide, all LGUs/LVOCs are
directed to ensure ramping up of the administration of due booster doses to the
eligible adult population ages 18 years old and above, as well.

The vaccination of the non-immunocompromised Pediatric A3 and ROPP ages

12-17 years old shall be implemented in/through fixed vaccination sites,
temporary posts and mobile vaccination.

The LGUs shall reactivate fixed vaccination sites and establish temporary posts
in catchment areas / barangays to ensure administration of booster doses to
eligible vaccine recipients.
 The administration of booster doses to non-immunocompromised Pediatric A3
and ROPP ages 12-17 years old shall be conducted simultaneously with the
ongoing house-to-house vaccination activities.

Medical Clinics, as vaccination sites, may be utilized consistent with DOH

Department Circular No. 2022-0017, otherwise known as, “Interim Operational
Guidelines on the Use of Medical Clinics as Vaccination Sites for COVID-19
Vaccination”.

Physician’s Clinics, as vaccination sites, may be utilized consistent with DOH

Department Circular No. 2022-0152, otherwise known as, “Jnterim Operational
Guidelines on the Use of Physician's Clinics in the Provision of COVID-19
Vaccination Services”.

Pharmacies, as vaccination sites, may be utilized consistent with DOH

Department Circular No. 2022-0013, otherwise known as, “Jnterim Operational
Guidelines on the Use of Pharmacies as Vaccination Sites for COVID-19
Vaccination ”’.

School-based vaccination activities shall be conducted for the vaccination of

booster doses to non-immunocompromised Pediatric A3 and ROPP, consistent
with Inter-Agency Task Force for the Management of Emerging Infectious
Diseases (IATF) Resolution No. 167-D series of 2022.

D. Capacity Building and Training

1. All implementing units and vaccination sites shall ensure that all members of the
vaccination teams undergo capacity building before rolling out of vaccination
activities.

E. Allocation and Distribution of COVID-19 Vaccines

1. The NVOC shall allocate and distribute COVID-19 vaccines for the
administration of booster doses based on the number of eligible populations
which are computed based on the recommended dose interval.

The CHDs and LGUs may utilize available Pfizer COVID-19 vaccines for 12
years old and older for the administration of the COVID-19 vaccine booster
doses, and ensure the availability of these vaccines at all times.
 3. The RVOCs or the CHDs may allocate and distribute COVID-19 vaccines
directly to implementing units and vaccination sites, in coordination with the
LGUs.

F. Pre-registration and Scheduling

1. The vaccination sites shall utilize various vaccination registration mechanisms to

ensure that any willing constituents shall be provided with access to any
registration tool/processes. The following mechanisms may be utilized:

a. Pre-registration and scheduling through the LGU’s registration

website/application/link
i. The LGUs shall deploy existing registration systems and tools where the
vaccine recipient may register through an app/link and thereafter be
provided with the schedule.
li. To facilitate coordination, the LGUs shall share the links to their
registration websites/apps/links to partners and to the CHDs for
consolidation and dissemination. LGUs may update the links here:
bit.ly/VaccinationRegistrationDirectory_ DILGupdate.
ill. The LGUs shall widely disseminate their registration websites/links
through various media platforms and information systems, both online
and offline, to ensure that constituents are fully informed and the links
are readily available.

b. Masterlisting by barangays and scheduling

i. If the LGU does not have any website/app/link as a registration system,
the barangays may conduct masterlisting activities and assign vaccine
recipients to vaccination sites on a daily basis.
il. The barangays are encouraged to conduct house-to-house activities and
determine who among the constituents are still unvaccinated. After
determining, the constituents must be scheduled and assigned to
vaccination sites.

c. Fixed vaccination sites and temporary vaccination posts shall accommodate

walk-ins.

G. Requirements for Vaccination of Booster Doses

1. Vaccination card with complete details of the administered two doses of the
primary series.
 Valid identification cards or documents with a photo of the parent/guardian and
the vaccine recipient. (See Annex A for the list of valid identification cards or
documents)

Document/s to prove filiation. (See Annex B for the list of acceptable documents)

H. Preparation of the Vaccination Sites

1. The vaccination site shall be large enough to accommodate the presence of the
vaccine recipient’s parent/guardian.

If the vaccination site is also vaccinating the adult population, a separate lane
shall be prepared and assigned for the vaccination of the vaccine recipients ages
12-17 years old.

I. Vaccination Process

1. The vaccination process and AEFI monitoring and case management shall
primarily follow the steps stipulated in the DOH’s Administrative Order No.
2022-0005, otherwise known as “Omnibus Guidelines on the Implementation of
the National Deployment and Vaccination Plan (NDVP) for COVID-19
Vaccines” , Department Circular No. 2021-0483 or the “Jnterim Operational
Guidelines on the COVID-19 Vaccination of the Rest of the Pediatric Population
Ages 12-17 Years Old,” and Department Memorandum No. 2022-0041 or the
“Interim Guidelines on the Management and Administration of Tozinameran
COVID-19 mRNA vaccine (nucleoside-modified) {Cominarty] Pfizer COVID-19
~ Vaccine
to Pediatric Population Ages 5-11 Years Old” and other relevant policies
issued by the DOH.

. The vaccine recipient shall be accompanied by a parent/guardian at the

vaccination site.
The vaccine recipient shall be accompanied by a parent/guardian at the
vaccination site.
An informed consent given and signed by the parent/guardian, together with an
assent given and signed by the vaccine recipient, are both required prior to the
administration of an additional COVID-19 vaccine dose.

Without the signed informed consent of the parent/guardian or any individual

authorized to act as the substitute parental authority, the vaccine recipient shall
be deferred for COVID-19 vaccination unless such documentary requirements
are accomplished.

If the vaccine recipient did not give his/her assent, he/she shall not be coerced to
receive the additional COVID-19 vaccine dose.

In case the vaccine recipient is not capable of giving assent due to neurological
comorbidities and moderate to severe intellectual impairment, the parent or the
authorized parental substitute can sign on his/her behalf.

All LVOCs and LGUs are instructed to simplify the processes in the vaccination
sites for the administration of COVID-19 vaccine booster doses. The following
directives are being reiterated:

a. Triage and Registration

i. Ask the vaccine recipient due to be given with first booster dose the
following documents ONLY:
1. Original vaccination card showing the completion of the primary

dose series
2. Any valid identification card

iu. Provide an informed consent form and/or the health

screening/declaration form for booster doses in the registration area. The
vaccine recipient and the parent/guardian may start answering the said
forms. Aside from those mentioned, no additional form shall be
to
required be
filled out in the registration area.
ili. To avoid bottlenecks, deploy additional (at least two to four) non-health
personnel to provide assistance in the registration area and facilitate the
vaccination process.

iv. Facilitate the encoding of vaccine recipient’s information in the

post-vaccination monitoring area.

v. Ensure that there is enough, well-ventilated space in order to comply

with the minimum public health standards at
all times.

b. Health Education, Health Screening and Informed Consent

i. The health education and informed consent step can be integrated with
other steps to streamline the processes in the vaccination site.
 ii. Provide health education/information materials in any area of the
vaccination site, especially in the waiting area and post-vaccination
monitoring area.

ili. Ensure that a health educator is available at all times to provide vaccine
recipients with the necessary information and to answer any questions.

iv. The informed consent may be signed in the registration area or in the
health screening area, after health education.

Utilize the health screening and declaration forms, as appropriate.

vi. If there of medical doctors as health screeners, trained nurses

is a shortage
may perform health screening in lieu of a medical doctor.

Vii. For the administration of booster doses, the vaccine recipient may be
screened prior to the vaccination proper. There are two ways in which the
vaccine recipient shall be screened:

1. LGU facilitated health screening: The CHOs/RHUs and Barangay

Health Stations can conduct the health screening assessment prior to
the vaccination schedule;

2. Self-health assessment: The vaccine recipient can utilize and answer

the health screening/declaration form on or before the vaccination
schedule.

ec. Vaccine Administration

i. For the administration of booster doses, the vaccinator shall,

1. Review the informed consent form and make sure that it is properly
signed.

2. Review thoroughly the health screening form and the eligibility of the
vaccine recipient, by asking relevant questions and physically
assessing the vaccine patient. If the vaccine recipient is not eligible,
defer the vaccination and provide an appropriate schedule or refer to
the appropriate vaccination site.
 3. Review the information on the vaccination card. Determine the date
and the vaccine brand of the primary dose series and the first booster
dose administered. Calculate the dose interval.

4. Determine the vaccine to be given.

5. Administer the vaccine using the correct technique.

6. Record the vaccine administered and other pertinent information in the

vaccination card.

d. Post-Vaccination Monitoring

i. Check the contents of the AEFI Kit. Ensure completeness of the kit.

ii. Observe the vaccine recipient for any Adverse Event Following
Immunization (AEFI).

ili. Give the following information to

the vaccine recipient:
1. Referral hospital/facility and contact details
2. Signs and symptoms to watch for
3. Instructions and steps on how to seek clinical care and report AEFI
events

iv. Ensure that the vaccine recipient is essentially well before leaving the
vaccination site.
y. Provide appropriate intervention to manage AEFI.

vi. Encode allinformation of the vaccine recipients (by the encoder) based on
the data requirements.

9. Vaccination sites shall have processes to ensure efficiency in the simultaneous

conduct of primary dose and booster dose vaccination in the vaccination sites by
setting up separate lanes for primary dose and booster dose vaccination to avoid
errors.

J. Vaccination Reporting

1. All vaccination sites shall categorize the vaccinated pediatric population ages
12-17 years old based on their previous Priority Groups:
a. Pediatric A3 (for non-immunocompromised Pediatric A3)
10
 b. Rest of the Pediatric Population

2. All LGUs shall submit the required data requirements to the Vaccine
Administration System (VAS - Line List) and Vaccination Operations Reporting
System (VORS) on a daily basis.

3. The VORS and VAS line list data fields shall be updated to include the
additional/booster dose.

K. Demand Generation and Communication Activities

1. All CHDs/RVOCs/LVOCs shall conduct information dissemination activities

such as town hall meetings, barangay lecture series, and distribution of
Information, Education, and Communication (IEC) materials.

2. LGUs and all Implementing Units shall maximize both online and offline
platforms, and promote community engagement through targeted COVID-19
vaccination key messaging, and prioritization of those Most-at-Risk Population
(MARP).

3. CHDs/RVOCs/LVOCs and LGUs are highly encouraged to engage with the local
medical societies, faith-based organizations, and other relevant stakeholders in
health promotion activities relating to COVID-19 vaccination.

4. CHDs and LGUs shall ensure feedback mechanisms and social listening by
promoting the use of the Knowledge Informs Responsible Action or Katuwang
na Impormasyon para sa Responsableng Aksyon (KIRA) chatbot
(hitps://m.me/OfficialDOHgov).

5. All implementing units are directed to calibrate and/or recalibrate their existing
crisis communication plans, in accordance with DM 2021-0224, otherwise
known
as, Interim Guidelines in Adverse Events Following Immunization (AEFI)
Community Management and Crisis Communications Related to COVID-19
Vaccines.

11
For dissemination and strict compliance.

By Authority of the Secretary of Health:

MYRNA C. CABOTAJE, MD, MPH, CESO ITI

Undersecretarwof Health
Field Implementation and Coordination Team
Chair, National Vaccination Operations Center

12
 ANNEX
A. LIST OF VALID IDENTIFICATION CARDS OR DOCUMENTS
Valid identification cards or documents with photo of the parent/guardian and the vaccine
recipient to verify documents shall be presented. These are the list of valid identification cards of
parent/guardian:

1. SSS Card

2. GSIS Card

3. Unified Multi-Purpose Identification (UMID) Card

4. Land Transportation Office (LTO) Driver’s License

5. Professional Regulatory Commission (PRC) ID

6. Philippine Identification (PhilID)

7. Overseas Workers Welfare Administration (OWWA) E-Card

8. Commission on Elections (COMELEC) Voter's ID or Voter's Certificate

9. Senior Citizen ID

10. Philippine Postal ID

11. Seafarer's Record Book

12. Valid or Latest Passport

13. Others
 ANNEX B. REQUIREMENTS TO PROVE FILIATION/ GUARDIANSHIP FOR
PEDIATRIC COVID-19 VACCINATION

A.At least one (1) of the following documents shall be presented to prove filiation or
guardianship:

1. In case the minor is accompanied by his/her parent:

a. The best evidence of filiation for the accompanying parent shall be an original
copy or a certified true copy of the Birth Certificate issued by the Philippine
Statistics Authority (PSA). In lieu of the PSA-issued Birth Certificate or certified
true copy of the same, a copy of the Certification issued by the Local Civil
Registrar of the City or Municipality where the vaccine recipient was registered
shall be acceptable. The Certification shall set forth the following:

i. LCR Registry Number;

ii. Page and book number of the entry of registration;

ii. Date of Registration;

iv. Name of Child;

v. Sex;

vi. Date of Birth;

vii. Place of Birth;

villi. Name of the Mother;

ix. Citizenship of the Mother;

x. Name of the Father, if applicable;

xl. Citizenship of the Father, if applicable;

xii. Date of Marriage of the parents, if applicable; and

xili. Place of Marriage, if applicable.

b. In case the vaccine recipient does not have a copy of the original or certified true
copy of his/her birth certificate or a Certification from the Local Civil Registrar,
secondary documents shall be acceptable as long as the same is coupled with a
valid government identification card issued to the parent and the vaccine
recipient. The following are the secondary documents that may be presented (The
list is not in order of preference):

i. Authenticated medical certificate of the child bearing the name of the

parent, issued by the hospital or the DOH;

il. Baptismal Certificate of the child with the name of the parent/s;
ili. School ID or records of the child (transcript of records, Form 137, etc.)
bearing the name of the parent;

Iv. PhilHealth, Social Security System (SSS), Government Service Insurance

System (GSIS) forms indicating that the vaccine recipient is a beneficiary
and a child of the parent. In lieu of physical copies, the parent may show
his/her online account of the PhilHealth, SSS and GSIS online portal
showing his/her filiation with the child;

Copies of insurance policies, health card membership, life plan, memorial

plan and similar policies wherein the vaccine recipient is the child of the
parent and the said policies were taken on behalf of the latter. In lieu of
physical copies, the parent may show his/her online account of the online
portal of the said service and health providers, showing his/her filiation
with the child;

Vi. Barangay Certification issued by the Barangay Captain indicating that the
parent/s and the child is personally known to
the latter and setting forth the
filiation of the said individuals, as attested by one (1) other witness who
personally knows the child and the parent;

Vii. If the parent is a Solo Parent, a copy of the Solo Parent identification card
from the City or Municipal Social Welfare and Development Office, a
Local Social Welfare and Development Office, Tallaq or Faskh
certification from the Shariah court or any Muslim Barangay or
religious
leader, provided that the name ofthe child is indicated therein;

Vill. Court Decree of Adoption, in case the child is adopted;

1X. PWD ID of the child, if available, wherein the name of the parent is
indicated in the ID pursuant to DOH AO No. 2017-0008 or the
“Implementing Guidelines of Republic Act 10754, otherwise known as “An
Act Expanding the Benefits and Privileges of Persons with Disability”, for
the Provision of Medical and Health-related Discounts and Special
Privileges;

Other public documents enumerated under Memorandum Circular 04-12,

or the “Clarification on the Scope of Public Documents under Republic
 Act No. 9225” dated October 18, 2004 issued by the Office of the Civil
Registrar General, as applicable.

c. In case the parent is residing abroad or cannot accompany their own children on
the day of the scheduled vaccination, the accompanying adult may present a
Special Power of Attorney executed by either parent of the minor designating the
minor’s companion to assist in the vaccination process. (If executed abroad, the
SPA must be apostilled, if applicable, or authenticated by the Philippine
Embassy/Consulate). The following documents may serve as an alternative
document to
the Special Power of Attorney:

i. Notarized authorization letter;

il. written affidavit of parent /guardian under an oath with a public official
such as the notary public or a person authorized to do so (eg. Barangay
Officials) with presentation of a valid government ID; or

ili. Barangay Certification issued by the Barangay Captain, the parent/

guardian will be accompanied by one witness personally known to the
latter who can attest that the parent/ guardian is indeed the parent/
guardian of the child. Together, they will meet the Barangay Captain
before issuing the Certification.

2. In case the minor is accompanied by his/her legal or judicial guardian (The list is
not in order of preference):

a. Affidavit of Guardianship executed by the Guardian;

b. Court decree or order of Guardianship, or Letter of Guardianship issued by a

Family Court;

Affidavit of Kinship;

PWD ID of thechild, if available, wherein the name of the guardian is indicated

in the ID pursuant to DOH AO No. 2017-0008;

Authenticated medical certificate of the child bearing the name of the guardian,
issued by the hospital or the DOH;

Baptismal Certificate of the child with the name of the guardian;

School ID or record of the child which bears the name of the guardian;
PhilHealth, SSS, GSIS forms indicating that the vaccine recipient is
a beneficiary
and a child under the guardianship of the accompanying adult. In lieu of physical
copies, the parent may show his/her online account of the PhilHealth, SSS and
GSIS online portal showing his/herrelationship with the child;
 i. Copies of insurance policies, health card membership, life plan, memorial plan
and similar policies wherein the vaccine recipient is the child under the
guardianship of the accompanying adult and the said policies were taken on
behalf of the latter. In lieu of physical copies, the parent may show his/her online
account of the online portal of the said service and health providers, showing
his/her relationship with the child;

j. Barangay Certification issued by the Barangay Captain indicating that the

guardian and the child are personally known to the latter and setting forth the
relationship of the said individuals, as attested by one (1) other witness who
personally knows the child and the parent.

k. If the accompanying person is a Solo Parent, a copy of the Solo Parent

identification card from the City or Municipal Social Welfare and Development
Office, a Local Social Welfare and Development Office, Tallaq or Faskh
certification from the Shariah court or any Muslim Barangay or
religious leader,
provided that the name of the child is indicated therein.

3. In case the minor is under the custody of a Child-Caring Agency:

a. A certified list of agencies as duly licensed and accredited by the Department of
Social Welfare and Development (DSWD) shall be provided by the DSWD,
including the corresponding heads/officers of the said agencies authorized to act
as guardians of the children under their care. The said list shall be the basis to
verify the names of the accompanying adult in order to determine his/her
_authority to give informed consentor be.
assent, as the case may

b. The Child-Caring Agency may also opt to provide the DOH a certified list of the
names of the minor vaccine recipients who will be vaccinated and the name of
their authorized accompanying adults, attaching photocopies of their valid IDs. If
so, both the vaccine recipients and the accompanying heads/officers shall be
required to present the actual valid government ID corresponding to the one
submitted by the Agency. For the accompanying heads/officers, they shall be
required to present the valid ID issued by the Child-Caring Agency issued under
their name.
In case the above-mentioned mechanisms are not feasible, based on the assessment of the
vaccination team after it has conducted due diligence in ensuring that the vaccine recipient
has difficulty in obtaining the primary documents, the accompanying adult and the vaccine
recipient shall present the following documents:

a. In case of an abandoned child whose birth or parentage is unknown,

a
copy of the
Certificate of Foundling and the valid ID issued by the Child Caring Agency to
the accompanying heads/officers.

Affidavit of Guardianship executed by the accompanying heads/officers and the

valid ID issued by the Child-Caring Agency.

Authenticated medical certificate of the child bearing the name of the

accompanying heads/officers, issued by the hospital or the DOH;

Baptismal Certificate of the child with the name of the accompanying

heads/officers;

School ID or record of the child which bears the name of the accompanying
heads/officers;

Barangay Certification issued by the Barangay Captain indicating that the

accompanying heads/officers and the child are personally known to the latter and
setting forth the relationship of the said individuals, as attested by one (1) other
witness who personally knows the child and the accompanying heads/officers.

For purposes of verifying the identity of the accompanying adult, the valid ID
issued by the Child-Caring Agency and a separate government issued ID shall be
presented by the latter..
ANNEX C. COVID-19 PEDIATRIC VACCINATION - 17 YEARS OLD) (12
ADDITIONAL/ BOOSTER DOSE INFORMED CONSENT FORM FOR
PFIZER-BIONTECH (may be accessed through bit.ly/PediaBoosterForms)

COVID-19 PEDIATRIC VACCINATION (12-17 YEARS OLD) ADDITIONAL/BOOSTER DOSE

Fah INFORMED CONSENT FORM AND ASSENT FORM FOR PFIZER-BIONTECH
“tir } of the Philippine National COVID-19 Vaccine Deployment and Vaccination Program
*
a as of June 20, 2022

Name of Minor: Birthdate: Sex:

Address:

Name of Parent/Guardian: Relationship:

Contact Number:

Vaccination Site:

Section 1: Information on the risks and benefits of Cases of myocarditis reported to the US Vaccine
the Pfizer-BioNTech COVID-19 vaccine Adverse Event Reporting System (VAERS) have
additional/booster dose occurred after MRNA COVID-19 vaccination, especially
in male adolescents and young adults. more often after

The Philippine Food and Drug Administration has the second dose usually within several days after
authorized the emergency use of the Pfizer-BioNTech vaccination. Most patients with myocarditis or
COVID-19 vaccine to individuals 12 years and older pericarditis who received care responded well to
under an Emergency Use Authorization (EUA). An medicine and rest and felt better quickly.
additional/booster dose of Pfizer-BioNTech may be
administered 5-6 months after the second dose of the Despite the side effects, recent studies show that
primary dose series or 28 days after the second dose the benefits of receiving the additional/booster
for immunocompromised individuals. The vaccine may dose of Pfizer-BioNTech COVID-19 vaccine far
prevent the person vaccinated from getting severe outweigh the risks.
COVID-19 infection and hospitalization.
Section 2: Parent's/Guardian’s Consent for Minor’s
Side effects that have been reported with the Vaccination
Pfizer-BioNTech COVID-19 vaccine include: injection
site pain, redness, itching, and swelling: tiredness: | confirm that | have been provided with and have read
headache; muscle pain, chills, joint pain; fever; nausea: the Pfizer-BioNTech COVID-19 vaccine Emergency
vomiting; diarrhea: feeling unwell; arm pain, insomnia, Use Authorization (EUA) Information Sheet and the
decreased appetite, excessive sweating, night sweats, same has been explained to me. The Philippine FDA
enlarged lymph nodes. There is a remote chance that has amended the EUA to allow its use as an
the vaccine cowld cause temporary one-sided facial additional/booster dose for the pediatric population
drooping and/or severe allergic reaction such as hives aged 12-17 in light of new scientific evidence.
or swelling of the face. A severe allergic reaction would
usually occur within a few minutes to one hour after | confirm that the minor has been screened for
geting a dose of the PYizer-BioNTech COVID-19 conditions that may merit deferment or special
vaccine. For this reason, the vaccine provider may ask precautions for additional/booster dose vaccination as
ihe recipient to stay at the vaccination site for indicated in the Health Screening Questionnaire.
monitoring post-vaccination
| have received sufficient information on the benefits
The United States Center for Disease Control and and risks of receiving an additional/booster dose of the
Prevention (US CDC} and its partners are actively COVID-19 vaccine and | understand the possible risks
monitoring reports of myocarditis and pericarditis after if the minor is not vaccinated with an additional’booster
COVID-19 vaccination. dose.

Myocarditis is the inflammation of the heart muscle, ‘was provided an opportunity to ask questions, all of
and pericarditis is the inflammation of the outer lining of which were adequately and clearly answered. |,
the heart. In both cases, the body's immune system therefore, voluntarily release the Government of the
causes inflammation in response to an infection or Philippines, the vaccine manufacturer, their agents and
some other triggers. Both myocarditis and pericarditis employees, as well as the hospital, the medical doctors
have the following symptoms: chest pain, shoriness of and vaccinators, from all claims relating to the results of
breath, feelings of having a fast-beating, fluttering, or the use and administration of, or the ineffectiveness of
pounding of the heart. the additional/booster dose of FPfizer-BioNTech
COVID-19 vaccine.
=
ANNEX D. COVID-19 PEDIATRIC VACCINATION - 17 YEARS OLD) (12
ADDITIONAL/ BOOSTER DOSE ASSENT FORM FOR PFIZER-BIONTECH
(may be accessed through bit.ly/PediaBoosterForms)

o
COVID-19 PEDIATRIC VACCINATION (12-17 YEARS OLD) ADDITIONAL/BOOSTER DOSE
INFORMED CONSENT FORM AND ASSENT FORM FOR PFIZER-BIONTECH
of the Philippine National COVID-T9 Vaocine Deployment and Vaccination Program
asof June 20, 2022
tundenstand that while most side effects aer miner and Section 3: Minors Assent for Vaccination
resolve om ther own, Sere is a small risk of severe
Siverse reactions, such as, but mot bimited to allergies | ACKNOWLEDGE THAT:
and that showld prompt medical attertion be mended,
referral $o the megrest hospital shall be prowidled tam being asked te deckte it |,
immediately by the Goverment of the Phiippines. |
have been given comtact information for follow up for
any symetoms which may be experienced after (Minors Mame)
waeocinahon
> Want to neorhwe the additionaliboostes
i
understand that by signing this Form, the minor has a ose of the Pizer-BioN Tech COWID. 1D
vacomnr.
might bo health benefit packages under the Philpore (Age. years)
Mevlth Insurance Corporation (PhiMeakh) in case
fhefshe suffers a severe andior serious adverse event
which
t
Ptaer oNTech
fownd to
COVID 18
be associated with the
weecing or its:
{have understood the
additionaiiboomer
information about the
dose of the Pfizer BioN Tech
adminisination. | understand that the night to claim COVID- 18 wancine which wall be vaccinated tc me, and |
compersation ts subject the guidelines
to of PaiMeaith confirm that) have understood the same

authenze nefeasing all mlormation needed for pubic

Health purpases inclucing reporting bo applicadle
| aakec several quesbons about additional booster
dose of the Plizer Bich Tesch DOWD. 18 waccine and got
te
national vaccine negisties, consistent with personal a@iswers to the same. | undecstume chat | can ask
and heath information storage protocols of the Data questions and raise comcem about COVILe nS
Privacy Act of 2092. Nonetheless, | understand that weocination anytione
despite such authoraeton and consent given by me to
rdease all personal and sensitive indornation for pudlic (understand the risk of the administration of the waccine
fealth purposes, | remain emttied to the nights afforded including the outcomes (that while most side effects are
to a Date Subject under te Data Priaecy Act of BOTS minor and resolve on Sveir own, there cam be a risk for
@dverse rewctoms in rare crcurvtances.)
inpeoviding my consent Drlow, | confirm that | hawe the
legal authonty to give consent for the vacomation of the | kmow thet | can stop at any time im the process of
minor names abowe with the acditonalonoster dose of vweccination without anyome reprimanding me. The
he PierBioNTech COVID-19 vacdne Mending physician wif still take care of me

ihereby give consent to the additional/booster cose Iwan to receive the COVID 19 waocine at this time
waocination of the mince mamed abowe with the i] W the minor is not
capabic of giving assent due
Pier Bion Tech COVID-1S vaccine. | affirm that | have to neweological comortinites and moderate to
understood and reviewed the informa@ton included in sevens intellectua! impairment, the parent or tie
Section herein. (Hf thes comment is mot signed. dated
to
authorized parental substitute can sign an
and returned. fhe eninar will mot be weocinabed) iéissher behalf,

Signature ower Printed Namie of the Paront’Guardian Signature over Printed Name of the Minor / Parent!
‘Guardian

Dato Date

Hyou choase motto hawe your childwarnd vaccinated, please It you choose not to get vaccinated. please lst down the
isa Gown the reasons: reasons:
ANNEX E. COVID-19 PEDIATRIC VACCINATION(12 - 17 YEARS OLD)
ADDITIONAL/ BOOSTER DOSE HEALTH DECLARATION SCREENING FORM FOR
PFIZER-BIONTECH (may be accessed through bit.ly/PediaBoosterForms)

COVID-19 PEDIATRIC VACCINATION (12-17 YEARS OLD) ADDITIONAL/BOOSTER DOSE

HEALTH DECLARATION SCREENING FORM FOR PFIZER
=o om! the Phitianine National COWID-19 Vaccine Deployment and Vaccination Program as of Jume 20, 2022

Hes mechived an recanted en atid onal beater dasa of DC 1) waeciee? oO

v
eerily
TART TSH
beowrs bewse
raed, Pas
h ter(ortby
Fone (5)
Darwery bench faa
ake fri) rrsewrttis
Theaes
/

sire Cooney
eerty-eyhd (Ta)
yates
cape since
Seraae petra ry cut beting your
aaertece
2-cheww pramary seria? Uf

imenenaennpetert, has it
o
Below 12 pears old? o o
Hat a severe ear VS erry iaytecdinet! of Ihe FFLER naceine? pried, fipate heayidecancate) I
o
aller
o
(04 eycrnoybetsarzanediplinafrencaret, 1diytloes]2
lisctretiytene gycot) AM.
Hcitetradecyiacetareds, 1.3\Dineanay-2-ghyceo-3-ptemphachaline anc chojecwrsl potanrior chlonde, morctuxic potssrtun shomhate
adam chinese, dita ture phosphate Sihydras, and wecrose}

Hurt a severe allergic Keaction after the Isto Ded duse nt the PFIZER vaccine? Q Oo

Mure allureyy ter Socrel, mega verdicts? Hora authena? Q Qo

= I vith allergy oe aattere will rennitoring tee putient for 90 menutes be a problern? Qo Lad

Huns haitery of bikading disorders ct currenty twhings anti ceuputanta

?

a a
- IT
avis biasing thistery or currieithy taking antiosaguiarts, ta thene a problern smcuting a gauge 23. 25 syringe tor injection? Qu Ld

Hons awn diwgraded with Multisyabern brfurnnancry Symedrorna (MISC) in ther past GO digg? Qo
i
Prewicurily aground vith Muhsin biflemenatery Sprelverter (WESC) ued in STU undtengiomnay recurve? gO
a
on SEP e160 rong DPS 100 fenklg WTI wiggree varied eof huarrtiegar?
teaser of BP
eyereptaorens
Q
erediton corguet
te HBR care ben taco, write MA" ie KES oahu inst required pores’ te waxscirnution
oO

menty aries DEP 2100 mets WETHOLT sigs and ayprnptons:

a
ot initially with SBP 2160 of urpan durage, fe There a problem matotualting bleed
Prague of PEO DO ment ater rrcrdtering tive Sint eviery CiNienn endartees?
@
Q
Miucritents: arty cee of The feollaveiteg aprigricers

a 2
a
a
Pewee! crwit Novagen Deathes a
a Meagache a Rachex a Shortrece of breath d#iculy in teething ob
a Cough 3 Fatigue a Nasnea! Woetng
a Culde 3a Weakwwes Otter sytytorna be aaieting comorbidity
Fégitte aoe
SS8ANe re oer
Recipies whe huss completa mentiteny SeeGer period WITHOUT
ck
Note: fave, beat 40d) with miied aymgnorrie, may be vaccinated

Huse hhanery of expusiey te & confirmed or sumpected OOVID 19 nase it tie past 14 deve? CG

previcualy dagnesed with COWL 19,

a recipient STILL undergsing vecewury of Ineatment?
o
Hira fetiiwer! ary wencite in the past 14 dave or plate plat te receive atotrer vectite 14 days following weescination? Oyj;yey;yo;o;o

c
Pura fox! Convwabiseent pirates oF Moco shal wttisa dies Tor COVID-
2 bt the past WD
deya? oa

tin the 1at timester of pregnancy, is There any oljectice te vaccination from Ihe priaenmed medical cheenance thom the wllending strysician?

bee arty of the todlaweing thadeagece of fenwith cherecrinng anty cl the Nallewin aeaaterert?
2 Active cance: twatrent for turner a of CBI fee blood
3 fing bareplrt mops MC taking me ticne to capnwss the enmune

|
rpites
a trangiart te. within the lant 2 pours OF taking meckcins t= gugprecs the bnimune ay sters
a Witt magecae cr pevere mamuredeboency jeuch at CiGecese ryncmese, Wichsty Aare? symdromet
a
a
Achvanced or untrwased HY ”
arent with high-coae conicoetenate DR other cruga tat Tiny auppress imrarw conporar
Qo

a Chahy aie
a TAN DeeaDe ang teatroest wtt apechic mmrmuncesno medica mie
a congriote ronaidend eqaWalent ta mmmunacorngEnmated Bta3 9
a Tor gerizarcieas OR Sewtooed reyocursean’ petcandin ater a doe of waccire mea
write areg oof thw abecmmertioned contador, then ery vaccum from medical clearance nwcsinat Q aT
1

co Gbjectian to pnicwerted pebar to ent dure?

Recipient's Name: Sex

Parent's! Legal Guardians Name: ‘wt [ing]: VACCINATE
Birthdate: Temp: if any of the white
homes is Chechen,
Signature of Health Worker HR: RA: Oz sat DEFER vaccination.
*
Pivace keen Ifa health acteenting for as oer! of the ceca’ offal meecovation wad enadical necond
ee
ae
ANNEX F. COVID-19 PEDIATRIC VACCINATION(12 - 17 YEARS OLD)
ADDITIONAL/ BOOSTER DOSE HEALTH ASSESSMENT SCREENING FORM FOR
PFIZER-BIONTECH (may be accessed through bit.ly/PediaBoosterForms)

—s
COVID-19 PEDIATRIC VACCINATION (12-17 YEARS OLD) ADDITIONAL/BOOSTER DOSE
HEALTH ASSESSMENT ALGORITHM FOR PFIZER

fed.
of the Phiippine Nationa! COWID-19 Vaccine Denioyment and Veccination Program as of June 20,
2022

bs ASSESS THE VACCINE RECIPIENT: Is the pationt any of the following? |

ee
ee
pa
ee
beer ig a aevaettneoR
elas ee
Pe ete Be Be
eog al cy
for imnnumeac ry

eeees
ees
tess than 8-4 months age
Pou Enon
te eee
tg
Pei uM Ri ds
Age < 12 years old

es
Masti

te
te sy

Ls
aeee ee ees Peay
aD ea
Lg
eee
Oe

me ee at
ig
bat eee

aaa gt Be ete Bo
DT

ad Pete Rhode | “43,9

:
UL PRECAUTIO

aa
;

rl
30 MINS
<4
- OBSERVE FOR
nO
F

at
I
: f
ane s

fk

USEGAUGE23-25. APPLY
no | |
veg
cued
|

FIRM PRESSURE.
cs
2
;

|
i

ho
tae eee |
at z otMukt ft
Meee drome Minty (MISC VES
‘caine
RESCHEDULE UNTIL FULL
RECOWERY FROM ILLNESS
AnD 9D DAYS AFTER

NG
With SSP e160 andor i
DEF 100 AND with wagres add aprrgtoeres:
Meadactw, bbstred whaion, conliueniot, saibore chee! paint, of
Nett Miauunacnnt! of 8P is not neyuind dedone maccieann
ster
eae
ateas ee WES
Deacmasre
REFER TO MD
‘isa ekidiel vis ent

Soe een
With SBP 2180 and/or DBP = 100 WITHOUT signs and syrmetams of
= engan damage, headache, blurred vaion, confusion, sexure, chest pain, YES
uu! shortness of breatn? -

a
;
=160/ 100 memkig
=
=

PROCEED if « 160/108 rmenitiig

= ctl, ba cacti
(Feet
i brmathieay,
Shptrgiov rants corey wore Dirael, Maligne, rirpad pea,
minmiss, ioae of arene,
=
hy,

Na diated, ahortresa of
o
beaatetdiTaoulty

2 ee ee mee ren non mempioms may cv

Nauemay vorreting) CR with other ayrrgaiantes: amivting Gorvcntsi city

Deo
oT REFER TO ME.
YES
= RESCHEDULE AFTER FULL
=z ed eaey

>
7 omit

RECOVERY

ha Has history of exposure to cocfirmed or suspected COWID-19 case im the

WES
om
past 14 days? RESCHEDULE AFTER
COMPLETION OF 14-DAY
QUARANTINE
ho Has been vaccinated in the pas! 14 days or plans te recene amother
WES
wacone 14 days following vaccination? RESCHEDULE AFTER 14-Day
a . INTERVAL FROM OTHER
VAICCEME
wo Has been previously dhagnesed for COWED-19 AND ic still undergoing
tre2tnent! recowery? ¥ES RESCHEDULE AFTER
r
— ABCOVERY OR TREATMENT
MPLETSON
ho Has wed
plasma oer sonia! anteb:

for
af vES
inthe past 90 days?
COVIO-TS i

es MESCHEOULE AFTER
DAYS
90

~~ and in first pimesterof pregnancy?

ie hi
Pregnant YES
Hiea Lewes dhagrecaed with wry ef the teblowviengs
- RESICHEDULE
TRIMESTER
OF ow FIRST

.* Asearce a arated HY ntechor

*
Active cancer Seuqnent for koreans or cancers te bhawd
Ctgan trauplart reciente AND tatong medicine to mepprmes the eTerue tees
of!

* Sheers ell Reamangiiem recipe ree reebthen thw: boot 2

icrertaree ay nts peur DR tadeireg ereticdoes to muppet
° AIA madera or Mee Dray TT enntetachency (Dele ge mevdtarre Milckocst Aldrich
Aaiaes baaterat WES GET CLEARANCE FROM
mG
©
ith higfe-Goma cortionsteecice OA tear deaga tit ena magprest

. ireraree re
chtorec mponite - ATTENDING

ee ears
ie sinschilistanabtinl chalyeu
© WES autatnmane churaee and taatrrane with apacitc inmrunceuppemnutes medications PEDIATRICIAN,
. GT RON AD ONE QE RAE RD TTT UOC Doren RUEH Be
PHYSICIAN
* Wyocandin or garcunditn OF cevringed wyccandines pertnwtite: afer a rime
doay of
* AND was net cleaned
by attendiny peckanician) physician prior te weccinadian?