Screen Reader Mode Icon Check SCREEN READER MODE to make this survey compatible with screen readers. Philippines COVID-19 Vaccines Outcomes and Experiences Basic information about you and your experiences with COVID-19 Vaccination This questionnaire is being disseminated by the Lunas Pilipinas Coalition to collect data that will help us understand the COVID-19 vaccination experience in the Philippines and assess the government's pandemic response. You may answer this questionnaire for yourself or for others (for example, your children, a relative, friend, employee, acquaintance, or other loved one), whether you are vaccinated or unvaccinated. We will first ask basic questions to get to know you. Then we will ask specific questions related to COVID-19 vaccination and your experience with it. Please answer all questions with regards to your current situation. Feel free to make comments in the provided comment boxes. If you are answering this questionnaire on behalf of others, please use 1 questionnaire per person. Thank you for your time and consideration in answering this questionnaire. The information that you have provided will help ensure that we learn from the pandemic experience. OK Question Title * 1. I am answering this questionnaire ... For myself For someone else OK Question Title * 2. What is your province? OK Question Title * 3. What is your city? OK Question Title * 4. What is your age? 0-11 12-17 18-29 30-39 40-49 50-59 60-69 70-79 80+ OK Question Title * 5. What is your sex at birth? Male Female Prefer not to answer OK Question Title * 6. What is your education level? No Formal Education Up to grade school Grade school graduate (or equivalent) Up to high school High school graduate (or equivalent) Up to college College graduate (or equivalent) Masters/Doctorate/Graduate studies Other (please specify) Other (please specify) OK Question Title * 7. What is your current occupation / employment status? Home Maker / Stay at home mother / father Unemployed / Not Looking for work / Unfit for work Unemployed / Looking for work / Fit for work Employed by Others Self Employed / Own Business Student Retired Other (please specify) Other (please specify) OK Question Title * 8. How many doses of Covid-19 Vaccine have you taken? Mark as many as applicable. One dose only (if you received Jansen single dose, please mark as "two doses only") Two (2) Doses only / Completed primary series (use this option if you received single dose Jansen Vaccine) Three (3) Doses Four (4) Doses Five (5) Doses Six (6) Doses Seven (7) Doses Eight (8) Doses Nine (9) or more Doses I am not vaccinated. If you are vaccinated, please indicate the brands of doses taken. OK Question Title * 9. Do you plan to take any further doses of Covid-19 Vaccine? Yes No Maybe, if required or recommended by health authorities Other (please specify) OK Question Title * 10. Please list the vaccine brands received, and date of receipt of each dose. (Please skip this question if you are not vaccinated.) OK Question Title * 11. Why did you take the COVID-19 vaccines? Check all those that are applicable, and comment to provide any explanation you would like to share. I believe the vaccines will prevent me from getting COVID-19. I believed the vaccine would prevent me from getting severe COVID-19. I believed the vaccine would prevent me from giving COVID-19 to other people (stop transmission). I was frightened of getting very sick with COVID-19. I took the vaccines to get ayuda, bonuses, and other incentives offered by my LGU for vaccination. My LGU/Barangay required vaccination. My employer required me to be vaccinated so I can continue working. My school/university required me to be vaccinated so I can attend school/study/do practicum/graduate. I needed to be vaccinated to travel internationally for work/leisure. My family and/or friends insisted that I be vaccinated to join family/community events. I am not vaccinated. Other (please specify) OK Question Title * 12. How pressured did you feel to take the COVID-19 Vaccines? (Note: Please answer this question even if you are not vaccinated.) Not at all pressured Slight pressure Moderate pressure High pressure Extreme pressure. I really felt that I had no choice. Other (please expound on your experience) OK Question Title * 13. Where were you vaccinated? Check all that apply. (Please skip this question if you are not vaccinated.) Local vaccination center Drive through vaccination center In a hospital / medical center At my home / health workers brought vaccination to me At my work / health workers brought vaccination to my workplace Other (please specify) OK Question Title * 14. When you were vaccinated, were you made aware that you might experience adverse effects/harm from the injections? (Please skip this question if you are not vaccinated.) Yes, I was informed for all the vaccinations I had. Yes, but only for some of the vaccinations I had. No, I was not informed for any of the vaccinations I had. Please explain. OK Question Title * 15. Do you know that there is a PhilHealth compensation/indemnity fund for persons who are injured or die after COVID-19 vaccination? (Please answer this question even if you are not vaccinated.) Yes No I have never heard of the PhilHealth COVID-19 indemnity fund. Please explain. OK Question Title * 16. Do you know that adverse effects/injuries/deaths from the COVID-19 vaccines can be reported to the Philippine Food and Drug Administration (FDA pharmacovigilance system)? Yes. No. I have never heard of the FDA pharmacovigilance system. Other (please specify) OK Question Title * 17. How has your health been after you received the COVID-19 vaccines? (Please skip this question if you are not vaccinated.) Much better than usual Better than usual The same Worse Much worse Please provide details about your health with symptoms, if possible. OK Question Title * 18. How would you describe the health issues you had after COVID-19 vaccination (if any)? (Please skip this question if you are not vaccinated.) I did not experience any side effects. Mild - I felt unwell but was able to do normal activities. Moderate - I felt unwell and was not able to do normal activities for some time. Severe - I was very unwell/bedridden/hospitalized/did not recover. Please explain. OK Question Title * 19. If your health has worsened since the vaccinations, please answer this question: Have you or your doctor reported this health problem/ adverse event to the Philippine FDA? (Please skip this question if you are not vaccinated.) Yes - I (or my doctor) filed a report No - I did not report because I did not want to draw attention to myself. No - I did not see any benefit or value in filing a report. I wanted to report, but I did not know how. I did not know there was a reporting system Other (please specify) OK Question Title * 20. Have you been infected with COVID-19? (Please answer this question even if you are not vaccinated.) Yes No Please specify. OK Question Title * 21. Please indicate how many times you were diagnosed as infected with COVID-19, and the month and year for each infection. If you are vaccinated, please indicate the month and year that you received each dose of the vaccine. OK Question Title * 22. Looking back, would you want to take the COVID-19 vaccines again the way you did? I am very glad I could be vaccinated. I am no longer sure whether I made the right choice. I would not take the vaccines. I am very glad that I am not vaccinated. Please explain. OK Question Title * 23. Please comment how you feel now about having received the COVID-19 vaccine. (If you are not vaccinated, please comment on how you feel about your decision to not be vaccinated.) OK Question Title * 24. Do you intend to receive further COVID-19 Vaccinations if the government recommends/requires it? Yes No Please explain your decision. OK Question Title * 25. Is there anything else you would like to share? Would you like to tell us your story? OK Question Title * 26. Do you or your loved ones need help in relation to any adverse effects that you have experienced from the COVID-19 vaccination? If you wish to be contacted, please indicate your name and contact details (mobile number, landline, email address, FB name) below. OK THANK YOU FOR ANSWERING THIS QUESTIONNAIRE.