Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Week Name Name of Father’s Age Date of Name of Batch number of AEFI noted Category Entered
No of vaccine Name vaccination vaccines vaccines given (symptoms) (Serious/ Case in case
sub- given Severe/ seen by reporting
centre non- Mo/c form
serious) ( yes/no) ( yes/no)
Month Year:
Name of the BLOCK PHC/PHC in charge: Block Name:
Phone Number: District: Date:
Following table need to be filled up after reviewing AEFI register of respective month. Tabulate the data for minor AEFIs listed in respective month.
Distribution of Minor AEFIs line listed in AEFI register as per their clinical presentation
Name of PHC Systemic Any other
Fever <39 Localised Localised
/Sub Centre degree
Local Swelling
Pain Redness
Irritability Malaise symptoms unusual MINOR
( ex. Fatigue etc ) events
Total
Vaccine
Irritability, malaise and
(pain, swelling, redness) Fever > 38°C
systemic symptoms