RESEARCH INSTRUMENT
The Mabasa, Dupax del Norte Nueva Vizcaya Teenagers will be the respondents of this study.
DOSE POPULATION SAMPLE
Second Dose
Table 1 . Number of respondents in Mabasa, Dupax del Norte Nueva Vizcaya teenagers
vaccination.
Questionnaires
I. Profile: Be honest on answering the following questions.
Name:_______________________Date:_____ Sex:_________
Age:______
Before you answer the following statements below, you must first answer the following questions. Put
✅ on YES if you did and put ✅ on NO if you don’t.
Pre-existing Conditions
Pre-existing Conditions Yes No
None
Diabetes
Asthma
Allergy
Others
•Have you had any contact with anyone who has been diagnosed or suspected of the coronavirus?
Yes No
•Have you traveled to outbreak areas of the coronavirus disease in the past 14 days?
Yes No
II. Instructions: Answer the following statements below . Put YES if you experienced the
symptoms, NO if not.
Symptoms Yes No
1.Do you have fever(>37.6°C)?
2.Do you have shortness of
breath or difficulty of breathing?
