AEFI REGISTER (to be kept at PHC/cold chain point/sector or block PHC) (to be filled by ANMs once a week)

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)

1. Kindly follow the AFP Surveillance Calendar to identify week no.

2. Information of serious and severe AEFI should be shared weekly with the district along with the H-002 form
3. The details of non-serious AEFI are to be maintained at PHC/cold chain point/sector or block PHC and monthly cumulative data to be entered in
HMIS report
 Assessment of Minor AEFIs at the PHC level
(Format to be shared in the first week of every month to DIO)
To be filled by MO in charge

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

Any Aggregation or Clustering (Tick as appropriate) Possible reason Action proposed

A) Antigen wise and Batch wise - If antigen wise, does it exceed
expected reaction rate. Refer Table No. 1 (Yes /No)
B) Sub-centre wise/Vaccinator wise
C) Dose wise (First, Second, Booster Etc.)
D) Any other (e.g. usual minor event)

Name of In charge Medical officer- Signature-

Table No. 1

Local reactions Systemic reactions

Vaccine
Irritability, malaise and
(pain, swelling, redness) Fever > 38°C
systemic symptoms

BCG 90% – 95% – –

Hepatitis B Adults up to 15%, Children up to 5% 1 – 6% –

Hib 5 – 15% 2% – 10%

Measles/MR/MMR ~ 10% 5% – 15% 5% (Rash)

OPV None Less than 1% Less than 1%

Pertussis (DTwP) up to 50% up to 50% up to 55%

Tetanus/DT/aTd ~ 10% ~ 10% ~ 25