Health Care Providers Fact Sheet Version 1

These recommendations will be updated based on most recent evidence.

INTERIM
AEFI MANAGEMENT
PATHWAYS
For Healthcare Providers
Version 1

DEVELOPED BY: REVIEWED BY:

Department of Health - Disease Prevention and Control Bureau Department of Health - Public Health Services Team || Philippine Heart Association (PHA) || Philippine Society of Hypertension (PSH) || Philippine Society of Allergy, Asthma,
and Immunology (PSAAI) || Philippine College of Hematology and Transfusion Medicine (PCHTM) || Philippine Society of Microbiology and Infectious Diseases (PSMID)
INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

AEFI MANAGEMENT CLINICAL PATHWAYS

The Interim AEFI Management is a continuing project of the Department of Health Disease Prevention and Control Bureau initiated to formulate clinical pathways on adverse
events following immunization management that include primary care services and proper referral before, during, and after vaccination. As the country moves forward with its
national vaccination deployment program, the development of support tools to field implementers will optimize patient safety and healthcare service delivery quality. This material
is based on global and local clinical evidence and recent COVID-19 consensus from technical working groups and medical societies.

Different stakeholders and experts are encouraged to review the fact sheets and algorithms for improvement. The first versions were started by the core team of DOH DPCB and
were subjected to experts for vetting. These recommendations are subject to change in the future and will be updated based on the most recent evidence available.

Field implementers, end-users, and other stakeholders are encouraged to comment and send their feedback through dpcbcovid@doh.gov.ph.

The Interim AEFI Management - Health Care Providers Fact Sheet is divided into:

5 TYPES OF REACTIONS
Localized reactions
The definitions, management, and referral criteria for specific types of
Systemic reactions AEFI are provided as generally based on various references namely:
Locally available clinical guidelines and established manual of
procedures on AEFI management
Allergic reactions
Published consensus and opinions of COVID-19 task force,
experts, and technical working groups
Neurologic reactions Position statements of medical societies
International Public Health institutions and organizations
Hematologic reactions

DEVELOPED BY: REVIEWED BY:

Department of Health - Disease Prevention and Control Bureau Department of Health - Public Health Services Team || Philippine Heart Association (PHA) || Philippine Society of Hypertension (PSH) || Philippine Society of Allergy, Asthma,
and Immunology (PSAAI) || Philippine College of Hematology and Transfusion Medicine (PCHTM) || Philippine Society of Microbiology and Infectious Diseases (PSMID)

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INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

HEALTH CARE PROVIDERS FACT SHEET

Administering any medication, including vaccines, has the potential to cause an adverse event. This material is intended for health care providers to serve as a guide on distinguishing the type of reaction
and appropriate management and actions once encountered BEFORE, DURING, and AFTER (days and may extend to months) vaccination in the primary care setting. When adverse events occur, they can
vary in terms of seriousness, frequency, and severity. Since these reactions are based on the most common AEFIs reported in clinical trials and in the context of a short timeframe, management can still
vary, and usage of clinical judgment based on the patient’s clinical history and physical findings is highly encouraged. Symptoms are non-specific and may be due to other conditions (i.e., COVID-19);
hence, epidemiological link and symptoms must be well correlated. These recommendations may change in the future and will be updated with new guidelines and available data.

VACCINATION SITES AEFI REPORTING

Health care providers shall appropriately manage patient's conditions according to clinical
assessment regardless of the seriousness or causality of the AEFI.
If a health care provider sees that the patient warrants further evaluation and clinical
Adverse Events Following Immunization are any untoward medical occurrence which
management, referrals shall be coursed through the respective health care provider networks
follows immunization, and which does not necessarily have a causal relationship with the
within their locality.
usage of the vaccine.
All vaccination sites shall ensure that proper and appropriate guidance is communicated to and
All health care providers shall proactively detect AEFIs by asking for vaccination history
understood by each vaccine recipient regarding the contact information or health facilities for
among all patients seen, and classify seriousness based on established definitions
the vaccine recipient's primary referral in case of health emergencies outside the vaccination
Upon detection, all health care providers shall accomplish the case investigation form (CIF)
site.
for AEFI, as downloadable from bit.ly/CIF-2021
All vaccination sites shall prepare for AEFIs during the vaccination proper in terms of human
Please refer to AEFI guideline on the next page for more details.
resource capacity, medications and commodities, as recommended by clinical practice
guidelines and expert recommendations.

RECOMMENDATIONS COMMUNITY IMMUNIZATION

To identify sources of information and their corresponding bases, the statements and
recommendations found on this fact sheet are sub-categorized into four: BENEFIT AND RISK COMMUNICATION AND COUNSELING
Eligible vaccine recipients should be thoroughly informed and counseled about the
EVIDENCE-BASED RECOMMENDATIONS (EBR) benefits of and risks from vaccines using culturally sensitive language and at an
Local Clinical Practice Guidelines, Established Manual of Procedures appropriate educational level. Opportunity for questions should be provided before
each vaccination.
CONSENSUS-BASED RECOMMENDATIONS (CBR) PREVENTING ADVERSE REACTIONS
Experts, Technical Advisory Groups To minimize the likelihood of an adverse event, screen patients for vaccine
contraindications and precautions prior to vaccination.
PRACTICE-BASED RECOMMENDATIONS (PBR) PREPARATION
Position statements (i.e. Medical Societies) Health care providers administering vaccines should follow appropriate precautions to
minimize risk for disease exposure and spread. Hands should be cleansed with an
FOREIGN-BASED RECOMMENDATIONS (FBR) alcohol-based antiseptic hand rub or washed with soap and water before preparing
International sources (i.e. CDC, WHO) vaccines for administration and between each patient contact.
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INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

AEFI GUIDELINES OPERATING GUIDELINES

Further operational guidance in defining seriousness that would merit reporting, investigation and causality assessment:
REPORTING GUIDELINES
AEFI: Classified as SERIOUS if:
For MINOR or NON-SERIOUS AEFIs:
AEFIs that result in Health care provider examining the patient suspects that the drug resulted in or contributed to death.
All health care providers shall only be required to fill out all fields
death
on page 1 of the CIF.
AEFIs that result in (1) the health care provider examining the patient suspects that the AEFI resulted to admission of the patient
hospitalization to the hospital or prolongation of hospitalization of the patient; AND
For SERIOUS AEFIs: (2) the admission is considered medically justified to deliver active medical or surgical intervention, and not
All health care providers shall be required to fill out page 1 just observation or medical monitoring.
immediately for initial notification and reporting purposes, without For AEFIS detected in emergency visits that do NOT result in admission to the hospital; OR observation or
compromising provision of patient care. For the subsequent pages, medical monitoring are the activities performed, the AEFI should be evaluated for the other definitions.

health care providers, local and regional epidemiology and AEFIs that result in Health care provider examining the patient suspects that the AEFI resulted in a substantial disruption of a
persistent or significant person's ability to conduct normal activities of daily living, specifically in significant, persistent or permanent
surveillance units (ESU) shall cooperate and collaborate to
disabilty change, impairment, damage or disruption in the patient's body function/structure, physical activities and/or
comprehensively complete the other pages. quality of life.
Immediate notification shall be done to the respective Local AEFIs that result in (1) the exposure is prior to conception or during pregnancy; AND
Vaccine Operation Center and/or Local Epidemiology and Congenital Anomaly or (2) the health care provider examining the patient suspects that the drug resulted to a congenital anomaly or
Birth Defect birth defect.
Surveillance Unit, and Regional Vaccine Operation Center and/or
AEFIs that are Health care provider examining the patient suspects that the patient was at substantial risk of dying at the
Regional Epidemiology and Surveillance Unit based on locally set considered to be life- time of the adverse event.
or regionally set mechanisms. threatening
All local ESUs and hospitals ESUs shall update their respective AEFIs that require
(1) the health care provider examining the patient suspects that medical or surgical intervention was
RESUs or their representatives designated by the CHDs by intervention to prevent
necessary to preclude permanent impairment of a body function, or prevent permanent damage to a body
any of the
submitting updated CIFs and informing of the latest clinical status, structure; AND
abovementioned
investigation status, and other pertinent information on a daily (2) either situation is suspected to be due to the exposure.
outcomes
basis.

All hospitals, through their designated hospital Epidemiology and When further clarity is needed to define the seriousness of an AEFI, the Regional Epidemiology and Surveillance Unit shall have the
Surveillance Units, shall encode page 1 of the CIF from all newly authority to provide immediate guidance and classification of seriousness of the AEFI, as referred by the inquiring health care provider.
detected AEFIs within their institution directly to VigiFlow at The health care provider examining the patient must confer first with the RESU within their region for AEFIs that they may have doubts
on the classification of seriousness.
vigiflow.who-umc.org before 6:00 PM of each day, including weekend
The RESU, upon application of the above guidelines, and their judicious understanding of the case, may provide the classification as to
and holidays. seriousness.
The RESU shall regularly inform the Epidemiology Bureau of (1) these specific cases; (2) the decisions made as to classification of
seriousness; and (3) considerations taken to give rise to these decisions
The Epidemiology Bureau shall regularly review the submissions of the RESUs for harmonization and further standardization of the
criteria for seriousness of AEFIs.

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INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

TABLE OF CONTENTS
LOCALIZED REACTIONS 6

Pain, Redness, or Swelling

Arthralgia 6
Injection Site Abscess 6

SYSTEMIC REACTIONS 7

Hypotension 7
Hypertensive Emergency 7
Hypertensive Urgency 7
Dizziness 7
Fever 8
Myalgia 8
Fatigue 8
Nausea/ Vomiting 8

ALLERGIC REACTIONS 9

Anaphylaxis 9
Allergic Skin Reactions 11

NEUROLOGIC REACTIONS 12

Convulsions/ Seizures 12
Headache 12
Vasovagal Syncope 13

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INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

TABLE OF CONTENTS
HEMATOLOGIC REACTIONS 14

Vaccine Induced Thrombotic

Thrombocytopenia (VITT) 14
COVID-19 Vaccine-Associated Immune
Thrombocytopenia (ITP) 15

ALGORITHMS 16

Localized Reactions
Pain, Redness, or Swelling Pathway 16
Arthralgia Pathway 16
Injection Site Abscess Pathway 17
Systemic Reactions
Dizziness/ Hypotension Pathway 18
Elevated BP Pathway 19
Other Systemic Reactions Pathway 20
Allergic Reactions
Anaphylaxis Pathway 22
Allergic Skin Reactions Pathway 23
Neurologic Reactions
Convulsions/ Seizures 24
Headache 25
Vasovagal Syncope 26
Hematologic Reactions
Vaccine Induced Thrombotic
Thrombocytopenia (VITT) Pathway 27
COVID-19 Vaccine-Associated Immune
Thrombocytopenia (ITP) Pathway 28

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 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

LOCALIZED REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
Over the counter medications (ibuprofen, acetaminophen, antihistamine) can be prescribed
Pain, redness or swelling at the injection site that
PAIN OR REDNESS Application of clean, cool, wet cloth over the area If reaction persists for more than 7 days, refer to
Extends past the nearest joint or
OR SWELLING Use or exercising the arm. the higher level of care.
Persist for 0-7 days
Increase oral fluid intake. EBR [DOH-AEFI Manual]
FBR [Brighton Collaboration]
FBR [CDC]

Joint pain usually includes small peripheral joints If reaction persists and interferes with daily
May give analgesics
ARTHRALGIA Persistent: lasting longer than 10 days activities, refer to the higher level of care.
Encourage gentle movement of the joint(s) involved to prevent stiffness
Transient: 10 days or less EBR [DOH-AEFI Manual]
FBR [NCRIS]
EBR [DOH-AEFI Manual]

Incise and drain abscess

Outpatient
No diabetes or immunosuppression, boil or smaller abscess (<2cm in diameter)
Incision and drainage only are usually effective
Hot packs are helpful For abscess larger (>2cm in diameter within an
No need for antimicrobial therapy
Fluctuant or draining fluid-filled lesion at the area of erythema of >5cm) or multiple
Larger (>2cm in diameter within an area of erythema of >5cm) or multiple abscesses or
site of injection abscesses or systemic inflammatory response
systemic inflammatory response
INJECTION SITE Bacterial: with evidence of infection e.g. and there is no supply of recommended
Incision and drainage PLUS one of the following:
ABSCESS purulent, inflammatory signs, fever, culture antibiotics and diagnostics on site
Clindamycin 300-450 mg (higher dose in obese patient, BMI >40) PO TID x 5-10 days OR
Sterile: no signs/symptoms as above Cotrimoxazole 160/800mg (1 double strength (DS) tablet; 2 DS in obese patient, PO BID May refer to the higher level of care and
EBR [DOH-AEFI Manual] x 5-10 days OR treat as inpatient.
Doxycycline 100 mg PO every 12 hours x 5-10 days (may also be effective for community EBR [DOH-RITM]
acquired MRSA infections)
If no response after 2-3 days, follow-up exudate culture and sensitivity (C/S) results and
shift to culture-guided antibiotic therapy, or if C/S results not yet available shift to
another first-line antibiotic.
EBR [DOH-RITM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
National Centre for Immunisation Research and Surveillance, Australia. July 2019. Injection Site Reactions Information Sheet
PBR PRACTICE BASED RECOMMENDATION Department of Health - Research Institute of Tropical Medicine. 2017. National Antibiotic Guidelines.
Brighton Collaboration. 2004. 6
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

SYSTEMIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
May be absolute (e.g. sBP <90 mmHg, mean
Consider anaphylaxis (refer to major and minor criteria of anaphylaxis)
HYPOTENSION arterial pressure <65 mmHg) , or relative (e.g. a Refer to the EMERGENCY ROOM IMMEDIATELY
Secure IV access and may initiate infusion of 2 to 3 liters of 0.9% NaCl in 10-20 minutes
drop in sBP >40 mmHg) FBR [UpToDate]
Refer to the EMERGENCY ROOM IMMEDIATELY
FBR [UpToDate]
FBR [UpToDate]

Elevations of the sBP >180 mmHg and/or dBP

>120 mmHg WITH symptoms of target organ
HYPERTENSIVE damage or hypertensive-mediated organ damage Refer to the EMERGENCY ROOM IMMEDIATELY Refer to the EMERGENCY ROOM IMMEDIATELY
EMERGENCY such as Acute Coronary Syndrome, Heart failure, PBR [PHA-PSH] PBR [PHA-PSH]
Stroke and Acute kidney injury
PBR [PHA-PSH]

May proceed with vaccination, but observe client for 30-60 minutes post-vaccination to monitor
for evolving signs or symptoms of hypertensive emergency, as well as hypotension (anaphylaxis)
Elevations of the sBP >180 mmHg and/or dBP
Have the patient relax in a comfortable environment, do deep breathing exercises, or allow the If with evolving signs and symptoms of
<120 mmHg WITHOUT symptoms of target organ
HYPERTENSIVE patient to void. Re-check BP reading after 30 minutes. If previously diagnosed Hypertensive,
damage or hypertensive-mediated organ damage hypertensive emergency, refer to the
URGENCY adjust or resume medication if with poor compliance. If no previous diagnosis of hypertension,
such as Acute Coronary Syndrome, Heart failure, EMERGENCY ROOM IMMEDIATELY
may start medication with Renin-Angiotensin-Aldosterone System inhibitor, Calcium channel
Stroke and Acute kidney injury PBR [PHA-PSH]
blocker, or in combination; Calcium channel blocker for reproductive women
PBR [PHA-PSH]
Counsel to seek further consultation for proper work-up in the soonest possible time
PBR [PHA-PSH]

Dizziness can be lumped into four categories of

symptoms:
Rule out anaphylaxis (Amended NIAID/FAAN criteria for the diagnosis of anaphylaxis)
Vertigo - a sensation of movement, whirling, or
The most common category of dizziness is vertigo. Distinguish vertigo from other forms of
feeling of off-balance
dizziness.
Disequilibrium - feeling of unsteadiness or
Vertigo is:
impending fall that occurs primarily when
Never continuous for more than a few weeks If persistent despite medication, refer to the
walking
Occurs spontaneously, while others are precipitated by maneuvers that change head position higher level of care
DIZZINESS Presyncope - sense of feeling faint or on the
or middle ear pressure e.g. coughing, sneezing, or Valsalva maneuvers EBR [DOH-AEFI Manual]
verge of losing consciousness
Worsens by moving the head
Lightheadedness - usually nonspecific but can
Generally accompanied by nystagmus and postural instability
refer to feeling disconnected from the
Reassure and establish a supportive environment. Acute vertigo may be given symptomatic
environment or sometimes may refer to
treatment e.g. 1st generation antihistamines or antiemetics, if necessary
spinning sensation FBR [UpToDate]
FBR [UpToDate]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
UpToDate Inc. 2011-2021
PBR PRACTICE BASED RECOMMENDATION
Philippine Heart Association and Philippine Society of Hypertension. 2021. Algorithm on the Management of Blood Pressure Elevation Before and After Vaccination
7
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

SYSTEMIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
Endogenous elevation of at least one measured
body temperature of ≥ 38 C If fever does not resolve after 3 days with
FEVER May treat symptomatically with Paracetamol treatment or with extremely high temperature
Mild: 38 C to 38.9 C
EBR [DOH-AEFI Manual]
High: 39 C to 40.4 C Refer to the higher level of care
Extreme: 40.5 or higher EBR [DOH-AEFI Manual]
EBR [DOH-AEFI Manual]

Treat symptomatically as needed with acetaminophen, NSAIDs and/or muscle relaxant, if

If symptoms persist and interfere with daily
Muscle pain and soreness necessary
MYALGIA activities, refer to the higher level of care
FBR [UpToDate]
FBR [UpToDate] ]
FBR [UpToDate]

Difficulty or inability to initiate activity (subjective

Reassure client and establish supportive environment If symptoms persist and interfere with daily
sense of weakness); reduced capacity to maintain
FATIGUE activities, refer to the higher level of care
activity (easy fatigability) FBR [UpToDate] FBR [UpToDate] ]
FBR [UpToDate]

The unpleasant sensation of being about to vomit, Rule out anaphylaxis (Ammended NIAID/FAAN criteria for the diagnosis of anaphylaxis) If symptoms persist, or if with signs and
can occur alone or can accompany vomiting (the For nausea, may treat with oral antiemetics, metoclopramide, if necessary symptoms of moderate to severe dehydration,
NAUSEA/ VOMITING forceful expulsion of gastric contents) For vomiting, give oral rehydration salts for volume per volume replacement to prevent refer to the higher level of care
Severe enough to interfere with daily routine dehydration FBR [UpToDate] ]
FBR [UpToDate] FBR [UpToDate]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
PBR PRACTICE BASED RECOMMENDATION UpToDate Inc. 2011-2021
8
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

ALLERGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
If the patient presents the defined symptoms and within the level of diagnostic certainty,
Anaphylaxis is highly likely when one of the
following 2 criteria are fulfilled: 1. URGENTLY
Acute onset of an illness (minutes to several Put the patient in reclining position with legs up
hours) with simultaneous involvement of the Administer Epinephrine (Adrenaline)
skin, mucosal tissue, or both (e.g., generalized 0.5 mL per dose, intramuscularly ONLY on mid-outer thigh even through clothing, OR
hives, pruritus or flushing, swollen lips-tongue- 0.3 mg in auto-injector, intramuscularly ONLY on mid-outer thigh even through clothing
uvula) AND AT LEAST ONE OF THE 2. THEN
FOLLOWING: Secure IV access and start infusion with 0.9% NaCl (10-20 mL/min) If symptoms did not resolve after the execution
Respiratory compromise (e.g., dyspnea, Clear the airway of management steps 1 and 2
wheeze-bronchospasm, stridor, reduced Administer OXYGEN via face mask (at least 10 LPM) Call emergency assistance and refer to the
PEF, hypoxemia) Administer GLUCOCORTICOID (Hydrocortisone 200 mg IV)
ANAPHYLAXIS higher level of care.
Reduced BP or associate symptoms of Administer ANTI-HISTAMINE (e.g. Diphenhydramine 50 mg IV)
Perform conditional management steps 4, 5,
end-organ dysfunction (e.g., hypotonia Monitor vital signs**
and 6 in the previous box (MANAGEMENT)
[collapse], syncope, incontinence) 3. IF RESOLVED
Severe gastrointestinal symptoms (e.g., Discharge 4-8 hours after full resolution of symptoms
PBR [PSAAI]
severe crampy abdominal pain, repetitive Refer and advise follow-up to allergy service for consult as outpatient.
vomiting), especially after exposure to non-
**IF NOT RESOLVED,
food allergens
Acute onset of hypotension or bronchospasm
4. IF blood pressure drops
or laryngeal involvement after exposure to
Infuse 2000-3000 mL of 0.9% NaCl intravenously in 10-20 minutes
known or highly probable allergens for that
5. IF no improvement in 5-10 minutes
patient (minutes to several hours), even in the
REPEAT EPINEPHRINE INTRAMUSCULARLY
absence of typical skin involvement.
6. IF with bronchospasm
Give salbutamol MDI
FBR [Brighton Collaboration, WAO]
4-10 puffs via large volume spacer
PBR [PSAAI]

EBR EVIDENCE BASED RECOMMENDATION

LEGEND

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION Brighton Collaboration. 2004
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
World Allergy Organization. 2020. World Allergy Organization Anaphylaxis Guidance.
9
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

ALLERGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
MAJOR
ANAPHYLAXIS** Generalized urticaria (hives) and generalized erythema
Dermatologic
Angioedema, localized or generalized
Anaphylaxis is rare but or mucosal
potentially life threatening
Generalized pruritus with skin rash
allergic reaction occurring 0-24
hours after immunization. It is a Measured hypotension
clinical syndrome characterized Clinical diagnosis of uncompensated shock, indicated by the
by sudden onset, rapid Cardiovascular combination of at least 3 of the ff:
progression of signs and
tachycardia
symptoms, and involving
multiple (≥2) organ systems as capillary refill time >3 sec
follows: reduced central pulse volume
LEVEL 1 of diagnostic
certainty Bilateral wheeze
≥ 1 major dermatological Stridor
AND
Upper airway swelling (lip, tongue, uvula, larynx)
≥ 1 major cardiovascular
AND/OR ≥1 major Respiratory Respiratory distress - 2 or more of the ff:
respiratory criterion tachypnea
LEVEL 2 of diagnostic increased use of accessory respiratory muscles
certainty
recession
≥ 1 major cardiovascular
AND ≥1 major cyanosis
respiratory criterion grunting SEE PREVIOUS PAGE SEE PREVIOUS PAGE
≥ 1 major cardiovascular
OR ≥1 major MINOR
respiratory criterion AND Generalized pruritus without skin rash
≥ 1 minor criterion Dermatologic Generalized prickly sensation
involving ≥1 different
or mucosal Localized injection site urticaria
system (other than
cardiovascular or respiratory Red and itchy eyes
systems) OR
Reduced peripheral circulation as indicated by the combination of at
(≥ 1 major dermatologic)
AND (≥1 minor least of 2 of:
Cardiovascular
cardiovascular AND/OR minor tachycardia and a capillary refill time >3 sec without hypotension
respiratory criterion) a decreased level of consciousness
LEVEL 3 of diagnostic
certainty Persistent dry cough
≥ 1 minor cardiovascular Hoarse voice
OR ≥1 respiratory
Respiratory Difficulty breathing without wheeze or stridor
criterion AND **This reference is based on Brighton Collaboration
≥ 1 minor criterion of Sensation of throat closure
and will serve as an additional reference. The
each of ≥2 different Sneezing, rhinorrhea
systems/categories algorithm below (page 22) is based on the definition
Diarrhea of the World Allergy Organization (previous page) and
Check major and minor criteria Abdominal pain
Gastrointestinal was used as the main reference for the definition of
below: Nausea
FBR [Brighton Collaboration] anaphylaxis.
Vomiting FBR [Brighton Collaboration]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION Brighton Collaboration. 2004
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
World Allergy Organization. 2020. World Allergy Organization Anaphylaxis Guidance.
10
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

ALLERGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
An allergic reaction of the skin including any one of
Rule out anaphylaxis (Ammended NIAID/FAAN criteria for the diagnosis of anaphylaxis)
the following: urticaria (hives), erythema, pruritus,
Give antihistamines (oral/IV), glucocorticoids (oral/IV), and observe for 4 hours
prickly (or tingling) sensation, localized or If symptoms did not resolve, refer to the higher
ALLERGIC SKIN Secure IV line if medication will be given intravenously
generalized edema (in the deeper layers of the level of care.
REACTION Discharge 4-8 hours after full resolution of symptoms
skin, subcutaneous tissues or mucosa lining the PBR [PSAAI]
Refer and advise follow-up to allergy service for consult as outpatient.
throat, airways and gut) ONLY
PBR [PSAAI]
FBR [BC CDC]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
Brighton Collaboration. 2004.
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
BC Centre for Disease Control. 11
FBR FOREIGN BASED RECOMMENDATION World Allergy Organization. 2020. World Allergy Organization Anaphylaxis Guidance.
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

NEUROLOGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
Lay patient on his/her side. DO NOT try to hold down the patient. Keep sharp objects away to avoid
other injuries
Provide supportive care
Oxygen support
Secure IV access as much as possible
Benzodiazepine for initial treatment
Intravenous
Lorazepam 0.1 mg/kg (maximum 4mg); maximum cumulative adult dose 8mg, OR
Diazepam 0.15 - 2 mg/kg (maximum 10mg); maximum cumulative adult dose 20mg, OR
Clonazepam 0.015 mg/kg (maximum 1mg); maximum cumulative adult dose 2mg
Occurrence of generalized convulsions that are not Refer to the EMERGENCY ROOM IMMEDIATELY
All can be repeated after 5 minutes if no effect observed, up to the maximum cumulative
CONVULSIONS/ accompanied by focal neurological signs or FBR [British Epilepsy Association]
dose stated
SEIZURES symptoms
Non-intravenous
EBR [DOH AEFI Manual]
Midazolam IM/IN/buccal 10mg; 5mg in elderly or <40kg (maximum cumulative adult
dose 20mg, 10mg <40kg), OR
Diazepam 10mg rectal; 5mg in elderly or <40kg, OR
Lorazepam intranasal 4mg; 0.1mg/kg <40kg
All can be repeated after 10 minutes if no effect observed, up to the maximum
cumulative dose stated
NOTE: All benzodiazepines can cause respiratory depression, sedation and hypotension at
higher doses and in susceptible patients
Refer to the EMERGENCY ROOM IMMEDIATELY
FBR [British Epilepsy Association]

Pain in any region of the head and may occur on

one or both sides of the head, be isolated to a
certain location, radiate across the head from one
point, or have a viselike quality. A headache may
appear as a sharp pain, a throbbing sensation, or a
dull ache. Refer to the EMERGENCY ROOM IMMEDIATELY if identified as a headache needing emergency
Refer to the higher level of care if persistent
Headache needing EMERGENCY EVALUATION evaluation
despite medications
Sudden onset "thunderclap" If classified an a non-emergency case, provide supportive care.
HEADACHE
Acute or subacute neck pain or headache with Treat symptomatically with Paracetamol.
FBR [British Epilepsy Association]
Horner syndrome and/or neurologic deficit FBR [UpToDate]
Suspected meningitis or encephalitis
With global or focal neurologic deficit or
papilledema
With orbital or periorbital symptoms
With possible carbon monoxide exposure
FBR [UpToDate]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
British Epilepsy Association. 2019. Medical Management of Status Epilepticus: Emergency Room to Intensive Care Unit
PBR PRACTICE BASED RECOMMENDATION
UpToDate Inc. 2011-2021
12
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

NEUROLOGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA

Prevent injuries
Differentiate fainting attack from anaphylaxis

Clinical Features Fainting Anaphylaxis

Timing Before, during, or few minutes A short time, up to few hours

after injection

Skin Generalized pallor, cold Itching, generalized erythema,

clammy skin urticaria, swelling of lips, face,
tingling around lips

Respiratory Normal or shallow breathing Tachypnea, difficulty in breathing,

wheezing, stridor, hoarseness,
cyanosis, recession of intercostal
spaces

Cardiovascular Bradycardia, weak pulse, Tachycardia, weak pulse, carotid Refer to the higher level of care if persistent
Fainting episode as body reacts to various triggers
VASOVAGAL carotid pulse felt, reversed by pulse may be weak, hypotension despite supportive treatment and reassurance.
before, during, or after vaccination, perhaps triggered
supine position not reversed by supine position EBR [DOH-AEFI Manual]]
SYNCOPE by pain or emotional reaction to immunization
process itself
FBR [UpToDate, CDC] Gastrointestinal Vomiting Vomiting, diarrhea, abdominal
cramps

CNS Faintishness, lightheadedness, Anxiety and distress, loss of

relieved by supine position consciousness not relieved by
supine posture

Panic attack: No hypotension, pallor, wheeze, or urticarial rash or swelling. May have flushing or
blotchy skin

IF identified as fainting attack

Provide reassurance
Have patient sit or lie down.
Loosen any tight clothing and maintain open airway
Apply cool, damp cloth to patient's face.
Keep patient under close observation until full recovery.
EBR [DOH-AEFI Manual]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION British Epilepsy Association. 2019. Medical Management of Status Epilepticus: Emergency Room to Intensive Care Unit
PBR PRACTICE BASED RECOMMENDATION UpToDate Inc. 2011-2021
US CDC 13
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

HEMATOLOGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA
Ask patient about COVID-19 vaccine history and note the date that they received the doses, if any
Draw a complete blood count (CBC)
If platelet count is equal or less than 150 x 1,000,000,000 / L, AND their symptoms occur within
28 days after the COVID-19 vaccination, screen for VITT
Suspect VITT patients need to be referred to a higher level of care for further testing:
D-dimer
fibrinogen levels
Blood films to confirm thrombocytopenia
Platelet factor 4 (PF4) antibody assay (ELISA Heparin-Induced Thrombocytopenia (HIT)
assay)
A condition of blood clots associated with low
Imaging (e.g. CT or MRI) to rule out in particular CVST
platelet counts, that occurs following receipt of the
Functional platelet activation assay
vaccine
Cases are often characterized also with very raised D-Dimer levels (>4000 mcg/L or more than 4x
Most cases occurred 4 to 28 days after receipt of a
the threshold) above the level expected for VTE and many develop low fibrinogen levels
vector vaccine such as Astrazeneca or J&J
Antibodies to PF4, as detected by ELISA HIT assay, have also been identified in this syndrome
May present with cerebral sinus vein thrombosis
Secondary/ Tertiary Care:
(CSVT), or with other arterial or venous clots
DO NOT GIVE HEPARIN
VACCINE-INDUCED Clinical Presentation
Platelet transfusions are not recommended unless a life-threatening hemorrhage is present
Persistent and severe headache Refer to the higher level of care immediately
THROMBOTIC (or patient requires urgent surgery)
Focal neurological symptoms FBR [United Nations]]
THROMBOCYTOPENIA Consult a hematologist
PBR [PCHTM]
Seizures, or blurred or double vision (suggesting
(VITT) Give intravenous immunoglobulin 0.5 – 1.0g/kg/day for 2 days for severe or life-threatening
CSVT or arterial stroke)
clots, if available. Further, IVIG may require balancing bleeding and thrombotic risk
Shortness of breath or chest pain (suggesting
Start Steroids (Methylprednisolone 1mg/kg)
pulmonary embolism or acute coronary
Use first line anticoagulants: direct oral anti-Xa inhibitors (e.g. rivaroxaban, apixaban,
syndrome)
edoxaban), direct thrombin inhibitors (argatroban, bivalirudin), indirect (anti-thrombin-
Abdominal pain (suggesting portal vein
dependent) Xa inhibitors (danaparoid) or Fondaparinux
thrombosis)
Until VITT has been ruled out, anticoagulation with heparin (both unfractionated heparin and
Limb swelling, redness, pallor, or coldness
low molecular weight heparins) should NOT be given
(suggesting deep vein thrombosis or acute limb
Vitamin K antagonist (warfarin) is contraindicated during acute severe thrombocytopenia and
ischemia)
disseminated intravascular coagulation
FBR [United Nations]
Consider instituting early therapeutic plasma exchange or fibrinogen substitution to >1.0 g/L
if platelet count remains below 30 x 1,000,000,000/L despite IVIG and steroids or fibrinogen
level is less than 1 g/L
Specialized guidance available at: UK: Guidance Produced from the Expert Haematology
Panel (EHP) focused on Covid-19 Vaccine induced Thrombosis and Thrombocytopenia
(VITT) https://b-s-h.org.uk/media/19530/guidance-version-13-on-mngmt-of-thrombosis-with-
thrombocytopenia-occurring-after-c-19-vaccine_20210407.pdf
FBR [United Nations]
PBR [PCHTM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION United Nations. April 2021. Interim Guidelines: Diagnosis and Management of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 Vaccinations.
Specialized guidance available at: UK: Guidance Produced from the Expert Haematology Panel (EHP) focused on Covid-19 Vaccine induced Thrombosis and Thrombocytopenia (VITT)
PBR PRACTICE BASED RECOMMENDATION https://b-s-h.org.uk/media/19530/guidance-version-13-on-mngmt-of-thrombosis-with-thrombocytopenia-occurring-after-c-19-vaccine_20210407.pdf
14
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

HEMATOLOGIC REACTIONS
REACTION DEFINITION MANAGEMENT REFERRAL CRITERIA

An autoimmune reaction against platelets and Diagnosis:

megakaryocytes that is characterized by a decrease It is not possible at this time to distinguish between post-vaccination ITP and exacerbation of
in platelet count (<100 x 1,000,000,000/L) undetected ITP
Primary: if there is an identifiable trigger present Vaccine-associated ITP can be considered in patients with previously documented normal
Secondary: when it is associated with an underlying platelet count who develop thrombocytopenia within 1-2 weeks after vaccination
cause (drug-induced, autoimmune diseases, Obtain CBC immediately
immunodeficiency syndromes, lymphoproliferative Management at secondary/ tertiary level
COVID-19 VACCINE- diseases, infections, vaccines) Initial treatment: IV immune globulin and high dose corticosteroids
COVID-19 vaccine-associated immune Refer to the higher level of care immediately
ASSOCIATED IMMUNE Thrombopoietic agents and vinca alkaloids can be used if there is inadequate response
thrombocytopenia is a form of secondary ITP
THROMBOCYTOPENIA Suggest to exclude Rituximab as part of initial treatment due to longer time to response (8
PBR [PCHTM]
Signs and symptoms: weeks), and possibility of causing a blunted immune response to SARS-CoV-2 vaccination
(ITP)
Petechiae, mucosal bleeding, and/or bruising Consult hematologist
within 1 to 23 days post vaccination PBR [PCHTM]
Platelet count range was reported to be 1 to 36 x
1,000,000,000/L
PBR [PCHTM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION

Philippine College of Hematology and Transfusion Medicine, Inc. 20 April 2021. Philippine College of Hematology and Transfusion Medicine (PCHTM) Review of Hematologic Events Post COVID-19 Vaccination
PBR PRACTICE BASED RECOMMENDATION United Nations. April 2021. Interim Guidelines: Diagnosis and Management of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 Vaccinations.
15
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

LOCALIZED REACTIONS
PAIN, REDNESS, OR SWELLING, AND ARTHRALGIA PATHWAYS

There is
Over the counter medications (ibuprofen, acetaminophen, antihistamine) can be prescribed
PAIN, REDNESS, OR Application of clean, cool, wet cloth over the area
N
SWELLING Persist for more than 7 days? Use or exercising the arm.
at the injection site, or extends Increase oral fluid intake.
FBR [CDC]
past the nearest joint

Refer to a higher level of

REPORT AEFI
care
through reporting platforms
EBR [DOH-AEFI Manual]

Is the pain transient, lasting 10

N Is the pain persistent, lasting Y Refer to a higher level of
There is more than 10 days OR care
days or less?
ARTHRALGIA interfering with daily activities? EBR [DOH-AEFI Manual]

or joint pain usually including the

small peripheral joints
Y
N REPORT AEFI
through reporting platforms

May give analgesics

Encourage gentle movement of the joint(s) involved to prevent stiffness
FBR [NCRIS]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
National Centre for Immunisation Research and Surveillance, Australia. July 2019. Injection Site Reactions Information Sheet
PBR PRACTICE BASED RECOMMENDATION Department of Health - Research Institute of Tropical Medicine. 2017. National Antibiotic Guidelines.
Brighton Collaboration. 2004. 16
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

LOCALIZED REACTIONS
There is an INJECTION SITE ABSCESS PATHWAY
INJECTION SITE ABSCESS
at the injection site, or extends past the nearest joint

Incision and drainage PLUS one of the following:

Abscess is >2 cm in diameter Y Clindamycin 300-450 mg (higher dose in obese

within an area of erythema of > 5cm patient, BMI >40) PO TID x 5-10 days OR
Cotrimoxazole 160/800mg (1 double strength (DS)
There is no supply of recommended antibiotics
tablet; 2 DS in obese patient, PO BID x 5-10 days OR
Doxycycline 100 mg PO every 12 hours x 5-10 days and diagnostics on site
(may also be effective for community acquired MRSA OR
N
infections) There is no improvement after primary care
management
If no response after 2-3 days, follow-up exudate culture and
sensitivity (C/S) results and shift to culture-guided antibiotic
There are multiple abscesses Y therapy, or if C/S results not yet available shift to another first-
or there is a systemic
line antibiotic.
inflammatory response

N
May refer to a higher level of
care and treat as in-patient
EBR [DOH-AEFI Manual]

With diabetes or Y
immunosuppression

REPORT AEFI
through reporting platforms

May treat on an outpatient basis:

N Incision and drainage only are usually effective
Hot packs are helpful
No need for antimicrobial therapy
EBR [DOH-RITM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
National Centre for Immunisation Research and Surveillance, Australia. July 2019. Injection Site Reactions Information Sheet
PBR PRACTICE BASED RECOMMENDATION Department of Health - Research Institute of Tropical Medicine. 2017. National Antibiotic Guidelines.
Brighton Collaboration. 2004. 17
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

The patient is
experiencing
SYSTEMIC REACTIONS
DIZZINESS
DIZZINESS/ HYPOTENSION PATHWAY

Consider anaphylaxis (refer to Amended NIAID/FAAN criteria for

sBP <90 mmHg OR
Mean arterial pressure <65 mmHg OR
Y The patient is the diagnosis of anaphylaxis)
There is a drop in sBP >40 mmHg HYPOTENSIVE Secure IV access and may initiate infusion of 2 to 3 liters of 0.9%
FBR [UpToDate] NaCl in 10-20 minutes
FBR [UpToDate]

N
REFER TO ER REFER TO
Characterize REPORT AEFI
IMMEDIATELY ANAPHYLAXIS
the dizziness through reporting platforms
FBR [UpToDate] PATHWAY

Never continuous for Y

more than a few weeks?
AMENDED NIAID/ FAAN CRITERIA Occurs spontaneously?
for the Diagnosis of Anaphylaxis Not precipitated by coughing, sneezing, or Valsalva that changes N
Highly considering
Anaphylaxis is highly likely when any one of the following TWO CRITERIA is fulfilled: head position or middle ear pressure? Rule out anaphylaxis
Worsens by moving the head?
Anaphylaxis?
Generally accompanied by nystagmus and

1
Acute onset of an illness with simultaneous involvement of the skin and/ or
mucosal tissue (e.g., generalized hives, pruritus or flushing, swollen lips- postural instability?
tongue-uvula) FBR [UpToDate] N
AND at least Airway/ Breathing Other categories or symptoms of
one of the
following:
Respiratory compromise Y dizziness:
(eg, dyspnea, wheeze-bronchospasm, stridor, Disequilibrium - feeling of
reduced PEF, hypoxemia) unsteadiness or impending fall
Circulation
Patient may be that occurs primarily when
experiencing vertigo walking
Reduced BP or associated symptoms of end-
Presyncope - sense of feeling
organ dysfunction
(eg, hypotonia/collapse, syncope, incontinence) faint or on the verge of losing
consciousness
Severe Gastrointestinal Symptoms
Reassure and establish a supportive environment. Lightheadedness - usually
(e.g. Severe crampy abdominal pain, repetitive nonspecific but can refer to
May be given symptomatic treatment
vomiting) feeling disconnected from the
(e.g. 1st generation antihistamines or antiemetics, if
environment or sometimes
Acute onset of hypotension* or bronchospasm or laryngeal involvement** necessary)
2 after exposure to a known or highly probable allergen for that patient, even
in the absence of typical skin involvement
may
sensation
refer to spinning

FBR [UpToDate]
* Hypotension is defined as a decrease in systolic BP greater than 30% from that person's baseline, OR: Persistence despite medication?
i. Infants and children under 10 years: systolic BP less than (70 mmHg + [2 x age in years])
ii. Adults and children over 10 years: systolic BP less than <90 mmHg Consider referring to a higher REPORT AEFI
** Laryngeal symptoms include: stridor, vocal changes, odynophagia.
level of care for further work-up through reporting platforms
EBR [DOH-AEFI Manual]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
UpToDate Inc. 2011-2021
PBR PRACTICE BASED RECOMMENDATION
Philippine Heart Association and Philippine Society of Hypertension. 2021. Algorithm on the Management of Blood Pressure Elevation Before and After Vaccination
18
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

BP is elevated or above the normal range SYSTEMIC REACTIONS

WITH ELEVATED BP PATHWAY
symptoms of target organ
SBP >180 mmHg Y REFER TO ER
Y damage (TOD) or hypertensive- HYPERTENSIVE REPORT AEFI
and/or mediated organ damage (HMOD) IMMEDIATELY
DBP >120 mmHg such as ACS, Heart failure, Stroke EMERGENCY PBR [PHA-PSH]] through reporting platforms
and AKI

N
N
May proceed with Consider
HYPERTENSIVE
vaccination following anaphylaxis (refer to
URGENCY
special precautions Amended NIAID/
FAAN criteria for the
diagnosis of
anaphylaxis) REFER TO ER REFER TO
Have the patient relax in a
comfortable environment, do deep Secure IV access IMMEDIATELY ANAPHYLAXIS
Are there evolving
breathing exercises, or allow the and may initiate FBR [UpToDate] PATHWAY
signs or symptoms of
patient to void/ urinate. infusion of 2 to 3
hypertensive
Observe patient for 30-60 minutes emergency? liters of 0.9% NaCl in
post-vaccination 10-20 minutes
N FBR [UpToDate]

Are there signs or Y

symptoms of hypotension?

REPORT AEFI
through reporting platforms
N

With episodes of BP May adjust or resume Counsel to seek further

elevation NOT falling under Y Previously diagnosed Y medication if with poor
consultation for proper
hypertensive emergency Hypertensive? work-up in the soonest
adherence possible time
while monitoring? PBR [PHA-PSH] PBR [PHA-PSH]

N
N
May start medication with RAAS inhibitor, CCB, or in
combination; CCB for reproductive women
PBR [PHA-PSH]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
UpToDate Inc. 2011-2021
PBR PRACTICE BASED RECOMMENDATION
Philippine Heart Association and Philippine Society of Hypertension. 2021. Algorithm on the Management of Blood Pressure Elevation Before and After Vaccination
19
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

SYSTEMIC REACTIONS
OTHER SYSTEMIC REACTIONS PATHWAYS

The patient is May treat symptomatically with Febrile for more Y

Refer to a higher level REPORT AEFI
FEBRILE Paracetamol than 3 days despite
Temperature of > 40.5 of care
with a temperature reading of > 38 N EBR [DOH-AEFI Manual] symptomatic through reporting platforms
EBR [DOH-AEFI Manual]
degrees Celsius treatment?

Y N

REPORT AEFI
through reporting platforms

There is
MYALGIA
or muscle pain and soreness

Is it persistent OR does Y REPORT AEFI

Refer to higher level of care through reporting platforms
it interfere with daily FBR [UpToDate]
activities?
There is
FATIGUE N

or difficulty or inability to initiate activity

(subjective sense of weakness) Treat MYALGIA symptomatically as needed with acetaminophen, NSAIDs and/or muscle relaxant, if necessary
or reduced capacity to maintain activity Reassure patient and establish supportive environment
(easy fatigability) FBR [UpToDate]
FBR [UpToDate]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
UpToDate Inc. 2011-2021
PBR PRACTICE BASED RECOMMENDATION
Philippine Heart Association and Philippine Society of Hypertension. 2021. Algorithm on the Management of Blood Pressure Elevation Before and After Vaccination
20
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

The patient is
NAUSEOUS and/or VOMITING
SYSTEMIC REACTIONS
OTHER SYSTEMIC REACTIONS PATHWAYS
Rule out anaphylaxis
AMENDED NIAID/ FAAN CRITERIA
for the Diagnosis of Anaphylaxis
Anaphylaxis is highly likely when any one of the following TWO CRITERIA is fulfilled:
Highly considering
Y
Anaphylaxis?

1
Acute onset of an illness with simultaneous involvement of the skin and/ or
mucosal tissue (e.g., generalized hives, pruritus or flushing, swollen lips-
tongue-uvula)

AND at least Airway/ Breathing

N
one of the
Respiratory compromise
following:
(eg, dyspnea, wheeze-bronchospasm, stridor, Is BP elevated or
Y REFER TO REPORT AEFI REFER TO ER REFER TO
reduced PEF, hypoxemia) BP ELEVATION through reporting IMMEDIATELY ANAPHYLAXIS
above the normal
Circulation platforms PATHWAY
range? PATHWAY FBR [UpToDate]

Reduced BP or associated symptoms of end-

organ dysfunction
(eg, hypotonia/collapse, syncope, incontinence) N
Severe Gastrointestinal Symptoms
(e.g. Severe crampy abdominal pain, repetitive Y Consider anaphylaxis (Amended NIAID/FAAN criteria for the diagnosis of anaphylaxis)
vomiting) Is patient
Hypotensive? Secure IV access and may initiate infusion of 2 to 3 liters of 0.9% NaCl in 10-20 minutes
Acute onset of hypotension* or bronchospasm or laryngeal involvement**

2
FBR [UpToDate]
after exposure to a known or highly probable allergen for that patient, even
in the absence of typical skin involvement
N
* Hypotension is defined as a decrease in systolic BP greater than 30% from that person's baseline, OR:
i. Infants and children under 10 years: systolic BP less than (70 mmHg + [2 x age in years])
ii. Adults and children over 10 years: systolic BP less than <90 mmHg
Y REPORT AEFI
** Laryngeal symptoms include: stridor, vocal changes, odynophagia. Signs of Moderate to Refer to higher level of care
Severe Dehydration? FBR [UpToDate] through reporting platforms

N
May treat symptomatically:
For nausea, may treat with oral antiemetics, metoclopramide, if necessary
For vomiting, give oral rehydration salts for volume per volume replacement to prevent dehydration
FBR [UpToDate]

REPORT AEFI
N Symptoms persist
Y
through reporting platforms despite symptomatic
treatment?
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
UpToDate Inc. 2011-2021
PBR PRACTICE BASED RECOMMENDATION
Philippine Heart Association and Philippine Society of Hypertension. 2021. Algorithm on the Management of Blood Pressure Elevation Before and After Vaccination
21
FBR FOREIGN BASED RECOMMENDATION
INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

ALLERGIC REACTIONS
Assess the patient for
possible
ANAPHYLAXIS
ANAPHYLAXIS PATHWAY
Patient presents with: AMENDED NIAID/ FAAN CRITERIA
(1) Acute onset of generalized hives, for the Diagnosis of Anaphylaxis
pruritus or flushing, swollen lips-tongue-uvula,
Anaphylaxis is highly likely when any one of the following TWO CRITERIA is fulfilled:
AND at least one of the following:
a. Respiratory compromise (eg dyspnea, wheezing-bronchospasm) REFER TO
1
Acute onset of an illness with simultaneous involvement of the skin and/ or
b. Reduced BP or associated symptoms of end-organ dysfunction
c. Severe gastrointestinal symptoms (adbominal pain, repetitive vomiting)
N SYSTEMIC AND/OR mucosal tissue (e.g., generalized hives, pruritus or flushing, swollen lips-
tongue-uvula)
OR ALLERGIC SKIN
REACTIONS AND at least Airway/ Breathing
(2) Acute onset of hypotension or bronchospasm or laryngeal involvement after
one of the
exposure to a known or highly probable allergen (several minutes to hours), PATHWAY Respiratory compromise
following:
(eg, dyspnea, wheeze-bronchospasm, stridor,
even in the absence of typical skin involvement.
reduced PEF, hypoxemia)
(See table on Amended NIAID/FAAN criteria
Circulation
for the diagnosis of anaphylaxis)
Reduced BP or associated symptoms of end-
FBR [WAO]
organ dysfunction
(eg, hypotonia/collapse, syncope, incontinence)
Y Severe Gastrointestinal Symptoms
(e.g. Severe crampy abdominal pain, repetitive
Put the patient in reclining position with legs up
vomiting)
Administer Epinephrine (Adrenaline)
0.5 mL per dose, intramuscularly ONLY on mid-outer thigh even through clothing, OR
Acute onset of hypotension* or bronchospasm or laryngeal involvement**
0.3 mg in auto-injector, intramuscularly ONLY on mid-outer thigh even through clothing
2 after exposure to a known or highly probable allergen for that patient, even
in the absence of typical skin involvement
Secure IV access and start infusion with 0.9% NaCl (10-20 mL/min)
* Hypotension is defined as a decrease in systolic BP greater than 30% from that person's baseline, OR:
Clear the airway i. Infants and children under 10 years: systolic BP less than (70 mmHg + [2 x age in years])
Administer OXYGEN via face mask (at least 10 LPM) ii. Adults and children over 10 years: systolic BP less than <90 mmHg
Administer GLUCOCORTICOID (Hydrocortisone 200 mg IV) ** Laryngeal symptoms include: stridor, vocal changes, odynophagia.
Administer ANTI-HISTAMINE (e.g. Diphenhydramine 50 mg IV)
Monitor vital signs
Discharge 4-8 hours after full resolution of
symptoms
Refer and advise follow-up to allergy service for
Symptoms Y
consult as outpatient.
resolved?
PBR [PSAAI]
N
Re-assess blood pressure, symptoms, and breath sounds

N Blood pressure N Still with symptoms Experiencing N

dropped? after 5-10 min? bronchospasm?
REPORT AEFI
Y Y Y

LEGEND
through reporting platforms EBR EVIDENCE BASED RECOMMENDATION
CBR CONSENSUS BASED RECOMMENDATION
Infuse 2000-3000 mL of Give salbutamol MDI, 4- PRACTICE BASED RECOMMENDATION
REPEAT EPINEPHRINE PBR
0.9% NaCl intravenously 10 puffs via large volume
INTRAMUSCULARLY
in 10-20 minutes spacer FBR FOREIGN BASED RECOMMENDATION
SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
Brighton Collaboration. 2004
Call for emergency and refer to
Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19
the higher level of care Vaccination.
PBR [PSAAI] World Allergy Organization. 2020. World Allergy Organization Anaphylaxis Guidance. 22
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

ALLERGIC REACTIONS
ALLERGIC SKIN REACTION PATHWAY

Assess the patient for possible

ALLERGIC SKIN REPORT AEFI REFER TO ER REFER TO
IMMEDIATELY ANAPHYLAXIS
REACTION through reporting platforms
PATHWAY
FBR [UpToDate]

Y
Patient presents with any one of the following: Rule out anaphylaxis
urticaria (hives), erythema, pruritus, prickly (or
Y (Amended
tingling) sensation, localized or generalized edema (in NIAID/FAAN criteria Highly considering
the deeper layers of the skin, subcutaneous tissues or for the diagnosis of Anaphylaxis?
mucosa lining the throat, airways, and gut) ONLY? AMENDED NIAID/ FAAN CRITERIA
anaphylaxis)
FBR [BC CDC] for the Diagnosis of Anaphylaxis
N Anaphylaxis is highly likely when any one of the following TWO CRITERIA is fulfilled:

N
1
Acute onset of an illness with simultaneous involvement of the skin and/ or
mucosal tissue (e.g., generalized hives, pruritus or flushing, swollen lips-
Give antihistamines (oral/IV), glucocorticoids (oral/IV), tongue-uvula)
and observe for 4 hours
The patient may go home but advise Secure IV line if medication will be given AND at least Airway/ Breathing
one of the
ER consult once signs and intravenously Respiratory compromise
following:
symptoms of allergic reaction are PBR [PSAAI] (eg, dyspnea, wheeze-bronchospasm, stridor,
reduced PEF, hypoxemia)
experienced.
Circulation
Reduced BP or associated symptoms of end-
Discharge 4-8 hours after full resolution of organ dysfunction
symptoms Symptoms (eg, hypotonia/collapse, syncope, incontinence)
REPORT AEFI
Refer and advise follow-up to allergy service for resolved?
through reporting platforms
consult as outpatient. Y N Severe Gastrointestinal Symptoms
(e.g. Severe crampy abdominal pain, repetitive
PBR [PSAAI] vomiting)

Acute onset of hypotension* or bronchospasm or laryngeal involvement**

2 after exposure to a known or highly probable allergen for that patient, even
in the absence of typical skin involvement

* Hypotension is defined as a decrease in systolic BP greater than 30% from that person's baseline, OR:
i. Infants and children under 10 years: systolic BP less than (70 mmHg + [2 x age in years])
ii. Adults and children over 10 years: systolic BP less than <90 mmHg
** Laryngeal symptoms include: stridor, vocal changes, odynophagia.
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
Brighton Collaboration. 2004
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
BC Centre for Disease Control. 23
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

The patient is NEUROLOGIC REACTIONS

CONVULSING
or having a REFER TO ER REPORT AEFI CONVULSION/ GENERALIZED SEIZURE PATHWAY
GENERALIZED SEIZURE IMMEDIATELY through reporting
FBR [UpToDate] platforms
without focal neurologic signs and symptoms
EBR [DOH AEFI Manual]

PROVIDE SUPPORTIVE CARE

Lay patient on his/her side.

Keep sharp objects away to avoid other injuries
DO NOT try to hold down the patient.

Intravenous Benzodiazepine
Provide O2 support
Lorazepam 0.1 mg/kg (max 4 mg); max cumulative adult
Y dose 8 mg, OR No effect observed
N
May provide initial treatment of IV access secured? Diazepam 0.15 - 2 mg/kg (max 10 mg); max cumulative 5 minutes after
Benzodiazepine* adult dose 20 mg, OR administration?
Clonazepam 0.015 mg/kg (max 1 mg); max cumulative
FBR [British Epilepsy Association]
adult dose 2mg
N Y

Non-intravenous Benzodiazepine
Midazolam IM/IN/buccal 10mg; 5mg in elderly or <40kg; max
cumulative adult dose 20mg, 10mg <40kg), OR Y No available IV
May give another dose up to
the max. cumulative dose
Diazepam 10mg rectal; 5mg in elderly or <40kg, OR Benzodizaepine?
Lorazepam intranasal 4mg; 0.1mg/kg <40kg

No effect observed N CONTINUE SUPPORTIVE

10 minutes after
MEASURES
administration

Y
* NOTE: All benzodiazepines can cause respiratory depression, sedation and
hypotension at higher doses and in susceptible patients May give another dose up to the max. cumulative dose
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
Brighton Collaboration. 2004
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
BC Centre for Disease Control. 24
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

NEUROLOGIC REACTIONS
HEADACHE PATHWAY

Is there presence of any of the following:

Assess the patient presenting with
Sudden onset "thunderclap"
HEADACHE Acute or subacute neck pain or headache with
Horner syndrome and/or neurologic deficit Y
Pain in any region of the head and may occur Suspected meningitis or encephalitis REFER TO ER REPORT AEFI
on one or both sides of the head, be isolated With global or focal neurologic deficit or IMMEDIATELY through reporting
to a certain location, radiate across the head papilledema FBR [UpToDate] platforms
from one point, or have a viselike quality. A With orbital or periorbital symptoms
headache may appear as a sharp pain, a With possible carbon monoxide exposure
throbbing sensation, or a dull ache. FBR [UpToDate]
FBR [UpToDate]

Provide supportive care.

Treat symptomatically with paracetamol

Is symptom Y
Report to the higher level
persistent despite
of care
medication?

N
REPORT AEFI
Provide reassurance through reporting
platforms
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION UpToDate Inc. 2011-2021

PBR PRACTICE BASED RECOMMENDATION

25
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

NEUROLOGIC REACTIONS
VASOVAGAL PATHWAY

Clinical Features Fainting Anaphylaxis

There is
Timing Before, during, or few A short time, up to few
LOSS OF CONSCIOUSNESS OR minutes after injection hours
FAINTING (VASOVAGAL Is there signs or Y REFER TO Skin Generalized pallor, cold Itching, generalized
SYNCOPE) Prevent injuries in the patient symptoms of ANAPHYLAXIS clammy skin erythema, urticaria,
anaphylaxis? PATHWAY swelling of lips, face,
Fainting episode as body reacts to various tingling around lips
triggers before, during, or after vaccination,
perhaps triggered by pain or emotional Respiratory Normal or shallow Tachypnea, difficulty in
N breathing breathing, wheezing,
reaction to immunization process itself.
FBR [UpToDate] stridor, hoarseness,
cyanosis, recession of
Have patient sit or lie down.
intercostal spaces
Loosen any tight clothing and maintain open airway.
Apply cool, damp cloth to patient's face. Cardiovascular Bradycardia, weak Tachycardia, weak pulse,
Keep patient under close observation until full pulse, carotid pulse felt, carotid pulse may be
reversed by supine weak, hypotension not
recovery. position reversed by supine
Provide reassurance. position

Gastrointestinal Vomiting Vomiting, diarrhea,

abdominal cramps

CNS Faintishness, Anxiety and distress, loss

Did the patient Y lightheadedness, of consciousness not
May send home with relieved by supine relieved by supine
make a full
reassurance and advise position posture
recovery?

N
Panic attack: No hypotension, pallor, wheeze, or urticarial rash or swelling.
May have flushing or blotchy skin
Refer to the higher level of care if persistent REPORT AEFI
despite supportive care and reaassurance through reporting
EBR [DOH AEFI Manual]
platforms EBR [DOH-AEFI Manual]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Department of Health. 2014. Adverese Events Following Immunization (AEFI).: A Manual of Procedure for Surveillance and Response to AEFI
CBR CONSENSUS BASED RECOMMENDATION
Brighton Collaboration. 2004
PBR PRACTICE BASED RECOMMENDATION Philippine Society of Allergy, Asthma, and Immunology. 2021. Algorithm on Diagnosis and Management of Severe Allergic Reactions After COVID-19 Vaccination.
BC Centre for Disease Control. 26
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

HEMATOLOGIC REACTIONS
Experiencing any of the
following: VITT PATHWAY
Persistent and severe
Has received a vector
headache Not VITT
vaccine (Astrazeneca or
Focal neurological Treat according to diagnosis
J&J) in the last 4 to 28 N PBR [PCHTM]
symptoms
days?
Seizures, or blurred or
double vision (suggesting Y
CSVT or arterial stroke)
Shortness of breath or REFER TO SECONDARY OR REPORT AEFI
chest pain (suggesting TERTIARY CARE IMMEDIATELY through reporting
FBR [United Nations;]; PBR [PCHTM] platforms
pulmonary embolism or
acute coronary
syndrome)
SCREEN FOR
Abdominal pain
(suggesting portal vein VACCINE-INDUCED N
thrombosis) THROMBOTIC Evaluate the ff parameters: N
Limb swelling, redness, Platelet count is < 150 x
CBC With thrombosis?
THROMBOCYTOPENIA (VITT) 1,000,000,000 / L
pallor, or coldness Imaging studies for Thrombosis
(suggesting deep vein
A condition of blood clots associated Y
thrombosis or acute limb
with low platelet counts, that occurs Y
ischemia)
following receipt of the vaccine
Request for
FBR [United Nations;]; PBR [PCHTM] Continue monitoring Platelets
confirmatory test (anti-
F4) and coagulation Until VITT has been ruled out,
the following should not be given:
tests Anticoagulation with heparin (both
(D-dimer, Fibrinogen, uF heparin and LMW heparins)
PT, aPTT) Platelet transfusions

FBR [United Nations]; PBR [PCHTM]

HIGH D-dimer** or
Treat as Y N
LOW Fibrinogen, PT, aPTT or
Steroids (methylprednisolone 1mg/kg)
CONFIRMED VITT POSITIVE anti-PF4**
IVIG (0.5 – 1.0g/kg/day for 2 days)
Non-heparin containing anti-coagulant (Rivaroxaban, Fondaparinux, etc.) ** If PF4 antibody immunoassay is
Avoid platelet transfusions, heparin, LMWH, VKA not available and D-Dimer is
markedly elevated (>4x threshold
Consider therapeutic plasma exchange if platelet remains below 30,000
for VTE), this is highly suggestive
despite IVIG and steroids of VITT. Treat as VITT.
FBR [United Nations;]; PBR [PCHTM]
PBR [PCHTM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

Philippine College of Hematology and Transfusion Medicine, Inc. 20 April 2021. Philippine College of Hematology and Transfusion Medicine (PCHTM) Review of Hematologic Events Post COVID-19 Vaccination
CBR CONSENSUS BASED RECOMMENDATION
United Nations. April 2021. Interim Guidelines: Diagnosis and Management of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 Vaccinations.
PBR PRACTICE BASED RECOMMENDATION Specialized guidance available at: UK: Guidance Produced from the Expert Haematology Panel (EHP) focused on Covid-19 Vaccine induced Thrombosis and Thrombocytopenia (VITT): https://b-s-h.org.uk/media/19530/guidance-version-13-on-mngmt-of-thrombosis-with-
thrombocytopenia-occurring-after-c-19-vaccine_20210407.pdf 27
FBR FOREIGN BASED RECOMMENDATION
 INTERIM AEFI MANAGEMENT V1
Health Care Providers Fact Sheet Version 1
These recommendations will be updated based on most recent evidence.

HEMATOLOGIC REACTIONS
COVID-19 VACCINE-ASSOCIATED ITP PATHWAY

There is any of the following:

Petechiae Is there history of Y

Obtain complete blood count, COVID-19 REPORT AEFI
Mucosal bleeding REFER TO HIGHER LEVEL OF through reporting
if available vaccination in the CARE IMMEDIATELY
Bruising within 1 to 23 days post past 1-23 days?
platforms

vaccination
PBR [PCHTM]

N
Consider

REFER TO SECONDARY OR
COVID-19 VACCINE-
TERTIARY CARE FOR FURTHER
WORK-UP ASSOCIATED ITP

Consult a hematologist
REPORT AEFI
through reporting Start treatment with IVIG and high
platforms dose corticosteroids
Consider thrombopoietic agents and
vinca alkaloids, if there is inadequate
response with initial treatment
PBR [PCHTM]
LEGEND

EBR EVIDENCE BASED RECOMMENDATION

SOURCES

CBR CONSENSUS BASED RECOMMENDATION

Philippine College of Hematology and Transfusion Medicine, Inc. 20 April 2021. Philippine College of Hematology and Transfusion Medicine (PCHTM) Review of Hematologic Events Post COVID-19 Vaccination
PBR PRACTICE BASED RECOMMENDATION United Nations. April 2021. Interim Guidelines: Diagnosis and Management of Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) following AstraZeneca COVID-19 Vaccinations.
28
FBR FOREIGN BASED RECOMMENDATION