Prepare to answer a series of questions before vaccination Prepare to answer a series of questions before vaccination

Prepare to answer a series of questions before vaccination

    This is our series on key coronavirus-related information. Click here to read other installments: #Coronavirus the facts. Find the latest information and answers from experts on everything COVID-19.

    Fill out a questionnaire

    Anyone who wants to receive a vaccine must first fill out a questionnaire. It asks about current health condition and any previous illnesses. A doctor will check the answers to determine if you are eligible for a shot.

    Translated forms available

    The official questionnaire is written in Japanese. Foreign residents can fill it out by referring to translations in 17 languages available on the health ministry website:
    Instructions for getting the vaccine are also available.

    List of 13 questions

    The form requires your address, name, telephone number, date of birth, gender, and body temperature that will measured onsite. There are 13 yes/no questions with space for explanations if necessary. They are listed below:

    1) Are you receiving the COVID-19 vaccine for the first time? If you have been vaccinated before, you need to list the date/s of the previous shots.

    2) Is the city, town, or village where you have resident registration the same as the one on your vaccination coupon?

    3) Have you read the "Instructions for the COVID-19 vaccine", and do you understand its effects and potentially adverse side effects? (Note: The instructions are delivered with your coupon. They can be read in 17 languages here:

    4) Do you fall into one of the high-priority target groups for the vaccination? If so, you can check a box that identifies the different target groups. People with underlying conditions must write down the name of the disease or illness.

    5) Are you currently suffering from any illness and receiving treatment or medication?

    6) Have you had a fever or been sick in the past month?

    7) Do you feel at all unwell today?

    8) Have you ever had a seizure or convulsion?

    9) Have you ever experienced severe allergic symptoms, such as anaphylaxis, from medications or foods?

    10) Have you ever been sick after receiving a vaccine?

    11) Is there any possibility you are pregnant; or are you currently breastfeeding?

    12) Have you received any vaccines within the last two weeks?

    13) Do you have any questions about the vaccination?

    The final decision is up to you

    While a doctor will determine whether you are eligible for the vaccine, you will make the final decision after filling out the checklist and understanding the benefits and possible side effects.

    This information is accurate as of July 27, 2021.

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