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HPV Vaccination Programme

HPV Vaccination Programme. HPV Vaccination Programme. Study No: Age (in years): ………… Last name: ………………………………… First name: ……………………. Middle name: ……..…………………. Address: ………….…………………………………………………….. ……………………………………………………………………………. …………………………………………………………………………….

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HPV Vaccination Programme

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  1. HPV Vaccination Programme HPV Vaccination Programme Study No: Age (in years): ………… Last name: ………………………………… First name: …………………….Middle name: ……..…………………. Address: ………….…………………………………………………….. ……………………………………………………………………………. ……………………………………………………………………………. District: ……………………..….. Village: ……………………..……….. Phone: 1 …………………………. 2 ………………………………….. New address: ………………………………………………………….. ……...……………………………………………………………………. …………………………………………………………………………… District: ……………………..….. Village: …………………..……….. Phone: 1) ……………………..…. 2) ……………………………….. Name and address of school being attended: ………………….……. ……………………………………………………………………………… Standard class: ……………….. Division: …………………………….  Site Group PHC Village House Number Serial Barcode Next follow-up: __/__/20__ Next follow-up: __/__/20__ Next follow-up: __/__/20__ Next follow-up: __/__/20__ Next follow-up: __/__/20__ Next follow-up: __/__/20__ Next follow-up: __/__/20__ In case of emergency, please contact: Study contact address and phone

  2. HPV Vaccination Programme HPV Vaccination Programme Vaccine group: 2 3 Sero-testing group: No Yes Vaccination:     Blood collection: Requested only at day 1 and months 12, 24, 36 and 48 for sero-testing group Cervical Cancer Screening: Mild and moderate adverse events (occurred at home):

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