ASK ONLY THOSE MOTHERS WHO DO NOT A VACCINATION CARD CV3 Has (NAME) ever received any YES 1 vaccinations to prevent him/her from NO 2 VA1 getting diseases, including vaccinations 98 DON’T KNOW received in a campaign or immunization day? CV4 Has (NAME) ever received a BCG YES 1 vaccination against tuberculosis that is, NO 2 – an injection in the arm or shoulder that 98 DON’T KNOW usually causes a scar? CV5 Has (NAME) ever received any YES 1 in the to NO 2 CV7 “vaccination drops mouth” protect him/her from getting diseases 98 CV7 – DON’T KNOW that is, polio? CV6 How many times was the polio vaccine received? NUMBER OF TIMES 98 DON’T KNOW CV7 (NAME) YES 1 A DPT/PENTA NO 2 CV9 – VACCINATION 98 CV9 DON’T KNOW PROBE BY INDICATING THAT DPT/PENTA IS SOMETIMES GIVEN AT THE SAME TIME AS CV8 How many times has (NAME) received an injection in the thigh or buttocks? NUMBER OF TIMES 98 DON’T KNOW CV9 Has (NAME) ever received a Measles YES 1 injection or an MMR injection that is, a NO 2 – shot in the arm at the age of 9 months or 98 DON’T KNOW older - to prevent him/her from getting measles?
ASK ONLY THOSE MOTHERS WHO DO NOT A VACCINATION CARD CV3 Has (NAME) ever received any vaccinations to prevent him/her from getting diseases, including vaccinations received in a campaign or immunization day? YES 1 NO 2 DON’T KNOW 98 VA1 CV4 Has (NAME) ever received a BCG vaccination against tuberculosis – that is, an injection in the arm or shoulder that usually causes a scar? YES 1 NO 2 DON’T KNOW 98 CV5 Has (NAME) ever received any “vaccination drops in the mouth” to protect him/her from getting diseases – that is, polio? YES 1 NO 2 DON’T KNOW 98 CV7 CV7 CV6 How many times was the polio vaccine received? NUMBER OF TIMES DON’T KNOW 98 CV7 (NAME) DPT/PENTA – PROBE BY INDICATING THAT DPT/PENTA VACCINATION IS SOMETIMES GIVEN AT THE SAME TIME AS YES 1 NO 2 DON’T KNOW 98 CV9 CV9 CV8 How many times has (NAME) received an injection in the thigh or buttocks? NUMBER OF TIMES DON’T KNOW 98 CV9 Has (NAME) ever received a Measles injection or an MMR injection – that is, a shot in the arm at the age of 9 months or older - to prevent him/her from getting measles? YES 1 NO 2 DON’T KNOW 98 A