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Prevaccination Screening Questionnaire for COVID-19 vaccine

The following are the translations of the official form in Japanese. Please fill in the Japanese form by referring to the following translations.
Prevaccination Screening Questionnaire for COVID-19 vaccine(mhlw.go.jp)

Instructions for COVID-19 vaccinatio
Manufactured by Pfizer (mhlw.go.jp)
Manufactured by Moderna (mhlw.go.jp)