Observe the 30-Day waiting period after vaccination

You should wait 30 days after the Vaccine was administered to you (or, if you are submitting a Claim on behalf of another, 30 days after it was administered to the individual you are submitting a Claim on behalf of), before taking any steps towards:

  • Completing or submitting a Claim Form and the Supporting Evidence Form, and
  • Obtaining any of the documents that are required to be submitted with these forms.

Once 30 days have passed since the Vaccine was administered, you can then begin to complete the above steps.

Exception: The 30-day waiting period will not apply when:

  • The Patient has died after a Vaccine was administered to them, and
  • A Registered Healthcare Professional considers their death to have been caused by that Vaccine or its administration.

The reason for this 30-day waiting period is to avoid situations where people who have not suffered a Serious Adverse Events associated with a Vaccine or its administration apply for compensation under the Scheme. This Scheme does not cover non-Serious Adverse Events.

Ensure all Claim materials are fully completed, signed, and dated

Once you have completed the 30-day waiting period, you can proceed to apply for compensation under the Scheme. To apply for compensation under this Scheme, you should:

  1. Complete the Claim Form;
  2. Ask a relevant Registered Healthcare Professional(s) to complete the Supporting Evidence form;
  3. Obtain any other documents that are required to be submitted with these forms; and then
  4. Submit them to the Administrator.

The Claim Form can be completed online or is available to download from the Scheme’s website at  C19VaccineNFC.com.

For completion of the Supporting Evidence Form or any other Scheme forms, please download the form from the Scheme’s website (C19VaccineNFC.com), print it, and complete it on paper (for the Supporting Evidence Form, have it completed on paper by one or more Registered Healthcare Professional(s)).

Only the Claim Form can be completed online on the Scheme’s website. The other Scheme forms (including the Supporting Evidence Form) cannot be completed online.

The Claim Form, the Supporting Evidence Form and all other Scheme forms must be completed and submitted in English – no other languages will be accepted by the Administrator. However, any other documents that are required to be provided with the Claim Form and the Supporting Evidence Form (which will be described in these forms) can be obtained and submitted in other languages.

Please see ‘Submit all Claim materials to the Administrator’ below for more details about how to submit the Scheme forms, once completed.

Submit all Claim materials to the Administrator

Once all your Claim materials have been fully completed, signed and dated, you can submit them to the Administrator. Please note that all Claim materials should be submitted together and at the same time using one of the methods described below. Please remember, all the forms should be submitted before the end of the Reporting Period.

All Claim Forms will be time and date stamped by the Administrator when the Administrator receives them. Within 24 hours of receipt by the Administrator, the Administrator will then send you an acknowledgement (by email or mail) that they have received your claim materials. This Acknowledgement will contain your Claim number and the name of your assigned claim representative of the Administrator that will deal with your Claim, and his/her direct contact information.

Submit online

To submit the Scheme Claim materials online, either:

Whichever above method you decide to use, you should then:

  • Upload and submit the Supporting Evidence Form and the other documents that you should submit with the Claim Form and the Supporting Evidence Form on upload documents.

Submit by email

To submit the Scheme Claim materials by email, please:

  1. Scan the printed and completed Claim Form, Supporting Evidence Form and the other documents that you should submit with these forms; and
  2. Email these scanned forms and documents (as one or more email attachments) to [email protected].

Submit by regular mail

To submit the Scheme Claim materials by regular mail, please:

  1. Scan the printed and completed Claim Form, Supporting Evidence Form and the other documents that you should submit with these forms; and
  2. Send these scanned forms and documents by regular mail to one of the Scheme’s Regional Centres.
Vaccine

A COVID-19 vaccine received in any Participating Country that is either: (i) procured and/or delivered by UNICEF on a Participating Country's behalf; (ii) donated to a Participating Country through UNICEF; or (iii) formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF), that:

  1. either (A) has licensure or authorisation from a stringent (“functional”) regulatory authority or (B) has received WHO prequalification, following licensure or authorisation from a stringent (“functional”) regulatory authority, or (C) has been issued authorisation for emergency use based on licensure or authorisation by a stringent (“functional”) regulatory authority; and
  2. is included in Schedule 1 of the Scheme’s Protocol, as updated from time to time; and
  3. has received all required approvals and authorisations for importation, distribution and use in the relevant country; and
  4. has not reached its Scope of Coverage Endpoint.
Claim

A written claim for compensation completed by a Claimant, using the Claim Form approved by and provided by the Administrator, as set forth in Schedule 2 of the Scheme’s Protocol, which must be accompanied by all Supporting Evidence.

Supporting Evidence

The supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:

  1. detailed medical documentation from a Registered Healthcare Professional describing the Injury and medical treatment required as a result of the Injury, together with details of any Hospitalisation or prolonged Hospitalisation, including but not limited to admission and discharge records;
  2. a description of the nature, extent, functional impact and prognosis of the Injury, as assessed by the Registered Healthcare Professional.
  3. a statement from the Registered Healthcare Professional that the Injury was, in the Registered Healthcare Professional’s opinion, the result of the Vaccine or its administration;
  4. certification from a Registered Healthcare Professional of when, where and which Vaccine was administered;
  5. in the case of death, a death certificate and any other documentation available from a Registered Healthcare Professional of the cause and manner of death; and
  6. any further evidence that the Administrator may deem necessary to adjudicate the Claim and/or Receivable Claim, as applicable, guided, as appropriate, by the Scientific Advisory Committee, the Review Panel, and/or the Appeals Panel.
Patient

A beneficiary of a Vaccine (i) procured and/or delivered by UNICEF on a Participating Country’s behalf; (ii) donated to a Participating Country through UNICEF; or (iii) formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF) who claims or in respect of whom it is claimed that he or she has suffered or sustained a Serious Adverse Event which is associated with a Vaccine or its administration, and which, in turn, has resulted in an Injury.

Registered Healthcare Professional

Any healthcare professional, including physicians, surgeons, nurses, midwives, nurse practitioners, physicians’ assistants, psychiatrists, psychiatrists, physical therapists, occupational therapists, dentists, and pharmacists, who is duly licensed or legally authorised to practice the profession in the country in which the Patient resides and received the Vaccine, or in the case of birth defects, where the Patient’s mother resides and received the Vaccine.

Serious Adverse Event

A serious untoward medical occurrence that (i) is sustained or suffered by a Patient following the administration of a Vaccine, and (ii) results in an Injury, as evidenced by the supporting evidence, using the form in Schedule 3 of the Scheme’s Protocol, required to evaluate a Claim and that shall include:

Scheme

The Covid-19 Vaccine Facility No-Fault Compensation Scheme, established to provide fair compensation to eligible vaccine recipients who suffer a Serious Adverse Event related to a COVID-19 vaccination that has been either:

  • procured and/or delivered by UNICEF on a Participating Country’s behalf;
  • donated to a Participating Country through UNICEF; or
  • formally included into the Scheme (but otherwise procured and/or delivered but not by or through UNICEF),

as detailed in the Scheme Protocol and its Schedules.

Administrator

ESIS, Inc., the claims Administrator appointed to manage and administer the Program, including, but not limited to, the receipt and registration of Applications, distributing acknowledgements of receipt of Applications, setting financial reserves for Receivable Claims, review of Applications, Supporting Evidence, and other documents to assess receivability, assessing Receivable Claims, and approve or deny, as the case may be, Payment for compensation, in accordance with the terms of the Program's Protocol.

Reporting Period

On a per Vaccine basis, the period during which a Claimant may file a Claim for compensation under the Scheme in respect of such Vaccine. The maximum Reporting Period for each Vaccine extends from:

  1. the date on which such Vaccine was first put into circulation by the manufacturer following regulatory approval or an emergency use authorisation of such Vaccine by any regulator (as indicated in Schedule 1 of the Scheme’s Protocol); and
  2. terminates on the date which is 36 calendar months immediately after the Scope of Coverage Endpoint for such Vaccine (as indicated in Schedule 1 of the Scheme's Protocol), provided always that the Vaccine was administered before this Vaccine’s Scope of Coverage Endpoint (as defined in Section 2 of the Scheme's Protocol and indicated in Schedule 1 of the Scheme's Protocol). See the illustrative diagram of the Reporting Period in Schedule 6 of the Scheme’s Protocol.

For each Patient, the Reporting Period depends on the date the Vaccine was administered to the Patient. To calculate the Reporting Period that applies to the Patient, the Patient (or the person who is a duly authorised to represent the Patient as provided in limb (ii) of the definition of Claimant in the Scheme's Protocol) needs to:

  1. determine (through Schedule 1 of the Scheme’s Protocol) what is the date of the Scope of Coverage End Point that applies to the Vaccine that was administered to Patient; and
  2. calculate the number of months and days from the vaccination date (i.e. date that the Vaccine was administered to the Patient) until the date of the Vaccine’s Scope of Coverage End Point, and add another 36 months. This establishes the Reporting Period that applies to the Patient.