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To be eligible, you need to meet all of the following requirements to get financial support:
- received a Therapeutic Goods Administration (TGA) approved COVID-19 vaccine
- met the definition of harm, for example, an administration-related injury or one of the clinical conditions listed in the policy
- been admitted to hospital as an inpatient, or claimed a waiver if seen in an outpatient care setting for an eligible clinical condition
- been admitted to hospital as an inpatient for an administration-related injury
- losses or expenses of $1,000 or more, not including pain and suffering, due to the COVID-19 vaccine.
When we assess your claim we may need to consult with the TGA, the Department of Health and Aged Care or an independent expert panel.
How to meet the definition of harm
To meet the definition of harm, your doctor must diagnose you with an eligible condition or injury covered by the scheme.
Your doctor needs to:
- explain how the final diagnosis was reached, including a description of relevant clinical findings and investigation results
- advise the specific harm you suffered was most likely caused by the COVID-19 vaccine and that other circumstances are less likely
complete a COVID-19 vaccine claims scheme medical report, which you must include with your claim.
If you had AstraZeneca Vaxzevria, the following clinical conditions are accepted under the scheme:
- Anaphylactic reaction
- Capillary leak syndrome
- Cerebral Venous Sinus Thrombosis (CVST) without Thrombocytopenia
- Guillain Barre Syndrome (GBS)
- Thrombosis with Thrombocytopenia Syndrome
- Thrombocytopenia, including immune Thrombocytopenia
- Transverse Myelitis.
If you’ve had Pfizer/Biontech Comirnaty, Moderna Spikevax or Novavax Nuvaxovid, the following clinical conditions are accepted under the scheme:
- Anaphylactic reaction
- Erythema Multiforme (Major)
Which injuries are eligible
The following clinically diagnosed injuries are also accepted under the scheme, regardless of which TGA approved vaccine you’ve had:
- a shoulder injury you got when you received a COVID-19 vaccine
- other moderate to significant physical injuries that caused permanent impairment, or the need for an extended period of medical treatment.
In both cases, the injuries must have been sustained during the physical act of being given the vaccine. You must also have been admitted to hospital as an in-patient. Presenting to an emergency department is not recognised as being admitted to hospital.
The following harm isn’t covered under the scheme:
- contracting COVID-19
- psychological and psychiatric conditions
- secondary injuries, for example, an injury suffered when fainting, or a haematoma where you were injected that becomes infected.
These other side effects aren’t accepted under the scheme:
- injection site reaction
- muscle or joint pain
- pain in extremity
- nausea or vomiting
- decreased appetite
- abdominal pain
- urticaria or rash
- influenza-like illness
- anxiety-related reactions.
Read more about the conditions and injuries accepted under the COVID-19 vaccine claims scheme policy on the Department of Health and Aged Care website.
To get financial support under the COVID-19 vaccine claims scheme, you must have been either:
- admitted to hospital as an in-patient due to COVID-19 vaccine-related harm
- treated by a specialist as an outpatient, due to COVID-19 vaccine-related harm. Presenting to a hospital emergency department doesn’t meet this requirement. If you weren’t admitted to hospital as an inpatient or treated in an outpatient setting, you need to seek a waiver. This only applies to the listed accepted clinical conditions, and not administration-related injuries.
Read more about requesting a waiver in the COVID-19 vaccine claims scheme policy on the Department of Health and Aged Care website.
Your doctor will also need to complete the COVID-19 vaccine claims scheme medical report. Your doctor must answer the questions about why you weren’t admitted as an inpatient to hospital and give details about the outpatient treatment you received.