|
Screening Checklist for Contraindications to Inactivated Injectable Influenza Vaccination
|
Patient Demographics
|
|
For patients (both children and adults) to be vaccinated: The following questions will help us determine if there is any reason
|
|
|
Is the person to be vaccinated sick today?
|
New Yes / No
|
|
Does the person to be vaccinated have an allergy to a component of the vaccine?
|
New Yes / No
|
|
Has the person to be vaccinated ever had a serious reaction to influenza vaccine in the past?
|
New Yes / No
|
|
Has the person to be vaccinated ever had Guillain-Barré syndrome?
|
New Yes / No
|
