Get And Sign Vaccine Informed Consent Form 2019-2021

11 MENINGITIS ACYW REQUIRED 12 MMR-II 13 RABIES Do you feel sick today Do you have allergies to medications food or any vaccine EX. Eggs Bovine Protein Gelatin Polymyxin Neomycin Phenol or Thimerosal If Yes Please List Have you received any vaccinations in the past 4 weeks If yes Please list Have you ever had a serious reaction to an Influenza vaccine or any other vaccine in the past Guillain-Barre Syndrome or other nervous system problem Are you 65 years of age or older OR do you smoke OR have...