Flumist Vaccination - Assessment, Release And Consent Form Page 3
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3• If you have gotten any other vaccines in the past
What if there is a serious
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4 weeks, or if you are not feeling well. It is usually
reaction?
okay to get flu vaccine when you have a mild illness,
but you might be advised to wait until you feel better.
What should I look for?
You should come back when you are better.
• Look for anything that concerns you, such as signs of
• You should get the flu shot instead of the nasal
a severe allergic reaction, very high fever, or behavior
spray if you:
changes.
- are pregnant
Signs of a severe allergic reaction can include hives,
- have a weakened immune system
swelling of the face and throat, difficulty breathing,
- are allergic to eggs
a fast heartbeat, dizziness, and weakness. These
- are a young child with asthma or wheezing problems
would start a few minutes to a few hours after the
- are a child or adolescent on long-term aspirin therapy
vaccination.
- will provide care for, or visit someone, within the
next 7 days who needs special care for an extremely
What should I do?
weakened immune system (ask your health care
• If you think it is a severe allergic reaction or other
provider)
emergency that can’t wait, call 9-1-1 and get the
- have taken influenza antiviral medications in the past
person to the nearest hospital. Otherwise, call your
48 hours
doctor.
The person giving you the vaccine can give you more
• Afterward, the reaction should be reported to the
information.
Vaccine Adverse Event Reporting System (VAERS).
Your doctor should file this report, or you can
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Risks of a vaccine reaction
do it yourself through the VAERS web site at
, or by calling 1-800-822-7967.
With a vaccine, like any medicine, there is a chance of
VAERS does not give medical advice.
side effects. These are usually mild and go away on their
own.
The National Vaccine Injury
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Problems that could happen after any vaccine:
Compensation Program
• Severe allergic reactions from a vaccine are very rare,
The National Vaccine Injury Compensation Program
estimated at less than 1 in a million doses. If one were
(VICP) is a federal program that was created to
to occur, it would usually be within a few minutes to a
compensate people who may have been injured by
few hours after the vaccination.
certain vaccines.
Mild problems that have been reported following LAIV:
Persons who believe they may have been injured by a
Children and adolescents 2-17 years of age:
vaccine can learn about the program and about filing a
• runny nose, nasal congestion or cough
claim by calling 1-800-338-2382 or visiting the VICP
• fever
website at There
• headache and muscle aches
is a time limit to file a claim for compensation.
• wheezing
• abdominal pain or occasional vomiting or diarrhea
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How can I learn more?
Adults 18-49 years of age:
• Ask your health care provider.
• runny nose or nasal congestion
• Call your local or state health department.
• sore throat
• Contact the Centers for Disease Control and
• cough, chills, tiredness/weakness
Prevention (CDC):
• headache
- Call 1-800-232-4636 (1-800-CDC-INFO) or
LAIV is made from weakened virus and does not cause
- Visit CDC’s website at
flu.
As with any medicine, there is a very remote chance of a
Vaccine Information Statement (Interim)
vaccine causing a serious injury or death.
Live Attenuated Influenza Vaccine
The safety of vaccines is always being monitored. For
more information, visit:
Office Use Only
08/19/2014
42 U.S.C. § 300aa-26
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