Original Medical Record Template (Page 2 of 2) in pdf

Possible Signs/Symptoms of Vaccine Reaction

Vaccine reactions, although rare, can sometimes occur. The protection against disease that vaccines provide far outweighs the potential risks

associated with vaccination. You should consider scheduling your pet’s vaccinations for a time when you can spend several hours with your pet

following vaccination. By being able to observe your pet during this time period, you would be able to contact a veterinarian if complications arise. Your

pet may be slightly lethargic, have a decreased appetite, scratch at the injection site, and/or run a slight fever for the first 24-72 hours after receiving

vaccines.

Rarely, a more serious reaction can occur .

Symptoms of a more severe vaccine reaction may include:

Severe and prolonged salivation, vomiting and/or diarrhea.

Skin hives, facial swelling, etc.

These more serious vaccine reactions usually occur within a matter of minutes to a few hours following vaccination. If any of these occur, your pet

needs to be seen by a veterinarian as quickly as possible, as these symptoms can progress to trouble breathing and heart trouble, and can be life-

threatening. With veterinary attention, these side effects can usually be reversed. Make sure to advise your veterinarian if your pet has experienced a

vaccine reaction in the past, as there are precautions that can be taken to minimize the risk of future reactions.

A fairly common finding after receiving a vaccine can be a small, marble-sized mass at the injection site. This is most commonly seen in association

with rabies vaccines but can occur after any injection. As long as there is no overt pain or discharge, this side effect is not considered dangerous. This

lump can sometimes persist for up to 3 months. If it is painful, has a discharge, gets bigger than a large marble or lasts longer than 3 months, please

call your veterinarian to schedule an appointment to have the lump examined.

If you are concerned about your pet’s reaction to its vaccination, please call the clinic that you visited. If it is after hours, we have limited veterinary coverage, so please

call 602-997-7585 and press 0 for an operator to see if one of our veterinarians is available. If no veterinarians are available, you will need to take your pet to a full-

service veterinary clinic or an Emergency Animal Center, at your expense.

Margaret McAllister Brock Veterinary Clinic

1521 W Dobbins Road, Phoenix AZ 85041 602-997-7585

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____I have read the information above regarding possible complications from vaccinations.

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Consent for Wellness Services

I,________________________________________________, legal owner of the described animal(s), give the

Enter your

Arizona Humane Society, its veterinarians, employees, volunteers, representatives, or agents authorization to

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name

receive, prescribe for, treat, operate on, vaccinate and/or perform diagnostic tests to said animal(s). I am at

least 18 years of age. I understand and acknowledge that the Arizona Humane Society uses modern

techniques and trained staff in the care of my animal(s) and that reasonable precautions are used to prevent

injury, escape, or destruction of said animal(s).

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____ I acknowledge that my animal has no known medical conditions, including pregnancy, that should

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prevent him/her from receiving a vaccination today.I understand that the physical examination the

veterinarian will conduct on my animal today is to determine the suitability of administering vaccinations

today. This exam is not meant to replace the recommended yearly exam of my pet by my personal

veterinarian. The veterinarian cannot address medical issues unrelated to the administration of vaccines at

this time.

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____ To my knowledge, my animal has not previously had an adverse reaction to a vaccine or medication. I

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understand and acknowledge that an adverse reaction to the vaccine may occur that may require medical

intervention by the site veterinarian. If further medical treatment is indicated, I acknowledge that I am

responsible for transporting my animal to a private veterinary clinic. I agree to pay all reasonable charges on

procedures authorized by the attending veterinarian to maintain a reasonable quality of life for my animal.

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____ I understand and acknowledge that, in the professional opinion of the attending veterinarian, my animal

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is an acceptable candidate for the chosen vaccination(s). I further understand that the attending veterinarian

may refuse to perform any procedure on my animal(s) that may reduce or terminate the quality of life of my

animal(s).

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____ I agree on behalf of myself, other agents and successors, personal representatives and executors, to

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indemnify and hold harmless the Arizona Humane Society, its officers, employees, and agents from all losses,

suits, damages, or costs arising from the care, treatment, transport, and surgery of my animal(s) including,

but not limited to personal injury, damage to property, pets, or costs and fees incurred in the health and care

of my animal(s).

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____ I understand that it is recommended that all cats be tested for Feline Leukemia Virus and FIV. I

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understand that if my cat is already infected with one of these diseases, the vaccination he/she receives today

is not a treatment or cure for any pre-existing condition.

I have fully read and fully understand these conditions.

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Sign

Signature ________________________

Date _____________

Original Medical Record Template Page 2

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