Vaccine Side Effect Chart
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1Vaccine Side Effect Chart
Patient Name:
Date:
Age:
Vaccine Name:
No. of Doses in Series:
No. of Doses Taken:
Date of Next Dose:
Location:
Allergies:
Medical Issues:
Prescription Medicine:
Dates Taken:
OTR Medicine:
Dates Taken:
Day One (Before Vaccination):
Great
Good
Fair
Bad
Awful
Symptoms:
Duration of Symptoms:
Day One (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Two (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Three (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Four (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Five (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Six (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Seven (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Eight (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Nine (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
Day Ten (After Vaccination):
Same
Worse
Better
Symptoms:
Duration of Symptoms:
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Parent category: Medical