Immunization Follow-up

DATE [blank line]

Today, [blank line]
received vaccines to prevent:

Diphtheria, Tetanus and Pertussis
Haemophilus Influenzae Type B (Hib)
Hepatitis A
Hepatitis B	
Human Papillomavirus
Influenza
Measles, Mumps and Rubella
Meningococcal Disease
Pneumococcal Disease
Rotavirus
Polio
Varicella (Chickenpox)
Other [blank line]

GENERAL 
INSTRUCTION/ 
REACTIONS
It is common for children to experience some ­discomfort from today’s vaccine(s).
	Soreness, redness, swelling, tenderness where shot is given
	Fussiness, tiredness, or poor appetite
	Fever (usually low grade)
For relief, you may
	apply ice for first
24 hours 
	Administer [blank field]
		every 4 to 6 hours
		Dosage: [blank field]

YOUR CHILD’S NEXT 
IMMUNIZATION IS DUE: {blank field]

Diphtheria
Tetanus
Pertussis
Measles
Mumps
Rubella
Polio
Hib
Hepatitis A & B
Varicella
Pneumococcal disease 
Influenza
Meningococcal disease
Rotavirus
Human Papillomavirus

In rare cases, moderate or severe reactions to vaccines can occur. 
This will usually be within a few minutes to a few hours after the vaccine.

SHOULD
YOUR CHILD EXPERIENCE
difficulty breathing
horseness or wheezing
swelling of the throat
weakness
fast heart beat
dizziness
hives
CONTACT THIS OFFICE
IMMEDIATELY AT:	[blank field]

FOR MORE INFORMATION
www.cdc.gov/vaccines
or call
800-CDC-INFO (232-4636)
In English / En español — 24/7
Reactions to any vaccine should be reported to the Vaccine Adverse Event Reporting System (VAERS) 800-822-7967

Logo Department of Health and Human Services
Logo Centers for Disease Control and prevention
Safer, Healthier People

http://www.cdc.gov/vaccines/pubs/downloads/f_imz_followup_508.rtf