Patient Information
Flu
Influenza (flu) is a
respiratory disease caused by influenza virus infection. The types, or
strains, of influenza virus that cause illness may change from year to
year, or even within the same year. People who get flu may have fever,
chills, headache, dry cough, and muscle aches, and may be sick for
several days to a week or more. Most people recover completely. However,
for some people, flu may be especially severe, and pneumonia or other
complications, including death, may occur.
Flu Vaccine
The regular flu
vaccine contains killed influenza virus of the types selected by the
U.S. Public Health Service and the Center for Biologics Evaluation &
Research of the U.S. Food and Drug Administration. The types of virus
included are those that have most recently been causing influenza. The
vaccine will not give you the flu because it is a killed
virus vaccine. As with any vaccine, flu vaccine may not protect 100% of
all susceptible individuals.
Risks & Possible Side
Effects
Influenza vaccine generally causes only mild side effects
that occur at low frequency. Most commonly, the reactions may be a sore
or tender arm where the injection was given, or possibly fever, chills,
headache, or muscle aches. These side effects usually last 24 to 48
hours. Most people who receive the vaccine either have no reaction or
only mild reactions. There is a possibility, as with any vaccine or
drug, that an allergic or other serious reaction, or even death, could
occur. Also, medical events completely unrelated to the vaccine may
occur coincidentally following vaccination.
Unlike the 1976 swine influenza vaccine,
flu vaccines used since then have not been clearly connected with an
increase frequency of Guillain-Barre syndrome, which is associated with
paralysis.
Special Notice - Vaccination is
generally not recommended for the following people:
1. People
allergic to eggs or egg products
2. People sensitive to thimerosal (a
substance used as an antiseptic and germ killer)
3. People who have
an active nerve disorder
4. People with a fever, or active
respiratory or other infection or illnesses
If you have any of the above, please
notify the staff. If you have any questions, please ask now or check
with a physician or your health department before receiving the
vaccine.
If you experience any significant
reactions, see your physician.
I have read the above information about
influenza and influenza vaccine, and I have had a chance to ask
questions. I understand the benefits and risks of influenza vaccination
and request that the vaccine be given to __ me or __ the person named
below for whom I am authorized to
sign.