Recommended Flu Vaccines

1.

Are you currently pregnant?

yes no

2.

Have you ever experienced a severe reaction to a flu vaccine?

yes no

3.

Have you ever experienced a severe reaction to eggs?

yes no

4.

Do any of the following describe you:

Chronic pulmonary, cardiovascular, renal, hepatic, neurologic/neuromuscular, hematologic or metabolic disorder
Immunosuppression (including immunosuppression caused by medications or by HIV)
Asthma
Childred under age 5 years with history of wheezing
Close contact or caregiver of severely immunosuppressed persons who require a protected environment

yes no

5.

Are you suffering from moderate to severe illness today?

yes no

6.

Have you ever experienced Guillain-Barré syndrome within 6 weeks of receipt of influenza vaccine?

yes no

7.

Select your age:

8.

Select your state:

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