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Pneumococcal vaccination consent

Pneumococcal vaccination consent

Medical screening questions

Please answer every question. All responses must be reviewed by the appropriately authorised healthcare professional against the current vaccine-specific PGD before vaccination.

Have you ever had a severe allergic reaction, including anaphylaxis, to a previous pneumococcal vaccine, another vaccine or any vaccine component?
Do you have a known allergy to any ingredient of the pneumococcal vaccine being offered?
Have you previously been advised by a healthcare professional not to receive a pneumococcal vaccine?

If you are unwell and have a fever (temperature) on the day of your vaccination appointment, please contact reception to reschedule your appointment.

Consent
Patient declaration