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2014-2015 Live Intranasal INFLUENZA Vaccine ADMINISTRATION RECORD (VAR) Name: First: Middle Initial: Last: Suffix Address: City: State: Zip Code: Phone: () — Date of Birth: / / Sex (Circle one):

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What is live intranasal influenza vaccine?

Live intranasal influenza vaccine is a type of flu vaccine that is sprayed into the nose instead of being injected.

Who is required to file live intranasal influenza vaccine?

Healthcare providers and facilities may be required to report administration of live intranasal influenza vaccine to the relevant authorities.

How to fill out live intranasal influenza vaccine?

Live intranasal influenza vaccine can be filled out by documenting the date, dosage, lot number, and patient information for each administration.

What is the purpose of live intranasal influenza vaccine?

The purpose of live intranasal influenza vaccine is to provide protection against the influenza virus by triggering an immune response in the nasal passages.

What information must be reported on live intranasal influenza vaccine?

The information that must be reported on live intranasal influenza vaccine includes the date of administration, dosage, lot number, and patient details.

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