Get the free Meningococcal Meningitis Vaccination Response Form - nyu

This form is required for new and returning students, as well as those over 21, to document meningococcal meningitis immunization status as per New York State Public Health Law.

How to fill out meningococcal meningitis vaccination response

How to fill out Meningococcal Meningitis Vaccination Response Form

1. Obtain the Meningococcal Meningitis Vaccination Response Form from your healthcare provider or institution.
2. Fill in your personal information, including your full name, date of birth, and contact information.
3. Indicate the date of your meningococcal vaccination in the appropriate section.
4. Provide details about the provider who administered the vaccine, including name and contact information.
5. Sign and date the form to confirm that the information provided is accurate.
6. Submit the completed form to your healthcare provider or the relevant authority as instructed.

Who needs Meningococcal Meningitis Vaccination Response Form?

1. Individuals who have received the meningococcal meningitis vaccine.
2. Students entering college or university, especially those living in dormitories.
3. Individuals traveling to specific areas where meningococcal meningitis is endemic.
4. People with certain medical conditions that increase their risk of meningococcal disease.

People Also Ask about

Can you have a reaction to the meningitis vaccine?

Be sure to notify your doctor of any side effects that occur after your child receives this vaccine. Fainting may occur after receiving intramuscular injections, such as this vaccine. It may occur with other symptoms including: blurred vision, numbness or tingling in your arms, hands, or feet, or seizures.

What are the reactions to meningococcal vaccine?

Among the participants who received NmCV-5 at age 15 months relative to participants who received MenACWY-TT, the difference in the prevalence of seroprotection was 0.8% (95% CI, –0.6% to 3.7%) for serogroup A, –0.8% (95% CI, –3.3% to 2.5%) for serogroup C, 0.3% (95% CI, –1.8% to 3.5%) for serogroup W, and 1.4% (95% CI

What are the side effects of the meningococcal vaccine?

Soreness, redness or swelling where the shot was given. Muscle pain. Headache.

What is the most common adverse reaction following either type of meningococcal vaccine?

If you have a reaction to the meningococcal shot, it will most likely be mild. Side effects may include: Mild pain and redness at the injection site. Slight fever.

Is it normal to feel sick after a meningococcal vaccine?

Meningococcal B vaccine side effects Soreness, redness, or swelling where the shot is given, tiredness, fatigue, headache, muscle or joint pain, fever, chills, nausea, or diarrhea can happen after meningococcal B vaccination. Some of these reactions occur in more than half of the people who receive the vaccine.

What is the meningitis response form?

Provide information about a student's past immunization for meningitis, or confirm that the student will not be immunized.

What are the results of meningitis vaccine?

The meningococcal conjugate vaccine (MenACWY) protects against four types of meningococcal bacteria (types A, C, W, and Y). It is recommended for all kids and teens age 11 and older.

For pdfFiller’s FAQs

What is Meningococcal Meningitis Vaccination Response Form?

The Meningococcal Meningitis Vaccination Response Form is a document used to report vaccinations against meningococcal disease, ensuring compliance with health regulations and monitoring immunization status.

Who is required to file Meningococcal Meningitis Vaccination Response Form?

Individuals, typically students or residents in certain settings, such as colleges or healthcare facilities, are required to file the form to confirm their meningococcal vaccination status.

How to fill out Meningococcal Meningitis Vaccination Response Form?

To fill out the form, individuals must provide personal information, vaccination details including the type of vaccine received, date of administration, and the signature of the healthcare provider.

What is the purpose of Meningococcal Meningitis Vaccination Response Form?

The purpose of the form is to ensure that individuals are vaccinated against meningococcal disease, to track immunization rates, and to provide necessary documentation to educational or healthcare institutions.

What information must be reported on Meningococcal Meningitis Vaccination Response Form?

The form must report the individual's name, date of birth, vaccination history, type of vaccine received, date of vaccination, and healthcare provider's details, including their signature.