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2009 H1N1 Injectable Influenza Vaccine Consent Form CHILDREN 36 MONTHS AND OLDER Section 1: Information about person receiving vaccine (please print) NAME (Last) (First) (M.I.) MAILING ADDRESS DATE
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How to fill out 2009 h1n1 injectable influenza

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How to fill out 2009 H1N1 injectable influenza:

01
Check the expiration date of the vaccine to ensure it is still valid and safe to use.
02
Thoroughly wash your hands with soap and water before handling the vaccine.
03
Prepare the vaccine by following the instructions provided. This may include mixing ingredients or diluting the vaccine with a sterile diluent.
04
Use a new, sterile needle and syringe to withdraw the correct dosage of the vaccine.
05
Choose an injection site, typically the upper arm or thigh, and clean the area with an alcohol wipe.
06
Hold the syringe with one hand and use your other hand to pinch a fold of skin at the injection site.
07
Insert the needle at a 90-degree angle into the pinched skin, making sure to go deep enough to reach the muscle.
08
Inject the vaccine slowly and steadily, pushing the plunger until the full dose is administered.
09
Remove the needle from the skin and apply gentle pressure with a sterile cotton ball or bandage to the injection site to prevent bleeding.
10
Properly dispose of used needles and syringes in a designated sharps container.

Who needs 2009 H1N1 injectable influenza?:

01
Individuals at a higher risk of severe complications from the H1N1 flu virus, including:
1.1
Pregnant women
1.2
Young children (typically 6 months to 4 years old)
1.3
Older adults (usually over the age of 65)
1.4
Individuals with chronic medical conditions (such as asthma, heart disease, diabetes, etc.)
02
Healthcare workers and other professionals exposed to the virus due to their occupation.
03
Individuals living in crowded environments, such as dormitories or long-term care facilities.
04
People who are caregivers for high-risk individuals or infants.
Overall, it is important to consult with a healthcare professional or follow local health guidelines to determine if you or someone you know needs the 2009 H1N1 injectable influenza vaccine.
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H1N1 injectable influenza vaccine is a vaccine that helps protect against the H1N1 strain of the influenza virus.
People who are recommended to receive the H1N1 injectable influenza vaccine as part of their vaccination schedule are required to file it.
To fill out the H1N1 injectable influenza vaccine, individuals can visit their healthcare provider or a vaccination clinic to receive the vaccine. The healthcare provider will then document the vaccination in the individual's medical records.
The purpose of the H1N1 injectable influenza vaccine is to prevent individuals from getting sick with the H1N1 strain of the influenza virus.
The information reported on the H1N1 injectable influenza vaccine typically includes the individual's name, date of vaccination, vaccine lot number, and the healthcare provider who administered the vaccine.
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