INFLUENZA VACCINE (FLU SHOT) CONSENT FORM
INFLUENZA VACCINE (FLU SHOT) CONSENT FORM . 1. Have you ever had a reaction to the flu vaccine? If yes, please describe the type of reaction: _____ Yes or No 2. Do you have a history of Guillain-Barre Syndrome (GBS)? (GBS is an illness associated with the swine flu of 1976 characterized by fever, nerve damage and muscle weakness) ... ................
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