VACCINATION INFORMATION SHEET

Vaccination is a form of prophylaxis (prevention) which consists of stimulating the

production of antibodies (defences) via the administration of viruses, bacteria or toxins.
It is means of preventing you from having certain illnesses.

Before being vaccinated, you should tell your doctor if:

(please tick the relevant circle)
If you are a woman: Are you pregnant? Yes O No O
Have you ever had a reaction to vaccines? Yes O No O
Have you or have you recently had an illness or fever? Yes O No O
Do you have any illness which affects your immune system? Yes O No O
Have you received a long-term treatment with corticoids or immunosuppressors? Yes O
No O
Are you suffering from any neurological illness (convulsions)? Yes O No O
Are you being treated or have you been treated in the last 3 months with
immunoglobulins or transfusions? Yes O No O

The vaccinations recommended by your doctor are:

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If you have to travel again or return to your country of origin, you are advised to contact
your doctor TWO MONTHS in advance, in case you need to be vaccinated.

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(Add for women of childbearing age and administration of triple viral vaccine)

If you are being administered a triple viral vaccine - which could affect the foetus if you
are pregnant - please check that you are not pregnant and use appropriate contraception
to avoid getting pregnant for the three months following the vaccination (For
contraception, please contact your Family Planning Centre).