Angol nyelvű beteg beleegyező nyilatkozat - ÁNTSZ

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Please answer the following questions (mark the right answer)!
Do you feel healthy now? YES NO
Have you experienced fever during the
previous 7 days?
Did you experience unpleasant, severe
adverse reactions following previous
influenza vaccination?
YES
YES
Have not received
flu vaccine before
NO
NO
Do you have allergy for antibiotics? YES NO
Have you ever feel sick after blood
taking?
YES
NO
Do you faint sometimes? YES NO
Based on the answers of the above questions, the medical doctor will decide
whether you can be vaccinated against pandemic flu.
Within 3 days after vaccination you can experience local redness of skin, local
pain, muscle pain, swelling. If you experience more severe reactions after
vaccination, please consult with your general practitioner.
You can find more detailed information about the prevention of influenza on the
following webpage: www.antsz.hu.