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Surname First Name M.I. Suffix
Address________________________________________________________Contact No.__________________
Date
Dosage Seq. Vaccine Manufacturer Batch no. Lot No.
(mm/dd/yy)
2nd Dose
(Schedule / / )
Vaccinator Name Signature
Pain, redness, swelling at the injection site Put ice pack/ice on the injection site for 15 min
3x a day in the first 24 hrs.
Fever, Chills
Take Paracetamol 1 to 2 tablets every 6 hours as
Headache, muscle pain, joint pain needed
Tiredness Rest
Lymph node swelling at neck or arms Usually gets better by itself in a week or so
These vaccines may cause a severe allergic reaction in very rare instances
If you experience aPP severe allergic reaction, seek immediate medical attention.