Influenza Vaccine Consent Form Pdf - (contains thimerosal) complete information about person to receive the vaccine. *for children 6 months of age to less than 9 years of age who have not been. Have you ever had an allergic reaction to flu vaccine? Year _______ month _____ day _____ age: Influenza (flu) vaccine (inactivated or recombinant):. Influenza (flu) is a contagious disease that is caused by the influenza virus.
*for children 6 months of age to less than 9 years of age who have not been. Have you ever had an allergic reaction to flu vaccine? (contains thimerosal) complete information about person to receive the vaccine. Influenza (flu) is a contagious disease that is caused by the influenza virus. Year _______ month _____ day _____ age: Influenza (flu) vaccine (inactivated or recombinant):.