Self-Screening Checklist for FluMist

FluMist nasal-spray vaccines are available and recommended for healthy people in the groups below.

Download PDF version formatted for print:
Self-Screening Checklist for FluMist (PDF:29KB/1 page)

Should I get vaccinated?

If you check all four boxes, you may choose to be vaccinated with FluMist.

1.
I am at least 2 years of age but younger than 50 years of age
AND..............................................................................................................
2.
I am healthy and do not have any of the following conditions:
 
Pregnancy
 
Kidney disease
 
Heart disease
 
Blood disorders (including anemias)
 
Lung disease including asthma, COPD (chronic obstructive pulmonary disease)
 
check box
 Possible reactive airway disease (wheezing in the past 12 months) in a child age 2 through 4 years
 
Metabolic disease (including diabetes and liver disease)
   
Neuromuscular conditions that make breathing difficult
 
Have a weakened immune system caused by cancer or cancer treatment, HIV/AIDS, or steroid therapy
 
I am less than 18 years of age with a condition that requires ongoing aspirin therapy
 
3.
I have not taken any antiviral medication (such as Tamiflu or Relenza) for flu symptoms in the last 48 hours
 
4.
I have not received any other live virus vaccine in the past 28 days. This includes measles, mumps, rubella (MMR) vaccine, chickenpox (VAR) vaccine, or another nasal-spray flu vaccine

I checked all four boxes above, but I cannot receive FluMist vaccine because:

 I have a severe allergy to hens' eggs or to a previous dose of flu vaccine
I have a history of Guillain-Barré disease
I'm moderately or severely ill today (Get vaccine when better)
I have congestion of the nose (Wait until it clears up)
I care for or am a family member of person(s) who are severely immunocompromised such that they need to be in protective isolation

Updated Wednesday, 15-Aug-2012 08:40:42 CDT