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北京市甲型H1N1流行病毒裂解疫苗接种知情同意书Consent Form for
Vaccine Recipient:
H1N1
Consent Form for Immunization with the H1N1 Split Virus Vaccine
at Beijing United Family Hospital and Clinics
20094H 1N 1
H 1N 1
H 1N 1
H 1N 1H 1N 1
. In April 2009, a new mutated strain of flu virus, influenza A (H 1N 1), was found first in
Mexico, and has gradually spread across the globe through durative human-to-human transmission.
H 1N 1 is a communicable disease of the respiratory system that mainly shows respiratory infection
symptoms.
The Beij ing municipal government has given a great deal of attention to prevention and control of
H 1N 1 infection by carrying out an immunization program among key population groups, such as
elementary/middle/high school students, and healthcare professionals. In the maj ority of cases,
immunization with the H 1N 1 split virus vaccine can effectively prevent H 1N 1 transmission and
infection.
H 1N 1
. We would like to share with you the following vaccination information regarding type,
administration method, side effects, contraindications, and what to expect post-immunization so
that you can make your own informed decision.
Vaccine Type H 1N 1. H 1N 1 split virus vaccine.
Method of Administration . Intramuscular inj ection.
Side Effects . Common side effects
include fever, fatigue, headache, dizziness, nausea, etc.
. Recipients may also occasionally experience localized
redness, pruritus (itchiness), sore throat, muscle pain, cough, abdominal pain, arthralgia (j oint
ache), dry mouth, loss of appetite, diarrhea, allergy, or chest stuffiness.
24 .
The aforementioned adverse reaction
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