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Here's Sat Pleas Abou The federal program of trying to vaccinate as many people in the United States as possible against swine flu requires that a form be signed by the person receiving the vaccine. The wording may vary slightly in some parts of the country for one reason or another, but basically, the form - as shown - indicates that the person receiving the vaccine has read it, does clearly understand the benefits and risks involved, has had ample opportunity to ask any questions he or she might have, and dees (This is a sam the facility wf The Disease Influenza (flu Illness may li pneumonia or especially seri< It is unlikely outbreaks in 4 The Vaccine The vaccine % during the ne pest. In contri Possible Vacci Most people i several days. J Special Precai As with any i However, the people receivi ? Peopl ? Peopl ? Peopl the fl If you have ar I have read understand tf Name of Vac np/e Of Thi e Res t Swii request that the vaccine be given to him or her. The company plans to follow the federal guidelines of the program although we are administering the vaccine under our own Influenza Immunization Program in a way that is supplemented by the federal plan. Each employee who receives the vaccine will be asked to sign one of the forms in the presence of the Industrial Nurse in charge of administering the vaccine at his or her facility. Question Encouraged Clinton Mills doesn't want pie form smjjl^ to the one wh ere he or she is receiving the sv IMPORTANTINFORI ) is caused by viruses. When p ist several days or a week o death in some people. For th HIS. that you have built up adequi 15 years. vill not give you flu because i xt flu season (winter 1976 sc ist with some live vaccines, infl ine Side Effects will have no side effects from Some people will also have feve it ions vaccine or medication, the poj re have been no reported deat ng vaccine have had allergic re< c wmi miuwii diiciyy iu cyip *i le with fever should delay getti le who have received another 1 u vaccine. iy questions about flu or flu va the above statement ahout tl e benefits and risks of flu vacc cinee (Please print) e Form... id, Un le Flu anyone to sign something mey naven i naa plenty 01 time to read and think about. We also want them to have plenty of time to ask questions. We certainly do encourage any employee that has any questions at all about the vaccine or his or her ability to take it to please check with the Plant Industrial Nurse. Don't pass up a chance for this valuable protection, just because you have some question and don't want to bother about asking someone. lich each employee will be asked vine flu vaccine.) NATION ABOUT SWINE INFL eople get flu they may have fev ir more, and complete recovery te elderly and people with diabt ite natural protection against swi t is made from killed viruses. O wing 1977). Today's flu vaccine luenza vaccine can be taken safel the vaccine. However, tenderne ir, chills, headache, or muscle acl sibility of severe or potentially hs from flu vaccine since the ear actions. You should note very ca lould receive the vaccine only ui ng vaccinated until the fever is g type of vaccine in the past 14 d< iccine, please ask your Plant Indi REGISTRATION FORM le swine flu and the vaccine. I ination and request that it be giv Age of Vaccinee - * f dersta . tf i vacci Moving Fast ^ Once we get our supply of ^ vaccine, we're going to be to moving fast in getting these j0( people taken care of. So, qu there simply is not going to ^ be the time to stand there in line reading the whole form before you sign it while you hold up a line of people behind you. foi re Therefore, we're presen- tb ting a sample of this form on m this page so that employees lb can sit down, read it at ba leisure, and make sure they us understand or know what vs questions they want to ask. re to sign in the presence of the Industi UENZA (FLU) VACCINE rer, chills, headache, dry cough or m r is usual. However, complications r >tes or heart, lung, or kidney diseases ine flu, since it has not caused widesp ne shot will protect most people fro is cause fewer side effects than those ly uuniiy picyiMirvy. ? at the site of the shot may occur "?es within the first 48 hours. fatal reactions to flu vaccine must tx ly days of vaccine use (1940's). In so refully the following precautions: ider special medical supervision, one. lys should consult a physician before Listrial Nurse. have had an opportunity to ask qi fen to me. Signature of Vaccine* nd ne Ve want everyone to have s protection, but we want make sure that everyone es understand without estion the protection jy're getting. Samples of the actual rms will be posted in your spective plants. However, e [Minted form here, in ost instances, will carry e information you need to ive. The actual forms given i by the government may try slightly from the one produced here. ial Nurse at uscle aches, nay lead to , flu may be read human m swine flu ? used in the and last for i considered, me instances taking uestions and