Headings
Vaccines due · Contraindication screen · Vaccine, lot number and site · Information given · Observation period · Next dose due
When to use it
Use this for a nurse or clinician visit where vaccines are the only purpose. It records the contraindication screen, the lot number and injection site for each dose, the information given and the observation period, which is what a vaccine record needs. It is shorter than a preventive screening note and ends with when the next dose is due.
Example
Fictional example
Vaccines due
C.D., 66. Influenza, recombinant shingles dose 1, pneumococcal conjugate.
Contraindication screen
No fever today. No prior vaccine reactions. No latex or egg allergy. Not on immunosuppressants.
Vaccine, lot number and site
High-dose influenza, lot FL2231, left deltoid. Shingles, lot ZS4410, right deltoid. PCV20, lot PN7782, left deltoid, 2.5 cm below flu site.
Information given
Vaccine information statements for all three. Sore arm and fatigue for 1 to 2 days expected after shingles vaccine.
Observation period
Observed 15 minutes. No reaction.
Next dose due
Shingles dose 2 in 2 to 6 months. Next influenza vaccine next fall.