Typhim Vi by nuhman10

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									                                           Typhim Vi@
                                 Typhoid Vi PolysaccharideVaccine
      t
Patien Information/Consent
                         Form

Tlryhoid
    T1'plroid fever'is an infectiousdiseasecausedby Salmonella   typhi- Infecdoru result from the mnsuurption
    of food or water thai hasbeericontaminated.   Systenic iltnii.pres:nts witr symptons of faner,myalgia,
    anorexia, abdominal discomfortand headadres.   Typhoid fever is endenricinminy coun6ies of the world.

fypnin Vi Veccine
    The vaccine is a sterile solution conaining tlre cell surface Vi potysaaharide extracted
                                                                                                 ttoo.r Selmonella
    typhi Ty 2 stralo-grotrn in a seuri-synthefrc
                                                rnedirrsr without         pm6ins ne inrn'riarn           jose is a
                                                                   "didt
    .itgFtniecrimof 05nL Reinsurnizatiqrconsistsofasingte-dooeforus.uavelas;.r]r"r"fi;'nder
    conditions of repeated ol continu€dexpo$sa Vaccincstroun bc
                                                                        $ven at least Z *."G'ploi'to     erp*t"a
    ex?osurc.

Risks & PossiblcSidc EffecS
    No scnere o! unus"rl side effects wcrc observed in trials. Local rcactions suctr as iniection site pain,
    gytneTa (redness), and induration (swctling) alnrost always rcsolved wi6in aS horul of vaeinaton.
    Fever abovel0O.4"Fwas obscnr€d l% of rraeirecs.
                                   in
speciel loti9c - check with a phpician if vaccinationis bcing considercd bn
   . Childrrrrundcr2ycarsof age.
   . Pregnartw@ten
   . Personswith acute inftction or fcbrile illness

U you have any questions,please nour. If ]rou qpedenced arry significant r€acti66rs,
                               ask                                                 cilrtact a physician-




I have read the aborre infoaration and have had a drance to ask questions. I tr3dggstad the bens6c and rlsks
of vaccination and request that the naccine be grver. to me or the pcrson narned below ior whonr I anr auttcizec
to



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