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THE DANGER
THE VACCINE
THE PRIORITY
THE STRATEGY
adverse event info
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my vaccination
smallpox overview

Last Updated:
22 Feb 12
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 RESOURCE CENTER: FORMS

    If you have clinical questions related to vaccination,
    please contact the DoD Vaccine Clinical Call Center at 1-866-210-6469.

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 VAERS
   Vaccine Adverse Event Reporting System

 30-day Diary Card PDF  7 Feb 08
   Symptom Diary After Smallpox Vaccination

 Initial Competency Assessment: Smallpox Vaccine Administration PDF  7 Mar 08
   MILVAX Agency

 Initial Competency Assessment: Smallpox Vaccine Reconstitution PDF  7 Mar 08
   MILVAX Agency

 Smallpox Vaccine Screening Form PDF  8 Jan 10
   2-page format, STANDARD FORMAT

 Smallpox Vaccine Screening or Medical Note Continuation Page PDF  7 Feb 08
   Smallpox Vaccination Continuation Note CHRONOLOGICAL RECORD OF MEDICAL CARE

 Smallpox Vaccine Sick Call Medical Note PDF  23 Jul 09
   Follow-Up Note for Sick Call Evaluation of Patients [pre position this form at ERs and troop medical clinics]

 Smallpox Vaccine Take Check Medical Note PDF  23 Jul 09
   Follow-Up Note for Standard "Take-Check" Visits

 VAERS Pregnancy Supplement PDF  1 Mar 08
   Supplemental Form for Smallpox Vaccine in Pregnancy Registry