Screening Checklist for Contraindications to Vaccines for Adults Logo
  • Screening Checklist for Contraindications to Vaccines for Adults

    After you submit this form, you will be taken to the Drive-Thru Registration Form for September 27, 2025 and will have the ability to register and select your preferred time.
  • After you submit this form, you will be taken to the Drive-Thru Registration Form for September 27, 2025 and will have the ability to register and select your preferred time.

     

    For patients: The following questions will help us determine which vaccines you may be given. If you answer “yes” to any question, it does not necessarily mean you should not be vaccinated. It just means we need to ask you more questions. If a question is not clear, please ask your healthcare provider to explain it.

    There are more notes at the bottom that further explain what the question means.

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  • It is important to have a personal record of your vaccinations. If you don’t have a personal record, ask your healthcare provider to give you one. Keep this record in a safe place and bring it with you every time you seek medical care. Make sure your healthcare provider records all your vaccinations on it.

  • Information for Healthcare Professionals about the Screening Checklist for Contraindications to Vaccines for Adults

  • Read the information below for help interpreting answers to the screening checklist.

    1. Are you sick today? [all vaccines] There is no evidence that acute illness reduces vaccine efficacy or safety. However, as a precaution, all vaccines should be delayed until moderate or severe acute illness has improved. Mild illnesses with or without fever (e.g., otitis media, “colds,” diarrhea) and antibiotic use are not contraindications to routine vaccination.

    2. Do you have allergies to medications, food, a vaccine ingredient, or latex?[all vaccines] Gelatin: If a person has anaphylaxis after eating gelatin, do not give vaccines containing gelatin. Latex: An anaphylactic reaction to latex is a contraindication to vaccines with latex as part of the vaccine’s packaging (e.g., vial stoppers, prefilled syringe plungers, prefilled syringe caps). For details on latex in vaccine packaging, refer to the package insert (listed at www.fda.gov/vaccines-blood-biologics/vaccines/vaccines-licensed-use-united-states). COVID-19 vaccine: History of a severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a COVID-19 vaccine component is a contraindication to use of the same vaccine type. People may receive the alternative COVID-19 vaccine type (either mRNA or protein subunit) if they have a contraindication or an allergy-related precaution to one COVID-19 vaccine type. Allergy-related precautions include history of 1) diagnosed non severe allergy to a COVID-19 vaccine component; 2) non-severe, immediate (onset less than 4 hours) allergic reaction after a dose of one COVID-19 vaccine type (see Note). Not contraindications: Eggs: ACIP and CDC do not consider egg allergy of any severity to be a contraindication or precaution to any egg-based influenza vaccine. Injection site reaction (e.g., soreness, redness, delayed-type local-reaction) to a prior dose or vaccine component is not a contraindication to a subsequent dose or vaccine containing that component

    3. Have you ever had a serious reaction after receiving a vaccine? [all vaccines]
    · Anaphylaxis to a previous vaccine dose or vaccine component is a contraindication
    for subsequent doses of the vaccine or vaccine component. (See question 2.)
    · Usually, one defers vaccination when a precaution is present unless the benefit
    outweighs the risk (e.g., during an outbreak). 

    4. Do you have any of the following: a long-term health problem with heart, lung, kidney, or metabolic disease (e.g., diabetes), asthma, a blood disorder, no spleen, a cochlear implant, or a spinal fluid leak? Are you on long-term aspirin therapy? [MMR, VAR, LAIV]
    LAIV is not recommended for people with anatomic or functional asplenia, a cochlear implant, or cerebrospinal fluid (CSF) leak. Underlying health conditions that increase the risk of influenza complications such as heart, lung, kidney, or metabolic disease (e.g., diabetes) and asthma are precautions for LAIV. MMR: A history of thrombocytopenia or thrombocytopenic purpura is a precaution to MMR. VAR: Aspirin use is a precaution to VAR due to the association of aspirin use, wild type varicella infection, and Reye syndrome in children and adolescents.

    5. Do you have cancer, leukemia, HIV/AIDS, or any other immune system
    problem? [LAIV, MMR, VAR] Live virus vaccines are usually contraindicated in immunocompromised people, with exceptions. For example, MMR vaccine is recommended and VAR may be considered for adults with CD4+ T-cell counts of greater than or equal to 200 cells/ mcL. See Note.

    6. Do you have a parent, brother, or sister with an immune system problem? [MMR, VAR] MMR or VAR should not be administered to a patient with congenital or hereditary immunodeficiency in a first-degree relative (e.g., parent, sibling) unless the patient’s immune competence has been verified clinically or by a laboratory. 

    7. In the past 6 months, have you taken medicines that affect your immune
    system, such as prednisone, other steroids, or anticancer drugs; drugs for the treatment of rheumatoid arthritis, Crohn’s disease, or psoriasis; or have you had radiation treatments? [LAIV, MMR, VAR]
    Live virus vaccines should be postponed until chemotherapy or long-term high dose steroid therapy concludes. See Note. Some immune mediator and modulator
    drugs (especially anti-tumor necrosis factor [TNF] agents) may be immunosuppressive. Avoid live virus vaccines in people taking immunosuppressive drugs. 

    8. Have you had a seizure or a brain or other nervous system problem?
    [influenza, Td/Tdap]
    Tdap: Tdap is contraindicated in people with a history of encephalopathy within
    7 days following DTP/DTaP. An unstable progressive neurologic problem is a
    precaution to using Tdap. For people with stable neurologic disorders (including
    seizures) unrelated to vaccination, vaccinate as usual. A history of Guillain-Barré
    syndrome (GBS): 1) Td/Tdap: GBS within 6 weeks of a tetanus toxoid-containing
    vaccine is a precaution; if the decision is made to vaccinate, give Tdap instead of
    Td; 2) all influenza vaccines: GBS within 6 weeks of an influenza vaccine is a
    precaution; influenza vaccination should generally be avoided unless the benefits
    outweigh the risks (e.g., for those at high risk for influenza complications).

     9. Have you ever been diagnosed with a heart condition (myocarditis or
    pericarditis) or have you had Multisystem Inflammatory Syndrome (MIS-A
    or MIS-C) after an infection with the virus that causes COVID-19?
    Precautions to COVID-19 vaccination include a history of myocarditis or pericarditis
    within 3 weeks after a dose of any COVID-19 vaccine or a history of Multisystem
    Inflammatory Syndrome (MIS-C or MIS-A). Myocarditis or pericarditis within 3
    weeks after a dose of any COVID-19 vaccine is a precaution: the patient should
    generally not receive additional COVID-19 vaccine. A person with a history of
    myocarditis or pericarditis unrelated to vaccination may receive a COVID-19
    vaccine once the condition has completely resolved. A person with a history of
    MIS-C or MIS-A may be vaccinated if the condition has fully resolved and it has
    been at least 90 days since diagnosis. Refer to CDC COVID-19 vaccine guidance
    for additional considerations for myocarditis, pericarditis, and MIS (see Note).

    10. In the past year, have you received immune (gamma) globulin, blood/blood products or an antiviral drug? [MMR, VAR, LAIV]
    See Note (schedule) for antiviral drug information (VAR, LAIV). See “Timing and
    Spacing of Immunobiologics” (www.cdc.gov/vaccines/hcp/imz-best-practices/timing-spacing-immunobiologics.html) for intervals between MMR, VAR and certain blood/blood products, or immune globulin.

    11. Are you pregnant? [HPV, HepB, IPV, LAIV, MenB, MMR, VAR]
    Live virus vaccines (e.g., LAIV, MMR, VAR) are contraindicated in pregnancy
    due to the theoretical risk of virus transmission to the fetus. People who could
    become pregnant and receive a live virus vaccine should be instructed to avoid
    pregnancy for 1 month after vaccination. IPV and MenB should not be given
    except to those with an elevated risk of exposure during pregnancy. HPV is not
    recommended during pregnancy.

    12. Have you received any vaccinations in the past 4 weeks? [LAIV, MMR, VAR, yellow fever] People given live virus vaccines, such as those listed above, should wait 28 days before receiving another live virus vaccine (wait 30 days for yellow fever vaccine). Inactivated vaccines may be given at the same time or at any spacing interval.

    13. Have you ever felt dizzy or faint before, during, or after a shot?
    Fainting (syncope) or dizziness is not a contraindication or precaution to vaccination; it may be an anxiety-related response to any injection. CDC recommends vaccine providers consider observing all patients for 15 minutes after vaccination. See Immunize.org’s resource on vaccination and syncope at www.immunize.org/catg.d/p4260.pdf.

    14. Are you anxious about getting a shot today?
    Anxiety can lead to vaccine avoidance. Simple steps can help a patient’s anxiety
    about vaccination. Visit Immunize.org’s “Addressing Vaccination Anxiety” clinical
    resources at www.immunize.org/clinical/topic/addressing-anxiety.

  • VACCINE ABBREVIATIONS
    HepB = Hepatitis B vaccine
    HPV = Human papillomavirus vaccine
    IIV = Inactivated influenza vaccine
    ccIIV = Cell culture inactivated influenza vaccine
    IPV = Inactivated poliovirus vaccine
    LAIV = Live attenuated influenza vaccine
    MenB = Meningococcal B vaccine
    MMR = Measles, mumps, and rubella vaccine
    RIV = Recombinant influenza vaccine
    Td/Tdap = Tetanus, diphtheria, (acellular pertussis) vaccine
    VAR = Varicella vaccine

  • After you submit this form, you will be taken to the Drive-Thru Registration Form for September 27, 2025 and will have the ability to register and select your preferred time.

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