AJV, in partnership with Mercury Drug (Pag-Asa Branch) is pleased to offer the Bantay Kalusugan Flu Vaccination Program to provide quality healthcare, awareness and protection to our children.

With the onset of rainy season and sudden change of weather, students/parents/guardians are exposed to viral influenza like flu. With the continuation of the vaccination yearly, we are protected from this strain.

Vital signs will be check by the Doctors and screening questionnaires should be accomplished before the vaccination.

Kindly place their order and settle the 500.00/person fess at the AJV admin office c/o Ms. Brenda on or before June 6, 2015.

    Schedule of vaccination (Tentative): July 15, 2015 – 8:00 AM – 5:00 PM
    Vaccine Dosage Schedule PRICE/Vaccine
    Inactivated Influenza Vaccine spilt-virion (Vaxigrip) Once yearly Php 500.00

    Kindly fill out the table below and answer the next questionnaire if you wish to avail.

    Parent's Name (required)

    Parent's Email (required)

    Parent's Phone (required)

    For those who will avail, kindly fill up the following screening questionaire:

      Screening Questionaire

      For Adult / Children patients:

      The following questionnaire will help you determine if there is any reason we
      should not give you or your child inactivated inject influenza vaccination. If you
      answer “yes” to any of the questions, it does not necessarily mean that you or your child should not be vaccinated: only, additional questions shall be asked for
      verification purposes. You may ask our school nurse to explain items that are not
      clear to you.

      Name of Parent:

      Contact Number of Parent:

      Name of Student:

      Grade and Section:

      Date of Birth:

      1. Do you have allergies to medications, food, a vaccine component (eggs/chicken), or latex?
      YesNoI don't know

      2. Have you had a serious reaction after receiving influenza vaccine in the past?
      YesNoI don't know

      3. Have you had a seizure or a brain or other nervous system problem? Have you even had Guillain-Barre Syndrome?
      YesNoI don't know

      4. For women: Are you pregnant or is there a chance you could become pregnant during the next month
      YesNoI don't know

      5. Is it your first time to have a Flu Shot?
      YesNoI don't know

      Note: If your child hasn’t received any Flu vaccine, he is to complete the prescribed dosage for 2 shots. After the 1st shot, 30-day interval will be observed before giving the 2nd shot.

      Putting your wellness first,

      Ms. Ma. Devie B. Mabao
      School Nurse-AJV