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Vaccine Blank Consent Form
Pneumococcal-23 Pneumovax 23 0.5 ml Merck IM / SC RD/RA LD/LA Td (tetanus/diphtheria) TDVax 0.5 ml Grifols IM RD LD Tdap (tet/dip/pertussis) Boostrix 0.5 ml GSK IM RD LD Varicella (chicken pox) Varivax 0.5 ml Merck SC RA LA Other * RD - Right Deltoid, LD - Left Deltoid, RA - Right Arm, LA - Left Arm
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