Document 2002804

o
~p::; ~
r--"1
2 v: ~
oj
.-<
~$.~
~r-lru1~J
-j
oo-<,j(lJ
or~K1
'" 'T;jO
; ~ ~Lr(ll
c ~ ~ ~
--
:g....
oJ >
g 0 .==
C/)~
"g-g ~ <I~~
§~ ~ OU~ 0
o:.l<O:J
!'lO C
~ " g"§ Cl-J~.~
u c..E
.=(f;
E
I() ~oJ;:
~ ~ ~ 011"03
~ ' ; ' i <JKr ~
~~ ~ iirlllli
:;:: ;; (/)
_ <J
<J iii
iii;jQO
-,-...LO T"'"
1-<1\
0
o'J]] N
0
N
T"'"
ru~ -j ~
a.J Il:IlnJ ~r
oJ:rO
oj ---- -<
!!f
:(J
II"
<J
o
~
ollll
K10
Kil
Ii"J
uf-­
o
"3"J
olll
JIJ
o
KIO
1110
o
~
co
~
o
rr in
°
°
om ~J ~J ~Ill JIJ
~
olJ
o
_u
.
;jQJ ;jQIU
~J
..1 ~
III
~ JIJ mlJ ijr
Kf-- ru DO
,,111
<In~
'1 0 ;jQ U ~ 01111
_~..1
KO o
r-i~
K..,.O
o ~
r-.u o OIJ oj
I I nOOf ~J ~
<f--K"J
Kf-- "T
"3"J 0 Kjo Ill~ Kill
N _] TID ~J K
~oJ
~ III
~1U11II~~IIllO
Kill ijr ~J
or <jr
~Illf-­
.....:.JIJIJ-J~
KW LH
U .... > 0 .J
JIJ!:S I:IIIll
"KTI ~
~K
-ru- · 01
.J_«UT-<
JIJ LH is! o'J-J
"KjO
~.2. - l on
Tll
KIll~~
LiT KO ;to
o K
1:11111 Kr
:iJJ Il
JIJ
C<O -rrJ
iiiD 0
~O JIJ -..1 ~O <f-- .....:. -:m..J DO oj 01
-< _ -<
n
U 'IUV ~
:<~
Dru~~
~O 0-<' 1WI
~ "T
u u
-1l10
~:(
01
JIJ 0 K1 IUIOl DO oll
ruj"T"T
~o
o
a~ -J
-< I c<0 K -< I
~ll
-<I iiiD ~
~o
otN
-< -<
ru ~ 0 ru IUIIII nO DO~ ru oj Dj<
~iif
r-. ~J 0 K Of
.2. 01 K
JJ iiilll ijr JJ ~J -:(J o i'J'K Il ruj;to . ~ rulJ
I u
~ 01 ~ ~ 1ll~:Kf 'IO~ JIJ
KKK
KK Dou
Kjo ~ ~J~Jo"T .... OIJ
~J
a­
Di
° ijr °
a­
-l 0
u
In
­ .J
~
0 ....
~
OF
~o
-L­
~
K
ll~
DO
~
~
r-.
0
~
.J
~m
ruj
0
W
-l
~
o '
Kil ~o Ill~ Ill~ ollll <I] JIJ ~J JIJ
otN u Ill~ O lllllll~ ru~ oj ;to
>
Q1ill
Lf)
~o
\.D~ oj Km oj oj
> ijr
~"T I:IIIll DO I:lIOl I:IIIll ulJ DO ~JDO 1:I IIlll:llru DO o~ ~oj oj Kill <f--
:::r
."...
Ill~
u
OiJ 010
I
r-.
~ou
0
!_:.:.0iIIl
ruj
~ KID .
01
o
oj
ruJ
.
. .:. "T
"'D WlO
~J
10
nj
o
~~]
r-.
~ <In o~
-< I u' 01 Jjl~ <f-0
B Olm
-<
.
ru"T -o-<'KO
iijillu
r-.
<jr"T
01 I "3"J .2. iiill <f-- ~ K<11l
Il
0
0
-rtJlllo
--<
KtO =Cl
KK"J
:iQIl1111 0-<.
KD ~u ~Jo ,,111
0"T Ill~ ;to 001- ru <f-­
:iQIJ
Or
;0 r1f all
t-jllll
Wlo Kiillll 0 11ll
fTi
-J
~J,,111 oW
is
o ollll
Ill~o~~
Kia
JIJ
JIJ 'Kjr 1:I11ll~w•
;jQJ Wla Wla
t:H
0
K
KKil -OJI ~J
~ ~O ~ Of olr ruj ;KlJ Wla Dim
~J
_
r-. ~ Ill~ r-. KIO am Djr I1J i:r r-. Uf-- lit<
ODO
JIJ 0 0
KK"J
JIJ
;to
~J
Ill~
foO I:IIIll :K 11- ~11ll K OIJ
'O]OF oJ 1<' Jf-- oj r;D r;w
T"'" I ~Iru
ir
°-1R~
;rJ am
~
nil- ~
III;
~,OJ ~r oJ
s
<"J_
-r
0:<
"
=
"TT"""
ZL
S5':'
:5
=-
<"J
o
~
O~J
:r
oj
~
iir
0\
~J
•
-I
J5IU
"!rIJ
o
-0
~ .
u
'100"T
!:l
I:H <Ill
~ ~
"0
C
~
!
Kll
"
u
"]""
<Ill
DO
~
:.:::;
>
Q)
<{
::::
Q)
:J
C
iii
Q)
"0
C
-=
:J
Q)
N
m
c
~
U
u
c
Q)
:.::
o
~
c
m
co
~
a;
o
N
K~O
s
0
~<
0
JIJ
;to
ollll
KW
~
K
OiJ
~J
iir
R-
-0 K1 KjO ::( 80 "3"J
~ R' Kil KJ- ~IIJ ~
0-<.
IU~ . ~J
~ LH
Ilr ~J u· !Ill ti ru~
~~ Er "T oJ:r IjIIlJ
fOo:kin oj
~J o~
U1
OJ"'r
Il
..
;to
D'K ~
-<
~J Kf-­
ijr ruj
~ r-.
C<O:<
~ Kf-­
Dim OIJ
~
JIJ
~>
R'!:S K [}fJ
011
JIJ
jJJ n~
~
l1li oj ~ K"J
180
r1
Cit ~ - -'-< -ru OIJ
mf-- ~ .1Oj
reD
_ r-. 01 0
2.~ 0 iUD
UIO nJ
($ I:IIIIJ t::j ~
ISO
r"'- lUI LH ll~J
01\1 KIO ~
..,. tr
DlIl-J iijlll r-.
__
o
JIJ
KO
C<O
I
-<
nO 0
~
~
itlIJ
r"'- rtl
0III
:;;:0 itlIJ ...... -Ill 0
::r "~o"KJ
I
III­
LH
NI oru ;jQIU ~J ~J
~ ~ ruJ
K oj . ~ W] '1Oj K0
-<
~~~iifW
~-<r1
",~u~nj~.....:.
g
JIJ
011
'loJ " l _
JIJ JIJ .....:.
l\0 - -..1 ... Of-- r-. ~
;to
il Or 0 Of---< U
01
~..,. ~ ..1
e<"J
JIJ
or _ Ollll ~ ""0 01 0-<. -..1 -<J :< <In 1110 1\0 KID .1m
KjO
Ui 0
.J 1\
~ - _ -< reD
,'" 1110
Kil
~
reo:;=
ero
~
O
llll
r-.:;;
~
r::;-J
01
0-<.
~Ill 'OJ o~
reD
K ~O - -< - -<
Il rur ~
- OL <f-- 011 o~ - .IL .....:.
a~
~~
~~.s: .~r
~~~ ' r~($
KtO 0'"Iolru
~J lID
~O ,~~ 0 ~ . ~ J 2, u ~J RO ~ .. ~ ~ olm ~ ;u
"l!D:::r ijr
!F
JIJ
KjO
Kr
r-.
U
~J
0~"T
~JIJ
KO
~
nO
DU
loll
r:l1
of-­
Ii(
<ID
Til
lUI
-<[]
I
r-lJ
-<
jl\1U
W
nO
of-~
<
I
""0
OIJ
~ -~_O.~
1\
01 o~ itlIJ .~K~_~-~~
~~~~rtl~~~~~r-.oK
~LH~~~
~
:<o-j !fO ~ "'r ~m oru ~J M-J ~ KW = '1cl.TI 10 oj :s j j ~ ;<'"J KW :is' Of-- =0
IllIln~oIDI-Il
~ .
.,..5~
ICT
.
1
o JIJ ~ Till
~
~ 'loJ JIJ II10 ~ru OKll ~01 IOjI R'I\<
- r-. olru JIJ Kil 01- 0 RO or
II iiID
..... K
K r-. ~
.,.", <:>
I
­
I
;to~
IC5 .. ~J r-. I\r ~ ;u -Ill 0III -<0 J J JIJ 'IOIU I- 01- KW nJ 0III I'D ::r olll ~
liD III ~D ~ Illf-- lUI :([] ~
~J or tH Cit olm ~ III Kil III ~J or aulO ;
=~m
01- 01- ~IOl rtl ;jQJ KjO lie of-- ijr :< KO ~ KjO l"J OIJ ~J u ijr Olll 0 ~J or
olm =I'D~oru~Kll~~oOf~~KllR'iS!iifr-.*OZ~(JJ
o
010 :(ol
I - - - - - l i riO 0
('t')
,--_~I u:<
K
~~J
<f-or r-\ ru~
~ JIJ (JJ itlIJ I:IIIIJ
~[] t:H ~ :<oJ
-< L
~
--< -rru -
_ Dr ~ 'loJ"
;::J 7J
...
or
<
ollll iiilll
olru
OIJ
o
DO 01
KjO 01111
o!l
- C<O
Kill 0111
olm KIl"r/
o"""J
::r
Ci
fTi c<0 !
Klo - 1\,
KjJ olm
~
""0 -<J JIJ
....
1
ollll Oi'J nO Lf
-Kr
n ijr­
is
r-.~
:;
TID
JIJ"T
Lrl
nlll
eo ~ KoD
o
~
OiJ
-<I <Ill
~
r1 ~J"KJ
01 or
Ir
2
brJ
ru o~
nH
o~ :<
orruf--~
-""
~J ~ .2. ~
oCV
"'r
+:>I Il K
!:S I:Ilm ~
<f-- =<III
!,J
Il
or _ fl\
oj oJ-J
JIJ
~I
~: 01;jQIUmf-- . "0
.,.01
K . -J -<
......: t-j I Oluru~
-J~-<""O
K"J~
~="O u:r r n
~Ill nlJ
OJ~
~
::::::. ruf--"T Il ~Ill
..1 -J"T I:IIIIJ
n 0
o
-n
oj
iU I:IIIIJ ~ .....:. IUIIIJ
($~ - 0
ruj .
_ til oj KjO ~ ~
~~J °iilIruj
Olu
o I ~o Kil ~ ~J
ttl oD ~O ~O 01 u'
7UD"T
Kil _ ,K'r "T
101 <ill
01 ~
~
[}fJ 0 ~I< 1lIf-<1-0
-<
~ N) ;j(jf;to ollll I:IIIll
JIJ 0-<. . ~ OfJ <"J -:(J Kil <Ill
10;; or:< ol[] oj
'K, 0
K <f--u C5 TID "=-J~
~J iiilll"T nr­
f - - - \ 0 n~J o~ 0
_ 0 ~ JIJ il <f-­
mf--~ <In 1::11 ulru .. ;too ~
c<0 ruj lif lif
N
I:Ilm :jOf o~ "3"J itlIJ .DO;to DO
~J 0 I ~ ~
or <f-- ~-=< OJo WlO 0 ,------," TID <jr or Or
oo~~~oo oj
.s:
"" 0-<'
0
;jC!IIJ 0 0 0 ulru
0
52 ~O ,]O[J U· itlIJ
-<0 - Km - -<
Kia 0 - 711l JIJ
r-I -=< '" '
.
I I Lf) l\0 iliolO ;to u
U \.D ~J r1 'Kjr "T
nj ~ ~- 0 KIl~
itlIJo'iCi,lU I -~
:< 1110 Kill uIII
KIO
~~ itlIJ::;::
IIIIJ 0 ~O:< ~ 7jO
u oruJ -<J_K-J ~
wlr
r-\
OIJ
"j;r ~itlIJ 0
itlIJ u' ~ or -Z ~a
-< "T 0 ~ ;jQJ Kll
8J <Ill KO '" ru DO
- JlICC:..f ~2112 717~ ~ ~ ~-"f- tj6jol ~71q 3-~ '@ tcH !Bj!Bj712-1 ~ OlE! o~s
- ~PI~O£ O~A.TIIE!~ ~.§"B~~ o~solq ~~IJ
- oH-"f- '2:!9:lJlI7~ '2{oH~ Af§~ 7'§J OILH01I
'6'~"B~71 q V~%f ojl~ ~ ~-"f-(£Ik <j 011 7-l1 ~£I)
- AI'Ll 48 AIV OILH01I <j~Ef-<WA~ ~tl~OI21~ '2{~~
~Zf2! ~~Ol LtEt~ lJ~
.~UDt1
!j! ~ Ii .;: !21 ~VII ~ lit ~ Ot Ot WWit?
• {dZ{E!-
-'9 ~
~'§E!- ~-Sf
~t! ~~~ ~AI"Bf~ Af~01I7-l1 AfA11~ ~~~ 'fj~
'T
~1 ~LlCf .
(~_4~1_~_H~___~_~_m___~_~____________~J
£1'2{~nf Df&7~AI.£ I!IJ~01I~
Cf:::
¥6,f.§ol
~1~
'T
~l~L..lcf. ~~ ¥~.§:: ~DI"Bfjl Al~.£ 'iiiOl~L..lq.
~5 !j! :~!t
!!It!
•
=r
~~01I [HE!- ~Cj1271 t:!~ol {dE!- ~-"f-~ oH-Sf
=.~0l1/1~12l 01121 0 .£ ~~~L..lcf. ~Cj1271
t:!~:: ~~ ~t! ~;; .1jt ~ iE-01IAl ~ AIV 0ILH01I
I~NHJL..lcf.
" LAIV ~~.1jt qEfq~ lJDI2!
2-17).//£/ of-~J1f &:i:.f::_(·
• ~~, ~1If~ , 71:g ·
5~:
{dZ{E!- ~211271 t:!~£1 ;;~Ojl~ ~='2171, ~~12~
~ol ~ ~ ;;~, ~~ -2-~, {d~ ~~Ol ~2~~,
OlAI'2:l;;, %011 ~Ol 'iii;; ~ol ~l~L..lc~. 0121E!­
;;~:: ~~ ~~ .1jt 'T iE-01IAl 'T AIV LH01I
AI~~L..lc~.
!j!~ § OR Ot WWit?
• ~Cj1271 '2J~ol ~:z..t"B~7-lq ~t:J£171~ 7Ic~~
.£
~I E- E!- ~ tf
°I ~ {!j %f ~ -Sf 9- 1- 1
t:J:2:~"B~71q 7~}}~~ tg~
0.£ [-jI2-ljl
7~~AI2 .
o~L..I'2:!, £IA~01I7-l1 t:J:2:~"B~'GVI2.
• -=:121jl 8 c~;; ~~ ff-oH Af2jl ~jl AI A. '2J (VAERS)011 ~Cj1271 t:!g~ ~jloHOF gJ-L..IC~. £IA~7~ 01 ~jlAl ~ Ail~oHoF gJ-L..IC~. EE.~ ~~ VAERS -gj Afol.§. www.vaers.hhs.gov01IAl EE.~ 1-800-822-7967.£ t:J:2:~"BfCJ:j ~jl%f 'T ~1;;:; L..I c~ .. ~ ·
~~ ~ 2~~ § '@ uH ~~7HJ •
~~ EE.~ V~~ T-~, ~Af ·
~211E.71 tt.!-~, jl<i§j, ~s ~:2:~ ~ ~AiI7~ Af~~ 2f£1 ~7-l1 ~TI~~O~OF gJ-L..lc~. £::.
'T 'iii ~ 71 Ef
9l~ ~lIl:
OIWJI
5
6
-21 '2J.­
• ~~, ~1If~
• ~£I ~;;
• 71:g, ..2.E!-, TII.£/~'2{
18- 4 9).//
cz!w
~!i!m !I~
_ _ _ CI
ue,u
mGH
S!~
'21 '6'
~ ¥ ~ ~ TIl -oH ~~ E..£-=:1 '2\1 (VICP):: ::; ~
~~ [CH~01I '2~~ %J:: A~§01I7-l1 ~~"Bf71 ~loH
121 ~ 01 ~ '21 ~ ]I.£-=:1 ~ %J L..I q.
~~ 0.£ ~-oH '2~~ %J~cfjl {ljZ{"B~~ A~§::
1-800-338-2382 .£ t:J:2:~"B~7-lq VICP -gj Afol E
(www.hrsa.goy/vaccinecompensation) ~ '6'~ "BfCJ:j 0 I
£1'2{~n~ D~~P~AI.£ ~~Ol {d:z{E!- ~oH EE.~
A~'Y~ '§J o~ 7~:;~01 oH-Sf ftl'4gJ-LlcL 2.::'
~l-;;;-L..lcf.
OIWJlI
WOt~
~~ ~T-Ojl~ AI~ol ~l-;;;-L..lc~.
~~£I 0~~:: ~~ 2.L..IE1~LlcL c~ A~Ail~ A~~:: www.cdc.gov/vaccincsafcty/ ~ ~ ~"Bf ~ A12 . 'T
]I.£-=:1~:il~ I:lH~ ~T-01I fl"BfO~ ~O~~
7
UI*~
~~UDt1
['I lUil2!
T
• £Ili <j01I7-l1 ~£loHJAI2. 1-888-767-4687
• AIA~j:11 EE.~ 2f ~{:PF·.£ ~:2:~'5~~AI.2..
• c~;; '6'1fl0.£ ~~ ~Ail-tilEHCDC).£ '21 ~"B~~ AI.2. . - 1-800-232-4636 ((1-800-CDC-TNFO).£ t:J :2:~ "B~ ~ A1.2. .
- CDC -gj A~ol E(www.cdc.gov/flu)~ tg~"B~~AI2-
Vaccine Information Statement (Interim)
Live Attenuated Influenza Vaccine
K 0 re a n
DCH-1237K
AUTH: P.H.S.~ Act 42, Sect. 2126.
I 08/19/2014 I
Office Use Only
iJl
42 U.S .C. § 300aa-26
Translation provided by Ihe California Department of Public Health
9.1.a
-tt-a-A~7~ A~ ~~ '?1~ ~.:j,1
AJcH
A~ .!t, '?1~ ~=?1 ild7~,?Jc.l1 '?i ~s.jl O"Pa% 'i:! % 9- 9,(s:. ~ , o] 2i~ /8~L~
y ct. 7H ~ %--2:- 9i li -i'- B- A~ 7r ~ "1 ~ ?o1 A8.12. ii %-~ :± S!_ .!t 41 A]
Michigan Care Improvement Registry ~ .!t '-l] ~ ~ oJ
"!£s:. ~ R ~if
9-
~~ 1ic.j7~ ~~yct.