Informed consent form for hepatitis B vaccination for adults in Lishui
[Introduction to Disease]
Hepatitis B virus (hereinafter referred to as "hepatitis B") is caused by hepatitis B virus and is mainly transmitted through close contact between mother and child, blood (body fluids) and life. After being infected with hepatitis B virus, they can become carriers of hepatitis B virus, some people can be converted into chronic hepatitis B patients, and a small number of people develop cirrhosis and liver cancer.
Hepatitis B vaccine is an effective means to prevent hepatitis B.
（以接种门诊现有疫苗为准） [Vaccine introduction] ( Subject to existing vaccines in vaccination clinics)
3 种剂型，具体为 10 µg 、 20 µg 和 60 µg 。 At present, there are three dosage forms of hepatitis B vaccine for adults in our city , specifically 10 µg , 20 µg and 60 µg . This product belongs to the second type of vaccine, which is vaccinated by residents at their own expense .
[Target of Inoculation]
周岁及以上的成人，研究表明任何人接种乙肝疫苗对身体无损害。 For adults 16 years of age and older, studies have shown that there is no harm to the body of anyone receiving the hepatitis B vaccine. HbsAg 携带者或乙肝患者的家庭成员等。 It is especially recommended for adults who are not infected with hepatitis B virus, especially in some key populations: people at occupational risk (medical workers exposed to blood, students of medical schools, etc.), who are often treated with blood or blood products, carried by HbsAg Or family members of hepatitis B patients. µ g 乙肝疫苗特别推荐给完成 10 µ g 或 20 µ g 乙肝疫苗全程接种后低应答或无应答的人群。 The 60 µg hepatitis B vaccine is particularly recommended for those who have responded to low or no response after completing a 10 µg or 20 µg hepatitis B vaccine.
µ g 、 20 µ g 乙肝疫苗：上臂三角肌肌内注射 3 针，分别于第 0 、 1 和 6 个月各接种 1 针，每针 1.0ml 。 10 µg , 20 µg Hepatitis B vaccine: Intramuscular injection of 3 doses into the deltoid muscle of the upper arm , 1 dose each at 0 , 1 and 6 months , 1.0 ml each .
µ g 乙肝疫苗：上臂三角肌肌内注射 1 针。 60 µg hepatitis B vaccine: Intramuscular injection of the deltoid muscle of the upper arm . (Vaccines are provided in this vaccination clinic)
Individuals may have injections of local pain, redness, or moderate to low fever, which generally do not require special treatment and can be relieved by themselves. If necessary, they should contact the vaccination unit for symptomatic treatment in a timely manner.
【ban avoid disease】
Those with severe acute or chronic diseases, allergic to yeast ingredients.
发热者暂缓接种。 1. Fever is temporarily suspended.
接种后在现场留观 30 分钟后方可离开。 2. Wait 30 minutes after the inoculation before leaving.
疫苗的保护效果并非100%。 3. The protective effect of the vaccine is not 100%. A small number of people do not develop protection or remain ill after vaccination, which is related to factors such as the characteristics of the vaccine and the individual's physique.
10 µ g 乙肝疫苗 / □ 20 µ g 乙肝疫苗□ /60 µ g 乙肝疫苗 。 I have read the above informed consent and confirmed that the recipients are healthy and eligible for vaccination. They voluntarily vaccinated with □ 10 µg hepatitis B vaccine / □ 20 µg hepatitis B vaccine □ / 60 µg hepatitis B vaccine .
For the specific types and prices of the second-class vaccines, please refer to the vaccination clinic publicity materials.
Seed recipient signature: contact number: date: year month day
以下由接种医生填写-------------------- ---------------- The following is filled in by the vaccination doctor --------------------
接种医生签名： Vaccination site (marked √): upper left, upper right, lower left, lower right Signature of vaccination doctor: