A separate, signed application must be submitted for each individual to receive an exemption from Florida meningococcal vaccination requirements.
PLEASE COMPLETE THE FOLLOWING SECTIONS
Please complete the required fields: first name, last name, date of birth (in MM/DD/YYYY format) and zip code.
Read the Risks and Benefits of Meningococcal Vaccination below. After reading the Risks and Benefits, complete the Authorization section of the form and submit it to us.
RISKS AND BENEFITS OF MENINGOCOCCAL VACCINATION
Meningococcal disease is an acute, potentially severe illness that most often causesmmeningitis, an infection of the spinal fluid and the fluid that surrounds the brain. It leads to sudden onset of fever, headache, and stiff neck and is usually accompanied by nausea, vomiting, light sensitivity and altered mental status. Less commonly it can cause pneumonia, arthritis and ear/throat infections. Meningococcal disease can result in hearing loss, nervous system problems, seizures, strokes, loss of limbs (arms, legs) or even death.
A protective level of antibody is usually achieved within 7-10 days of vaccination. The vaccines protects about 90% of individuals who get them.
Possible Side Effects Of Vaccine
The most common side effects are redness or pain at the injection site lasting 1-2 days, headache, and fatigue. Serious allergic reactions are very rare.