Part One, About You

1. Are you
   Female   Male



2. For women only (Some vaccines can affect pregnancy.)
   I could become pregnant   I am pregnant now



3. What year were you born? (Some vaccines are age-related)
   190019011902190319041905190619071908190919101911191219131914191519161917191819191920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001

Part Two, Your Lifestyle and Your Work
You may need certain vaccines because of where you live, the kind of work you do, or other lifestyle factors.

1. Will you be traveling internationally in the near future?
   Yes   No



2. Are you a first-year college student who lives in a dormitory at college?
   Yes   No



3. Are you a resident in a nursing home or chronic-care facility?
   Yes   No



4. Do you work with patients in a nursing home, doctor’s office, hospital, or other healthcare setting?
   Yes   No

Part Three, Your Health Status
Your health and medical history can affect the vaccines you need.

1. Are you at risk for hepatitis A? (Check hepatitis A risk factors)
   Yes   No



2. Are you at risk for hepatitis B? (Check hepatitis B risk factors.)
   Yes   No



3. Are you at risk for meningitis? (Check meningitis risk factors.)
   Yes   No



4. Have you had or been vaccinated against chickenpox?
   Yes   No   Not Sure



5. Do you have any of these diseases or medical conditions?
   • Blood disorder (like anemia, leukemia, or sickle cell anemia)
   • Cancer or cancer treatments
   • Diabetes (also called sugar diabetes)
   • Heart or lung disease
   • Liver or kidney disease
   • Weakened immune system (HIV/AIDS, cancer treatments)
   Yes   No



6. Are you at risk for pneumococcal disease? (Check pneumococcal disease risk factors)
   Yes   No



7. Has your spleen been damaged or removed? (Find out about your spleen)
   Yes   No

That's it! Just click "My Results" to find out which vaccines can help you.