Child and Adolescent Vaccine Assessment Tool

Part One: About Your Child/Adolescent

1. Some vaccines are given based on your child's age. What is your child's birthday?
   Month January February March April May June July August September October November December Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
2. Is your child
   Female
   Male
3. Is your child American Indian or Alaska Native?
   Yes
   No
   Don't know

Part Two: High-Risk Conditions or Medical Conditions

1. Will your child be traveling outside the U.S. in the near future?
   Yes
   No
   Don't know
2. Does your child have a weakened immune system due to illness or medications?
   Yes
   No

3. Some of the medical conditions listed below can put you at higher risk of certain infections, or the infections pose a higher risk of complications if the condition is present. Does your child have any of these medical conditions? Check all that apply.
    Heart disease
    Diabetes, type 1 or 2 (also called "sugar diabetes")
    Chronic lung disease (including chronic disease of prematurity and asthma if treated with medications taken daily)
    Cystic fibrosis
    Chronic kidney disease, Kidney failure, end-stage renal disease, or on dialysis
    Chronic liver disease
    Spleen has been damaged or removed
    Sickle cell disease or other blood disorder
    Complement component deficiency or taking complement inhibitors such as eculizumab (Soliris) and ravulizuman (Ultomiris)
    Cancer or cancer treatments
    Bone marrow transplant
    Organ transplant (e.g., kidney, liver, lungs)
    Cerebrospinal fluid leak
    Cochlear implant
    HIV infection
   

Part Three: Sexual history

1. Review the items listed below and check all that might apply to your child:
    Currently pregnant
    Gay, bisexual, transgender, or men who have sex with men
    Sexual partner of a person who is gay, bisexual, transgender, or a man who has sex with other men
   

Part Four: Living Conditions

1. Is there currently an outbreak of meningitis in your community?
   Yes
   No
   Don't know
2. Is your child a first-year college student who lives in a dormitory or a new military recruit?
   Yes
   No
3. Does your child live in a dengue endemic area including Puerto Rico, American Samoa, US Virgin Islands, Federated States of Micronesia, Republic of Marshall Islands, or the Republic of Palau?
   Yes
   No

That's it! Just click "Results" to find out which vaccines your child may need.