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Rose Inn Street, Kilkenny
Call: 056 7721033 Fax: 056 7722946 High Street, Kilkenny
Call: 056 7721309 Fax: 056 7771971 Opening Hours

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Flu and Covid Booster Booking Form

Flu and Covid Booster Booking Formkateoconnell2022-11-02T23:18:27+00:00

Covid and Flu Vaccination Booking Form

Name(Required)
Gender(Required)
Are you pregnant?(Required)
Email(Required)
DD slash MM slash YYYY
Address(Required)
A PPS Number is always 7 numbers followed by either one or two letters. If you do not have one enter xxxxxxxxx (9 x's)
Have you had the flu vaccine in previous years?(Required)
Have you had a flu vaccination already this season?(Required)
In general, most people only require one flu vaccination per influenza season, which usually runs from September 2022 to end of April 2023
Are you recommended to get a 2nd flu vaccination in this season?(Required)
Cancer patients who receive the vaccine while on chemotherapy and who complete their treatment in the same season are recommended to get a second flu vaccine at least 4 weeks after their first
Have you ever had a serious allergic reaction to any previous flu vaccine or injectable therapy?(Required)
If you had an allergic reaction to a previous flu vaccine you will be at a higher risk of having an allergic reaction again. It is recommended that this is given in a different healthcare setting, such as doctor's surgery or hospital.
Do you have an allergy to eggs?(Required)
If you have an allergy to eggs then you should not receive the vaccine in the pharmacy. Ask our pharmacist for more information.
Do you have a severe allergy to latex?(Required)
Are you at risk of lymphoedema in both arms?If you are at risk of lymphoedema in BOTH arms the vaccination service in the pharmacy will not be suitable for you, contact our pharmacist for further advice.(Required)
If you are at risk of lymphoedema in BOTH arms the vaccination service in the pharmacy will not be suitable for you, contact our pharmacist for further advice.
Do you suffer from any bleeding disorder or are you taking anticoagulant medication such as warfarin/Eliquis/ Pradaxa/Lixiana or Xarelto?(Required)
Have you had a haematopoeitic stem cell or solid organ transplant?(Required)
Are you taking combination checkpoint inhibitors (e.g. ipilimumab plus nivolumab)?(Required)
If taking combination checkpoint inhibitors you should not receive influenza vaccine because of a possible risk of immune associated adverse reactions.
Do you have very low levels of a type of white blood cell, neutrophils?
If you have very low levels of neutrophils then you should not receive a flu vaccination. Ask our pharmacist for more information.
Do you have an allergy to any of the following ingredients which are contained in the flu vaccine? If you do you should not receive your vaccine in the pharmacy please ask our pharmacist for further advice(Required)
QUADRIVALENT INFLUENZA VACCINE ADULT 18 YEARS+ (split virion, inactivated) (Sanofi) The vaccine may contain traces of eggs, such as ovalbumin, chicken proteins and of neomycin, formaldehyde and octoxinol-9, which are used during the manufacturing process. List of excipients: Buffer Solution: Sodium chloride, Potassium chloride, Disodium phosphate dihydrate, Potassium dihydrogen phosphate
Select if one of the following risk groups recommended by the HSE to get a flu applies to you:(Required)
If none are applicable, select the last option ‘None of the above applies’ You will be charged €30 for a private vaccine
Have you ever had a serious allergic reaction (anaphylaxis) that needed medical treatment: after having a previous dose of the Moderna (Spikevax®) or Pfizer/BioNTech (Comirnaty®) COVID-19 vaccine, OR to any of the vaccine ingredients, including polyethylene glycol known as PEG OR to any other previous vaccine (including the flu vaccine)?(Required)
Do you have an allergy to any of the following ingredients contained in the Pfizer Comirnaty vaccine?(Required)
(4-hydroxybutyl)azanediyl)bis(hexane-6,1-diyl)bis(2-hexyldecanoate) (ALC-0315), 2-[(polyethylene glycol)-2000]-N,N-ditetradecylacetamide (ALC-0159), 1,2-distearoyl-sn-glycero-3-phosphocholine (DSPC), cholesterol, trometamol, trometamol hydrochloride, sucrose, water for injections
Have you ever had a serious allergic reaction (anaphylaxis): after taking multiple different medications, with no reason known for the reaction. This may mean you are allergic to polyethylene glycol (PEG) OR after having a vaccine or a medicine that contains polyethylene glycol (PEG), OR unexplained reasons? This may mean you are allergic to polyethylene glycol (PEG)(Required)
Do you have an allergy to Trometamol (a contrast dye use in MRI radiological studies) and contained in Pfizer vaccines?(Required)
Have you had pericarditis (inflammation of the lining around the heart) after having a previous dose of the Moderna (Spikevax®) or Pfizer/BioNTech (Comirnaty®) COVID-19 vaccine?(Required)
Move Have you had myocarditis (inflammation of the heart muscle) after having a previous dose of the Moderna (Spikevax®) or Pfizer/BioNTech (Comirnaty®) COVID19 vaccine?(Required)
Have you ever had: Mastocytosis (rare condition caused by an excess number of mast cells gathering in the body's tissues) OR idiopathic anaphylaxis. This is a condition diagnosed by an immunologist. OR a serious allergic reaction (anaphylaxis) due to food, medication or venom from an insect or animal?(Required)
Do you have a history of capillary leak syndrome?(Required)
Which COVID-19 vaccine dose do you wish to book an apppointment for?(Required)
To determine which booster you are eligible for please consult HSE guidelines by clicking on the link below (please note that the "primary course" of vaccination is two Pfizer, Moderna or Astra Zeneca vaccines or one Janssen vaccine each vaccine after these are called boosters)
HSE Booster Vaccines Information
Are you booking a booster due to being in a very high risk or high risk group (as your age group is currently not eligible for vaccination)? Please note we will ask you when you present for your vaccine what your reason for vaccination is and may refuse to vaccinate you if you are outside the current age HSE age group and do not have a valid risk condition(Required)
For Booster 3 please click on the Booster 3 eligibility outside being over 65 or older list For Booster 2 please click on the Booster 2 eligibility outside being over 50 or older list

Booster 3 eligibility outside being over 65 or older list

Booster 2 eligibility outside being over 50 or older list

Do you have a regular G.P?(Required)
if none state none
What is your ethnicity?(Required)
This field is for validation purposes and should be left unchanged.

Opening Hours

  • Monday: 09.00 – 18.00
  • Tuesday: 09.00 – 18.00
  • Wednesday: 09.00 – 18.00
  • Thursday: 09.00 – 18.00
  • Friday: 09.00 – 18.00
  • Saturday: 09.00 – 18.00
  • Sunday and Bank Holidays: CLOSED

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Rose Inn Street, Kilkenny
Call: 056 7721033

High Street, Kilkenny
Call: 056 7721309

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Haven Pharmacy O'Connells
89 High Street, Kilkenny and 4 Rose Inn Street, Kilkenny, Ireland

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