General Vaccine Form

Patient must meet at least one of the following Moderately or Severely Immunocompromised Criteria to receive one of the selected vaccines:

• Acute treatment for solid tumor and hematologic malignancies
• Receipt of solid-organ transplant and taking immunosuppressive therapy
• Receipt of CAR-T-cell or hematopoietic stem cell transplant (within 2 years of transplantation or taking immunosuppression therapy)
• Moderate or severe primary immunodeficiency (e.g. , DiGeorge,Wiskott-Aldrich syndromes)
• Advanced or untreated HIV infection
• Active treatment with high-dose corticosteroids (i.e.,≥20mg prednisone or equivalent per day), alkylating agents, antimetabolites, transplant-related immunosuppressive drugs, cancer chemotherapeutic agents classified as severely immunosuppressive, TNF blockers, and other biologic agents that are immunosuppressive or immunomodulatory
• Chronic conditions associated with varying degrees of immune deficit, such as asplenia, sickle cell and chronic renal disease.
• Other diagnosed chronic condition with equivalent moderate to severe level of immunocompromised

The following questions about allergic reactions would include a severe allergic reaction [e.g., anaphylaxis] that required treatment with epinephrine or EpiPen® or that caused you to go to the hospital. It would also include an allergic reaction that caused hives, swelling, or respiratory distress, including wheezing.)