Dose the patient being treated have any of the following conditions?

• Under 2 years old.

• Trouble breathing, hives, dizziness, weakness, vomiting or nausea, excessive swelling of the stung area or surrounding areas.

• Family history of allergic reactions.

• Allergic reactions to insect stings in the past.

• Excessive redness, swelling, itching or irritation on an area that is away from the area that was stung.


Yes

No






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