De-labeling penicillin allergy De-labeling penicillin allergy PEN-FAST questionnaire for identifying low-risk penicillin allergies Child's name(Required) First Last Date of Birth MM slash DD slash YYYY Email(Required) PhoneHas it been 5 years or less since your child's last reaction?(Required) Yes, it has been 5 years or less No, it has been more than 5 years Did your child have any of the following reactions?(Required) Anaphylaxis Angiodema (sudden, deep swelling of the skin and tissues) Serum Sickness Stevens-Johnson Syndrome / Toxic Epidermal Necrolysis D.R.E.S.S. None of the above Was medical intervention required to treat the reaction? Yes No Examples of medical intervention would include hospitalization, emergency room care, administration of epinephrine or steroids, or prescription antihistaminesIf medical intervention was required, please explain: