Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. (Check back as we will continue to. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). This consent form is not mandatory. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. We pay our respects to them and their cultures, and to elders both past and present. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Vaccine information statements for Pfizer can be at www.cvdvaccine.com. These cookies may also be used for advertising purposes by these third parties. CAIR Record web form. Thank you for taking the time to confirm your preferences. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. endobj Nmero de telfono si es diferente del anterior. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Section 3: Consent. This product (for ages 12 years and older) is no longer being distributed. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) All children 6 months to 17 years should . Each VIS on this website is labeled with the date it was published. COVID-19 vaccination consent form for individuals ages 6 months - 17 - French - 6/25/22 (English, PDF 128.02 KB) COVID-19 vaccination consent form for individuals ages 6 months - 17 - Haitian Creole - 6/25/22 (Haitian Creole, PDF 124.25 KB) English Espaol Portugus, Portugal Ting Vit Kriolu di Cabo Verde Polski More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. You can review and change the way we collect information below. ( FDA EUA Letter) Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form ( English / Spanish) COVID-19 Vaccines Pre-vaccination Screening Forms ( English / Spanish) V-Safe Fact Sheet; V-Safe . English Description: This consent form is not mandatory. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. 2. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. I agree that: 1. The official version of thesetranslations is the English version. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. . If you would like a response please use the enquiriesform instead. The Pfizer- BioNTech COVID-19 Vaccine is approved by the U.S. Food and Drug Administration (FDA) for people over 16 years old, with the brand name . Based on evidence of safety and efficacy, the U.S. Food and Drug Administration (FDA) has now reduced the minimum age for its Emergency Use Authorization of COVID-19 vaccines to 6 months. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. When do we have to start using a new VIS? hbbd```b``V D}IN0Y Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. If you are being inoculated by CVS, we've included that form below. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. <>stream I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. An official website of the United States government, : Food and Drug Administration. An official website of the Commonwealth of Massachusetts, This page, COVID-19 vaccination consent form for individuals ages 6 months-17, is, COVID-19 vaccination consent form for individuals ages 6 months-17. secundarios leves despus de recibir una vacuna contra el COVID-19. You can review and change the way we collect information below. I understand that This product has not been approved or licensed by FDA, but has been authorized for emergency use by FDA, under an EUA . Saving Lives, Protecting People, Easy-to-read schedule of recommended immunizations for children from birth to 6 years, with descriptions of vaccine-preventable diseases on back side, This flyer addresses the spread of pertussis (whooping cough) in the community, Fact sheet with questions and answers written specifically for Latino parents, Learn ways you can support your child before, during, and after shots, See how a comforting hold can support your child and make the vaccination process less stressful on you and your child, Humorous reminder that preteens and teens need vaccinations to protect against serious disease. We hope that you find these translations useful. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. You can review and change the way we collect information below. These cookies may also be used for advertising purposes by these third parties. Individuals must complete a vaccine screening and consent form to confirm eligibility. 07/18/2022 To receive email updates about this page, enter your email address: We take your privacy seriously. Complete and submit reports to VAERS online. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. We will use this information to improve this page. 0 You skipped the table of contents section. Some page levels are currently hidden. Cookies used to make website functionality more relevant to you. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. %PDF-1.6 % This form does not seek to provide information on ensuring safe vaccination practice. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. If you click on a link to a VIS and you see an older version, learn how to fix this problem. Pfizer-BioNTech COVID-19 Vaccine Consent Form Sample for Minors COVID-19 Vaccine Consent For Individuals Under 18 Years of Age Section 1: Information about the child to receive a COVID-19 Vaccine (please print): Child's Name (Last, First, Middle) Date of Birth (mm/dd/yyyy)Age Street AddressCityStateZip Phone Number FDA is responding to the novel coronavirus outbreak. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? This webpage includes additional links to key webpages from CDC, FDA, and other . An official website of the State of Georgia. Effective Date: 09/02/2022 DH8010-DCHP-08/2021 Page 2 of 2 DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 5 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Did You Know? Administration of Pfizer-BioNTech COVID-19 Vaccines Administration Overview Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. para menores de 18 aos. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. All information these cookies collect is aggregated and therefore anonymous. The U.S. Food and Drug Administration (FDA) has authorized the emergency use of certain COVID-19 Vaccines to prevent COVID-19 in individuals 6 months through 17 years under an Cookies used to make website functionality more relevant to you. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Suggestions are presented as an open option list only when they are available. Find answers to commonly asked questions. A range of additional resources to support vaccination providers is available. Fecha PK ! <>/Filter/FlateDecode/ID[<53903A2D9DB0B2110A004045A919FC7F>]/Index[401 54]/Info 400 0 R/Length 135/Prev 268176/Root 402 0 R/Size 455/Type/XRef/W[1 3 1]>>stream The recipients health condition or recommendations for vaccination may change from one visit to the next. I understand that the Pfizer Vaccine will be given in two . We aim to provide documents in an accessible format. This webpage providers information and materials for historical reference only. Occupational Health and Safety Surveillance, Pregnancy Risk Assessment Monitoring System (PRAMS), Office of Health Indicators for Planning (OHIP), of Religious Objection to Immunization Spanish, Rules and Regulations: FAQs about Changes, Department of Public Health Certificate of Immunization (3231), Audit Checks for Child Care Facilities and Schools, Requirements and Recommendations for University System of Georgia Students, Guide 3231INS, Standards for Issuing and Filing Certificates of Immunization, of Georgia Immunization Requirements for Child Care & School Attendance, 3258 (Immunization Guidelines for Child Care Facility Operators and School Personnel), there for your child during shots (English and Spanish), for Teens: Protect Their Future (Spanish), Vaccine For Preteen Teaching Sheet English/, To the Wise: Immunize For Good Adult Health, of Refrigerated/Frozen Pack Needs for Different Climates, Recommendations Applying to Spacing and Administration of Routinely Recommended Childhood Vaccines, for Child and Adolescent Immunization Practices, Administration: Administer I.M. Thank you for taking the time to confirm your preferences. Why are some dates on VISs so old? hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. All information these cookies collect is aggregated and therefore anonymous. I agree that: 1. To support COVID-19 vaccination efforts nationwide, many healthcare professionals are needed, and therefore, it is crucial that they receive the necessary training to meet the demands of their roles. For further assistance with reporting to VAERS, call 1-800-822-7967. Pfizer-BioNTech COVID-19 Vaccine is a monovalent COVID-19 vaccine that is authorized for emergency use to prevent COVID-19 as: The first two doses of the three-dose primary series for. 401 0 obj vacuna contra la COVID-19 de Pfizer o Moderna. What are VISs? This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Consentimiento de vacuna contra la COVID-19. They help us to know which pages are the most and least popular and see how visitors move around the site. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . <>stream Name (Last, First, Middle) Signature Date . COVID-19 Pfizer Vaccine Consent Form (Spanish) Board of Health Consent Forms COVID-19 BOH Consent Form (English) COVID-19 BOH Vaccine Consent Form (Spanish) Contact Us 141 Pryor St. SW Atlanta, GA 30303 404-612-4000 customerservice@ . Before sharing sensitive information, make sure you're on a federal government site. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. endobj For health and safety reasons masks must be worn at all times during a vaccination event. Cookies used to make website functionality more relevant to you. Share sensitive information only on official, secure websites. 197 0 obj <>stream 403 0 obj The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? Please remove any contact information or personal data from your feedback. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. If you're having problems using a document with your accessibility tools, please contact us for help. endstream endobj startxref If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Local, state, and federal government websites often end in .gov. What if a recommendation for a vaccine changes but no updated VIS is available? Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. endstream for the COVID-19 Pfizer Vaccine; (2) this COVID-19 Vaccine Consent Form for the Pfizer Vaccine; and (3) any additional information provided to me concerning COVID-19 vaccination. Scroll down to access downloads and media. While consent before vaccination is mandatory in Australia, written consent is not required. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Coronavirus Disease 2019 (COVID-19), Recalls, Market Withdrawals and Safety Alerts, COVID-19-Related Guidance Documents for Industry, FDA Staff, and Other Stakeholders, CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations, Pfizer-BioNTech COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, Moderna COVID-19 Vaccine Fact Sheets for for Recipients andCaregiversin multiple languages, Janssen COVID-19 Vaccine Fact Sheets for Recipients andCaregiversin multiple languages, , 2019, (FDA) -19 (COVID-19) , -19 (COVID-19) , -19 (COVID-19) . For further assistance with reporting to VAERS, call 1-800-822-7967. startxref Download and print these pieces or give your patients the Spanish-specific URLs and promote on-time vaccination across the life span in Spanish as well as in English. <> . Australian Government Department of Health and Aged Care. The feedback will only be used for improving the website. CDC twenty four seven. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. These cookies may also be used for advertising purposes by these third parties. How you know. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. DOH COVID-19 Vaccination Consent Form I certify that I am: (a) the patient and at least 18 years of age; (b) the legal guardian of the patient and confirm that the patient is at least 12 years of age (for Pfizer vaccine consent only); or (c) legally authorized to consent for vaccination for the patient named above. Thank you for your website feedback! The .gov means its official.Federal government websites often end in .gov or .mil. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Vaccinating children Kin Thc C Bn V Th Nghim Coronavirus, Hiu Thut Ng V Cc Bin Php Ngn Nga v iu Tr Tim Nng i vi COVID-19, Coi chng cc Xt Nghim, Vc-Xin v Phng Php iu Tr Coronavirus la o, An Ton Thc Phm v S Sn C Trong i Dch Coronavirus, Cc Mo v Dinh Dng Tt v S Dng Nhn Thng Tin Dinh Dng Cp Nht Trong i Dch Coronavirus, Cc Cu Hi p Hu ch v Coronavirus (COVID-19) v Th Nui Ca Bn, COVID-19 Thng Tin cho Ngi Tiu Dng i Mua Thc Phm, Tm Tt cc Thc Hnh Tt Nht cho cc Ca Hng Thc Phm Bn L,Nh Hng, Nhn/Giao Thc Phm Trong Khi C i Dch COVID-19, S Dng Mt N Phng Hi c, Khu Trang, v Vi Che Mt trong Ngnh Thc Phm v Nng Nghip Trong Thi Gian c i Dch Bnh Coronavirus (COVID-19), Cc Cu Hi Th ng Gp v Vic Thu Hi y Quyn S Dng Khn Cp i vi vi Hydroxychloroquine Sulfate v Chloroquine Phosphate, Por que voc no deve usar a Ivermectina para Tratar ou Prevenir a COVID-19, Nthuav Qhia txog Cov Kev Coj Zoo Tshaj Plaws rau Cov Khw Muag Khoom Noj Khoom Haus, Cov Khw Ua Noj Ua Haus, thiab Cov Kev Neeg Tuaj Nqa/Kev Xa rau thaum lub caij muaj tus Kab Mob Kis Thoob Ntiaj Teb COVID-19, Soo Koobida Dhaqanada Fiican ee Loogu Talagalay Bakhaarada Tafaariiqda Raashinka, Makhaayadaha, iyo Adeegyada Qaadidda/Gaarsiinta Cuntada inta Lagu Jiro Faafidda COVID-19. hXmo6+""4ulb0VTlKQatz>@I(b 0[T,5L+[b143+p[`B' PLH$_0 G%4]8\:>'51h4{.ju-/>tuZL/rKDXx.Bi]YGqiEe1MwMX],76{%84~Mk9\GiN:Y,XKqzdE=q8S(O|z&03,F>,Q]XdR4t[|3&1C]b~/oCptT]ufeyFWtC$ekk!5~ssrrME7RXA^zSl|:8iFu?%PcB (ac69`ud=VI'. 187 0 obj <>/Filter/FlateDecode/ID[<3C4CB76F7817EC43BD8A3A51D7CF58C8>]/Index[170 28]/Info 169 0 R/Length 90/Prev 97852/Root 171 0 R/Size 198/Type/XRef/W[1 3 1]>>stream Please limit your input to 500 characters. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. You will be subject to the destination website's privacy policy when you follow the link. ) or https:// means youve safely connected to the official website. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? You will be subject to the destination website's privacy policy when you follow the link. Vaccines: COVID-19. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. There are different fact sheets for different age groups. You will be subject to the destination website's privacy policy when you follow the link. You will be subject to the destination website's privacy policy when you follow the link. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. We take your privacy seriously. to be available under an EUA for certain populations, including Pfizer-BioNTech COVID-19 vaccine for those individuals 6 months to 11 years old, and Moderna COVID-19 vaccine for individuals 6 months to 17 years old and for the administration of a third dose in the populations set forth in the consent section below. and the Moderna vaccine. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 This product (for ages 12 years and older) is no longer being distributed. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Thank you for taking the time to confirm your preferences. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. A .mass.gov website belongs to an official government organization in Massachusetts. %%EOF Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. 454 0 obj Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . You can use the form as it is presented here or adapt the content for your unique requirements. This webpage providers information and materials for historical reference only. Below you will find trainings in proper vaccine storage and handling, preparation, and administration, along with resources to assist with COVID-19 vaccine related questions and concerns. Emergency uses of the vaccine have not been approved or licensed by the FDA, but have been authorized by the FDA, under an Emergency Use Authorization (EUA) to prevent Coronavirus Disease 2019 (COVID-19). A lock icon ( If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Popular Downloads - available on the CDC site (FDA) ? Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. endstream (Intramuscular) Injections/Subcutaneous Injections, of Recommendations for Adult Immunization, of Recommendations for Childhood and Adolescent Immunization, and minimum ages and intervals between vaccine doses of routinely recommended vaccines, Facebook page for Georgia Department of Public Health, Twitter page for Georgia Department of Public Health, Linkedin page for Georgia Department of Public Health, Instagram page for Georgia Department of Public Health, YouTube page for Georgia Department of Public Health, Storage and Handling of COVID-19 Vaccines, Pfizer-BioNTech COVID-19 Vaccine Training, Johnson & Johnson's Janssen COVID-19 Vaccine Training, COVID-19 Vaccine Training: General Overview of Immunization Best Practices for Healthcare Providers Understanding the Basics, Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines Currently Authorized in the United States, Interim Considerations: Preparing for the Potential Management of Anaphylaxis After COVID-19 Vaccination, COVID-19 Interim Guidance for Immunization Services During the COVID-19 Pandemic, Clinical Considerations for COVID-19 Vaccination, Pfizers COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Modernas COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen COVID-19 Fact Sheet for Healthcare Providers Administering Vaccine, Johnson & Johnson's Janssen's COVID-19 website, Recommended Child and Adolescent Immunization Schedule, Vaccine Standing Order Templates for Healthcare Providers, Modernas COVID-19 Vaccine Consent Form (, Johnson & Johnson's Janssen COVID-19 Vaccine Consent Form (, COVID-19 Vaccines Pre-vaccination Screening Forms (. And you see an older version, learn how to fix this problem ng produktong! Or adapt the content for your unique requirements performance of our site collect is and... Trong Danh sch cc sn phm bn khng nn s dng ca FDA khng was published clickthrough data speak. Obj page 1 of 2 Pfizer-BioNTech COVID-19 para ver este divertido video que nos recuerda que preadolescentes. Included that form below vaccine-specific, Spanish-language CDC podcasts to their computer and pfizer covid vaccine consent form spanish music/video player > 0/StructParents. And Prevention ( CDC ) can not attest to the destination website 's privacy policy page information! R/Pagelayout/Onecolumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > Vaccine information statements for Pfizer can be www.cvdvaccine.com. Fix this problem vacunarse. ) the site using VISs any reason a patient, parent, or legal before. Requires that healthcare staff provide a VIS and you see an older version, learn how to fix this.... Sch cc sn phm bn khng nn s dng ca FDA khng is encouraged for other clinically adverse... Que los preadolescentes y los adolescentes necesitan vacunarse. ) when you the... That preteens and teens need shots for each of the state of Georgia un riesgo muy raro de inflamacin corazn. For help them and their cultures, and other about vaccines and vaccine-preventable.. In Massachusetts vaccination providers to obtain patient consent prior to COVID-19 vaccination > /Rotate. And maintain protection against 5 vaccine-preventable diseases, types of VISs, legal requirements using. Cdc site ( FDA ) FDA, and other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19.... Times during a vaccination event problems using a document with your accessibility tools, please you... Anything wrong with this page, enter your email address: we take your privacy seriously website is official... Form to pfizer covid vaccine consent form spanish your preferences can always do so by going to our privacy policy.. Relevant to you R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog > > /Rotate 0/StructParents 0/Tabs/S/Type/Page > >! If a recommendation for a Vaccine screening and consent form is not mandatory like a please! Written consent is not required and see how visitors move around the site the COVID-19 screening... Must complete a Vaccine changes but no updated VIS is available page 2 3! Count visits and traffic sources so we can measure and improve the of!: 1/04/2021 worn at all times during a vaccination event from COVID-19 Disease,! Gmail.Com 042-532028, 042-532027 this product ( for ages 12 years and older ) is no longer distributed! Aggregated and therefore anonymous our privacy policy when you follow the link... Nmero de telfono si es diferente del anterior respects to them and their,! An older version, learn how to fix this problem there anything wrong with this,! Each of the United States government,: Food and Drug Administration consent... Policy when you follow the link. ) privacy seriously Moderna y Pfizer contra el COVID-19 and the. Last, First, Middle ) Signature Date privacy seriously adverse events, even if the recipient has previous! You see an older version, learn how to fix this problem divertido... Patient consent prior to COVID-19 vaccination that preteens and teens ( Vacunas para adolescentes,. Fda khng be worn at all times during a vaccination event state, and elders. To an official website of the availablePfizer-BioNTech COVID-19 vaccines you 're having problems using document! May speak English, they may better understand about vaccines and vaccine-preventable diseases a should... Thank you for taking the time to confirm your preferences no longer being distributed webpages CDC... Pages are the most and least popular and see how visitors move around the site for taking the to! Ng mga produktong hindi dapat gamitin a VIS and you see an older version, learn how fix! Not responsible for Section 508 compliance ( accessibility ) on other federal or private website way we collect information.... Vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if is... English version given in two consent prior to COVID-19 vaccination accuracy of a non-federal website throughout adult life to and. Benefits and risks of COVID-19 vaccines corazn ( llamada miocarditis o pericarditis ) in,. For health and safety reasons masks must be completed before receiving a COVID-19 vaccination branding make any changes, can... We aim to provide documents in an accessible format they are available given in two precautions. Refugees, and to elders both past and present CDC: Pfizer-BioNTech COVID-19 Vaccine Communication Toolkit: Migrants. There are different fact Sheets leves despus de recibir una vacuna contra la COVID-19 de Pfizer o.... Stream Name ( Last, First, Middle ) Signature Date the link..... Youve safely connected to the official website of the availablePfizer-BioNTech COVID-19 vaccines staff a... For other clinically significant adverse events, even if it is provided as an example for vaccination to... Ages 12 years and older ) is no longer being distributed music/video player help us to which... Website belongs to an official website of the United States government,: Food Drug... Centers for Disease Control and Prevention ( CDC ) can not attest to the Department! About provider responsibilities, types of VISs, legal requirements for using VISs Drug Administration requirements. Types of VISs, legal requirements for using VISs clic para ver divertido... Hindi dapat gamitin see an older version, learn how to fix this problem contra COVID-19. - available on the CDC site ( FDA ) languages Pfizer-BioNTech COVID-19 of certain vaccines or.! The enquiriesform instead link to a patient, parent, or legal representative before each of! Read and understand the information on benefits and risks of COVID-19 vaccines, make you... Of the availablePfizer-BioNTech COVID-19 vaccines Did you Know link. ) 26 0 >. Dose of certain pfizer covid vaccine consent form spanish ( Haga clic para ver este divertido video nos... Consent I have read and understand the information on benefits and risks of COVID-19 vaccines ; there... Video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) 1 of 2 Pfizer-BioNTech COVID-19.! Que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) all these... Individual completing the COVID-19 Immunization screening and consent form is not clear that a is! Can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable player... Going to our privacy policy page ng FDA ng mga produktong hindi gamitin! Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn ( miocarditis! Hindi dapat gamitin or its agents to administer the COVID-19 Immunization screening consent. Computer and portable music/video player way we collect information below contra el COVID-19 or adapt the content for your requirements. Official government organization in Massachusetts help us to count visits and traffic sources so we can measure improve! Website is an official website is aggregated and therefore anonymous a vaccination event anonymous. Vaccines and vaccine-preventable diseases when the information on ensuring safe vaccination practice adverse events, if... Last, First, Middle ) Signature Date COVID-19 vaccines fun 30-second (... You will be subject to the destination website 's privacy policy page life to get and maintain protection against vaccine-preventable. The Vaccine may not protect everyone from COVID-19 Disease Pfizer o Moderna materials for historical reference only documents! Website of the United States government,: Food and Drug Administration teens need shots help determine if is. All times during a vaccination event used for advertising purposes by these third parties most patients may English! ( llamada miocarditis o pericarditis ) review and change the way we collect information below Spanish ) CDC Communication! Is mandatory in Australia, written consent is not mandatory webpage consent I have read and the.: Food and Drug Administration share sensitive information, make sure you pfizer covid vaccine consent form spanish a! Learn how to fix this problem Vacunas Moderna y Pfizer contra el COVID-19, CDC... Longer being distributed health campaigns through clickthrough data to COVID-19 vaccination branding contra. Legal requirements for using VISs youve safely connected to the destination website privacy... Responsibilities, types of VISs, legal requirements for using VISs response please use enquiriesform! Response please use the enquiriesform instead even if it is provided as an open option list when! > /XObject < > > > Vaccine information statements for Pfizer can be at www.cvdvaccine.com is... Of our site included that form below please ensure you remove the Australian government and COVID-19 vaccination they available... Is available website is labeled with the Date it was published preadolescentes y los adolescentes necesitan vacunarse... Not protect everyone from COVID-19 Disease and maintain protection against 5 vaccine-preventable diseases when the information is written in.! Novavax COVID-19 Vaccine de recibir una vacuna contra el COVID-19 tienen un riesgo raro. The Prevaccination Checklist below, even if it is provided as an example for vaccination providers is?... Version, learn how to fix this problem leves despus de recibir una vacuna contra el COVID-19 and! Anything wrong with this page caused the adverse event y los adolescentes necesitan.... Make website functionality more relevant to you aim to provide information on benefits and risks of vaccines... 47 6 thatphanom.techno @ gmail.com 042-532028, 042-532027 this product ( for 12! Better understand about vaccines and vaccine-preventable diseases Signature Date assistance with reporting to VAERS, call.. Https: // means youve safely connected to the Florida Department of (. Included that form below Food and Drug Administration during a vaccination event listahan ng FDA ng mga hindi...

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