Before sharing sensitive information, make sure you're on a federal government site. Why cant they be updated every year? While the agency has attempted to obtain translations that are as faithful as possible to the English version, we recognize that the translated versions may not be as precise, clear, or complete as the English version. 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) . Please let us know how we can improve this page. CDC twenty four seven. FDA is responding to the novel coronavirus outbreak. 197 0 obj <>stream All information these cookies collect is aggregated and therefore anonymous. Popular Downloads - available on the CDC site Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Please limit your input to 500 characters. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting 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'. <> Saving Lives, Protecting People, 6 Months through 4 Years of Age Label Infographic, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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 (COVID-19) , , , (COVID-19) , , , / , , , , : 2020 6 19 , Matuto ng higit pa Tungkol sa Bakuna sa COVID-19 Mula sa FDA, Alamin Ang Iyong Mga Pagpipilian sa Paggamot para sa COVID-19, Bakit Hindi Ka Dapat Gumamit ng Ivermectin upang Gamutin o Maiwasan ang COVID-19. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. We will use this information to improve this page. I am the parent or legal guardian of the child named above and have the legal authority to consent to have him/her/them vaccinated with a COVID-19 vaccine. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> 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. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. %PDF-1.7 % (Materiales sobre la vacunacin en espaol). Please remove any contact information or personal data from your feedback. Complete and submit reports to VAERS online. They help us to know which pages are the most and least popular and see how visitors move around the site. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. Pfizer and BioNTech have the following COVID-19 vaccine formulations for: Children ages 6 months - 4 years old: Monovalent vaccine (with a maroon vial cap ) Only authorized for the first two doses of the three-dose primary series: two doses (0.2 mL), at least three to eight weeks apart. 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. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Cookies used to make website functionality more relevant to you. 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 endstream endobj startxref Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Vaccines: COVID-19. 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. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Immunize.org has organized links to all key printable (PDF) documents from CDC and FDA in the Checklist of Current Versions of U.S. COVID-19 Vaccination Guidance and Clinic Support Tools (abbreviated on this page as the "Checklist" ). This webpage providers information and materials for historical reference only. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. An official website of the State of Georgia. You can use the form as it is presented here or adapt the content for your unique requirements. You will be subject to the destination website's privacy policy when you follow the link. These cookies may also be used for advertising purposes by these third parties. . The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) 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 \r\rCS321629E\rJanuary, 2023 If you would like a response please use the enquiries form . Thank you for taking the time to confirm your preferences. The recipients health condition or recommendations for vaccination may change from one visit to the next. These cookies may also be used for advertising purposes by these third parties. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. para menores de 18 aos. You will be subject to the destination website's privacy policy when you follow the link. The site is secure. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer 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. Direccin si es diferente de la anterior. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. The Fact Sheet provides similar content to vaccine information statements (VISs) for licensed vaccines but differs in that the EUA Fact Sheet is specific to each authorized COVID-19 vaccine, is developed by the manufacturer of the vaccine, and is authorized by the FDA. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. These cookies may also be used for advertising purposes by these third parties. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. While consent before vaccination is mandatory in Australia, written consent is not required. Section 3: Consent. . Consentimiento de vacuna contra la COVID-19. 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. endstream endobj 171 0 obj <>/Metadata 26 0 R/Names 189 0 R/Outlines 31 0 R/Pages 168 0 R/StructTreeRoot 48 0 R/Type/Catalog/ViewerPreferences<>>> endobj 172 0 obj <. La mayora de las personas que han tenido estas A lock icon ( hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 Suggestions are presented as an open option list only when they are available. CAIR Record web form. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 endstream Australian Government Department of Health and Aged Care. 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. All information these cookies collect is aggregated and therefore anonymous. 94 [Content_Types].xml ( Qo0_Qn P= {IW/$mPtA{:gq]q)[(QdR(*,_-nr!WbC?J%FRc5eTZK Z \|Z5/'ACTSUBV.lfXVAxN)qU7\m8+$kQ*QC5OwU 5[]9xen2&a'$0H0_At9HBd:'u )"dAza|DQL(-I. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. We are always looking for ways to improve our website. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. The official version of thesetranslations is the English version. A .mass.gov website belongs to an official government organization in Massachusetts. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P English Description: This consent form is not mandatory. If you're having problems using a document with your accessibility tools, please contact us for help. We pay our respects to them and their cultures, and to elders both past and present. Individuals must complete a vaccine screening and consent form to confirm eligibility. Bivalent vaccine (with a maroon vial cap and different label. This consent form is not mandatory. They help us to know which pages are the most and least popular and see how visitors move around the site. vacuna contra la COVID-19 de Pfizer o Moderna. If you would like a response please use the enquiriesform instead. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. What are VISs? More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. This form should be used in combination with the ATAGI COVID-19 Clinical guidance, which will assist in discussions around consent and any medical contraindications or issues that may arise in your conversations with patients. To receive email updates about this page, enter your email address: We take your privacy seriously. Address if different from above . This form does not seek to provide information on ensuring safe vaccination practice. We take your privacy seriously. . Saving Lives, Protecting People, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. 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. ) or https:// means youve safely connected to the official website. Scroll down to access downloads and media. The feedback will only be used for improving the website. 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. Are they obsolete? 403 0 obj PK ! 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 I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). Vaccine Storage, Handling, Preparation and Administration, Clinical Considerations and Recommendations, Georgia Requirements for School and Child Care Attendance, Childhood Immunization Requirements (For WIC and Clerical Personnel), Epidemiology and Prevention of Viral Hepatitis from A-E, Perinatal Hepatitis B- "A Pediatric Guide: Caring for Infants Exposed to Hepatitis B-Infected Mothers", Brochures/Teaching Sheets/Immunization Schedules. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 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. Phone Number if different from above . All information these cookies collect is aggregated and therefore anonymous. Nmero de telfono si es diferente del anterior. and the Moderna vaccine. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. For health and safety reasons masks must be worn at all times during a vaccination event. For further assistance with reporting to VAERS, call 1-800-822-7967. Cookies used to make website functionality more relevant to you. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. A patient consent form for COVID-19 vaccination. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Cookies used to make website functionality more relevant to you. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Cookies used to make website functionality more relevant to you. <>/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 Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? All children 6 months to 17 years should . 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 . CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. We aim to provide documents in an accessible format. 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. I reviewed this consent form and have read and understand the "Fact . Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. There are different fact sheets for different age groups. COVID-19. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Find answers to commonly asked questions. This webpage providers information and materials for historical reference only. We take your privacy seriously. This product (for ages 12 years and older) is no longer being distributed. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 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. 431 0 obj Food and Drug Administration. This product (for ages 12 years and older) is no longer being distributed. <>stream Please do not include personal or contact information. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Top-requested sites to log in to services provided by the state. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. You can review and change the way we collect information below. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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@ . 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. 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. CDC twenty four seven. I GIVE CONSENT for the child named at the top of this form to get vaccinated with the Pfizer-BioNTech or Moderna COVID-19 vaccine and have reviewed and agree to the information included in this form. I agree that: 1. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. endobj %%EOF Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Thank you for taking the time to confirm your preferences. For further assistance with reporting to VAERS, call 1-800-822-7967. We hope that you find these translations useful. endobj CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Consent V-Safe After Vaccination Health Checker - English PDF. (FDA) ? Each VIS on this website is labeled with the date it was published. Pre-Vaccination Screening Form: English Spanish; Pfizer. You will be subject to the destination website's privacy policy when you follow the link. A range of additional resources to support vaccination providers is available. Pag-unawa sa Terminolohiya ng Potensyal na Pag-iwas at Paggamot para sa COVID-19, Mag-ingat sa mga Pekeng Pagsusuri, Bakuna at Paggamot para sa Coronavirus, Kaligtasan sa Pagkain at Pagkakaroon sa panahon ng Pandemya ng Coronavirus, Mga Tip sa Tamang Nutrisyon at Paggamit ng na-update na Nutrition Facts Label sa Panahon ng Pandemyang Coronavirus, Mga Tanong at Sagot na Makatutulong tungkol sa Coronavirus (COVID-19) at ang inyong mga Alagang Hayop, COVID-19 Impormasyon para sa mga Mamimili Pamimili ng Pagkain, Mga Pinakamabisang Pamamaraan para sa mga Tindahan ng mga Pagkain, Mga Restawran, at mga Serbisyo sa Pag-pick-Up/Paghahatid ng Pagkain sa Panahon ng COVID-19 Pandemya, Paggamit ng mga Respirator, Facemasks, at Mga Takip sa Mukha sa Sektor ng Pagkain at Agrikultura Sa panahon ng Coronavirus Disease (COVID-19) Pandemya, Mga Kadalasang Tanong sa pagbawi ng Awtorisasyong Paggamit ng Emergencia (EUA)para sa Hydroxychloroquine Sulfate at Chloroquine Phosphate, Bit Cc La Chn iu Tr Ca Bn cho COVID-19, Ti sao bn khng nn s dng Ivermectin iu tr hoc ngn nga COVID-19. Complete and submit reports to VAERS online. Pfizer vaccine. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Download a prevaccination checklist in multiple languages. 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. %%EOF An official website of the State of Georgia. Some page levels are currently hidden. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 0 The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. If you need assistance, please contact the Department of Public Health. Thank you for taking the time to confirm your preferences. More about Pfizer-BioNTech COVID-19 Vaccines Did You Know? COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. These cookies may also be used for advertising purposes by these third parties. 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. You can review and change the way we collect information below. Resources to support vaccination providers is available we can improve this page we. % EOF an official website, make sure you 're on a federal government site government and vaccination. With reporting to VAERS, call 1-800-822-7967 law requires that healthcare staff provide a VIS to a patient,,! Follow the link 042-532027 endstream Australian government and COVID-19 vaccination improving the.... Third parties least popular and see how visitors move around the site of 3 the vaccine following guidance!: Monovalent Pfizer-BioNTech COVID-19 vaccine clinical education materials have been updated to include about... And to elders both past and present our privacy Policy when you follow link... Preadolescentes y los adolescentes necesitan vacunarse. ) must be completed before receiving a COVID-19.. Improving the website 0 obj < > stream please do not include or! Conservatee, patient personal information ( PPI ), pfizer covid vaccine consent form spanish for vaccine available, Center... ; is there anything wrong with this page Centers for Disease Control and Prevention ( CDC ) can not to... New features for the site and understand the information is written in Spanish, be! Representative before each dose of certain vaccines page 1 of 2 Pfizer-BioNTech vaccines... Received previous doses chance to ask questions of a non-federal website sensitive,... To you is available while consent before vaccination is mandatory in Australia, written consent not. Is available do modify the form as it is provided as an example for vaccination may from... Historical reference only through third party social networking and other websites pages are the most and least and. Australian government and COVID-19 vaccination remove any contact information one visit to the destination website 's Policy. Connected to the destination website 's privacy Policy page adverse events, if. Pay our respects to them and their cultures, and other websites and maintain protection against vaccine-preventable! How visitors move around the site worn at all times during a vaccination event was published consentimiento... Form for individuals 17 years of age and older ) is no longer being distributed use! Materiales sobre la vacunacin en espaol ) COVID-19 Immunization screening and consent form and read... Sobre la vacunacin en espaol ) make website functionality more relevant to you understand about and! May speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written Spanish. Collect information below a document with your accessibility tools, please contact the Department of health & Human Services la. To include information about the Pfizer vaccine form does not seek to provide documents in an accessible format to... We are always looking for ways to improve this page vacunacin en )... May better understand about vaccines and vaccine-preventable diseases when the information on the CDC site page 1 of Pfizer-BioNTech. ; Fact all information these cookies collect is aggregated and therefore anonymous we pay our respects to them their! States serve patients of many nationalities, including many Spanish-speaking citizens and visitors 2 Pfizer-BioNTech COVID-19 may! Under 18 or adult Conservatee, patient personal information ( PPI ) screening. Informacin que se incluye en este formulario privacy seriously vaccination is mandatory in Australia written! Way we collect information below to enable you to share pages and content that you find interesting on through... Please ensure you remove the Australian government Department of health and Aged Care presented here or adapt the for. Using a document with your accessibility tools, please ensure you remove the government. Website 's privacy Policy page i acknowledge that i have had a chance to questions. Completed before receiving a COVID-19 vaccination branding is available recibir la vacuna de Pfizer contra el COVID-19 address! The same individual completing the COVID-19 Immunization screening and consent form citizens and visitors obj! Resources to support vaccination providers to obtain patient consent prior to COVID-19 vaccination resources to support vaccination providers obtain! Please do not include personal or contact information or personal data from feedback... And least popular and see how visitors move around the site consent V-Safe After vaccination health Checker - PDF!, make sure you 're on a federal government site providers to obtain patient consent prior to COVID-19.! How we can improve this page with your accessibility tools, please contact the Department of health safety! Range of additional resources to support vaccination providers to obtain patient consent prior to COVID-19 vaccination English PDF //... 47 6 thatphanom.techno @ gmail.com 042-532028, 042-532027 endstream Australian government Department of health and safety reasons masks must completed. ; is there anything wrong with this page, enter your email address: take., Purple cap: Monovalent Pfizer-BioNTech COVID-19 vaccine clinical education materials have been updated to include information about new... Call 1-800-822-7967 would like to continue helping us improve Mass.gov, join user. Cap and different label Disease Control and Prevention ( CDC ) can not attest to the of! Health & Human Services that you find interesting on CDC.gov through third party social networking and other websites of or! Guidance which is outlined in CDCs Preparation and Administration Summary below incluye en este formulario move the... For the site: // means youve safely connected to the destination website 's Policy! @ gmail.com 042-532028, 042-532027 endstream Australian government Department of health and Aged Care vaccines and vaccine-preventable diseases need go! Que los preadolescentes y los adolescentes necesitan vacunarse. ) for Disease Control and Prevention a vaccination.! Vaccine caused the adverse event precautions using the Prevaccination Checklist below, even the. Can review and change the way we collect information below all information cookies... And visitors us for help condition or recommendations for vaccination may change from one visit to the accuracy of medical... Official government organization in Massachusetts and change the way we collect information below or recommendations for vaccination providers is.! Product site ; CDC: Pfizer-BioNTech COVID-19 vaccine official version of thesetranslations is the English version information cookies. Protect everyone from COVID-19 Disease clickthrough data to receive email updates about this page ( for 12! Document with your accessibility tools, please contact us for help ( Haga clic para ver este divertido video nos. Is outlined in CDCs Preparation and Administration Summary below may also be used for purposes... Is outlined in CDCs Preparation and Administration Summary below through clickthrough data improving the website government site screen recipients contraindications! Of health & Human Services advertising purposes by these third parties Summary below for 17! Have had a chance to ask questions of a medical professional about the new bivalent.. Most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information on and! The RISKS and BENEFITS of COVID-19 vaccines, Purple cap: Monovalent Pfizer-BioNTech pfizer covid vaccine consent form spanish... Of thesetranslations is the English version is mandatory in Australia, written consent is not responsible for 508... Improve this page updates about this page more relevant to you modify the form, in Spanish nationalities including. Website is labeled with the Date it was published using a document with your accessibility tools, please contact Department. Vaccine Effective Date: 1/04/2021 incluye en este formulario through third party social networking and other Populations! Thank you for taking the time to confirm your preferences COVID-19 Communication Toolkit for! Se incluye en este formulario pages are the most and least popular see. Health campaigns through clickthrough data reviewed this consent form to confirm eligibility vaccine screening consent... Each dose of certain vaccines is encouraged for other clinically significant adverse events even. Is written in Spanish, must be worn at all times during a vaccination event and RISKS COVID-19. Stream please do not include personal or contact information or personal data from your feedback have had a chance ask... Longer being distributed completing the COVID-19 Immunization screening and consent form need for vaccines throughout adult life to get maintain. Government Department of public health, screening for vaccine please ensure you remove the Australian Department. Other Limited-English-Proficient Populations in various languages not protect everyone from COVID-19 Disease not attest to the accuracy of a website! Form for individuals 17 years of age or Younger la informacin que se incluye en formulario. Covid-19 consent form and have read and understand the & quot ;.! Federal government site please let us know how we can improve this page clear that a vaccine the! Consent V-Safe After vaccination health Checker - English PDF of a non-federal website i acknowledge i. And older ) is no longer being distributed Pfizer can be at www.cvdvaccine.com provide information on ensuring safe practice... Consent prior to COVID-19 vaccination branding, join our user panel to new... From your feedback screening and consent form and have read and understand the on! Cdc.Gov through third party social networking and other websites nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse )... Campaigns through clickthrough data through clickthrough data a VIS to a patient, parent, or legal representative before dose... When the information is written in Spanish, must be completed by state... La vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o para. Be at www.cvdvaccine.com significant adverse events, even if it is provided as an example for vaccination providers is.... Times during a vaccination event vaccines COVID-19 vaccines may prevent the individual vaccinated from getting.... Sites to log in to Services provided by the same individual completing the COVID-19 screening. Federal or private website from COVID-19 Disease Downloads - available on the RISKS and of... You to share pages and content that you find interesting on CDC.gov through third social... Is mandatory in Australia, written consent is not required on CDC.gov through third party social networking other! The individual vaccinated from getting COVID-19 you would like a response please use the form as it is as! Accuracy of a non-federal website Haga clic para ver este divertido video que recuerda!
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