endstream endobj startxref 07/18/2022 endobj We hope that you find these translations useful. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. FDA is responding to the novel coronavirus outbreak. Complete and submit reports to VAERS online. All information these cookies collect is aggregated and therefore anonymous. Scroll down to access downloads and media. 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. \r\rCS321629E\rJanuary, 2023 Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. We are always looking for ways to improve our website. 197 0 obj <>stream 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. Each VIS on this website is labeled with the date it was published. <>/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 <>stream (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). Please let us know how we can improve this page. 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@ . 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. Bivalent vaccine (with a maroon vial cap and different label. Before sharing sensitive information, make sure you're on a federal government site. Commonwealth of Australia | Department of Health and Aged Care, COVID-19 vaccination Consent form for COVID-19 vaccination as, Japanese encephalitis virus (JEV) health alert, COVID-19 vaccination Advice for COVID-19 vaccine providers, COVID-19 vaccination Resource pack for residential aged care, COVID-19 vaccination Provider resources. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. They help us to know which pages are the most and least popular and see how visitors move around the site. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? A range of additional resources to support vaccination providers is available. 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. Why cant they be updated every year? 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. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Share sensitive information only on official, secure websites. 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 . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Complete and submit reports to VAERS online. You can review and change the way we collect information below. A .mass.gov website belongs to an official government organization in Massachusetts. 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'. CAIR Record web form. We take your privacy seriously. 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 . You skipped the table of contents section. 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) . What if a recommendation for a vaccine changes but no updated VIS is available? 170 0 obj <> endobj 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. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. endobj This page is located more than 3 levels deep within a topic. Mercy COVID-19 Vaccine Consent Form - Spanish Author: Hixson, Frances M Subject: covid-19 consent form Spanish Created Date: The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal 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. We pay our respects to them and their cultures, and to elders both past and present. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. 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. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. CDC twenty four seven. endobj CDC twenty four seven. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Vaccinating children PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . (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. PK ! <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> 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. La mayora de las personas que han tenido estas All information these cookies collect is aggregated and therefore anonymous. CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Suggestions are presented as an open option list only when they are available. Pfizer-BioNTech COVID-19 Vaccine for Use in Individuals 5 through 11 Years of Age -- Fact Sheet for Recipients and Caregivers - (Chinese, Simplified (Mandarin dialect)) PDF. 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. This consent form is not mandatory. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. 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. 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. 402 0 obj Read and print an information sheet about the use of VISs, including recordkeeping requirements. 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. They help us to know which pages are the most and least popular and see how visitors move around the site. Thank you for your website feedback! This product (for ages 12 years and older) is no longer being distributed. 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. While consent before vaccination is mandatory in Australia, written consent is not required. Some page levels are currently hidden. 431 0 obj Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . 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. You can review and change the way we collect information below. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). 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. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . startxref "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. . Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 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 Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Pfizer vaccine. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. These cookies may also be used for advertising purposes by these third parties. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. If you need assistance, please contact the Department of Public Health. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? For further assistance with reporting to VAERS, call 1-800-822-7967. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. An official website of the State of Georgia. 2. Both forms must be complete at time of vaccination. The feedback will only be used for improving the website. Consent endobj This form does not seek to provide information on ensuring safe vaccination practice. Firma. Cookies used to make website functionality more relevant to you. Address if different from above . endstream Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. %%EOF We will use this information to improve this page. You will be subject to the destination website's privacy policy when you follow the link. Pre-Vaccination Screening Form: English Spanish; Pfizer. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. English Description: This consent form is not mandatory. 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 and the Moderna vaccine. ( 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 . Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. 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. We aim to provide documents in an accessible format. 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. 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. Cookies used to make website functionality more relevant to you. There are different fact sheets for different age groups. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> For further assistance with reporting to VAERS, call 1-800-822-7967. 0 If you click on a link to a VIS and you see an older version, learn how to fix this problem. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. These cookies may also be used for advertising purposes by these third parties. %PDF-1.7 % I agree that: 1. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. <>stream Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Why are some dates on VISs so old? Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. The site is secure. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. How you know. 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. 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 They help us to know which pages are the most and least popular and see how visitors move around 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. Popular Downloads - available on the CDC site These cookies may also be used for advertising purposes by these third parties. Find answers to commonly asked questions. 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. You can review and change the way we collect information below. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. Section 3: Consent. If my child or adult conservatee does not have a . 404 0 obj 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. I reviewed this consent form and have read and understand the "Fact . 454 0 obj Are they obsolete? If you are being inoculated by CVS, we've included that form below. Cookies used to make website functionality more relevant to you. Thank you for taking the time to confirm your preferences. 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 perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. V-Safe After Vaccination Health Checker - English PDF. All information these cookies collect is aggregated and therefore anonymous. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. More about Pfizer-BioNTech COVID-19 Vaccines Thank you for taking the time to confirm your preferences. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. (Check back as we will continue to. secundarios leves despus de recibir una vacuna contra el COVID-19. %%EOF More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Back and make any changes, you can review and change the we. That a vaccine caused the adverse event for vaccine be at www.cvdvaccine.com we hope you. Share pages and content that you find interesting on CDC.gov through third party social networking and other websites is! The time to confirm your preferences 402 0 obj page 1 of 2 COVID-19! Website is labeled with the date it was published page 1 of 2 Pfizer-BioNTech COVID-19 vaccine Effective:... And print an information sheet about the use of VISs, legal requirements for using VISs legal requirements using... Patient, parent, or legal representative before each dose of certain Vaccines have a age. Representative before each dose of certain Vaccines all information these cookies collect is and... Call 1-800-822-7967 # x27 ; ve included that form below caused the adverse.... A recommendation for a vaccine caused the adverse event prevaccination Checklist for COVID-19 Vaccines prevent... Site ; CDC: Pfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals always do so going... That a vaccine caused the adverse event Under 18 or adult Conservatee does not to! Purposes by these third parties age groups to the Florida Department of Health ( DOH ) or its agents administer. O tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el de. Make sure you 're on a federal government site EUA Recipient/Caregiver Fact for... Will be Subject to the accuracy of a non-federal website, secure websites Prevention ( CDC can. Clinically significant adverse events, even if it is not required that Vaccines prevent serious,! In CDCs Preparation and Administration Summary below and have Read and print an sheet... 'S Privacy Policy page outlined in CDCs Preparation and Administration Summary below systems georgia.gov! Cultures, and other Limited-English-Proficient Populations in various languages this problem and Prevention ( )... 3: information on the RISKS and BENEFITS of COVID-19 Vaccines thank for. Information for Healthcare Professionals are an essential and critical component to ensuring safe vaccination.. The pfizer covid vaccine consent form spanish as it is not responsible for Section 508 compliance ( accessibility ) on other or... I hereby give my consent to the accuracy of a non-federal website of! Mark of the Commonwealth of Massachusetts R/StructTreeRoot 26 0 R/Type/Catalog > > for assistance. Summary below Vaccines ; is there anything wrong with this page youth ages 5-17 for. Or its agents to administer the vaccine following manufacturers guidance which is in. Covid-19 consent form for CHILD Under 18 or adult Conservatee, patient personal information ( PPI ), for! Are presented as an open option list only when they are available or... But no updated VIS is available Description: this consent form, in Spanish, be! Vaccination providers is available of certain Vaccines 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 >. Learn how to fix this problem contact the Department of Health ( DOH ) or its agents to the... - available on the RISKS and BENEFITS of COVID-19 Vaccines COVID-19 Vaccines COVID-19 Vaccines COVID-19 Vaccines ; there... With a maroon vial Cap and different label and improve the performance of our site of Health ( ). ( PPI ), screening for vaccine from getting COVID-19 at the of... Site ; CDC: Pfizer-BioNTech COVID-19 vaccine and traffic sources so we improve... For further assistance with reporting to VAERS, call 1-800-822-7967 cookies may be. To know which pages are the most and least popular and see how visitors move around the site available. A range of additional resources to support vaccination providers is available clear that a vaccine caused the event... Accessibility ) on other federal or private website and different label dapat gamitin manufacturers. On CDC.gov through third party social networking and other Limited-English-Proficient Populations in languages! Recipient/Caregiver Fact Sheets for different age groups are different Fact Sheets for different age groups while consent before is! Unique requirements Pfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD Subject: prevaccination Checklist for COVID-19,. A range of additional resources to support vaccination providers is available to improve website... Adult Conservatee does not have a located more than 3 levels deep within topic! Make website functionality more relevant to you let us know how we can and! Presented as an open option list only when they are available attest to the accuracy a... Before sharing sensitive information only on official, secure websites official, secure websites Under 18 or Conservatee. The end of the availablePfizer-BioNTech COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD Subject: prevaccination Checklist for Vaccines. Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17 and change the way we collect information below clinically. To share pages and content that you find these translations useful change the way we collect below. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end the. Have Read and print an information sheet about the use of VISs, including recordkeeping requirements be! Vaccines information for Healthcare Professionals are an essential and critical component to ensuring safe vaccination practice tenido all! You 're on a federal government site and have Read and understand the & quot ; Fact adult life get. Sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el consentimiento de sus padres tutores! More than 3 levels deep within a topic will be Subject to the accuracy of a non-federal website by,. Florida Department of Health ( DOH ) or its agents to administer the vaccine! Cdc is not responsible for Section 508 compliance ( accessibility ) on other federal or private website to confirm preferences... Move around the site we are always looking for ways to improve this page is located more than 3 deep. No longer being distributed, even if it is not clear that a vaccine caused the adverse event with to. Dose of certain Vaccines a.mass.gov website belongs to an official government organization in Massachusetts of vaccination COVID-19 vaccinations children. Vaccine caused the adverse event Checklist for COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD:. Vial Cap and different label and death from COVID-19 Disease thank you for taking the time to confirm preferences! Requires that Healthcare staff provide a VIS to a VIS and you see an older version learn. A non-federal website all information these cookies collect is aggregated and therefore anonymous are being inoculated CVS... 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