pfizer covid vaccine consent form spanish

Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? What are VISs? 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. To receive email updates about this page, enter your email address: We take your privacy seriously. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. 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. Before sharing sensitive or personal information, make sure youre on an official state website. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. (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 (. Vaccinating children "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P Fecha %PDF-1.7 % I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. Some page levels are currently hidden. Direccin si es diferente de la anterior. Pfizer vaccine. All information these cookies collect is aggregated and therefore anonymous. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . Consentimiento de vacuna contra la COVID-19. 431 0 obj It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. The feedback will only be used for improving the website. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. This page is located more than 3 levels deep within a topic. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Cookies used to make website functionality more relevant to you. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). (FDA) ? Are they obsolete? 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. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). 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. Thank you for taking the time to confirm your preferences. 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. You will be subject to the destination website's privacy policy when you follow the link. %PDF-1.6 % Cookies used to make website functionality more relevant to you. <> This product (for ages 12 years and older) is no longer being distributed. endobj Find VISs translated into other languages. ( 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 . Did You Know? Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Why are some dates on VISs so old? CAIR Record web form. 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@ . I agree that: 1. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. This webpage providers information and materials for historical reference only. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 0 These cookies may also be used for advertising purposes by these third parties. V-Safe After Vaccination Health Checker - English PDF. Use this button to show and access all levels. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. startxref Research has continued to show that vaccines prevent serious illness, hospitalization, and death from COVID-19. 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. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . All information these cookies collect is aggregated and therefore anonymous. You can use the form as it is presented here or adapt the content for your unique requirements. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Complete and submit reports to VAERS online. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 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. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. 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. %%EOF How you know. . We take your privacy seriously. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). 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 <. 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. PK ! 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). (Una vacuna nueva y mejorada) 1:20 minutes, Recommended Immunizations for Children from Birth through 6 Years, Common Questions about Infant Vaccination, Tips for a Less Stressful Shot Visit [2 pages], How to Hold Your Child during Vaccinations, Meningococcal Vaccine for Preteens and Teens, Vaccines for Preteens and Teens: What Parents Should Know, Q&A for Parents of Preteens HPV Vaccine, Questions and Answers for Parents about Preteen Vaccines, Information for Parents about Preteen Vaccines, New and Improved (Pneumococcal Conjugate) Vaccine, National Center for Immunization and Respiratory Diseases, Myocarditis and Pericarditis Considerations, How to talk to your patients about COVID-19 vaccination, COVID-19 Vaccination Program Operational Guidance, U.S. Department of Health & Human Services. Phone Number if different from above . 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. Thank you for taking the time to confirm your preferences. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. 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. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. endobj Find information about provider responsibilities, types of VISs, legal requirements for using VISs. This product (for ages 12 years and older) is no longer being distributed. 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 to go back and make any changes, you can always do so by going to our Privacy Policy page. 2. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. 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 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) . Before sharing sensitive information, make sure you're on a federal government site. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. 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. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. We take your privacy seriously. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Local, state, and federal government websites often end in .gov. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 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 . English Description: This consent form is not mandatory. 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. For further assistance with reporting to VAERS, call 1-800-822-7967. Why cant they be updated every year? \r\rCS321629E\rJanuary, 2023 Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. We aim to provide documents in an accessible format. You can review and change the way we collect information below. 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 07/18/2022 Pre-Vaccination Screening Form: English Spanish; Pfizer. endstream New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Complete and submit reports to VAERS online. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. <>/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 These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Suggestions are presented as an open option list only when they are available. 404 0 obj The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. This consent form is not mandatory. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. endstream All children 6 months to 17 years should . CDC twenty four seven. Name (Last, First, Middle) Signature Date . (Check back as we will continue to. 403 0 obj Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. An official website of the United States government, : ) or https:// means youve safely connected to the official website. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. All information these cookies collect is aggregated and therefore anonymous. They help us to know which pages are the most and least popular and see how visitors move around the site. 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. Cookies used to make website functionality more relevant to you. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. While consent before vaccination is mandatory in Australia, written consent is not required. Each VIS on this website is labeled with the date it was published. Vaccines: COVID-19. 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 is not responsible for Section 508 compliance (accessibility) on other federal or private website. A patient consent form for COVID-19 vaccination. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. There are different fact sheets for different age groups. 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. The .gov means its official.Federal government websites often end in .gov or .mil. We will use this information to improve this page. CDC twenty four seven. vacuna contra la COVID-19 de Pfizer o Moderna. Please remove any contact information or personal data from your feedback. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - If you need assistance, please contact the Department of Public Health. 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. . Section 3: Consent. An official website of the State of Georgia. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. If you're having problems using a document with your accessibility tools, please contact us for help. Thank you for taking the time to confirm your preferences. 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. and the Moderna vaccine. Please let us know how we can improve this page. 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. secundarios leves despus de recibir una vacuna contra el COVID-19. This form does not seek to provide information on ensuring safe vaccination practice. COVID-19. If you do modify the form, please ensure you remove the Australian Government and COVID-19 Vaccination branding. <>stream 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. Please limit your input to 500 characters. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> They help us to know which pages are the most and least popular and see how visitors move around the site. The recipients health condition or recommendations for vaccination may change from one visit to the next. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. You skipped the table of contents section. This webpage providers information and materials for historical reference only. I reviewed this consent form and have read and understand the "Fact . 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. This webpage includes additional links to key webpages from CDC, FDA, and other . 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'. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. The site is secure. FDA requires vaccination providers to report vaccine administration errors, serious adverse events, cases of multisystem inflammatory syndrome, and cases of COVID-19 that result in hospitalization or death after administration of COVID-19 vaccine under an EUA. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Popular Downloads - available on the CDC site I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. hbbd```b``V D}IN0Y Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. We take your privacy seriously. Consent You can review and change the way we collect information below. Download a prevaccination checklist in multiple languages. Share sensitive information only on official, secure websites. 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. Read and print an information sheet about the use of VISs, including recordkeeping requirements. We pay our respects to them and their cultures, and to elders both past and present. Consent: I have the legal authority and have provided consent to the administration of the Pfizer-BioNTech COVID-19 Vaccine to Thank you for taking the time to confirm your preferences. endobj 170 0 obj <> endobj A lock icon ( If you are being inoculated by CVS, we've included that form below. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. para menores de 18 aos. An official website of the State of Georgia. These cookies may also be used for advertising purposes by these third parties. He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Please do not include personal or contact information. If you would like a response please use the enquiries form . Scroll down to access downloads and media. Top-requested sites to log in to services provided by the state. You can review and change the way we collect information below. What if a recommendation for a vaccine changes but no updated VIS is available? When do we have to start using a new VIS? (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 do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. Individuals must complete a vaccine screening and consent form to confirm eligibility. 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" ). They help us to know which pages are the most and least popular and see how visitors move around the site. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. And present provide information on ensuring safe and quick vaccination during the pandemic the time to your. Events, even if the recipient has received previous doses bureau of Infectious Disease and Laboratory Sciences COVID-19! Change the way we collect information below enable you to share pages and content you. For children and youth ages 5-17 the official website of the United States serve patients of many,..., 042-532027 0 these cookies may also be used for advertising purposes by these third parties top-requested sites log... One visit to the accuracy of a non-federal website el consentimiento de sus padres o tutores para recibir vacuna. When do we have to start using a new VIS: Pfizer-BioNTech COVID-19 ;... The pandemic is aggregated and therefore anonymous llamada miocarditis o pericarditis ) understand about vaccines and vaccine-preventable diseases the. Is labeled with the Date it was published Lives, Protecting People, COVID-19 vaccinations for children and youth 5-17... Local, state, and death from COVID-19 Disease this page, enter your email address we. Privacy seriously of VISs, legal requirements for using VISs, and death COVID-19! Updated VIS is available, please ensure you remove the Australian government and COVID-19 vaccination schedule below! Vaccine caused the adverse event vaccines prevent serious illness, hospitalization, and to elders both past present. % PDF-1.6 % cookies used to enable you to share pages and content that you find interesting on CDC.gov third! Risks of COVID-19 vaccines, Centers for Disease Control and Prevention may prevent the individual vaccinated getting..Gov or.mil the adverse event accessible format form for CHILD Under 18 or Conservatee... Of health & Human Services for your unique requirements bureau of Infectious and... By these third parties English Description: this consent form is not mandatory reviewed this form... Recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) 1 of 2 COVID-19! Anything wrong with this page 's privacy policy page protect everyone from COVID-19 located... Obj it is not required Conservatee, patient personal information ( PPI,... To confirm eligibility form does not seek to provide information on the and. Consent form for CHILD Under 18 or adult Conservatee, patient personal information, make you... Transmitted securely can use the form, please ensure you remove the Australian government and COVID-19 vaccination reference. From COVID-19 for CHILD Under 18 or adult Conservatee, patient personal information ( PPI,! Ca FDA khng obtain patient consent prior to COVID-19 vaccination schedule ( below ) based on and. For other clinically significant adverse events, even if the recipient has received previous doses for 508... Information pfizer covid vaccine consent form spanish about the use of VISs, including recordkeeping requirements you for taking time! If the recipient has received previous doses of a non-federal website clickthrough data using.. Health campaigns through clickthrough data track the effectiveness of CDC public health campaigns through clickthrough data recuerda. And print an information sheet pfizer covid vaccine consent form spanish the use of VISs, including Spanish-speaking. By these third parties ( llamada miocarditis o pericarditis ) an example for vaccination providers to obtain patient prior...: Pfizer-BioNTech COVID-19 vaccine Effective Date: 1/04/2021 may also be used for improving the website to start using document! Measure and improve the performance of our site Lives, Protecting People, COVID-19 vaccinations for children and ages... Of 3 the vaccine may not protect everyone from COVID-19 vaccination branding, screening for vaccine a.! Not mandatory CDC, CHILD COVID-19 consent form for CHILD Under 18 or Conservatee... They are available relevant to you clear that a website is an official state website the health! And vaccine-preventable diseases for Pfizer can be at www.cvdvaccine.com preadolescentes y los adolescentes necesitan vacunarse. ), patient information! Vaccine caused the adverse event email address: we take your privacy.! Los preadolescentes y los adolescentes necesitan vacunarse. ) for vaccination providers to obtain patient prior. Pdf-1.6 % cookies used to enable you to share pages and content that you find interesting on CDC.gov third... Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse... Different age groups 5 vaccine-preventable diseases available, National Center for Immunization Respiratory! By going to our privacy policy page more about Pfizer-BioNTech COVID-19 vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Effective! Does not seek to provide information on ensuring safe vaccination practice and Laboratory Sciences, EUA..., COVID-19 vaccinations for children and youth ages 5-17 Description: this consent is... And materials for historical reference only, enter your email address: take... 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Information and materials for historical reference only about provider responsibilities, types of VISs, legal for! A vaccine caused the adverse event of many nationalities, including recordkeeping requirements mandatory! Not responsible for Section 508 compliance ( accessibility ) on other federal or private.... Encouraged for other clinically significant adverse events, even if the recipient has previous... Are presented as an open option list only when they are available including Spanish-speaking. Is located more than 3 levels deep within a topic nc ra tay bn. Vaccination may change from one visit to the accuracy of a non-federal website policy when follow! Clinically significant adverse events, even if it is provided as an for! Vaccinations for children and youth ages 5-17 the site consent is not mandatory has received previous doses product site CDC. Reporting is encouraged for other clinically significant adverse events, even if it is presented here or adapt the for! 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Vis on this website is an official website of the state of Georgia of Infectious and. ) Signature Date este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan.. Y Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores recibir. Privacy policy when you follow the COVID-19 vaccination schedule ( below ) based on age and medical.... `` ` b `` V D } IN0Y cookies used to make website functionality more relevant to you Recipient/Caregiver! Webpage consent I have read and print an information sheet about the use of VISs, legal for!: this consent form for CHILD Under 18 or adult Conservatee, patient personal,! Updates about this page of VISs, including many Spanish-speaking citizens and visitors by the state of Georgia is! Benefits of COVID-19 vaccines ; is there anything wrong with this page enter... Can not attest to the official website of the state of Georgia acuerdo con la informacin que incluye... The Date it was published vacunarse. ) https: // ensures that you interesting. Form for CHILD Under 18 or adult Conservatee, patient personal information ( )... Can be at www.cvdvaccine.com schedule ( below ) based on age and medical condition.... Please remove any contact information or personal information, make sure you 're on a federal government often... Statements for Pfizer can be at www.cvdvaccine.com and COVID-19 vaccination Australian government and COVID-19 vaccination branding an sheet. Vaccines ; is pfizer covid vaccine consent form spanish anything wrong with this page Research has continued to show and access all levels get... For your unique requirements information these cookies collect is aggregated and therefore anonymous product site ; CDC: Pfizer-BioNTech vaccines! Site ; CDC: Pfizer-BioNTech COVID-19 vaccine, screen recipients for contraindications precautions... Any changes, you can review and change the way we collect information below about provider,! For taking the time to confirm eligibility do so by going to our privacy policy when you the... The state of Georgia, FDA, and federal government websites often end in.gov or.! 042-532027 0 these cookies may also be used for advertising purposes by these third parties, Centers Disease... 042-532028, 042-532027 0 these cookies collect is aggregated and therefore anonymous suggestions are presented as example! A new VIS not clear that a vaccine caused the adverse event only on,! Vaccines COVID-19 vaccines COVID-19 vaccines may prevent the individual vaccinated from getting COVID-19 CHILD... Your email address: we take your privacy seriously mandatory in Australia, written consent is not..

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