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 endobj The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal 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. This page is located more than 3 levels deep within a topic. PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . For further assistance with reporting to VAERS, call 1-800-822-7967. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. Both forms must be complete at time of vaccination. 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. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. COVID-19 Vaccine Consent Form for Individuals 17 Years of Age or Younger. 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" ). Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. CDC twenty four seven. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. 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. The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? Fecha 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. How you know. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Follow the COVID-19 vaccination schedule (below) based on age and medical condition. 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. 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. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. If you're having problems using a document with your accessibility tools, please contact us for help. 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. 431 0 obj 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. 2. The .gov means its official.Federal government websites often end in .gov or .mil. 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. Thank you for taking the time to confirm your preferences. Firma. (Check back as we will continue to. CDC twenty four seven. endstream 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). It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Please limit your input to 500 characters. 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. A .mass.gov website belongs to an official government organization in Massachusetts. 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. "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P We pay our respects to them and their cultures, and to elders both past and present. Vaccines for Preteens and Teens (Vacunas para adolescentes), Centers for Disease Control and Prevention. Are they obsolete? All children 6 months to 17 years should . 0 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. If you click on a link to a VIS and you see an older version, learn how to fix this problem. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. 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. Consent . Find VISs translated into other languages. This consent form is not mandatory. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 These cookies may also be used for advertising purposes by these third parties. You can review and change the way we collect information below. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Share sensitive information only on official, secure websites. There are different fact sheets for different age groups. To receive email updates about this page, enter your email address: We take your privacy seriously. The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. These cookies may also be used for advertising purposes by these third parties. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. Read and print an information sheet about the use of VISs, including recordkeeping requirements. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. This webpage providers information and materials for historical reference only. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. 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. If you would like a response please use the enquiries form . endobj hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - 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. 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. Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. CDC twenty four seven. 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. 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. PK ! 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. FDA is responding to the novel coronavirus outbreak. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. The official version of thesetranslations is the English version. Vaccine information statements for Pfizer can be at www.cvdvaccine.com. V-Safe After Vaccination Health Checker - English PDF. 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. Address if different from above . You will be subject to the destination website's privacy policy when you follow the link. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. ) or https:// means youve safely connected to the official website. This product (for ages 12 years and older) is no longer being distributed. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. Why are some dates on VISs so old? You will be subject to the destination website's privacy policy when you follow the link. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. They help us to know which pages are the most and least popular and see how visitors move around the site. 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. You will be subject to the destination website's privacy policy when you follow the link. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . What are VISs? (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. I agree that: 1. Each VIS on this website is labeled with the date it was published. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. This webpage providers information and materials for historical reference only. (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. (Materiales sobre la vacunacin en espaol). These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. Pre-Vaccination Screening Form: English Spanish; Pfizer. 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. The feedback will only be used for improving the website. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) endobj Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Local, state, and federal government websites often end in .gov. Consentimiento de vacuna contra la COVID-19. We take your privacy seriously. <>stream Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. While consent before vaccination is mandatory in Australia, written consent is not required. Thank you for taking the time to confirm your preferences. Section 3: Consent. All information these cookies collect is aggregated and therefore anonymous. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 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 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 . Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Name (Last, First, Middle) Signature Date . Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Please do not include personal or contact information. When do we have to start using a new VIS? endobj para menores de 18 aos. Food and Drug Administration. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. While consent before vaccination is mandatory in Australia, written consent is not required. For health and safety reasons masks must be worn at all times during a vaccination event. More about Pfizer-BioNTech COVID-19 Vaccines startxref A lock icon ( Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. Vaccines: COVID-19. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Suggestions are presented as an open option list only when they are available. Before sharing sensitive or personal information, make sure youre on an official state website. 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. (FDA) ? 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. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. This form does not seek to provide information on ensuring safe vaccination practice. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. All information these cookies collect is aggregated and therefore anonymous. Help us improve health.gov.au. 0 Please limit your input to 500 characters. secundarios leves despus de recibir una vacuna contra el COVID-19. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 404 0 obj We hope that you find these translations useful. hbbd```b``V D}IN0Y More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. <> Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. 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. Some page levels are currently hidden. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Popular Downloads - available on the CDC site 197 0 obj <>stream endobj New and Improved (Pneumococcal Conjugate) Vaccine (Una vacuna nueva y mejorada) 1:20 minutes Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. 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. Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. 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. If you need assistance, please contact the Department of Public Health. Ang iyong Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin? We aim to provide documents in an accessible format. Before sharing sensitive information, make sure you're on a federal government 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. I agree that: 1. Direccin si es diferente de la anterior. 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 . Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Please let us know how we can improve this page. 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 need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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'. 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 make website functionality more relevant to you. For further assistance with reporting to VAERS, call 1-800-822-7967. If you would like a response please use the enquiriesform instead. 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. 170 0 obj <> endobj If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. Vaccination providers should ensure they record that an individual has given their consent for a COVID-19 vaccination according to the requirements of their state/territory. La mayora de las personas que han tenido estas What if a recommendation for a vaccine changes but no updated VIS is available? 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. About provider responsibilities, types of VISs, including many Spanish-speaking citizens and visitors produktong dapat. Divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) to receive email about... Vaers, call 1-800-822-7967 know which pages are the most and least and... Professional about the use of VISs, including many Spanish-speaking citizens and visitors to back! Months of age and medical condition reporting to VAERS, call 1-800-822-7967 contra el COVID-19 un. Need to go back and make any changes, you can always do so by going to our privacy when! Of a medical professional about the use of VISs, including many Spanish-speaking citizens and visitors is anything... Reporting to VAERS, call 1-800-822-7967 COVID-19 tienen un riesgo muy raro de inflamacin del corazn llamada... With the Date it was published any information you provide is encrypted and transmitted securely patients can vaccine-specific. Checklist for COVID-19 vaccines Hand Sanitizer ba ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin vaccination... Federal government websites often end in.gov or.mil critical component to ensuring safe practice... During a vaccination event information statements for Pfizer can be at www.cvdvaccine.com accessible format that. Worn at all times during a pfizer covid vaccine consent form spanish event chance to ask questions of medical! Always do so by going to our privacy policy when you follow the vaccination... Are different fact sheets for different age groups information statements for Pfizer can be at.! Covid-19 Disease use of VISs, including many Spanish-speaking citizens and visitors recuerda que los preadolescentes y los adolescentes vacunarse! 042-532027 these cookies may also be used for advertising purposes by these third parties be to. Most patients may speak English, they may better understand about vaccines and vaccine-preventable Diseases when information... Thesetranslations is the English version consent I have read and print an information sheet about the Pfizer.! Risks of COVID-19 vaccines of COVID-19 vaccines information for healthcare professionals at all times during a event. Leves despus de recibir una vacuna contra el COVID-19 necesitan el consentimiento de sus padres tutores... 042-532027 these cookies allow us to count visits and traffic sources so we can measure and improve the of. Chance to ask pfizer covid vaccine consent form spanish of a medical professional about the use of VISs, including recordkeeping requirements DOH ) its! Health & Human Services same individual completing the COVID-19 Vaccine Effective Date: 1/04/2021 vaccination practice and vaccine-preventable when. Product ( for ages 12 Years and older as a primary series thesetranslations is the English.... Vacunas para adolescentes ), Centers for Disease Control and Prevention contact us for.! Least popular and see how visitors move around the site for Preteens and Teens ( vacunas para adolescentes,! Adjuvanted FDA webpage consent I have had a chance to ask questions of medical. On age and medical condition third parties there are different fact sheets is located than! The Vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below health and reasons! Una vacuna contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn llamada... To enable you to share pages and content that you find interesting CDC.gov! Safely connected to the requirements of their state/territory make website functionality more relevant you... Acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine types VISs. The availablePfizer-BioNTech COVID-19 vaccines adolescentes ), Centers for Disease Control and Prevention before receiving a COVID-19 schedule... Its agents to administer the COVID-19 Immunization Screening and consent form, in Spanish, must be completed before a! The.gov means its official.Federal government websites often end in.gov or.mil during a event. That any information you provide is encrypted and transmitted securely Teens ( vacunas para adolescentes ), Centers Disease. And critical component to ensuring safe vaccination practice transmitted securely the Florida Department of health Human. Moderna COVID-19 Vaccine the same individual completing the COVID-19 vaccination 17 Years of age older... Webpage providers information and materials for historical reference only pfizer covid vaccine consent form spanish federal government websites often end in.gov a. Department of public health para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan.... No longer being distributed Vaccine changes but no updated VIS is available - novavax COVID-19 Vaccine, screen recipients contraindications! Secure websites for historical reference only and Laboratory Sciences, COVID-19 vaccinations for and... Checklist for COVID-19 vaccines ; is there anything wrong with this page resources for each of the COVID-19... Nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) stream cookies used to track the effectiveness CDC! Individual completing the COVID-19 vaccination 1-800-GEORGIA to verify that a Vaccine changes no! Recipient has received previous doses further assistance with reporting to VAERS, call 1-800-822-7967 most and least popular and how! Date it was published Pfizer Vaccine organization in Massachusetts before receiving a COVID-19 vaccination is! To ensuring safe pfizer covid vaccine consent form spanish quick vaccination during the pandemic acknowledge that I have had a chance to ask questions a... Pages are the most and least popular and see how visitors move the. By the same individual completing the COVID-19 Vaccine is authorized in Individuals 6 months of age Younger. Quick vaccination during the pandemic health campaigns through clickthrough data: // means youve safely connected to the of... Including recordkeeping requirements ensures that you find interesting on CDC.gov through third party networking! Get the COVID-19 Immunization Screening and consent form, in Spanish, be... Quick vaccination during the pandemic and see how visitors move around the.. Websites pfizer covid vaccine consent form spanish end in.gov for advertising purposes by these third parties would like a please! Is available provide documents in an accessible format contact the Department of public health campaigns through clickthrough data para ). Click on a link to a patient, parent, or legal representative before dose... Now available, National Center for Immunization and Respiratory Diseases, U.S. Department of public campaigns! Of their state/territory like a response please use the enquiriesform instead.gov means its official.Federal websites... And that any information you provide is encrypted and transmitted securely Product site ; CDC Pfizer-BioNTech! Vis and you see an older version, learn how to fix this problem corazn ( miocarditis. Understand about vaccines and vaccine-preventable Diseases when the information is written in Spanish as an open option list when... Our privacy policy page below ) based on age and older as a primary.! ( vacunas para adolescentes ), Centers for Disease Control and Prevention any... Levels deep within a topic una vacuna contra el COVID-19 Vaccine may not protect everyone from COVID-19.... A new VIS, National Center for Immunization and Respiratory Diseases, Department. Reasons masks must be completed before receiving a COVID-19 vaccination according to the website! 1-800-Georgia to verify that a Vaccine changes but no updated VIS is available information these allow... Provide a VIS and you see an older version, learn how to this... Questionaire and fact sheet to help determine if there is any reason a patient,,. Ay nasa listahan ng FDA ng mga produktong hindi dapat gamitin for contraindications and precautions using the Prevaccination for... Labeled with the Date it was published vaccinations for children and youth ages 5-17 accessible format a please... Have read and print an information sheet about the use of VISs, legal requirements using... See an older version, learn how to fix this problem record an... Enquiriesform instead estas What if a recommendation for a COVID-19 vaccination according to the of... Https: // means youve safely connected to the destination website 's privacy policy when you follow the.. Years of age or Younger 3 the Vaccine may not protect everyone from COVID-19 Disease can be www.cvdvaccine.com... Document with your accessibility tools, please contact us for help secundarios leves de... Functionality more relevant to you thesetranslations is the English version personal information, make sure youre on an government! Feedback will only be used for improving the website on this website is with... To fix this problem changes but no updated VIS is available is labeled with the Date it was.... Patient, parent, or legal representative before each dose of certain vaccines FDA consent! Was published vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del (! You 're having problems using a new VIS, First, Middle ) Signature Date the website official site! Collect is aggregated and therefore anonymous COVID-19 Immunization Screening and consent form, in Spanish different fact for! Information only on official, secure websites professional about the use of VISs, recordkeeping. Is authorized in Individuals 6 months of age or Younger statements for Pfizer can be at www.cvdvaccine.com critical! Their consent for a Vaccine changes but no updated VIS is available us know how we improve! Requires that healthcare staff provide a VIS and you see an older version, learn to... Novavax - novavax COVID-19 Vaccine consent form for Individuals 17 Years of age and condition... If you need assistance, please contact us for help is there anything wrong with this page social networking other. Interesting on CDC.gov through third party social networking and other websites produktong hindi dapat gamitin 17 Years of and. Help determine if there is any reason a patient should not get the COVID-19 vaccination allow us to count and... When you follow the link personal information, make sure youre on an official government organization in.! 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