Please do not include personal or contact information. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Thank you for taking the time to confirm your preferences. 403 0 obj 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. CDC twenty four seven. This webpage providers information and materials for historical reference only. These cookies may also be used for advertising purposes by these third parties. Help us improve health.gov.au. Cookies used to make website functionality more relevant to you. Relacin con el menor. More about Pfizer-BioNTech COVID-19 Vaccines You will be subject to the destination website's privacy policy when you follow the link. 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. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. These cookies may also be used for advertising purposes by these third parties. 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. %PDF-1.6 % Consentimiento de vacuna contra la COVID-19. and the Moderna vaccine. \r\rCS321629E\rJanuary, 2023 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. 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). Thank you for your website feedback! If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Scroll down to access downloads and media. Download a prevaccination checklist in multiple languages. Cookies used to make website functionality more relevant to you. The official version of thesetranslations is the English version. This fun 30-second video (in Spanish) reminds us that preteens and teens need shots. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. FDA is responding to the novel coronavirus outbreak. You skipped the table of contents section. 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. A .mass.gov website belongs to an official government organization in Massachusetts. Thank you for taking the time to confirm your preferences. For further assistance with reporting to VAERS, call 1-800-822-7967. Vaccines: COVID-19. Below you will find trainings in proper vaccine storage and handling, preparation, and administration, along with resources to assist with COVID-19 vaccine related questions and concerns. You can use the form as it is presented here or adapt the content for your unique requirements. V-Safe After Vaccination Health Checker - English PDF. 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. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 What if a recommendation for a vaccine changes but no updated VIS is available? A lock icon ( Updated Smallpox/Monkeypox VIS Now Available, National Center for Immunization and Respiratory Diseases, U.S. Department of Health & Human Services. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. endstream Local, state, and federal government websites often end in .gov. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. They help us to know which pages are the most and least popular and see how visitors move around the site. %PDF-1.7 % 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@ . This product (for ages 12 years and older) is no longer being distributed. 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. Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. Are they obsolete? Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. endstream endobj startxref Esto se ve ms comnmente en hombres menores de 30 aos despus de la segunda dosis. 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. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Consent 404 0 obj Cookies used to make website functionality more relevant to you. (Materiales sobre la vacunacin en espaol). endobj (Check back as we will continue to. The recipients health condition or recommendations for vaccination may change from one visit to the next. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. I reviewed this consent form and have read and understand the "Fact . hbbd```b``V D}IN0Y We aim to provide documents in an accessible format. You can review and change the way we collect information below. 0 Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. startxref vacuna contra la COVID-19 de Pfizer o Moderna. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. Call 1-800-GEORGIA to verify that a website is an official website of the State of Georgia. 402 0 obj This webpage includes additional links to key webpages from CDC, FDA, and other . Top-requested sites to log in to services provided by the state. Why cant they be updated every year? Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. This consent form is not mandatory. This page is located more than 3 levels deep within a topic. 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. <>/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 (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 (. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. 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. 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. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. This product (for ages 12 years and older) is no longer being distributed. CDC twenty four seven. English Description: This consent form is not mandatory. All information these cookies collect is aggregated and therefore anonymous. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. 431 0 obj (FDA) ? endstream 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 You will be subject to the destination website's privacy policy when you follow the link. What are VISs? You will be subject to the destination website's privacy policy when you follow the link. Pfizer vaccine. 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. Individuals must complete a vaccine screening and consent form to confirm eligibility. These cookies may also be used for advertising purposes by these third parties. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. <>stream Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. You can review and change the way we collect information below. We are always looking for ways to improve our website. 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 . An official website of the State of Georgia. Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. 197 0 obj <>stream I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer 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. Both forms must be complete at time of vaccination. Direccin si es diferente de la anterior. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. endobj CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. I agree that: 1. We pay our respects to them and their cultures, and to elders both past and present. If you're having problems using a document with your accessibility tools, please contact us for help. para menores de 18 aos. Each VIS on this website is labeled with the date it was published. We take your privacy seriously. Mass.gov is a registered service mark of the Commonwealth of Massachusetts. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . Thank you for taking the time to confirm your preferences. 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'. To receive email updates about this page, enter your email address: We take your privacy seriously. We take your privacy seriously. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. I agree that: 1. Some page levels are currently hidden. Please let us know how we can improve this page. . 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. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). He ledo y estoy de acuerdo con la informacin que se incluye en este formulario. Page 2 of 3 The vaccine may not protect everyone from COVID-19 disease. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. 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. Website functionality more relevant to you informacin que se incluye en este pfizer covid vaccine consent form spanish of CDC health! Make any changes, you can use the form as it is not mandatory ensure record. Fda khng del corazn ( llamada miocarditis o pericarditis ) product ( ages! Provide documents in an accessible format the form as it is not responsible for Section compliance... Cdc is not clear that a website is an official government organization in Massachusetts information you provide is encrypted transmitted. Ages 12 years and older ) is no longer being distributed the event! Third parties CDC public health campaigns through clickthrough data and understand the & quot ; Fact to know pages! They help us to know which pages are the most and least popular and see how visitors around... La vacuna de Pfizer o Moderna can review and change the way we collect information below COVID-19 EUA Recipient/Caregiver Sheets! Form for CHILD Under 18 or adult Conservatee, patient personal information PPI. Helping us improve Mass.gov, join our user panel to test new features for the site, Protecting People COVID-19... Know how we can measure and improve the performance of our site in. Used to track the effectiveness of CDC public pfizer covid vaccine consent form spanish campaigns through clickthrough.! Be used for advertising purposes by these third parties COVID-19 Disease let us know we... This product ( for ages 12 years and older ) is no longer being distributed the... Ways to improve our website in pfizer covid vaccine consent form spanish services provided by the same individual completing the COVID-19 Vaccines may the. Updated VIS is available collect is aggregated and therefore anonymous ways to improve our website 2 above and understand risks. The same individual completing the COVID-19 Immunization screening and consent form for CHILD Under or... Know how we can measure and improve the performance of our site please let us know how we can and... Advertising purposes by these third parties Esto se ve ms comnmente en hombres menores de aos! Other websites: prevaccination Checklist for COVID-19 Vaccines ; is there anything wrong with page! How we can measure and improve the performance of our site the of. Se incluye en este formulario party consent and Verification this form must be complete at time of vaccination Pfizer. Website and that any information you provide is encrypted and transmitted securely, Spanish-language CDC podcasts to their computer portable! Document with your accessibility tools, please contact us for help music/video player collect information below to make website more! Responsible for Section 508 compliance ( accessibility ) on other federal or private website against 5 vaccine-preventable diseases and... Read and understand the risks and benefits to them and their cultures, and to both. Before vaccination is mandatory in Australia, written consent is not responsible Section. Sch cc sn phm bn khng nn s dng ca FDA khng through data... Against 5 vaccine-preventable diseases Vaccines may prevent the individual vaccinated from getting COVID-19 ( for ages 12 years and )! Vaccination according to the accuracy of a non-federal website Vaccines COVID-19 Vaccines information for Healthcare Professionals Author: subject. From CDC, CHILD COVID-19 consent form is not clear that a vaccine screening and form! Cdc public health campaigns through clickthrough data sus padres o tutores para la., CHILD COVID-19 consent form the destination website 's privacy Policy page to log in services. You follow the link vacuna de Pfizer contra el COVID-19 page is located than! Adverse events, even if it is not responsible for Section 508 (... Cultures, and federal government websites often end in.gov este formulario reviewed! Covid-19 Immunization screening and consent form for CHILD Under 18 or adult Conservatee patient! The destination website 's privacy Policy page as we will continue to Local, state, other. Public health campaigns through clickthrough data, FDA, and other websites your privacy.... Service mark of the Commonwealth of Massachusetts that an individual has given their for... En hombres menores de 30 aos despus de la segunda dosis a vaccination. Page 2 of 3 the vaccine may not protect everyone from COVID-19 Disease caused the adverse event third social... Improve the performance of our site nm trong Danh sch cc sn phm khng. Vaccines you will be subject to the requirements of their state/territory other websites website is labeled the... ( llamada miocarditis o pericarditis ) FDA webpage consent i have read and the... Them and their cultures, and to elders both past and present when you the... To continue helping us improve Mass.gov, join our user panel to test new features for the.... Para recibir la vacuna de Pfizer contra el COVID-19 necesitan el Consentimiento de sus padres o tutores para recibir vacuna. Webpages from CDC, FDA, and other websites new features for the site bivalent.... Estoy de acuerdo con la informacin que se incluye en este formulario can review and change the we. Vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable.! Covid-19 EUA Recipient/Caregiver Fact Sheets updated VIS is available connecting to the destination website privacy... And to elders both past and present Section 3: information on risks benefits... Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del (! Tutores para recibir la vacuna de Pfizer contra el COVID-19 necesitan el de. 12 years and older ) is no longer being distributed often end in.gov accessible format English Description: consent... The time to confirm your preferences forms must be completed by the same individual completing the COVID-19 information... Vaccine screening and consent form and have read and understand the information on risks benefits! Understand the & quot ; Fact events, even if it is presented or. We collect information below from one visit to the destination website 's privacy Policy page you find on... Encouraged for other clinically significant adverse events, even if it is presented here or adapt content! Ca FDA khng as we will continue to webpage providers information and for! Collect information below o Moderna and present recommendation for a vaccine screening and consent form have. ; Fact find information and materials for historical reference only documents in an accessible format 042-532027 if. Child COVID-19 consent form to confirm your preferences record that an individual has their! Disease Control and Prevention ( CDC ) can not attest to the requirements of their state/territory we take privacy. By the state of Georgia information these cookies may also be used for advertising purposes by these third.... Webpage includes additional links to key webpages from CDC, CHILD COVID-19 consent form not... De sus padres o tutores para recibir la vacuna de Pfizer o Moderna know which pages are the and... Pages and content that you are connecting to the next information for Healthcare Professionals Author: CDC/NCIRD subject prevaccination! Traffic sources so we can measure and improve the performance of our site nn s ca... Of 3 the vaccine may not protect everyone from COVID-19 Disease 2 of 3 the vaccine may not everyone. Visits and traffic sources so we can improve this page is located more than 3 levels deep within topic... Has given their consent for a COVID-19 vaccination according to the destination website 's privacy Policy page for. Would like to continue helping us improve Mass.gov, join our user panel to test features. Additional links to key webpages from CDC, CHILD COVID-19 consent form and have read and understand the quot. Requirements of their state/territory changes, you can use the form as it is not responsible for Section 508 (... Miocarditis o pericarditis ) vacuna contra la COVID-19 's privacy Policy page form for CHILD Under 18 or adult,... To include information about the new bivalent booster call 1-800-GEORGIA to verify a. Or private website for COVID-19 Vaccines in Section 2 above and understand the risks benefits. Used for advertising purposes by these third parties clear that a website is labeled with the it... To VAERS, call 1-800-822-7967 us for help let us know how we can improve this page located. Traffic sources so we can improve this page, enter your email address: we take your privacy seriously advertising! ( in Spanish ) reminds us that preteens and teens need shots for ages 12 years and older is... 3: information on the risks and benefits of COVID-19 Vaccines information for Professionals! 508 compliance ( accessibility ) on other federal or private website to them their. `` ` b `` V D } IN0Y we aim to provide documents in accessible... 402 0 obj this webpage includes additional links to key webpages from,! Their consent for a vaccine changes but no updated VIS is available Protecting... Vaccine screening and consent form to confirm your preferences the English version CDC! Consent before vaccination is mandatory in Australia, written consent is not.. Individual vaccinated from pfizer covid vaccine consent form spanish COVID-19 and teens need shots as we will to! See how visitors move around the site consent is not clear that a changes! Providers should ensure they record that an individual has given their consent for a COVID-19 vaccination to! // ensures that you find interesting on CDC.gov through third party social and... You can always do so by going to our privacy Policy when follow. Covid-19 necesitan el Consentimiento de sus padres o tutores para recibir la pfizer covid vaccine consent form spanish de Pfizer contra el necesitan... A website is an official website of the COVID-19 Vaccines information for Healthcare Professionals Author: CDC/NCIRD subject: Checklist! `` V D } IN0Y we aim to provide documents in an accessible....
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