Questionaire and fact sheet to help determine if there is any reason a patient should not get the COVID-19 Vaccine. endobj Thank you for taking the time to confirm your preferences. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. These cookies may also be used for advertising purposes by these third parties. 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 . 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 Please do not include personal or contact information. . These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. ) or https:// means youve safely connected to the official 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. 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. hb```RB eap`W?V%YOJtq(H~@AV f13::x_2@,6&AQu.RLWXn3gcbre+Z%|fbgi)|/i EXDA"' 0 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 would like a response please use the enquiriesform instead. endobj While consent before vaccination is mandatory in Australia, written consent is not required. Pre-Vaccination Screening Form: English Spanish; Pfizer. 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. (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. They help us to know which pages are the most and least popular and see how visitors move around the site. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. endstream endobj startxref Direccin si es diferente de la anterior. I understand that the Pfizer Vaccine will be given in two . More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 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. hbbd```b``V D}IN0Y It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. We aim to provide documents in an accessible format. SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . This page is located more than 3 levels deep within a topic. Each VIS on this website is labeled with the date it was published. 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" ). If you click on a link to a VIS and you see an older version, learn how to fix this problem. endstream 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 fun 30-second video (in Spanish) reminds us that preteens and teens need shots. 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. hb``g``h01G|A , }i=S1g\$y!$Lj*`eA*23 ,``LZdw &a`2M!>c*IP3~ c?U - Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals Author: CDC/NCIRD Subject: Prevaccination Checklist for COVID-19 Vaccines Information for Healthcare Professionals. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. All children 6 months to 17 years should . Podcasts Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. Are they obsolete? Thank you for taking the time to confirm your preferences. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 Why are some dates on VISs so old? endobj Section 3: Consent. State of Georgia government websites and email systems use georgia.gov or ga.gov at the end of the address. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. (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 (. 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) . Scroll down to access downloads and media. Read and print an information sheet about the use of VISs, including recordkeeping requirements. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Download a prevaccination checklist in multiple languages. endobj <>stream 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. This consent form is not mandatory. Nc ra tay ca bn c nm trong Danh sch cc sn phm bn khng nn s dng ca FDA khng? Vaccine information statements for Pfizer can be at www.cvdvaccine.com. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. Pfizer contra el COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer contra el COVID-19. This form does not seek to provide information on ensuring safe vaccination practice. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. If you would like a response please use the enquiries form . Food and Drug Administration. CDC twenty four seven. You will be subject to the destination website's privacy policy when you follow the link. (Check back as we will continue to. Further, I hereby give my consent to the Florida Department of Health (DOH) or its agents to administer the COVID-19 vaccine. If you do not allow these cookies we will not know when you have visited our site, and will not be able to monitor its performance. CDC twenty four seven. A range of additional resources to support vaccination providers is available. These cookies may also be used for advertising purposes by these third parties. Did You Know? While most patients may speak English, they may better understand about vaccines and vaccine-preventable diseases when the information is written in Spanish. Some page levels are currently hidden. 401 0 obj 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. If you are being inoculated by CVS, we've included that form below. 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@ . CDC twenty four seven. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . 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 . All information these cookies collect is aggregated and therefore anonymous. Cookies used to make website functionality more relevant to you. 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. 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. 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. Bureau of Infectious Disease and Laboratory Sciences, COVID-19 vaccinations for children and youth ages 5-17. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. An official website of the State of Georgia. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. <>/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 Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. If you need assistance, please contact the Department of Public Health. Reporting is encouraged for other clinically significant adverse events, even if it is not clear that a vaccine caused the adverse event. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. An official website of the United States government, : While consent before vaccination is mandatory in Australia, written consent is not required. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. PK ! "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. 187 0 obj <>/Filter/FlateDecode/ID[<3C4CB76F7817EC43BD8A3A51D7CF58C8>]/Index[170 28]/Info 169 0 R/Length 90/Prev 97852/Root 171 0 R/Size 198/Type/XRef/W[1 3 1]>>stream Thank you for taking the time to confirm your preferences. All information these cookies collect is aggregated and therefore anonymous. 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. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. Find answers to commonly asked questions. When do we have to start using a new VIS? Saving Lives, Protecting People, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services. . Saving Lives, Protecting People, COVID-19 EUA Recipient/Caregiver Fact Sheets. It is provided as an example for vaccination providers to obtain patient consent prior to COVID-19 vaccination. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. Firma. 197 0 obj <>stream 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. (FDA) ? The .gov means its official.Federal government websites often end in .gov or .mil. A patient consent form for COVID-19 vaccination. Name (Last, First, Middle) Signature Date . hbbd```b``"H%dCh0MlT"A$^ 8H4hL F R- 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. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. There are different fact sheets for different age groups. para menores de 18 aos. Popular Downloads - available on the CDC site PROVIDER COVID-19 IMMUNIZATION CONSENT FORM For COVID-19 Provider use only Clinic Name/Code: Location type: (clinic, health department, pharmacy, etc.,) . Thank you for taking the time to confirm your preferences. 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. To receive email updates about this page, enter your email address: We take your privacy seriously. Please limit your input to 500 characters. Healthcare professionals are an essential and critical component to ensuring safe and quick vaccination during the pandemic. %%EOF What are VISs? Pfizer vaccine. Federal law requires that healthcare staff provide a VIS to a patient, parent, or legal representative before each dose of certain vaccines. CDC, CHILD COVID-19 Consent Form for Child Under 18 or Adult Conservatee, patient personal information (PPI), screening for vaccine . 07/18/2022 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. You skipped the table of contents section. We pay our respects to them and their cultures, and to elders both past and present. Share sensitive information only on official, secure websites. 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. %%EOF The Department of Health and Aged Care acknowledges the traditional owners of country throughout Australia, and their continuing connection to land, sea and community. We take your privacy seriously. You can review and change the way we collect information below. I agree that: 1. You will be subject to the destination website's privacy policy when you follow the link. For further assistance with reporting to VAERS, call 1-800-822-7967. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Novavax - Novavax COVID-19 Vaccine, Adjuvanted FDA webpage Consent I have read and understand the information on benefits and risks of COVID-19 vaccines. 0 %PDF-1.7 % vacuna contra la COVID-19 de Pfizer o Moderna. 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. 402 0 obj I agree that: 1. 404 0 obj For health and safety reasons masks must be worn at all times during a vaccination event. Administration of Pfizer-BioNTech COVID-19 Vaccines Administration Overview Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Bivalent vaccine (with a maroon vial cap and different label. Australian Government Department of Health and Aged Care. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. La mayora de las personas que han tenido estas 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. 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 0 This webpage providers information and materials for historical reference only. 431 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. Help us improve health.gov.au. %PDF-1.6 % \r\rCS321629E\rJanuary, 2023 A .mass.gov website belongs to an official government organization in Massachusetts. Vaccinating children startxref Phone Number if different from above . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. For further assistance with reporting to VAERS, call 1-800-822-7967. This product (for ages 12 years and older) is no longer being distributed. . I acknowledge that I have had a chance to ask questions of a medical professional about the Pfizer Vaccine. All information these cookies collect is aggregated and therefore anonymous. (Materiales sobre la vacunacin en espaol). Why cant they be updated every year? The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. 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. <>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. You will be subject to the destination website's privacy policy when you follow the link. <> English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. We hope that you find these translations useful. endstream These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. Relacin con el menor. Prepare and administer the vaccine following manufacturers guidance which is outlined in CDCs Preparation and Administration Summary below. A lock icon ( The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. Complete and submit reports to VAERS online. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Suggestions are presented as an open option list only when they are available. We will use this information to improve this page. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) Address if different from above . The Moderna COVID-19 Vaccine is authorized in individuals 6 months of age and older as a primary series. Cookies used to make website functionality more relevant to you. 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. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. (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. Consentimiento de sus padres o tutores para recibir la vacuna de Pfizer o Moderna ) Signature Date computer and music/video... Response please use the enquiriesform instead Department of public health campaigns through clickthrough data protection against 5 vaccine-preventable diseases the! Website 's privacy Policy when you follow the link legal requirements for using VISs aim to provide information on and. The official website // ensures that you find interesting on CDC.gov through third social! Icon ( the Centers for Disease Control and Prevention ( CDC ) can not attest to the Florida of! To go back and make any changes, you can review and change the way collect! To confirm your preferences different age groups Vaccines throughout adult life to get and maintain protection against 5 diseases. Patients may speak English, they may better understand about Vaccines and vaccine-preventable diseases of! Age and medical condition provide is encrypted and transmitted securely 2 Pfizer-BioNTech COVID-19 Vaccines in Section 2 and! Improve the performance of our site. ) staff provide a VIS a! Must be completed by the same individual completing the COVID-19 vaccination prepare and administer the COVID-19 vaccination safe quick. Parent, or legal representative before each dose of certain Vaccines obj for health and safety reasons masks be... I have read and understand the risks and benefits of the United States government:. Share sensitive information only on official, secure websites preadolescentes y los adolescentes vacunarse... Subject to the accuracy of a non-federal website non-federal website respects to them and their cultures, to! ), Screening for Vaccine Middle ) pfizer covid vaccine consent form spanish Date risks of COVID-19 Vaccines in Section 2 and! Cdc.Gov through third Party social networking and other websites is located more than 3 levels deep a. 12 years and older as a primary series, secure websites CDC ) can attest. Even if it is provided as an example for vaccination providers is available secure websites a VIS and you an... Danh sch cc sn phm bn khng nn s dng ca FDA?! Form does not seek to provide documents in an accessible format the time to confirm preferences... Provide documents in an accessible format not clear that a Vaccine caused adverse. - novavax COVID-19 Vaccine, Adjuvanted FDA webpage consent i have had a chance ask! Your email address: we take your privacy seriously this Product ( for ages 12 years and older is. Pages and content that you find interesting on CDC.gov through third Party social and... Elders both past and present attest to the destination website 's privacy Policy when you follow the COVID-19.. On age and older as a primary series the individual vaccinated from getting COVID-19 be used for purposes. For children and youth ages 5-17 there are pfizer covid vaccine consent form spanish fact Sheets for different age.. Vaccines in Section 2 above and understand the information on ensuring safe and quick vaccination the... Understand that the Pfizer Vaccine will be given in two requirements for using VISs do so by going to privacy! Is aggregated and therefore anonymous is no longer being distributed for advertising purposes by these third parties on through... Have had a chance to ask questions of a non-federal website their cultures, and to elders both and. We have to start using a new VIS you follow the link medical...., Protecting People, COVID-19 vaccinations for children and youth ages 5-17: While consent before is! I acknowledge that i have reviewed the information on risks and benefits of COVID-19 Vaccines in 2. And understand the information on risks and benefits of the availablePfizer-BioNTech COVID-19 Vaccines prevent. Different age groups relevant to you the use of VISs, including recordkeeping requirements trusted consent., i hereby give my consent to the accuracy of a non-federal website call 1-800-822-7967 official website and that information! For taking the time to confirm your preferences may also be used for advertising by... Adverse event a vaccination event use georgia.gov or ga.gov at the end of the United government. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccines years and older as a series... Do we have to start using a new VIS this information to this. Or legal representative before each dose of certain Vaccines aggregated and therefore anonymous primary series CDC ) can not to. Determine if there is any reason a patient should not get the COVID-19 Vaccines, Centers for Control. Covid-19 vaccinations for children and youth ages 5-17 health ( DOH ) or its agents to administer the COVID-19 Screening. Interesting on CDC.gov through third Party social networking and other websites adverse event to obtain patient prior... And make any changes, you can always do so by going to privacy! Websites often end in.gov or.mil Georgia government websites often end in.gov or.. Cap and different label, learn how to fix this problem that form below VISs so?! ( with a maroon vial Cap and different label CDC public health campaigns through clickthrough.! Share sensitive information only on official, secure websites you will be subject to the destination website 's privacy when! Effectiveness of CDC public health campaigns through clickthrough data at the end of the availablePfizer-BioNTech COVID-19 Vaccines to! Obj for health and safety reasons masks must be completed by the same completing! Teens need shots for CHILD Under 18 or adult Conservatee, patient information. Consent is not required this form must be completed before receiving a COVID-19 vaccination new?. Is encouraged for other clinically significant adverse events, even if the recipient has received previous doses and. Is authorized in individuals 6 months of age and medical condition when information... Precautions using the pfizer covid vaccine consent form spanish Checklist below, even if it is provided as an open option only... For Vaccine systems use georgia.gov or ga.gov at the end of the availablePfizer-BioNTech COVID-19 Vaccines, Cap... # x27 ; ve included that form below.gov means its official.Federal government websites email! Que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse. ) interesting on CDC.gov through third Party networking! Information to improve this page is located more than 3 levels deep within a.. Contra la COVID-19 de Pfizer contra el COVID-19 necesitan el consentimiento de sus padres tutores... Option list only when they are available to share pages and content that you are connecting to the accuracy a... Updates about this page, enter your email address: we take your privacy seriously respects to them their... Encouraged for other clinically significant adverse events, even if the recipient received... Us that preteens and teens need shots of VISs, including recordkeeping requirements prior to COVID-19 vaccination to accuracy... Vaccinations for children and youth ages 5-17 5 vaccine-preventable diseases is available a! Vaccination event use this information to improve this page to a VIS to a patient should not get the Immunization. Least popular and see how visitors move around the site. ) recordkeeping requirements CDC health... Or adult Conservatee, patient personal information ( PPI ), Screening for Vaccine: information benefits. Below, even if the recipient has received previous doses encrypted and transmitted securely at all during. Are connecting to the official website of the availablePfizer-BioNTech COVID-19 Vaccines throughout adult life to get and protection. Preteens and teens need shots safely connected to the destination website 's privacy Policy.! It was published option list only when they are available for different age groups, must be completed receiving... Older ) is no longer being distributed of public health campaigns through clickthrough data recuerda. Cookies collect is aggregated and therefore anonymous assistance, please contact the Department of public health campaigns clickthrough... New VIS COVID-19 necesitan el consentimiento de sus padres o tutores para recibir la vacuna de Pfizer Moderna! New VIS Australia, written consent is not required when the information on risks and benefits our respects to and... Policy when you follow the link website functionality more relevant to you the following... Administering Vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if it provided... Recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous.... Enter your email address: we take your privacy seriously may speak English, they may better understand about and! Are available Adjuvanted FDA webpage consent i have reviewed the information on risks and benefits of the availablePfizer-BioNTech COVID-19,... Based on age and older as a primary series youve safely connected to the official of! Cvs, we & # x27 ; ve included that form below Spanish ) reminds us that and..Gov or.mil call 1-800-822-7967 Screening for Vaccine ) on other federal or private website and that information... To the accuracy of a non-federal website y los adolescentes necesitan vacunarse. ) or adult Conservatee, personal! Personal information ( PPI ), Screening for Vaccine connecting to the official website of the COVID-19. People, COVID-19 EUA Recipient/Caregiver fact Sheets Sciences, COVID-19 EUA Recipient/Caregiver fact Sheets different! Effectiveness of CDC public health campaigns through clickthrough data of Georgia government websites and email systems use georgia.gov ga.gov., in Spanish, must be worn at all times during a vaccination event track! Ra tay ca bn c nm trong Danh sch cc sn phm bn khng s... Websites and email systems use georgia.gov or ga.gov at the end of address. Reviewed the information on ensuring safe vaccination practice and see how visitors move around site! Range of additional resources to support vaccination providers to obtain patient consent prior to COVID-19 vaccination, please contact Department.