Find VISs translated into other languages. <> (Check back as we will continue to. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. FDA is responding to the novel coronavirus outbreak. Name (Last, First, Middle) Signature Date . 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. <>/Metadata 18 0 R/PageLayout/OneColumn/Pages 399 0 R/StructTreeRoot 26 0 R/Type/Catalog>> 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@ . Did You Know? Suggestions are presented as an open option list only when they are available. To receive email updates about this page, enter your email address: We take your privacy seriously. If you would like a response please use the enquiriesform instead. Your patients can download vaccine-specific, Spanish-language CDC podcasts to their computer and portable music/video player. 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. Thank you for taking the time to confirm your preferences. Cookies used to make website functionality more relevant to you. More about Pfizer-BioNTech COVID-19 Vaccines, Purple Cap: Monovalent Pfizer-BioNTech COVID-19 Vaccines, Centers for Disease Control and Prevention. 2. I have reviewed the information on risks and benefits of the COVID-19 Vaccines in Section 2 above and understand the risks and benefits. Las vacunas Moderna y Pfizer contra el COVID-19 tienen un riesgo muy raro de inflamacin del corazn (llamada miocarditis o pericarditis). Relacin con el menor. 454 0 obj They help us to know which pages are the most and least popular and see how visitors move around the site. 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 . If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This page is located more than 3 levels deep within a topic. Why are some dates on VISs so old? If you're having problems using a document with your accessibility tools, please contact us for help. Adverse events that occur in a recipient after COVID-19 vaccination are required to be reported to the Vaccine Adverse Event Reporting System (VAERS). 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. Page 1 of 2 Pfizer-BioNTech COVID-19 Vaccine Effective Date: 1/04/2021 . (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. 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 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. Find information and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. 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. Both forms must be complete at time of vaccination. Trusted Party Consent and Verification This form must be completed by the same individual completing the COVID-19 Immunization Screening and Consent Form. Ultra-cold COVID-19 Vaccine: Cap Color Pfizer 0.3mL Primary 12yrs (Gray) Pfizer 0.2mL Primary 5- 11yrs (Orange) "5l0{1mfH4&$Vq+DzI`"@ &;^l{3X/% 6qM P Some page levels are currently hidden. If you need assistance, please contact the Department of Public Health. This consent form is not mandatory. Before sharing sensitive or personal information, make sure youre on an official state website. Are they obsolete? vacuna contra la COVID-19 de Pfizer o Moderna. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. You skipped the table of contents section. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. Vaccine Information Statements (VISs) are information sheets produced by the CDC that explain both the benefits and risks of a vaccine to vaccine recipients. Pfizer vaccine. Please do not include personal or contact information. Popular Downloads - available on the CDC site SECTION 3: INFORMATION ON THE RISKS AND BENEFITS OF COVID-19 VACCINES COVID-19 Vaccines may prevent the individual vaccinated from getting COVID-19. 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 limit your input to 500 characters. Find information about provider responsibilities, types of VISs, legal requirements for using VISs. 47 6 thatphanom.techno@gmail.com 042-532028 , 042-532027 If my child or adult conservatee does not have a . 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. Nmero de telfono si es diferente del anterior. 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. Use this button to show and access all levels. COVID-19 EUA Fact Sheets for Recipients and Caregivers, List of Multi-, Routine-, & Non-Routine-Vaccine VISs, Centers for Disease Control and Prevention. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Pfizer's COVID-19 Vaccine Consent Form ( English / Spanish) Moderna's COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine . endstream endobj startxref secundarios leves despus de recibir una vacuna contra el COVID-19. COVID-19; COVID-19 vaccines; Is there anything wrong with this page? endobj endobj endobj 197 0 obj <>stream 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 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 and resources for each of the availablePfizer-BioNTech COVID-19 Vaccines. (Haga clic para ver este divertido video que nos recuerda que los preadolescentes y los adolescentes necesitan vacunarse.). We take your privacy seriously. Official Product Site; CDC: Pfizer-BioNTech COVID-19 Vaccine. I agree that: 1. English Espaol (Spanish) CDC COVID-19 Communication Toolkit: For Migrants, Refugees, and Other Limited-English-Proficient Populations in various languages Pfizer-BioNTech COVID-19. Before administering vaccine, screen recipients for contraindications and precautions using the Prevaccination Checklist below, even if the recipient has received previous doses. Australian Government Department of Health and Aged Care. Cookies used to make website functionality more relevant to you. CDC twenty four seven. 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. La mayora de las personas que han tenido estas Pfizer COVID-19 Vaccine clinical education materials have been updated to include information about the new bivalent booster. This webpage includes additional links to key webpages from CDC, FDA, and other . 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. If you need to go back and make any changes, you can always do so by going to our Privacy Policy page. This product (for ages 12 years and older) is no longer being distributed. 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. Healthcare professionals in the United States serve patients of many nationalities, including many Spanish-speaking citizens and visitors. These cookies may also be used for advertising purposes by these third parties. COVID-19 vaccination consent form for individuals ages 6 months - 17 - French - 6/25/22 (English, PDF 128.02 KB) COVID-19 vaccination consent form for individuals ages 6 months - 17 - Haitian Creole - 6/25/22 (Haitian Creole, PDF 124.25 KB) English Espaol Portugus, Portugal Ting Vit Kriolu di Cabo Verde Polski Bivalent vaccine (with a maroon vial cap and different label. Summarizes need for vaccines throughout adult life to get and maintain protection against 5 vaccine-preventable diseases. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Follow the COVID-19 vaccination schedule (below) based on age and medical condition. <>stream We take your privacy seriously. 170 0 obj <> endobj CAIR Record web form. 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. Fecha Find a suite of information and materials that are needed for the Pfizer-BioNTech vaccine that cover administration, storage and handling, safety, and reporting. 07/18/2022 Consent 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. A patient consent form for COVID-19 vaccination. 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. Vaccines: COVID-19. This consent form, in Spanish, must be completed before receiving a COVID-19 vaccination. You can review and change the way we collect information below. . While consent before vaccination is mandatory in Australia, written consent is not required. They help us to know which pages are the most and least popular and see how visitors move around the site. 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